Tenterfield hospital death: report to go to coroner; root cause analysis starts

File photo
File photo

The October 27 death of a 46-year-old man at Tenterfield Hospital will be referred to the NSW Coroner and a root cause analysis (RCA) has been initiated by the health service.

NSW Police have confirmed officers attended the hospital that morning and "a report will be prepared for the Coroner."

"About 7.30am ... officers from New England Police District attended Tenterfield Hospital, following the death of a 46-year-old man," a spokesperson said.

It comes as friends and family prepare to honour the life of David Freeman with a memorial celebration in Brunswick Heads on Sunday.

It's understood that, as part of the RCA, there will be interviews with Mr Freeman's family members, nurses working that morning, and paramedics and telehealth colleagues who assisted.


According to a NSW Health policy document, the analysis aims to compile "an analysis of the event, any contributing factors and what the team is recommending to prevent a similar occurrence in the future".

Among the possible factors are issues with: communication; knowledge, skills and competence; the work environment or scheduling; patient factors; equipment; policies or procedures; or safety mechanisms.

The matter has alarmed locals as it occurred with a registered nurse and an enrolled nurse rostered on, but no doctor, in a new emergency department opened just a few days earlier.

Shire councillor Bronwyn Petrie, who has been backing calls to have at least three nurses on staff at all times, said: "How dare they think it's acceptable to not have at least three nurses per shift and not have a doctor?"

"At any given time we have over 4000 people in town between residents and the motels, plus all your outlying population, plus two major highways," she said.

"How on earth do they consider that it is acceptable to have a registered nurse and an enrolled nurse staffing our hospital?"

How on earth do they consider [it] acceptable to have a registered nurse and an enrolled nurse staffing our hospital?

Bronwyn Petrie

Asked whether staffing would be reviewed as a result, a Hunter New England Local Health District spokesperson said the facility was "staffed appropriately and is rostered in accordance with the Public Health System Nurses' and Midwives' (State) award".

"The management team regularly meets with our staff to hear their feedback about nursing hours and patient activity.

"As with all our facilities, we continuously monitor activity and staffing numbers at Tenterfield Hospital to ensure the safe delivery of patient care.

"If activity increases, additional nursing staff can be rostered on if required."