Tuesday, December 20, 2005

Years in an Australian public hospital for nothing

At huge cost and with very destructive side-effects

Teenager Samantha Farr spent four years bedridden in a $650-a-day hospital room after being diagnosed with a rare immune disorder that independent medical experts say she may never have had. In a case the NSW Health Care Complaints Commission found involved "serious identified breaches of practice", Ms Farr has been left diabetic, addicted to drugs and with no reproductive cycle after her treatment. Now 21, Ms Farr also suffered a series of serious health setbacks during her hospital stay, including kidney and liver failure, septic shock, lung disease and catching a hospital "superbug".

Health investigators are now pursuing answers from a number of hospitals and neurologist Suzanne Hodgkinson over the case, which cost taxpayers millions of dollars in public hospital costs. Her family is seeking millions in compensation from the NSW Government.

Ms Farr's father, Andy, claims she "nearly died" as a result of the treatment at Liverpool Hospital in southwest Sydney. "Sam has lost four years of her life and she has been physically and psychologically damaged for life. It is appalling that a leading hospital could do this to a patient," he said.

Dr Hodgkinson is the wife of controversial University of NSW professor of immunology Bruce Hall, who was publicly accused of exaggerating laboratory results before obtaining a federal research grant. Professor Hall - whom an inquiry later found guilty of academic misconduct but cleared of scientific fraud - was the director of medicine at Liverpool while his wife was treating Ms Farr there.

The Farr family's saga began in Cairns in 2000 when Ms Farr, then barely 16, suddenly "stopped breathing". After a battery of tests, Cairns Base Hospital doctors could not find a cause and referred the case to specialists at Sydney Children's Hospital in Randwick, where doctors diagnosed her with a rare and obscure disease called myasthenia gravis, which affects five in every 100,000 people. This is caused by an abnormality of the immune system in which antibodies attack or attach themselves to the nerve endings that control muscle movement, including breathing. In 2001, Mr Farr and his wife Kim moved to Blackheath in the Blue Mountains west of Sydney and after an attack Ms Farr was transferred to Liverpool Hospital, where she was seen by the head of neurology, Dr Hodgkinson.

"Dr Hodgkinson told us Sam was suffering from 'refractory' myasthenia gravis and that she needed 'aggressive treatment' or she would die," Mr Farr said. Mr Farr, who now has access to all her daughter's medical records, said she was given "dozens of plasma exchanges that did nothing"; strong immuno-suppressant drugs; corticosteroids; morphine-based painkillers; anti-cancer drugs; and ... powerful myasthenia gravis drugs, all of which had side effects". "The crazy thing was that one of these drugs in particular had side-effects that mimic the disease, affecting muscle movement and breathing," he said. "Every time we saw Sam she seemed worse ... Dr Hodgkinson told us that if Sam stopped taking this particular drug she would 'die within hours'." That is why Mr Farr was so disturbed when he went to Liverpool Hospital in April to find out that Dr Hodgkinson was on "stress leave".

Her patients were given to another neurologist, who immediately sent Ms Farr to specialists at the Royal Prince Alfred Hospital, the main teaching hospital for Sydney University, for a second opinion. Mr Farr said most of the tests came up negative, including the test for raised antibodies. By this time, Mr Farr had complained to his MP and then health minister Morris Iemma, who ordered another "independent neurological assessment" by a retired neurology professor at Sydney University. "The professor concluded that, at worst, at some stage, Samantha may have had a 'mild case' of myasthenia gravis -- effectively 'drooping eyelid'," Mr Farr said.

Dr Hodgkison yesterday defended her diagnosis, saying "there were excellent reasons for believing Samantha had myasthenia gravis". Dr Hodgkinson said she did "reassess" Samantha through her 3 1/2 years in hospital under her care. "It was a long, long time, but she was a very sick girl."

A spokesman for the NSW Health Minister John Hatzistergos said: "It is not appropriate to comment as the case has been referred to the Health Care Complaints Commission for investigation." But a spokesman for the NSW Southwest Area Health Service said: "This is a very complex case and the hospital remains in close contact with the family. It is being investigated internally and externally at the Area Health Service's request. "Our investigations have led to a full review of our protocols and procedures, particularly regarding long-term patients."


Alabama: State set to track patients' use of drugs: "Alabama will soon keep track of who is taking Xanax, OxyContin and other addictive drugs and how often. The tracking will be done with a prescription drug database system designed to prevent addicts and drug pushers from 'doctor shopping' for multiple doses of pain killers and other medicines. At least 20 other states have such databases. State Health Officer Don Williamson said the program will begin as a pilot project on Jan. 1, with doctors and pharmacists providing the prescription data voluntarily. Mandatory reporting will begin on April 1, he said. ... At least 20 other states have established such databases to crack down on prescription drug abuse, according to the Web site of the National Conference of State Legislatures."


For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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