Wednesday, December 09, 2009

Judge outraged by uncaring British health bureaucrats

A senior family judge took the extraordinary step of leaving court to calm down because he was so angered by two local authorities who “abandoned” a sick boy to save money.

Mr Justice Hedley said that he was left with a sense of disbelief that the two local authorities, Cambridgeshire County Council and the Orkney Island Council (OIC), had distanced themselves from the boy to avoid footing the bill for his care. He made his judgment public yesterday and also sent it to Westminster and Holyrood to draw attention to the two local authorities. “I found it necessary to adjourn briefly so as to ensure that no wholly improper judicial observations escaped my lips,” he said of the October hearing. “This judgment has been reserved because I did not trust myself to express my views in a temperate manner.”

Mr Justice Hedley said that the school-age boy, who cannot be named for legal reasons, was born with a serious congenital heart problem on the Isle of Orkney but is now cared for by relatives, a professional couple who live in Cambridgeshire. He required major surgery within weeks of his birth, and his biological parents were unable to care for him, requiring the child’s move to Cambridgeshire, under the supervision of the Orkney Island Council. The distant relatives, Mr and Mrs O, have effectively adopted him.

At first, the OIC offered financial assistance but it has since indicated that it will be withdrawn. It said Cambridgeshire County Council should pay up. But the county council says it is so cash-strapped that it cannot afford it.

Mr Justice Hedley said that the foster parents had been told that “neither authority believed that they had any duty to offer even basic support, let alone the extras that a child with special needs requires”.

Both local authorities have refused to pay for Mr and Mrs O’s application for a special guardianship order that would make their care for the boy more permanent.

“Mr and Mrs O could be forgiven for feeling abandoned to care for a child disowned by the state in its local authority form, and they could be forgiven too if the thought ever entered their minds as to why they had taken on this child in the first place,” the judge said. “They entered into this arrangement in good faith and in reliance on the apparent assurance of the OIC to support them financially through the boy’s minority. “Because they are honourable people, committed to the boy, they cannot just repudiate the agreement as the OIC claims to be entitled to do. They are stuck with the poison fruit of these two local authorities’ dispute,” he said.

He called the actions of OIC a “huge triumph for its budget manager” but a “complete catastrophe for any foster parent unwise enough to rely on [its] word”. He concluded his judgment by saying: “I wish to pay tribute to Mr and Mrs O for their care for the boy and for their steadfastness through all these difficulties not of their making.”

He ruled that it was the responsibility of Cambridgeshire County Council to prepare a supporting statement for a special guardianship order. However, Mr Justice Hedley said he had no power to address the matter of which local authority, if either, should give financial support for the boy, and said that was a matter for the Government to decide.



Four current articles below:

Surprise! Nobody knows how to fix Australia's unfixable "free" hospital system

Rudd knows he doesn't have the moneypit needed

PEAK health groups have demanded Kevin Rudd stop talking and act on improving the nation's health system, flatly declaring he is taking too long to decide how to reform the troubled sector. And the opposition has ridiculed the Prime Minister as a health bureaucrat more interested in process than action after yesterday's Council of Australian Governments meeting in Brisbane failed to deliver substantive health reform. Mr Rudd yesterday defended his reform process, insisting that reforms of the multi-billion-dollar system must be done properly and with proper consultation.

Mr Rudd won the 2007 federal election promising to end what he called "the blame game" between states and the commonwealth. He vowed he would lift funding to states but relieve them of control of public hospitals if they failed to improve their performance. Despite delivering a 50 per cent, five-year funding boost to the states in a $64 billion funding agreement signed last year, complete with more federal strings attached, Mr Rudd has yet to finalise his plans for structural reform of the system.

Yesterday, he emerged from a two-hour discussion on health with the premiers with no news beyond a $300 million boost in funding for elective surgery and an agreement on a decision-making process for next year. "Our healthcare system is under great stress and pressure, and therefore we must get it absolutely right for the long-term," Mr Rudd said.

Earlier, he had briefed the premiers on the report of the National Health and Hospitals Reform Commission, produced earlier this year, proposing a range of possible changes to the operation of the health system.

The lack of progress drew a sharp response, with Australian Medical Association president Andrew Pesce saying the health sector was running out of patience. "People are losing confidence because the timeframes keep changing and getting put back," Dr Pesce said. "We can only tolerate further delays if we can get some assurance that solutions are being considered that will actually fix our deteriorating system. Our governments must give a firm indication of the direction and extent of the health reform that is being developed."

Catholic Health Australia chief executive Martin Laverty labelled COAG a talkfest and demanded Mr Rudd "stop talking and start acting". "We appreciate the level of consultation on health reform but today's Council of Australian Governments talkfest has not delivered what patients in hospitals and residents in aged care services need," he said. "Unwieldy and inconsistent legislation and regulation, and overlapping responsibilities between states and the commonwealth, are delaying or even preventing timely access to aged care for many older Australians in need. "By simplifying and centralising the funding and assessment processes, the federal government could ensure quality aged care is available to all who need it, when they need it, with choice over where and how to receive care."

Australian Healthcare and Hospitals Association executive director Prue Power said she was disappointed by the lack of action. "Now that these processes have been undertaken, it is time for governments to act," Ms Power said. "The community expects it and the future of our health system depends upon it. "The outcome today can only be characterised as a continued holding pattern for the Australian community. If the government is not careful, the plane may run out of fuel before it has a chance to land safely."

Opposition health spokesman Peter Dutton said Mr Rudd had spent two years making promises but had done nothing. "Mr Rudd is Australia's favourite bureaucrat," Mr Dutton said. "He loves to talk in bureaucratic terms, he talks in convoluted terms and today he was the health bureaucrat."

Mr Rudd was unmoved. He said his reform process was adhering to his stated targets and that he had significantly boosted funding to states in the new funding agreement. "These are massive numbers which affect the totality of the health system and therefore they have to be got right," the Prime Minister said. "A bit of sticking plaster here and a bit of sticking plaster there frankly, when you are looking at long term reform won't work."


Baby sent home had blood clot that could have killed him

On the one hand, the seven-month-old's life was saved with surgery to remove an 8cm x 2.8cm blood clot pushing on his brain. However, his traumatised mother Tamara says that only hours before, when she first took James to the Gold Coast Hospital's emergency department, he was not treated and allowed to go home.

Gold Coast Hospital emergency director David Green yesterday strongly disputed Mrs Owen's account. He said Mrs Owen and James left the emergency department "against clinical advice after the patient was assessed and under observation". However, Mrs Owen said: "The triage nurse said he had only a minor head injury that didn't need to be seen by a doctor. "If we hadn't taken him back to the hospital when we did, he would have died in a matter of minutes."

Mrs Owen, 28, said James landed on his head after rolling off his parents' bed at the family's Upper Coomera home about 8am on November 24. "Immediately, his head swelled up so we put him in the car and took him straight to see our GP," she said. "Our doctor gave us a referral letter and said, 'Please take him to the hospital', so we did."

Mrs Owen and her husband Steven, 31, arrived with their baby at the Gold Coast Hospital emergency department about 9.20am. She said a triage nurse led them into a treatment room for initial assessment. "However, the nurse then pushed on the part of (my son's) head that was bruised and swollen and he didn't stop screaming," Mrs Owen said. "She said, 'If you like, you can sit in the waiting room for four hours and we'll come and check his vital signs every half-hour'. "She also said that we should try to put him to sleep out there but we thought after a head injury, the last thing you should do is go to sleep."

Mrs Owen said the family retreated to the waiting room as directed, but after 90 minutes no further medical checks had been performed. "So we decided then to take (James) home as he wouldn't calm down and we were the only ones observing him anyway," she said. She said the triage nurse agreed they could leave, handing Mrs Owen a "list of signs to watch out for." "Things like vomiting . . . being non-responsive," she said.

Once back at their house, James, would not take his bottle. He appeared extremely tired, and Mrs Owen says against her better instincts, she let him sleep. "With the nurse earlier saying, 'Put him to sleep', we (now) didn't think there was anything wrong with that," she said.

Three hours later, James barely flickered when his mother tried to rouse him. "He'd kind of look at me and crash again," Mrs Owen said. "He became unconscious."

Returned to the Gold Coast Hospital emergency department via ambulance, James was given a CT scan, which showed he was clinging to life with a fractured skull and a large haematoma compressing his brain. He was rushed to theatre, where a piece of his skull was removed to gain access to the clot and extract it.

Mrs Owen says James has bounced back remarkably and she is thankful for the skill of the surgeons. However, she remains furious with what she can only surmise are procedural flaws in the way emergency departments deal with suspected head injuries. "I'm so angry that when we took him to emergency that morning we were turned away when my baby's life was at stake," she said. "I'm still not coping with how close we came to losing our son due to this negligence. "Standing there, looking at my helpless baby boy – not knowing if he would make it – was the worst thing I have ever felt."


Pregnant women ignored as they suffered miscarriages at RBWH

A PREGNANT woman was ignored by emergency department staff for hours as she miscarried and suffered a life-threatening haemorrhage at Queensland's biggest public hospital. Just six days later, Royal Brisbane and Women's Hospital emergency staff were again reported over their handling of another woman's miscarriage.

This time, a specialist was shocked to discover the patient "pale" and "dizzy" and "lying in a large amount of blood". The doctor said he filed a patient harm report "given that this is the second similar episode in a week".

In the first case, blood was gushing from the cervix of an 11-weeks pregnant woman who arrived at RBWH emergency on June 8 this year. Despite this, and the fact she had already passed "several large clots at home", emergency staff did only one set of observations in three hours.

A clinical incident report, compiled by an unidentified medical officer and granted to The Courier-Mail under Right to Information laws, criticised the doctors and nurses involved. They were accused of carrying out infrequent and inadequate checks on the patient's vital signs, "distraction and inattention" and "lack of workplace knowledge".

The woman's blood was not sent away for important pre-transfusion compatibility testing and she had a heart-rate of 120 beats a minute when finally delivered to the operating theatre where her haemorrhage was controlled and her "life saved".

In the second episode, a RBWH consultant gynaecologist reported that the emergency department's failure to run tests and perform examinations as instructed – as well as its poor communication – had compromised the care of a miscarrying patient. He explained that when emergency staff initially notified him of the patient, at 9.30am, he asked about the level of bleeding and the results of a per vaginal examination. "But (I) was told these (tests) hadn't been performed as the (emergency) registrar thought it was inappropriate/unnecessary," the doctor wrote on the incident reporting system.

The doctor said he was contacted again about 1pm, by which time an ultrasound scan had confirmed an "incomplete miscarriage". But an internal vaginal examination still had not been done. "I specifically asked the resident medical officer if she thought I needed to see (the patient) immediately and the reply was 'No'," the doctor said. "(Then) I attended the patient (about) 1.30pm. (She) had been moved to (a ward) and had had observations performed showing pulse of 110 – this had not been notified to myself. "The notes also stated the patient had fainted at home after losing 1-1.5 litres of blood prior to hospital (presentation). This also wasn't conveyed to me. On entering the patient's room . . . the patient was lying in a large amount of blood (500ml)."

The doctor said he did the vaginal examination himself, which proved difficult because of the profuse bleeding. He alerted the nurses, but "could get help from only one". "I administered fluid resuscitation while transferring her to the operating theatre," the doctor said.

Queensland Health director-general Mick Reid said the incidents were concerning but media reporting of "isolated" events caused unwarranted community alarm. "Each day nearly 50,000 people are treated in Queensland Health facilities and 92 per cent of patients (are) satisfied with all aspects of their hospital stay," Mr Reid said. [Who cares if a few of the cattle die, in other words]


Public hospital negligence kills baby

A MAN who told staff at a mental institution about his urge to kill a baby was later released into the care of the girl's family, only to kill her three days later. Jayant Kumar Singh, 56, was transferred to Rozelle psychiatric hospital in mid-2006 after receiving treatment at Canterbury Hospital for diabetes and depression. At Rozelle he received a visit from the mother and her children, with whom he had boarded for years. The woman was unaware of his thoughts about killing her 10-month-old daughter.

During a hearing yesterday to determine whether Mr Singh was not guilty by reason of mental illness, the court heard he had had electroconvulsive therapy before returning to the woman's home on December 19, 2006. In the days after his release, the nursing staff who checked on Mr Singh found he had not taken his antipsychotic or antidepressant medication. But he was not readmitted, the court heard.

A crown prosecutor, Tony McCarthy, told the court that on the morning of December 22 the mother had gone shopping and left her three children in Mr Singh's care. She returned to find the back door locked and her two older children, aged two and four, screaming inside. "When the mother left the house the crown alleges that the accused … took a walking stick and commenced to hit the infant child a number of times about the head," Mr McCarthy said. "He also took the stick to the … older children … to stop them interfering." The court heard that Mr Singh tried to suffocate the baby with a pillow and to choke her with his hands. "He then went to the kitchen and took … one of the knives to its throat and ultimately [partially] decapitated the child," Mr McCarthy said.

The woman broke into her home and found Mr Singh. She removed the older children before carrying the dead baby towards her father-in-law, who was at a nearby pub. Police came and arrested Mr Singh.

"Will the Crown evidence establish whether or not the Rozelle Hospital bothered to inform the mother that the accused had told them that he had thoughts of killing the child?" Justice Robert Shallcross Hulme asked Mr McCarthy. "There is no evidence that they did do that," he replied.

The court heard that a psychiatrist, Stephen Allnutt, believed Mr Singh had been "urged" towards a decision to kill the baby. Dr Allnutt said he could not determine from hospital records why staff discharged Mr Singh, but suggested it may have been because they believed his condition had improved.

"Thoughts of killing a baby are so extreme that one would have thought one would need to be pretty well convinced that they [the thoughts] had gone for good, not just a case that he's not 100 per cent," Justice Hulme quipped back.

The family, originally from overseas, had befriended Mr Singh, a Fijian Indian, and he had lived with them for several years. The woman, now pregnant, and her husband, who was overseas at the time, intend to take civil proceedings against Sydney South West Area Health Service and Central Sydney Area Health Service, in charge of Canterbury and Rozelle hospitals.


Abuse in lieu of argument again: Reid Compares Opponents of Health Care Reform to Supporters of Slavery

Senate Majority Leader Harry Reid took his GOP-blasting rhetoric to a new level Monday, comparing Republicans who oppose health care reform to lawmakers who clung to the institution of slavery more than a century ago. The Nevada Democrat, in a sweeping set of accusations on the Senate floor, also compared health care foes to those who opposed women's suffrage and the civil rights movement -- even though it was Sen. Strom Thurmond, then a Democrat, who unsuccessfully tried to filibuster the Civil Rights Act of 1957 and it was Republicans who led the charge against slavery.

Senate Republicans on Monday called Reid's comments "offensive" and "unbelievable."

But Reid argued that Republicans are using the same stalling tactics employed in the pre-Civil War era. "Instead of joining us on the right side of history, all the Republicans can come up with is, 'slow down, stop everything, let's start over.' If you think you've heard these same excuses before, you're right," Reid said Monday. "When this country belatedly recognized the wrongs of slavery, there were those who dug in their heels and said 'slow down, it's too early, things aren't bad enough.'"

He continued: "When women spoke up for the right to speak up, they wanted to vote, some insisted they simply, slow down, there will be a better day to do that, today isn't quite right. "When this body was on the verge of guaranteeing equal civil rights to everyone regardless of the color of their skin, some senators resorted to the same filibuster threats that we hear today." That seemed to be a reference to Thurmond's famous 1957 filibuster -- the late senator switched parties several years later.

Reid's office stood by the remarks, with spokesman Jim Manley saying Republicans have "done nothing but obstruct health care" in the Senate. "Today's feigned outrage is nothing but a ploy to distract from the fact they have no plan to lower the cost of health care, stop insurance company abuses or protect Medicare," Manley said.

But Republicans said they were genuinely appalled. Sen. Orrin Hatch, R-Utah, said Reid's remarks were over the top. "That is extremely offensive," he told Fox News. "It's language that should never be used, never be used. ... Those days are not here now."

Sen. John McCain, R-Ariz., who on the Senate floor read from this article and asked that it be placed in the record, called on Reid to return to the floor and, if not apologize, at least explain what he meant. Sen. Saxby Chambliss, R-Ga., suggested Reid was starting to "crack" under the pressure of the health care reform debate. "I think it's beneath the dignity of the majority leader," Sen. Tom Coburn, R-Okla., said. "I personally am insulted."


The "Public Option" Malaise

Call it the "public option" malaise. Senate Majority Leader Harry Reid (D-NV) still does not have the 60 votes he needs to pass the so-called "public option" this year, which Senate Republicans say will cost some $2.5 trillion over ten years once fully implemented. At the moment, Reid lacks the unanimous support of his own caucus for the centerpiece of Barack Obama's domestic policy agenda.

According to the Associated Press, "on the issue of a government-run health plan to compete with private insurers, [Senators Joe] Lieberman and [Susan] Collins said they part ways with Reid. Rejecting a compromise that would allow states to opt out of the government plan, Lieberman is threatening to filibuster the bill."

Said Lieberman, “To me the public option, so-called — which is really a government-created and government-run insurance company — doesn't support any of [the] purposes" of controlling costs, extending coverage to millions of uninsured and barring the insurance industry practices from denying coverage to people with pre-existing medical conditions.

Making matters worse for Reid, Senator Blanche Lincoln (D-AR), who is also among the list of dissidents, has said she would oppose ending a filibuster against the “public option.” Meaning Reid is short at least two votes.

As reported by NBC's Ken Strickland, Lincoln most recently said, “I've been very clear. I don't support a public option that is government funded or government run, and that puts the taxpayers at risk in the long run.”

So, even if he picks up Senator Olympia Snowe’s (R-ME) support (by adding a so-called “trigger” to the “public option, for instance), he will need either Lincoln or Lieberman to go back on their words to their constituents to oppose the “public option” no matter what.

Complicating matters for Reid is Senator Ben Nelson (D-NE), who has said he would join the Republican filibuster against the bill. He wants the so-called Stupak language included from the House version of the bill restricting coverage for abortions. His amendment will come up for a vote early next week, according to the New York Times.

That would leave Reid at least three votes short, meaning he would need to pick up some Republicans. But, to date, Reid has not persuaded a single Republican to come on board. According to Senator Dick Durbin (D-IL), “We still don't have a promise of a vote from the Republican side, so we would need his vote,” referring to Nelson.

But even tightening up the abortion language may not be enough. Most Americans oppose the bill because of the “public option.” All told, 62 percent of voters oppose a single-payer system like the “public option,” according to Rasmussen Reports.

Which may explain why Reid is still coming up short. With an election year right around the corner, vulnerable Senators like Ben Nelson and Blanche Lincoln, at least for the moment, are listening to their constituents—which seems increasingly wise.

Should they cave into the “public option” malaise in the halls of the Senate this week, they may well fall to the public’s option at home come next November.


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