Australia: A risk-averse public health bureaucracy puts its whims before patient welfare

Contrary to a claim made below, there is no clear research evidence about the best procedures for avoiding surgical site infections but that appears to be unknown to the bureaucrats. It is fire risk that moves them -- even though there have been no fires. They are prepared to take a daily risk in order to avoid a remote risk! It's just a bee in the bonnet of some bureaucrats and they are allowed to dictate patient care methods. Leaving surgical procedures to the surgeons concerned is too much to ask, apparently

PATIENTS are being put at risk because NSW Health had an inexplicably inconsistent approach to infection control procedures before operations, an orthopedic surgeon says. Dr Robert Molnar has for the past six months unsuccessfully sought an explanation from the Health Department as to why he is not permitted to use alcoholic surgical preparation solution on his patients at Westmead Hospital, yet he is able to at St George and Sutherland public hospitals.

The rules vary across hospitals: alcoholic solution can be used at Fairfield, Concord, Prince of Wales, Royal Women's and Royal Prince Alfred hospitals but is barred at Liverpool, Nepean, Gosford, Canterbury or Royal North Shore.

Dr Molnar believes a Westmead patient contracted an infection after surgery on a hip fracture last year because the hospital deemed the alcoholic preparation he wanted to use a fire risk. The patient has had 10 more operations, including one to remove the metal plates and screws in his hip, and now needs a hip replacement. Dr Molnar had used an aqueous antiseptic to prepare the skin. "You may as well spit on the wound. This guy's life is ruined; it's tragic and it's so predictable," he said, noting that alcoholic solution could be used at most private NSW hospitals.

After a series of letters between him, the Health Department and the office of the Health Minister, Reba Meagher, Dr Molnar was given exclusive permission last November to use the solution at Westmead but not in conjunction with electrically induced heat due to the risk of fire. That ruled out 95 per cent of his operations, he said. There has been no theatre fire in NSW due to alcoholic solution, a spokeswoman for the Health Department said.

In a letter in March to the parliamentary secretary for health, Noreen Hay, Dr Molnar wrote: "I believe the situation places patients in western Sydney at significant risk of morbidity." Dr Molnar told the Herald: "Most orthopedic surgeons wouldn't operate without it, just because of the risk of infection. They're ruining people's lives. It's bureaucratic madness."

A Sydney orthopedic surgeon, Doron Sher, said that if the surgeon was appropriately educated the risk of fire was minimal. "There is evidence in the literature showing that infection rates are lower using alcoholic Betadine," he said. "I use the alcoholic solution when I get the option because I believe that you get a lower infection rate."

Sydney West Area Health Service, which includes Westmead, put the restriction down to fire risk. Northern Sydney Area Health Service did not explain why it was not used. South Eastern Sydney Illawarra Area Health Service said it allowed alcoholic preparation at all its hospitals.

The Opposition Health spokeswoman, Jillian Skinner, said: "Infection is rife in our hospitals so I would expect Reba Meagher would endorse the use of products that are considered world's best practice."

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Australia: Pregnant women 'lie' to get beds in their city's better public hospitals

The "equal high quality for all" idea behind public hospitals is not mirrored in reality

DESPERATE pregnant women are using fake addresses so they can give birth at Melbourne's leading maternity hospitals. The Royal Women's and Mercy hospitals and Monash Medical Centre are sending women who are not from their areas and who do not anticipate complications elsewhere. The hospitals say they want to keep the beds for at-risk patients.

Hundreds of mothers from Melbourne's northwest suburbs have launched a protest against the Brumby Government, saying they are being shortchanged. Since October, mothers from Coolaroo, Craigieburn, Roxburgh Park and Meadow Heights have automatically been referred from the Royal Women's to the Northern Hospital in Epping if their pregnancy was expected to be straightforward. The state's other top level maternity wards - Mercy Hospital for Women and Monash Medical Centre - also direct women with uncomplicated pregnancies to local hospitals.

Women have lied to secure a bed at the highly regarded Women's. One pregnant woman, who asked not to be named, said she was scared to go to the Northern Hospital because she had suffered a miscarriage there. She had used a friend's address to get a booking at the Royal Women's.

Protest group Fair Go For Hume has bombarded Premier John Brumby with more than 460 complaints. Royal Women's Hospital spokeswoman Mandy Frostick said births at the hospital had jumped from 4600 in 2001 to 6500 last year. She said the hospital had to send women with low-risk pregnancies from the northern suburbs to the Northern Hospital. Mercy chief Stephen Cornelissen said it had a duty to care for mothers with "more complex" needs.

A Monash spokeswoman said they shared pregnancies between themselves, Casey and Dandenong, depending on circumstances. Northern Hospital maternity director Hammish Manning said they offered high-quality care. [The customers obviously don't think so]

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