Medical staff at an Adelaide hospital used paper towel to record clinical notes for a patient who was suffering psychiatric side effects from his cancer treatment, a coronial inquest into the man's death has heard.
South Australian Coroner Mark Johns is investigating the death of James Nicholson, 65, who tried to kill himself at Noarlunga Hospital in August 2015.
He never regained consciousness and died three days later in another hospital.
The inquest was told that in December 2014, Mr Nicholson was prescribed a corticosteroid medication as part of his cancer treatment and about three months later his family noticed his behaviour was erratic, delusional and showed signs of paranoia.
They took him to Noarlunga Hospital after he threatened to take his own life at home.
In his opening address, counsel assisting the coroner Ahura Kalali said emergency department consultant Donald Hannam diagnosed Mr Nicholson with steroid-induced psychosis and placed him on a Level One Inpatient Treatment Order (ITO) which meant he would be under one-on-one supervision.
"Dr Hannam informed the family that steroids can make people behave erratically and that this was not an uncommon side effect of the drug," Mr Kalali said.
"Dr Hannam told the family it was not Mr Nicholson's fault, he explained that this behaviour would normally correct itself after he stopped taking the medication."
However, the court heard on-call consultant psychiatrist Dr Edina Osenk assessed Mr Nicholson the following day and misdiagnosed him as having a "steroid withdrawal" and discontinued the ITO.
Mr Nicholson's son Scott told the inquest a junior doctor and a nurse at the hospital used paper hand towel to record medical notes about his dad's presentation.
In a statement to police which was tendered in court, Scott Nicholson said he was upset by the doctor's actions and found it unprofessional.
During his evidence, Dr Andre Michalski-Russell — who was an emergency physician intern at the time — admitted to using paper towel to record clinical notes.
"Generally, it would have been paper, although there were occasions if I didn't have paper available I would have taken hand towels, so that would be correct yes," he said.
The court heard expert psychiatrist Dr Maria Naso had reviewed Mr Nicholson's case and found he presented at Noarlunga Hospital with a textbook case of steroid-induced psychosis.
In her report she said corticosteroids could cause psychiatric symptoms including psychosis, depression and hypomania and that about 30 per cent of patients would experience changes to their mental state.
"He should have remained on an ITO… and treated with a combination of dexamethasone withdrawal and antipsychotics," she said.
"My opinion is that if Mr Nicholson had been correctly diagnosed and treated his suicide would have prevented."
