Inquest hears how overworked, exhausted doctors make mistakes

The issue of overworked, exhausted doctors and the impact this has on the quality of care delivered has come under scrutiny at an inquest in Queensland.

The inquest in the Coroners Court in Brisbane, over the case of a 10 year old girl who died after she was sent home from a Queensland hospital, has heard that the concerned doctor had been on duty for 20 hours with another 4 hours to go on his shift.

The girl was taken to Caloundra Hospital by her parents after a fall from a bunk bed when she struck her head in January 2002. The Brisbane family were on holiday at Caloundra, in Queensland.

The girl, Elise Neville, was seen by Dr. Andrew Doneman who was in his second year of practice and the bleeding in her brain went unnoticed and according to the hospital's policy of not admitting children the Toowong, Elise was discharged.

She fell asleep on her parents' bed in Caloundra but when her family woke at 7am she was found to be critically ill and unconscious. Elise was flown to Brisbane for treatment and died days later.

Back in 2004 Dr. Doneman pleaded guilty to unsatisfactory professional conduct but the issue of fatigue was raised and at the time is was remarked that it seemed "extraordinary" that anyone should be working such long hours.

The court were told that Dr. Doneman, a junior doctor, was the only doctor on duty at the Sunshine Coast's Caloundra Hospital and the fatal misdiagnosis of a brain injury could have been prevented if adequate doctor fatigue strategies had been in place at the hospital.

Acting Director of Queensland Health's medical workforce advice and coordination unit Suzanne Le Boutillier gave evidence about new fatigue strategies that will soon be implemented across the public health system.

Ms Le Boutillier told the inquest that by July 2009, all public hospitals will be required to have fatigue management plans in place.

Ms Le Boutillier told the court that Queensland Health has also developed a colour-coded calculation system whereby medical staff would answer a series of questions to determine their level of fatigue which would include specific directions for the management of different levels of fatigue.

However Ms Le Boutillier says the biggest challenge is breaking down the underlying culture within the profession that makes it difficult for some doctors to admit to fatigue but says in recent years a number of senior doctors have led a campaign to educate younger staff about fatigue management.

The inquest into the girl's death will investigate a number of issues including her treatment, the hours worked by doctors, how patients are transferred in emergencies and the adequacy of staff training at the Caloundra Hospital as well as the safety of bunk beds, it is expected to continue for three days.