AUSTRALIA'S PUBLIC MEDICINE CHAOS CONTINUES

Two articles below

Doctor fatigue a problem in public hospitals, says coroner

A CORONER has slammed the Medical Board of Queensland for not stopping doctors working long hours, warning fatigue is a problem in many hospitals. Brisbane Coroner's Court was told yesterday that failures in the health system meant that a 10-year-old girl who had fallen from a bunk bed had very little chance of survival.

Elise Susannah Neville died on January 9, 2002, from an extensive extradural haematoma and a fracture to the left side of her skull after falling 1.4m from a top bunk bed with no guard rails in a Caloundra holiday unit two days earlier. She was taken by her parents to Caloundra Hospital but was sent home an hour later by a junior doctor who was in the 19th hour of a 24-hour shift. Elise was rushed back to hospital and then flown to Brisbane, where she later died, mainly because of delays in medical treatment, the Brisbane Coroner's Court found.

Brisbane coroner John Lock said Elise had died because Dr Andrew Doneman at the Caloundra Hospital failed to assess and diagnose the child's injuries correctly. Mr Lock yesterday also criticised the Medical Board of Queensland for failing to deliver its promised policy to regulate doctors' working hours in hospitals around the state, saying doctor fatigue was a significant problem. "The Medical Board of Queensland accepted responsibility to develop a standard or other policy alternative on doctors' working hours," he said. "It has not completed its work and should do so with priority."

He also criticised the Office of Fair Trading for dragging its feet on work to ensure all bunk beds in domestic and commercial settings were compliant with safety standards.

Outside court, Elise's parents, Gerard and Lorraine Neville, said they were relieved that the inquest was finally over and they were satisfied with most of the coroner's findings. "We believe the doctor should have been charged; the coroner doesn't feel there is evidence to support that," her father said.

But Mr Neville said he was staggered that Caloundra Hospital still would not be getting until August next year a CT scanner - which could have helped diagnose his daughter's injuries and save her life.

In 2004, Dr Doneman pleaded guilty to unsatisfactory professional conduct before Queensland's Health Practitioners Tribunal and he was ordered to be stringently supervised for one year.

Dr Lock said Queensland Health should review the capacity of rural or remote hospitals to perform emergency neurosurgical and vascular surgical procedures which may have saved Elise's life. Queensland Health director-general Michael Reid said Queensland Health had worked hard to address the issues raised by the inquest, with work still continuing.

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Public hospital coverup

Some cancer patients at the Royal Adelaide Hospital are believed to have had their lives shortened by up to two weeks because of a radiation treatment bungle. An independent report into the error warns of the possibility of "a reduction in survival of up to two weeks for (five) patients who were receiving radiotherapy for high-grade brain tumours". Health Minister John Hill has ordered a second investigation into the decision by the then RAH management "to not notify patients" or the Government.

The report, tabled in Parliament yesterday, labels the error "significant" and "serious" and states 869 patients were exposed to an under-dose of radiation treatment of about 5 per cent. "In terms of error, this incident is considered significant because of the volume of patients exposed to the error," the report states. "Although . . . the overall clinical impact might be small, an error such as this can provide significant warning for a potential more serious error in the future and should be considered serious."

A review panel led by NSW radiation oncologist Professor Geoff Delaney found the under-dose on a malfuctioning radiotherapy machine at the RAH between July 28, 2004, and July 21, 2006, would not have an impact on the "vast majority" of patients. However, the panel said its "educated estimate" was the under-dose had shortened the lives of a group of brain tumour sufferers by up to a fortnight. This was said to be a "best guess". The panel also said it was not able to study every individual case or assess individual risk because that would take months. Rather, the panel consulted international literature before generally reviewing patients' diagnosis and treatment.

They then identified seven patients in three different tumour groups who may have had a "small but real" clinical impact. Aside from the five brain tumour patients, there was one head and neck cancer patient who "may have had their cancer compromised" and another prostate cancer patient who requires follow-up care. Health Department chief executive Dr Tony Sherbon said he was trying to contact the seven patients yesterday. He said 14 other patients in high-risk categories had since died. "We are not in a position to say whether the under-dosing affected their survival," he said.

The Government has accepted the report's 14 recommendations, including to hire six more staff. When the error was discovered two years ago the dosage was rectified. But the then RAH general manager Virginia Deegan, currently employed by the University of Adelaide, and the hospital's director of cancer services, Professor Dorothy Keefe, decided it was not significant enough to alert the public, the department or the minister.

Dr Sherbon only found out about the error on July 16 this year, after a complaint. He took up his position as Health Department chief executive just weeks after hospital management found out about the error. "I would have liked to have been briefed on it, yes, I would have liked to have known," he said. Dr Sherbon said that in 2006, Ms Deegan was notified by Professor Keefe, who advised "the under-dosing was not signficant and the manager (Ms Deegan) took that advice".

Although he will await the outcome of a second inquiry, by former Premier's Department chief Ian Kowalick, into the hospital's handling of the matter, Dr Sherbon said he will take any action recommended against Professor Keefe. "Mr Kowalick will make reference to the standards of public sector management," he said.

But RAH medical staff society chair Dr James Moore last night warned Dr Sherbon not to "overstep the mark". "He runs a very real risk of making it impossible to attract people to come and work in this state," Dr Moore said. "If he believes that all problems are going to be reported now, he's living in cloud cuckoo land. "The Government had been warned a good 12 months before this emerged that there was a risk of something like this happening because of the staffing problems.

Opposition health spokeswoman Vickie Chapman said the investigation should be widened to include the department.

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