Queensland State Coroner, Michael Barnes SM, in the Cairns Coroner’s Court in 2007,

acknowledges, that it is not uncommon for paramedics to encounter a patient who refuses
to provide consent for the treatment that is recommended by a paramedic. The refusal of
treatment from Nola Jean Walker, concreted the decision making for the Queensland
Ambulance Service.

A paramedic, when informed of a patient’s decision to refuse treatment, must consider the
question of whether the patient has the necessary decision-making capacity to make that
decision. Under the 10.47 Australian Common Law, competent adults can consent to and
refuse medical treatment. Under the Australian Common Law, state and territory
guardianship and mental health legislation provides for a decision-maker who is chosen,
assigned by the legislation, or appointed to make health decisions for an adult who is not
capable of giving consent. However, in this case, as Ms Walker was lucid and spoke clearly
and coherently, impressing the officers with her ability to remember and accurately
pronounce the names of the pharmaceutical drugs she had taken, she had the capacity to
make the decision to refuse treatment.

The QAS Clinical Practice Guidelines of patient refusal of treatment or transport has a VIRCA
assessment conducted by the paramedic. Officers Nucifora and Blake conducted this
assessment which considers voluntariness, the refusal is informed and relevant. The patient
has the requisite capacity to understand the nature and consequences of the decision made
and that the patient is provided with the advice to promote comfort and safety if the patient
remains at home, or in this case, the scene. As of this, the paramedics on scene had a duty
of care to Ms Walker, to adhere to a reasonable standard of care while performing any acts
that could foreseeably harm patients. Ms Walkers had severe damages, resulting to her
death, however, the paramedics had a duty of care to her up until she refused further
treatment; and to this, no breach of negligence was reached.

As spoken previously, the importance of the ethical principles of beneficence, non-

maleficence and autonomy are relevant when a refusal of treatment decision is considered
by a health professional. These ethical decision-making takes place as advocated in the
codes of conduct such as Code of Conduct: Paramedic Australasia. As a duty of care, health
professionals must provide such information as is necessary for the patient to give consent
to treatment.

Under the Medicines and Poisons Act 2019, QAS can administer treatment doses under this
EPA. Nola Jean Walker was currently taking several medications, one such as Furosemide
due to cardiac surgery prior 5 years ago, which Queensland Paramedics can administer. This
drug is a loop diuretic, which can have side effects of lowering blood pressure, dizziness, and
changes in pulse rate especially when consumed with alcohol. The QAS officers did not
consider alcohol consumption, however, the QPS officer, Constable Simpson noticed an
odour of ethanol of Ms Walker’s breath, and more profound when in the back seat of the
police van. The QAS officers on scene have prior knowledge of the side effects therefore,
another indication that Ms Walker was pressed into going to hospital by Officer Nucifora.
The paramedics on scene did not take notice of possible intoxication and should have acted
reasonably and taken alcohol consumption into advising Ms Walker future needs. However,
it comes back down to her refusal which concretes her decision and does not breach her
care. Intoxicated patients create difficulties for paramedics in the field. The complexities
involved a balance between various considerations and the law of negligence.

Ahpra. (2022, June 29). Codes, guidelines and policies. Paramedicine Board of Australia.
https://www.paramedicineboard.gov.au/professional-standards/codes-guidelines-and-
policies.aspx

Australian Government . (2014, May 20). Informed consent to medical treatment. Australian
Law Reform Commission . https://www.alrc.gov.au/publication/equality-capacity-and-
disability-in-commonwealth-laws-dp-81/10-review-of-state-and-territory-legislation/
informed-consent-to-medical-treatment/

QAS , C. Q. & P. S. (2022, July 1). DTP_FRU_0722. Drug Therapy Protocols: Furosemide
(Frusemide).
https://www.ambulance.qld.gov.au/docs/clinical/dtprotocols/DTP_Furosemide.pdf

QAS, C. Q. & P. S. U. (2016, October 1). CPG_OT_PTR_1016. Clinical practice guidelines:

Other/patient refusal of treatment or ...
https://www.ambulance.qld.gov.au/docs/clinical/cpg/CPG_Patient%20refusal%20of
%20treatment%20or%20transport.pdf

The State of Queensland. (2017, October 9). Consent. Queensland Government.

https://www.qld.gov.au/health/support/end-of-life/advance-care-planning/legal/consent