REGULATORY INJUSTICE

In the public health system of the Australian State of New South Wales

Delays of up to three years have struck investigations into 56 doctors, nurses and other health practitioners over serious allegations such as sexual assault of patients - with many of those accused still practising despite multiple complaints against them. The Herald has obtained documents from the NSW Health Care Complaints Commission under freedom of information laws that show 140 investigations pending, with 45 cases outstanding for more than 18 months and 12 of those for three years. The acting complaints commissioner, Ken Taylor, said much work had been done to clear the backlog but acknowledged some complaints - particularly those involving multiple allegations and complex investigations - had not been dealt with.

When Judge Taylor was appointed head of the troubled health watchdog in March, he found more than 900 files waiting for assessment and 448 investigations pending into complaints received before August 2003. Some had been outstanding since 1998. He said the backlog would be cut to 34 by the end of next month. "Delay is an evil, it generates a sense of grievance in the complainants and the respondents," he said. "We spent four of five months reviewing files and ensuring the difficult cases were investigated and resolved." He said it appeared many of the cases involving multiple complaints had gone unresolved because of a lack of resources.

This year, the NSW Government boosted the commission's funding by an extra $5.7 million, allowing the commission to double its investigation team and clear the backlog. The crisis in confidence in the commission came to a head in December last year, when the Government sacked the commissioner, Amanda Adrian, and set up a special commission of inquiry into dozens of allegations of poor patient care at Camden and Campbelltown hospitals. Describing the commission as "close to paralysed" when he arrived, Judge Taylor said his first task was to refocus the commission on rigorously investigating cases of poor health care. Of the practitioners with multiple complaints against them, 53 were suspended or had restrictions placed on their practice, the commission said.

The executive director of the Consumers' Health Forum, Helen Hopkins, said despite improvements the health complaints system still lacked transparency. "Clearing the backlog is not the end. The next step is to ensure they are introducing systemic changes that make it easier to talk about what might have gone wrong," she said. The executive director of the Australian Salaried Medical Officers' Federation, Peter Somerville, acknowledged there had been significant improvements at the commission in the past year. However, he said if Ms Adrian had had the resources Ken Taylor had, the commission might not have fallen so far behind. Judge Taylor said the commission could come under stress again if it was required to investigate a big incident.

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MORE ON THE "DESTINY" HEALTH INSURANCE SYSTEM

I mentioned the "Destiny" health insurance system yesterday. Readers might well ask why such a sane system has not been more widely implemented. One of my medical correspondents suggests why:

"One problem with Destiny - it runs against the game of the "poverty" and other industries - there are HUGE numbers of people who would be put out of work within a few years if Destiny was widely adopted: This is limited mainly to Diabetes; there are many others. For example:

1 Diabetic care specialists - nurses that visit patients at home, write notes about how this old fart won't take his medicine or follow his diet.

2 Diabetic foot care specialists - cut toenails etc..

3 Social workers - who tell patients what's "owed" them through Government programs for "the poor" and "the sick".

4 Surgeons who now are milking Medicare dollars since obesity has been declared "a disease" and now funding Gastric Bypass type surgery - so patients don't have to "feel bad" about poisionig themselves with food.

5 Vascular surgeons - a large part of their clientelle are diabetics and smokeres.

Smoking greatly increases "peripheral vascular disease; this not only causes narrowing of arteries requiring surgery; poor circulation reduces blood flow to all organs, such as bone, and infections are more difficult to cure in smokers). Some surgeons have gone so far as to refuse to do certain operations, such as hip and knee replacements in smokers - osteomyelitis is very difficult to treat in such patients. Of course, "smokers rights" groups would claim "insensitivity" "

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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