Does Australia need Ryan’s Rule?

11th Aug 2016

As a parent, it is natural to worry when your child becomes sick. Depending on their age, a lack of communication can make it harder to determine their symptoms as they cannot describe where and how it hurts. Likewise, when a loved one becomes sick, it can be difficult to watch them suffer while treatment is being organised.

With time being of the essence, parents and family members may feel their concerns are not being listened to. After all they are the ones who know when their children and loved ones are unwell. Unfortunately, a situation arose in 2007 which changed the way in which Queensland Health listened to these concerns.

Ryan’s Rule

In 2007, Ryan Saunders, a young boy of nearly three, was suffering from pain all over his body. His mother took him to see a GP who misdiagnosed him with mumps and prescribed Panadol and Nurofen. Four days later Ryan’s condition had not improved. He was transferred by ambulance to Emerald Hospital where his condition remained undiagnosed. He was later transferred to Rockhampton Hospital but his condition deteriorated further. Thirty hours after being admitted, Ryan passed away. Ryan was in significant pain and his parents believed there was something seriously wrong. They felt their concerns were not being listened to. 

The Coroner found Ryan’s passing was likely preventable. The Health Quality and Complaints Commission made recommendations and as a result of both outcomes Ryan’s Rule was developed. Ryan’s Rule was established by the Patient Safety and Quality Improvement Service, Department of Health in consultation with consumers and clinicians statewide. It was incrementally rolled out state wide to all public hospital between December 2013 and March 2015. They system is now implemented in all Queensland Health Public Hospitals.

Ryan’s Rule allows parents, carers and family members to request a Clinical Review of a patient of any age who is being treated in a Queensland Health Hospital if they feel their concerns are not being heard. There is a misconception that Ryan’s Rule only applies to children, but this is incorrect it can be requested for a patient of any age. Once requested, a nurse or doctor will attend to the patient to review the situation and provide assistance.

A woman being treated at a hospital after the birth of her second child invoked Ryan’s Rule when she felt her condition was deteriorating. She contacted 13 HEALTH and requested a Ryan’s Rule Clinical Review. A Hospital Director returned her call immediately and within minutes of that phone call the woman received the treatment that she required. 

In another case, a woman requested a Ryan’s Rule Clinical Review after her young daughter was turned away from hospital eight times in 17 days. Following her call, her concerns were listened to and the appropriate treatment was provided. 

It has taken some time for Queenslanders to become aware of Ryan’s Rule with 79 calls being made in the first 10 months. Awareness of Ryan’s Rule is increasing due to the media reporting on stories where it has been implemented and also where it has potentially saved lives. 

Unfortunately stories regarding deaths of patients in other parts of Australia as a result of treatment providers failing to listen to mother’s intuition and/or family members concerns continue. 

So just what is available nationally?

Currently in NSW, there is a program called REACH (Recognise, Engage, Act, Call and Help is on its way). REACH was developed as a safety net for patients where their family members noted their condition had deteriorated. While this program has been implemented in a number of hospitals in NSW, it does not appear to be state wide.

Canberra Hospital has the CARE (Call And Respond Early) program. This process is very similar to Ryan’s Rule in that the family member is asked to discuss their concerns with the nursing staff prior to contacting a telephone number requesting a review of the patient. 

It would appear however that there is no similar process in any of the other States or Territories of Australia. Patient Liaison Officers can be contacted to attend upon the patients and/or their families and discuss their concerns with them.

The outcome for Ryan’s parents was tragic and they have suffered the worst outcome possible by losing their precious boy. The legacy left behind by Ryan however has already potentially saved lives in Queensland.

There is scope for law reform in this area. A Ryan’s Rule program should be implemented nationally together with an awareness campaign ensuring that Australians are aware of their right to seek a second opinion.  Data could be collected allowing an annual public report to be published including information on how the program works and lessons that can be learned from the mistakes. Not only could this program save lives, it may also reduce the number of compensation claims against hospitals where treatment and appropriate care has failed to be provided.

This article was updated on 30 January 2017 to clarify the roll-out period, at the request of the Queensland Department of Health.

Joanne Baker graduated from USQ in April 2016 and is currently undertaking PLT at College of Law.  She started her legal career as an Office Junior in a small UK law firm and over the past 20 years progressed to Law Clerk before finishing her Bachelor of Laws.  She is currently Graduate Lawyer in the Medical Negligence team at Slater & Gordon Lawyers.  She has two children who keep her busy outside of work and has a passion for VW Kombies and one day hopes to own one!  

The views and opinions expressed in these articles are the authors' and do not necessarily represent the views and opinions of the Australian Lawyers Alliance (ALA).

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