GOVERNMENT MEDICINE IN AUSTRALIA

Two current reports below:

Public hospital turns abused boy away

A toddler was locked out of Beaudesert Hospital and his family turned away despite their fears the boy had been sexually assaulted. Queensland Health said the incident should never have happened, The Courier-Mail reports.

The boy's grandfather called Beaudesert Hospital before 5am on Monday when he suspected his three-year-old grandson had been sexually assaulted. Hospital staff told the man to bring his child to hospital immediately. But the family was not let inside the hospital when they arrived at the emergency department, but was instead spoken to outside its main entrance. The nurse then returned inside and continued the conversation over an intercom. She said the family would need to go to Logan Hospital - 45km away - where there was a child sexual assault unit.

The grandfather, who cannot be identified to protect the child, said he told the nurse he couldn't get the child to Logan because the family could not afford any more petrol. The nurse later denied knowledge of this.

On Tuesday, Queensland Health issued an apology and began an investigation. "The situation was not handled appropriately, or in accordance with Queensland Health policy," Southside Health Service district manager Dr Mark Mattiussi said. "Queensland Health takes any allegation of child sexual assault seriously and is following up these concerns in accordance with child safety laws." Under Queensland Health policy, the family should have been taken into Beaudesert Hospital for support, initial assessment and referrals.

When asked if hospital staff faced disciplinary action over the incident, Mr Mattiussi said: "Staff have been given feedback . . . and relevant Queensland Health policy has been discussed and clarified." The Beaudesert Hospital registered nurse in question has claimed the boy's grandfather "appeared angry", which was why she retreated inside to use the intercom.

But the boy's grandfather said he was just desperate to get the young child treated. "It was a terrible experience, to be so worried and to just get turned away," he said.

Child protection campaigner Hetty Johnston said the hospital should have offered preliminary care and advice to the family. "I can't imagine it being handled in a worse way," Ms Johnston said. Opposition health spokesman Mark McArdle said all cases of suspected child abuse should be reported as a matter of law: "The parents of any child should not be treated like participants in a game of pass the parcel," he said. The boy ultimately received further treatment at a GP and later attended the Logan Hospital.

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Hospitals hurting, say doctors

Clinicians fear the financial crisis may distract governments from the need to fix public hospitals

Even for the scandal-plagued NSW hospital system, the news two weeks ago struck a new low: that a doctor in a busy regional city hospital had to spend $700 on her personal credit card to buy a three-day supply of a chemical reagent essential for routine blood tests. The chemical's supplier, fed up with the chronic non-payment of bills by the state's Greater Western Area Health Service, had decided enough was enough. It only seemed to make it worse, not better, when it later emerged the company had all along been prepared to continue supply in essential cases, such as this. Communication was so bad that even this vital message had not been passed on by health service management. Other hospitals in the same area had already been reduced to serving meatless meals, after butchers similarly put their foot down over ballooning unpaid accounts.

Coming after a barrage of previous disasters -- ranging from a miscarriage in an emergency waiting room toilet, to the botched design of a brand-new hospital where trolleys could not fit through doors, nor ambulances into the car park -- all this seemed to be moving from the tragic to the ridiculous.

But while the doctors, nurses and other health workers are hoping for some strong medicine to be prescribed by a parliamentary inquiry, due to report within a month, there is now concern that the opportunity for a once-in-a-generation shake-up is starting to recede.

The Garling Inquiry was announced by the NSW Government in January after strong criticisms from an inquest into the death of a 16-year-old girl who died in Sydney's Royal North Shore Hospital two days after being admitted with a skull fracture. Since then the inquiry has become imbued with extra significance. As well as the clinical and organisational disasters, and tangled bureaucracy, other problems are coming to light -- such as concerns that a lack of training positions in hospitals will soon reach critical proportions as the massive increases in medical student places starts flowing through the system. At some point in the near future, critics say, these newly-minted doctors will emerge from medical school with no training places in hospitals where they can complete their training and further their careers.

That issue, which is clearly national, is slowly coming to a head, with a rally of medical students, junior doctors and medical educators being organised by the NSW Australian Medical Association at 11am this Saturday on Sydney's lower north shore. But more generally the inquiry's outcome has implications for other states, which have been experiencing some of the same problems, if usually to a lesser degree. Health experts say other state governments will be watching what happens after Garling reports almost as intently as NSW itself does.

But there's an increasing fear that the inquiry's recommendations will be buried -- either drowned out by the welter of economic bad news, or pushed out of the limelight by a state government that suddenly finds itself with more pressing political problems and a quickly souring financial position. "We are expecting quite a lot out of the Garling report," says emergency physician Clare Skinner, one of a number of doctors, nurses and others who are part of the Hospital Reform Group. "We think it's probably the last chance to help fix the NSW hospital system. Every single state in Australia has overcrowded emergency departments. Every single state is struggling to find enough doctors and nurses, and every state is watching this (inquiry) to see how we can do things smarter." However, the caution stems from the long existing list of previous health inquiries that have received little more than lip service from the government of the day, and are quickly forgotten.

Skinner puts workforce and training as the two highest priorities on the to-fix list. Both of these problems, she thinks, require taking politically unpopular decisions: a feature of NSW hospitals is that there are many more specialised units spread across many smaller hospitals, which she says disperses the available expertise.

While NSW has six to eight trauma centres across the state, Victoria has just one. The difference means that Victoria's centre has the best staff, and enough of them to ensure 24-hour cover; while in NSW, someone taken to hospital after a 2am car crash is much more likely to arrive with no specialist on duty to look after them.

Physician and immunologist Professor Brad Frankham agrees, saying for too long rosters have been run along old-fashioned lines that benefit senior doctors rather than patients. Although elderly and complex cases increasingly arrive in hospitals in the evenings and at weekends, he says these are exactly the times when senior doctors aren't around, and instead there is a skeleton staff of inadequately supervised more junior clinicians.

But despite the workforce pressures, budgets are controlled so tightly and centrally that it's usually impossible to hire an extra staff member, as the request has to go through as many as nine management levels before approval -- by which time the need, or more often the candidate, has evaporated. Often this merely ends up wasting money, as when hospitals prevented from hiring permanent staff bid against each other to secure locums at sky-high rates, costing the system far more.

Another area of waste that the Garling inquiry may sort out is in how hospitals are funded. Currently budgets tend to be based on adjustments of previous budgets, whereas reform advocates are arguing for a more comprehensive roll-out of Victoria's activity-based funding, also known as casemix, which pays for the work that hospitals do.

What Skinner, Frankham, a senior nurse who spoke to Weekend Health, and another member of the Hospital Reform Group, emeritus professor at Sydney University Kerry Goulston, all agree on is the need to give back to clinicians more say in the running of hospitals and how care is delivered. Currently doctors and nurses are kept so far from the decision-making that Frankham, even though he's an area director, says he "can't spend even $100" without getting authorisation from several rungs up the management ladder. Frankham says given a greater say, clinicians would be more innovative, working out "clinical networks" or teams of doctors, nurses and allied health workers involved in particular diseases, to ensure the best ways of dealing with those patients.

Goulston says restoring clinicians' decision-making autonomy would both restore trust between clinicians, managers and patients, and also restore clinicians' morale, which he says is currently as low as it has been for some years. "Our main concern is that the recommendations, when they are released, are implemented," Goulston says. "We think Garling and (counsel assisting the inquiry, Terence) Tobin have done a very thorough job. "My concern is that the Government and the bureaucrats will say 'We are doing all these things', when in actual fact they are not doing them."

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