Tuesday, November 06, 2007

British Paramedics 'refused to run as boy lay dying'

Paramedics refused to run along a beach to a dying boy for fear that they would be in breach of health and safety regulations, the child's father has claimed. James Poynton, 11, suddenly collapsed while walking along Caldy Beach, Wirral, Merseyside, with his family. His parents called an ambulance but when paramedics arrived they walked towards them, according to James's father, Jim, 49. When he asked why they had not broken into a run, they allegedly said that had they tripped they would have been unable to adequately treat James.

Mr Poynton, a company director, said: "I'm appalled that they wouldn't run. If someone is dying, aren't you supposed to save their life?" Mr Poynton and his wife, Ann, believe that had the paramedics acted with more urgency their son might have lived. James died during an evening walk with his parents, his sister, Claudia, now 15, and a friend, on June 9 last year. Unknown to his family, he was suffering from an undiagnosed heart condition.

George Kokai, a paediatric pathologist, told an inquest in Wallasey that he had only seen the condition, arrhythmogenic right ventricular dysplasia (ARVD), twice in his career. Christopher Johnson, the coroner, recorded a verdict of death by natural causes.

A spokesman for the North West Ambulance Service NHS Trust said the paramedics involved were off duty and could not be contacted. "They carry up to 25kg of equipment, and if it's an uneven terrain, such as a beach, they can't always run with the equipment. "In addition to that, once they reach the patient they need to be in a condition where they can carry out resuscitation techniques. They don't want to arrive so breathless that they can't then help the patient."


Australia: Another disastrously mismanaged public hospital

This time in Victoria. Coverup included, of course

Victoria's leading hospital trauma centre has been in disarray for several years, with top surgeons refusing to operate with its director, Professor Thomas Kossmann. Since 2004, several surgeons working at The Alfred hospital have avoided operating with Professor Kossmann due to concerns about whether his treatment of some patients was excessive. They also complained about his billing arrangements with the Transport Accident Commission - which pays for medical treatment of road crash victims in Victoria.

The Age can reveal the medical department heads and senior managers at the hospital, which last month announced an external review into Professor Kossmann's clinical practices, have dismissed multiple complaints made by surgical staff over the past three years. Staff have told of a culture of fear and silence at the trauma centre, which treats most of the severe road crash victims in the state. Several surgeons who complained to department heads were told to keep quiet. One who confronted Professor Kossmann about his decision to operate on a patient, judged by other doctors to have such serious injuries that surgery was futile, did not get his contract renewed in 2005.

Professor Kossmann has stood down from surgery while the review takes place. He has declined requests to be interviewed, but in a brief statement through the hospital, he said: "I refute the allegations."

The Alfred has declined to release the review's terms of reference. It has also declined to answer questions and told The Age that it had only recently received complaints about Professor Kossmann, who was recruited from a Swiss hospital to head the trauma unit in 2001. However, an internal memo obtained by The Age suggests that problems in the trauma unit are longstanding. The memo, written in February 2005 by the then head of neurology, Professor Jeffrey Rosenfeld, orders surgeons to assist Professor Kossmann in theatre when requested. "It is expected that you will assist Professor Kossmann . in spinal surgery," it says. The memo was written after some surgeons refused to assist him. Several surgeons who still work at The Alfred continue to avoid operating with Professor Kossmann. "It's true. People have chosen not to participate in surgical procedures that he's been involved in," said a doctor with recent experience at The Alfred.

Over the past 12 months, The Alfred conducted a review of its trauma department with a focus on patient care. It is believed doctors raised concerns about Professor Kossmann during this review, which were not acted on. The Age has interviewed more than a dozen medical sources who tell a consistent story about concerns over Professor Kossmann's performance and the hospital's repeated failure to act.

One concern is about his treatment of TAC-funded patients. The commission pays for the medical care of every Victorian injured on the state's roads under the personal injury insurance scheme, paying doctors generous fees for procedures performed on victims. It is believed Professor Kossmann has a deal with the hospital that allows him to receive payments direct from the commission, with a percentage going to The Alfred. This contrasts with many other staff doctors, whose payments are pooled, with the money distributed equally.

It is believed the review into Professor Kossmann was ordered by Alfred chief executive Jennifer Williams after she was recently given a series of patient cases that doctors believed warranted scrutiny. Hospital insiders say Ms Williams is now taking the issue seriously and may not have been aware of all the previous complaints, with senior managers and department heads not passing them on.


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