Wednesday, November 29, 2006

Filth and shame in an NHS hospital

Twenty-four hours to save the NHS! I wonder how often that promise comes back to haunt Tony Blair 10 years later. Week after week reliable reports and the government’s own figures tell a disgraceful story of incompetence, debt, misery and filth in the National Health Service. That story is supported, week after week, by heart-rending personal accounts of horrors on the wards.

The broken new Labour promise that caught most public attention last week was the failure to abolish mixed-sex wards. Janet Street-Porter, the ferocious media personality, wrote about the misery of her sister when dying of cancer in a mixed-sex NHS ward. Plenty of other people have tried to draw attention to this disgrace and Baroness Knight, the Conservative peer, has been campaigning about it for years but — such is the spirit of the times — it takes a loud-mouth celebrity to get public attention.

The same thing happened when Lord Winston made a fuss about the dreadful treatment that his elderly mother received in hospital. Only then did the government stop denying that there was anything wrong.

Street-Porter published extracts last week of the diary of Patricia Balsom, her dying sister. They were horrifying. Among the miseries she endured was lying neglected in a mixed ward, where she was woken more than once to see a naked male patient masturbating opposite her bed. Her shocking stories prompted a flood of others.

The late Eileen Fahey, for instance, dying of cancer, was put onto a mixed geriatric ward where confused people wandered about without supervision. One man with dementia regularly masturbated at the nurses’ station and tried to get into women patients’ beds; he was a threat to them all but staff took no notice, according to her daughter Maureen. Other patients have to give answers to intimate questions in the hearing of other patients. One deaf old man was repeatedly asked when he last had an erection, until tears ran down his cheeks.

A former midwife described eloquently on Radio 4 the indignities of being in a 24-bed mixed-sex ward, stripped of all dignity and intimidated. Bedlam was the word she used, and it applies even more accurately to the secure psychiatric mixed ward in London endured by Susan Craig last year, after a breakdown. She suffered regular sexual harassment, with mentally ill men groping her and exposing themselves. The nurses disbelieved her and told her husband she was “flaunting herself”.

If so (I don’t believe them), their job was to protect a patient from her own folly. Instead they chose, in modern cant, to blame the victim. Sexual harassment is only a small part of the problem. Many people, both men and women, feel their modesty is violated by such closeness to random members of the opposite sex, even when they are not threatened.

Patients lie naked, half washed and forgotten, their sick and ageing flesh exposed to everyone, while nurses rush elsewhere. It is commonplace to have to walk to filthy mixed lavatories with gowns wide open at the back. At a time of sickness and anxiety many people are profoundly embarrassed to be surrounded by a clutter of bed pans, colostomy bags, nakedness, cries of pain and sweat, blood and tears — their own and other people’s.

All this is much worse, for many, when they are surrounded by members of the opposite sex; shame and anxiety are not the best bedfellows of hope and healing. Much has been written about the rape of modesty and the death of shame. However, it is still true in this weary country that most men and women prefer to perform private bodily functions alone if possible, and among their own sex only, if not. That’s why we have separate public lavatories and separate changing rooms in shops and clubs and pubs. That’s why people put up towels on the beach. That’s why women give birth in female wards, not in mixed wards or not — I hope — so far.


Sex-offender doctor still allowed to practice

What government mismanagement of medical training leads to

A Tasmanian doctor who sexually assaulted female patients will be practising again by June next year after the Medical Complaints Tribunal factored the state's general practitioner shortage into his punishment. The tribunal last month found Dr Ulhas Lad guilty of professional misconduct over his dealings with two female patients between April 2003 and July 2004. Dr Lad, 61, from Blackmans Bay, was yesterday suspended from practising until June 2007 and ordered to see only male patients when he resumes.

Medical Complaints Tribunal chairman David Porter, QC, said one of the factors the tribunal considered was "the regrettable situation that exists in this state in relation to general practitioners". Should an order to deregister Dr Lad be made there would be no little difficulty in filling the void, Mr Porter said.

Dr Lad's suspension and restriction to male patients arose from a complaint by a woman identified by the tribunal as AB. Mr Porter said Dr Lad's professional misconduct when dealing with AB involved a serious breach of trust and a gross violation of the doctor-patient relationship. Dr Lad sexually assaulted the woman at his surgery on a number of occasions, Mr Porter said. He said Dr Lad fondled his patient's breasts and buttocks, and had her separate her buttocks while she was bent over.

Dr Lad also performed a sex act in front of her at his surgery one night when she went there for pain relief. Mr Porter said the sex act was outrageous behaviour and a serious affront to the patient's dignity. He said Dr Lad's sexual assault of another female patient known as YZ3 was seen by the tribunal as previous relevant conduct.

The tribunal had also taken into account the overwhelming level of support for Dr Lad from the general and professional community, Mr Porter said. Dr Lad's lawyer Ken Procter, SC, presented the tribunal with 32 character references for his client. "We note all that has been said on behalf of Dr Lad," Mr Porter said.

Dr Lad was also fined $1000 for his professional misconduct in relation to a separate complaint by a second female patient known as CD. The woman said Dr Lad required her to undress to be weighed and made inappropriate comments when she saw him for antibiotics for the flu. Mr Porter said Dr Lad's behaviour towards CD was thoroughly inappropriate and his remarks were offensive. The $1000 fine imposed by the tribunal was one-fifth of the maximum amount it could impose, he said.

During the hearing seven more former patients came forward to complain about Dr Lad after reading reports of the case in the Mercury. Dr Lad denied the allegations against him. But the tribunal found it preferred the evidence of patient AB to that of Dr Lad, whose evidence was deemed "not at all convincing".

Dr Lad refused to comment as he left the Federal Court in Davey St, Hobart, yesterday. But his daughter Aparna said her father was innocent. Patient numbers at the surgery operated by her father and mother Dr Geeta Lad had not dropped since the women's complaints were made public nor since the tribunal's guilty finding, she said. Dr Lad's son Anoop said his father could rest easy because he had a clear conscience. The family would be looking at appeal options, he said.



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. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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