Minister for Health Guy Barnett is having a ‘mare, but that’s nothing compared to the patients and families on the receiving end.
The layers of drama reverberating in the Tasmanian Department of Health this past week are mind-boggling to behold.
The whirlpool of debris started circulating the drain last weekend when Calvary Health Care pulled the pin on its involvement in developing a private hospital to be co-located on the Launceston General Hospital campus.
Calvary CEO Martin Bowles said it was down to “challenging budget escalations” which were “insurmountable” for one of the country’s biggest private healthcare companies at this time.
Nobody can argue that the cost of building stuff hasn’t skyrocketed lately. Just the week before St John of God beat a similar retreat from its operation of the Hawkesbury Hospital when its contract expires on 31 March. A lot of that can be put down to the company’s need to pour money into its commitment to build a new private hospital in Perth’s eastern suburbs.
Whatever the reasons, Calvary’s disappearance in Launceston presents a double-barrelled dilemma for the Tassie Department of Health.
Apart from being stuck with trying to find another private partnership for the Launceston project – something Health Minister Guy Barnett recommitted to during the week – speculation is there were big hopes the private hospital would be a handy source of beds to ease bed block at LGH.
Mr Barnett didn’t help his cause on Friday afternoon during a fraught appearance at the Select Committee on Transfer of Care Delays (Ambulance Ramping) hearing at which he refused to be specific about when he knew the Calvary deal had fallen over.
Ramping
The aforementioned Select Committee was back in session this week and went from bad to worse for the department and its allies.
Whistleblowers have featured strongly and bravely so far.
That was emphasised on Monday when the CEO of Ambulance Tasmania Jordan Emery was forced to apologise to an AT employee who gave evidence back in November.
Mr Emery wrote to the committee claiming the employee, who he named repeatedly, had given incorrect information to the committee. Unfortunately, as the committee chair (and former epidemiologist) Dr Rosalie Woodruff pointed out, Mr Emery misquoted the witness and appeared to be trying to intimidate him.
“I apologise unreservedly to [the witness] in respect to the statements made in my corresponding letter. Secondly, I absolutely reject any suggestion that I would ever intimidate an employee,” said Mr Emery.
Ouch.
None of that awkwardness could distract from the ugly facts about ramping at Royal Hobart and the LGH, however.
“We asked the department about the number of patients that died while ramped in a five-year period,” said Dr Woodruff when questioning DoH secretary Kathrine Morgan-Wicks.
“The response from the department was that no patients have died in that five-year period. However, we know from the coroner that a woman died while she was ramped at the LGH during that time and another woman died in the ramp area at the Royal Hobart Hospital. How do you explain that discrepancy?”
Ms Morgan-Wicks replied:
“We don’t have data that indicates that location according to the deaths because those deaths were later then recorded as proceeding into the emergency department.”
Dr Woodruff: “Why doesn’t the department’s data capture those as deaths on the ramp?”
Ms Morgan-Wicks: “The death is recorded as a death that is occurring within the RHH or the LGH, or that location. Where our systems are currently failing us is to pinpoint specific locations and categorising the data right down to the physical location of where that death actually occurred.”
That’s a statement that will haunt Ms Morgan-Wicks in light of what happened during Tuesday’s committee hearing when a brave LGH registered nurse, Amanda Duncan, read a long statement that blew the hearing wide apart.
Falsified death certificates
Ms Duncan lifted the lid on a culture that involved falsification of death certificates, intimidation of junior ED doctors who refused to change causes of death, breaches of privacy and two deaths which were not reported to the coroner.
In total Ms Duncan said she had “11 reports from doctors and nurses who have disclosed alleged misconduct relating to the death of a patient including falsified medical certificates of deaths in ward 5a, 5b, the intensive care unit, the operating room suite and the emergency department at the LGH”.
“There are two deaths which were not reported to the coroner by the LGH. In total there are 15 deceased patients who I am concerned may be impacted,” she said.
So, in brief, patients are being held for hours on the ramp, under the care of paramedics who are limited by their scope of practice in what treatments they can offer, while listening to 000 calls going unanswered or severely delayed.
Meanwhile if a patient dies somewhere between arrival by ambulance and admission to a bed, there is no record of where in the process that death occurs – was it on the ramp, was it after transfer of care to the ED team?
And then there’s the possibility of a false cause of death being recorded. What would be the reason for that? Covering up negligent care? Covering up a death on the ramp?
Nightmare.
What happens next?
In terms of ramping Mr Barnett and Ms Morgan-Wicks have introduced two new protocols this week.
The first allows paramedics to drop category four and five patients directly into the emergency department waiting room, rather than joining the queue on the ramp.
That, says the department, will allow paramedics to get back on the road, responding to 000 calls, and will, presumably shorten the ramp time for those patients with life-threatening conditions.
Does it solve bed block – ie, does it improve patient flow from ED into beds either in the hospital itself, into community aged care or disability beds? Nope, not one ounce.
The second new protocol, to be implemented next month, mandates a maximum 60-minute wait for all patients arriving by ambulance to be transferred to the care of emergency department staff. Under the new protocol, paramedics will work with emergency department staff to commence handover of patients approaching the 60-minute deadline, including completion of relevant patient documentation, he said.
I don’t know about you, but that makes no sense to me.
If patients could be transferred into the ED staff’s hands within 60 minutes, wouldn’t that be happening already? Isn’t that exactly what ramping is – unavoidable delays in transferring care?
Saying it must happen, doesn’t make it so, Number 1.
Does it make beds available in ED suddenly? Does it make beds available up in the wards?
Nope.
Mr Barnett showed up to the inquiry on Thursday afternoon to apologise for the consequences of the ramping delays.
“I want to reassure all Tasmanians and enormous effort is being made to address this issue and we will not rest until significant improvements are made on behalf of the government,” he said.
“I sincerely apologise for any adverse outcomes transfer of care delays have caused. My heart goes out to the patients, their families, and the healthcare workers impacted.”
As to the falsified death certificates, the DoH says an “independent clinical expert” with determine if the cases are reportable deaths not referred to the coroner.
If they are, said the department, they will be referred pursuant to the Coroner’s Act to all relevant authorities, including Tasmania Police if a potential breach of the law is detected.
Secretary Morgan-Wicks said she had received information from a staff member in relation to one patient and was continuing to make further inquiries in relation to this case. She has also received four more anonymous complaints which support the allegations raised by witnesses to the Select Committee, but these do not identify any patient information to review.
“We’ve had contact from another medical practitioner that has identified eight patient matters,” she told the inquiry.
“And we are in the process of pulling all of those records however, at least one of those I’m informed has already been reported to the coroner and we need to go through each matter which illustrates to us that there may be some communication or closing the loop issues with staff that are involved in a patient death occurrence.”
Watch this space. This isn’t over by a long stretch.