Thread by @dhadjowa

Day 7 of the inquest into Veronica Nelson's death in custody. Morning - Registered Nurse, Stephanie Hills, who testified about failures in the prison reception medical assessment is back on the stand. Afternoon - Dr Sean Runacres, who conducted the assessment will give evidence

The link to view the inquest livestream: csvic.webex.com/csvic/onstage/…
#JusticeForVeronicaNelson

Registered Nurse Stephanie Hill returns to the stand, and Stella Gold, Counsel for Aunty Donna Nelson, Veronica’s Mother, begins questions about Ms Hills’ earlier description of clinical signs of dehydration, where she had given the example of “eyes sunken and skin pulled in”

Counsel confirms that someone being dehydrated can be a medical emergency, asks Ms Hills about the possibility of administering IV fluids to a patient in a prison context
Hills: No it’s impossible
Gold: Why is it impossible
Hills: We are unable to cannulate or provide IV fluids

It’s not something that’s able to be done
Gold: Can you explain why? Why couldn't it be done? Staff? Equipment?
Both - there’s no equipment for the monitoring that you would need.. When you are administering fluids you need to also be able to mintor electrolyte balances as well

Counsel: We heard evidence from Dr brown that another method of rehydration is through a naso-gastric tube? Is that also something that can’t be done in a prison setting?
Hills: No, I never saw naso gastric tubes available in our equipment room, no

Counsel Stella Gold moves to questions of Ms Hills about the difference in options for medical treatment for dehydration available in a prison setting versus what would have been available in a hospital setting
#JusticeForVeronicaNelson

Q: In a hospital setting, if someone is dehydrated ...someone would be provided with IV fluids?
A: Absolutely
Q: Easily and readily available in a hospital setting
A: Yes absolutely
Q: In a prison setting the only option is oral rehydration?
A: That’s correct

Gold: You’d agree that a patient giving informed consent to health care is critical for you to be able to ethically provide them with healthcare?
Hills: Absolutely
Gold: Need to consent still applies in a prison setting?
Hills: Yes absolutely
#JusticeForVeronicaNelson

Asked about Veronica's condition, how unwell she was when she signed the consent form & if she remembered how she held the pen, Hills responds, ".... she was not able to hold it... she had a loose grasp on the pen, she wasn’t able to grip it…"
#JusticeForVeronicaNelson

Counsel for Aunty Donna then asks Hills (Registered Nurse) to look at a comparison between two documents to see if Veronica's signature at the time was affected. Hills agrees that the signature provided at the time is "consistent with a loose grasp" [indicative of her condition]

A question is put to the witness about evidence from a Corrections Officer that Dr Runacres is said to have stated, "how many prisoners do we see withdrawing?She needs to stop asking. We can't give her anything else."
#JusticeForVeronicaNelson

The court hears evidence that when Hill finished her shift she conducted a verbal handover with an incoming nurse and recommended that be 3-hourly nursing observations (blood pressure, heart rate, oxygenation, temperature observations) of Veronica
#JusticeForVeronicaNelson

Counsel: What did you say about observations?
Hills [registered nurse]: I verbally handed over that I recommended at least 3 hourly nursing observations overnight
#JusticeForVeronicaNelson

Hills gives evidence that these ob's of Veronica needed to be in person
Q: What are nursing observations?
A: Blood pressure, heart rate, oxygenation, temperature observations
Q: You would need to see someone face to face? You couldn't do it through a trap?
A: No you could not

Hills: I verbally handed over that I recommended at least 3 hourly nursing observations overnight
Gold: So just to make it crystal clear, you meant physical observations? Going into the room and checking on Veronica’s vitals?
Hills: That’s correct

Questions then move to whether, given her condition, Veronica Nelson should have been in prison at all or if she should have been transferred to hospital. Hills (Registered Nurse in the prison at the time) agrees she should have been sent to hospital
#JusticeForVeronicaNelson

C: What I want to suggest for you is if a patient is so unwell to warrant nursing observations, the place for them is not in the medical unit at DPFC
Hills: Yes, I agree
C: What really needs to happen is they need to go to hospital?
Hills: Yes, i agree
#JusticeForVeronicaNelson

C: ... you say that you suggested sending Veronica to hospital. Did you ask this as a question or a proposition?
Hills: I can’t specifically recall if I suggested it or asked it as a question
C: either way your suggestions or proposition was shut down?
Hills: Yes that’s correct

Hills gives evidence that after having advocated for Veronica to be transported to hospital, "I was specifically told, I am the doctor, I will make the decision. And I do believe from my memory i was told, 'you are just a nurse'"
#JusticeForVeronicaNelson

Stella Gold, Counsel for Aunty Donna, Veronica's Mother, moves to asking Hills about the notes she took of her interactions with Veronica, and whether she was ever asked for a statement by Correct Care - her employer at the time #JusticeForVeronicaNelson

C: You have given evidence that you took notes a couple of days after Veronica passed. Was this at the request of your employer or off your own back?
H: No it was actually at the suggestion of one of my best friends after I debriefed with her...who is also a registered nurse

Correct Care Australasia are the private health service provider in Dame Phyllis Frost Centre (DPFC) maximum security prison where Veronica died in custody. Hills gives evidence that she tried to give Correct Care a statement and was rebuffed #JusticeForVeronicaNelson

C: Did anyone from Correct Care ever call you to get your account of what happened?
H: No I attempted to give my statement to our regional manager at the time when I learned Ms Nelson had passed, he did not want to take the statement
#JusticeForVeronicaNelson

Ms Hill is asked what she said to her regional manager when she attempted to provide a statement

#JusticeForVeronicaNelson

C: Just to clarify on 2 separate occasions you offered your superior a statement. Was that in person?
H: In person
C: And on 2 separate occasions he rebuffed you?
H: He didn’t want my statement, no.
C: And he said he would get it another day, but didn't.
H: Yes

C: There was a debrief conducted...in relation to the death in custody on 16th of January? You were not invited?
H: No
C: And if you had attended that debrief that you would have said things consistent with your statement of the evidence you've given?
H: Yes

C: Are you aware that a formal review is always conducted after someone dies in custody? Did anyone ever contact you about it?
H: No
C: I take it you would have given evidence consistent with what you are saying in court?
H: Absolutely
Witness teary and requests short break

Wallace, Counsel for Percy Lovett, Veronica's partner, is now asking qs

Hill is asked about the incoming prison reception medical assessment.

C: I understand your evidence that Veronica was not weighed during that assessment intake appointment was that right?
H: Thats correct

C: Do you have any idea and if you don't know that's, that's fine, but do you have any idea where a weight estimate (for Veronica) put into JK might have come from?
H: I can’t say
#JusticeForVeronicaNelson

C: So with regard to any other time that Dr. Runacres may have conducted observations of Veronica on the 31st. That couldn't have happened without you being present?

H: No because I was in the room at the time

#JusticeForVeronicaNelson

C: Now on the 31st were any other intake assessments of prisoners conducted after Veronica, or was she the last one for the day?

H: Veronica was the last assessment for the day and i believe Sean (Dr Runacres) left right after the assessment

#JusticeForVeronicaNelson

Hill is asked about other experiences working with Dr Sean Runacres

C: Other times or shifts you've done with Dr. Sean has he ever said this type of thing to you before? “I'm the doctor you're the nurse” type of comment

H: At times, yes
#JusticeForVeronicaNelson

C: Was there any particular animosity between the two of you?

H: not until a few months after the passing of Ms Nelson

#JusticeforVeronicaNelson

C: Did you witness this yourself of Dr Runacres saying these types of “I'm the doctor, you're the nurse” to other nurses or is it something you've heard on the grape vine?

H: It was discussed between other staff, other nurses. Also the way he portrayed himself with other nurses

C: Was there ever an occasion that you witnessed Dr. Runacres speaking to patients...like this? This is a hypothetical eg, if a patient said “I need this medication” or “I have this problem”...that he would speak...in a way that disregarded what they had [said]?
H: At times, yes

C: Would you say that happened more than a handful of times or it's less than a handful of times?

H: Probably 50/50

#JusticeForVeronicaNelson

Erin Gardner, Counsel for for Correct Care takes over the questioning of the witness. She puts a series of questions to Hills about her the notes on the JCare file, handover documents to Correct Care and what was in her oral handover.

#JusticeForVeronicaNelson

In response to questions about why Ms Hill didn’t elect to add additional notes to the JCare file, Hills describes long shifts, high demand, understaffing [doing job of 3] in the prison and maintains that her oral handover instructions for 3-hourly medical observations were clear

Counsel qs Hills on her evidence about not being asked for a statement:
C: There was no barrier to you making your own notes at the time, with ref to JCare was there?
C: Yes there was
C: What preclude you from doing this?
A: The JCare file was locked. It was being handed over

Q: You could have made your own notes without reference to med record?

A: I did in my own notes at home

#JusticeForVeronicaNelson

Counsel for Correct Care: In relation to the debrief have you been involved in a debrief when other prisoners have passed away?

Hills: I have never been involved in another death in custody

#JusticeForVeronicaNelson

The Court is shown CCTV of the med assessment. Counsel puts to Hills that Veronica was sitting up, and that this suggests she was not struggling

H: She wasn’t sitting up fully. She’s not sitting up straight
C: You might say, a relaxed position
H: I wouldn’t say relaxed, no

Moving to the prison reception medical assessment.
Counsel for Correct Care: For privacy reasons there's no CCTV
Hills: Yes
Counsel: So only you and Dr Runacres know what took place in that room
Hills: That’s correct
#JusticeForVeronicaNelson

The court hears from Counsel for Correct Care that 2 of the Corrections Officers on shift that night have provided statements that they can't remember Veronica’s medical reception or if they were present.
One remembers that Veronica was very thin and vomiting

Challenging Hills on her description of Veronica’s condition, Counsel for Correct Care says, “If Veronica was in the condition you say she was, a wheelchair would have been used”

Hills explains that these are in a storage unit, hard to access and rarely or never used

Challenged several times on her recollection of events, Hills responds, “What i remember is that she [Veronica] had to be assisted to walk down the hallway to the treatment room, that is my recollection"

#JusticeForVeronicaNelson

Counsel puts to Hills that there was no rec in the notes from the MH nurse that Veronica be sent to hospital
Hills: I am happy to answer the q about the diff between a MH nurse and a Med nurse... and why a MH nurse wouldn’t [be able] to assess...whether a person needed ambulance

The court is played audio from the intercom where Veronica is heard asking for water [told there is a cup and she must stand up and use it], telling COs that she feels sick to the stomach and is told she must wait for maxolon to kick in. She can be heard crying and throwing up

Asked by Counsel for Correct Care if the intercom calls that happened during her shift were matters that were brought to her attention, Hills responds [through tears],
“No… and you can hear she is extremely unwell”

#JusticeForVeronicaNelson

Counsel for Correct Care puts it to Hills that this audio means Veronica is stating her needs, Hills responds, “Corrections staff are giving med advice”. Asked what med advice, Hills says, “you’ve got to wait for the maxolon to kick in” and states,“they are not medically trained”

Counsel puts it to Hills that if Veronica was in the condition Hills says she was, she would have done more for her, including calling for a review

Hills responds,“she had already been reviewed by the med officer, who overruled me when I said she needed to go to hospital”

Asked by Counsel for Correct Care if the prison intake medical assessment is a joint task of the nurse and the doctor, Hills responds, “yes, the nurse completes nursing tasks, but the doctor ultimately makes the medical decisions”
#JusticeForVeronicaNelson

Counsel for Correct Care puts to Hill that Dr Runacres’ account will say that if Veronica had presented in the way she said, he would have recorded this and hospital transport would have been arranged.

Hills responds, “I disagree with his statement”
#JusticeForVeronicaNelson

Counsel for Correct Care: He [Dr Runacres] says physical exam of heart, lungs and abdomen were undertaken and..That he knows he did this because he has made record in JCare

Hills [Registered Nurse]: They absolutely were not done
#JusticeForVeronicaNelson

Counsel for Correct Care: He [Dr Runacres] will say if he could not do physical assessment of the prisoner due to them being unwell, he would have arranged a transfer

Hills: I am disagreeing with him

#JusticeForVeronicaNelson

Counsel: Dr Runacres says as a result of reading your statement, he now recalls that you raised with him the escalation, including to hospital...He acknowledges that having been reminded of it by your statement he did not believe hospital was required

Hills: I’m confused

Counsel: He (Dr Runacres) doesn't disagree with you that the two of you had a convo about what happened with Veronica, but he did not think that her presentation required hospitalisation
Hills: So you are saying he agrees with half of my statement, but not half of my statement?

Counsel for Correct Care makes ref to Dr Runacres statement, "He agrees that you had a conversation, but does not agree that Veronica required hospital"

Hills: Okay

#JusticeForVeronicaNelson

Counsel: The account you have given of the medical assessment. You've stated it was utterly ineffective and meaningless?
Hills: I stated that it didn’t occur
Counsel: You stated the assessment did not occur?
Hills: No she (Veronica) stayed in the chair the entire time

Counsel for Correct Care puts to Hills that if the med assessment was of such poor quality, she shouldn’t have signed the form.

Hills disputes this and says that the box is used to delineate people who come in for reception after hours and need to come back the next day.

Mr Brown, Counsel for Sec. of Dept of Justice, who is responsible for Corrections Victoria, is now asking qs. Asking Hills about med risk ratings (M1, M2, M3) on the paperwork, Hills answers that she was never trained in this and nurses “never filled in that part of the form”

Counsel: So you don’t understand what is meant by M3?

Hills: No, this is the Dr’s medical assessment

#JusticeForVeronicaNelson

Explaining the medical ratings system, Counsel outlines that M1 rating = “serious med condition requiring immediate treatment”

Counsel: Is a rating of M1 consistent with how Veronica was presenting to you?

Hills: Yes

#JusticeForVeronicaNelson

Ms Hills gives evidence that there were challenges in entering additional electronic notes for patients while on shift in the prison due to time constraints, demand for medical care, and a limited number of working computers, often in use

Asked by Q McKay if what she communicated to the nurse on handover was sufficient, Hills responds:
Yes, so it’s v unusual that someone would stay in med overnight, esp a new reception. I...recommended a min of 3 hrly nursing obs. If she was to deteriorate, to send her to hospital

Asked how info could have ended up in the JCare entry if Dr Runacres didn't undertake med exam of Veronica, Hills explains that Drs had access to a file where they copied+pasted all receptions & changed what they needed to save time, “that’s why I imagine there were errors”

Counsel Assisting resumes questioning. Hills testifies it was not the practice of nurses to write their own notes after a med assessment had taken place & agrees that the notes entered by the Dr were considered the record & results of med assessment & health status of the patient

Counsel Assisting asks Hills if she would agree with evidence provided to the Court from Corrections Officer Watts, who reported that Veronica “appeared exhausted and uncomfortable and couldn’t get comfortable.”

Hills responds, “absolutely”

#JusticeForVeronicaNelson

Hills then goes on to agree with Officer Watts’ further description that Veronica appeared "malnourished, really hot and couldn’t stop sweating”

#JusticeForVeronicaNelson

Counsel Assisting: Officer Herman report her (Veronica) as extremely ill, vomiting and quite weak - do you agree with that?

Hills: Yes, I do

#JusticeForVeronicaNelson

CA takes Hills back to an earlier answer she was giving [when cut off] about Veronica being unable to take her suboxone in 1 go. CA asks her to finish:

“suboxone is…like a listerine strip...Veronica was unable to take it in 1 go...which shows she didn’t have hand coordination”

CA: When you say she was unable to take it. Do you mean physically hold it?
Hills: She had no hand/eye coordination, she wasn't able to.. Generally women are good at getting sub strips off and placing them on the tongue, but she couldn’t do it in one go, she had to do it twice

CA:You say that related to a deficiency in hand/eye coordination. Does that tell you..about her neurological state?
H: It does
CA: Something about how clearly she is thinking?
H: No it's physical..to do with withdrawals..could be to do w electrolyte imbalance & flow on effect

Hills' evidence concludes. She asks the Coroner, “Am I able to offer my condolence to Ms Nelson’s family?

When told she can, Hills turns to the Court:
"I offer my condolences to Ms Nelson's family and her friends and loved ones. I am extremely sorry."

#JusticeForVeronicaNelson

@threadreaderapp unroll