A risk-averse health bureaucracy puts its whims before patient welfare

Contrary to a claim made below, there is no clear research evidence about the best procedures for avoiding surgical site infections but that appears to be unknown to the bureaucrats. It is fire risk that moves them -- even though there have been no fires. They are prepared to take a daily risk in order to avoid a remote risk! It's just a bee in the bonnet of some bureaucrats and they are allowed to dictate patient care methods. Leaving surgical procedures to the surgeons concerned is too much to ask, apparently

PATIENTS are being put at risk because NSW Health had an inexplicably inconsistent approach to infection control procedures before operations, an orthopedic surgeon says. Dr Robert Molnar has for the past six months unsuccessfully sought an explanation from the Health Department as to why he is not permitted to use alcoholic surgical preparation solution on his patients at Westmead Hospital, yet he is able to at St George and Sutherland public hospitals.

The rules vary across hospitals: alcoholic solution can be used at Fairfield, Concord, Prince of Wales, Royal Women's and Royal Prince Alfred hospitals but is barred at Liverpool, Nepean, Gosford, Canterbury or Royal North Shore.

Dr Molnar believes a Westmead patient contracted an infection after surgery on a hip fracture last year because the hospital deemed the alcoholic preparation he wanted to use a fire risk. The patient has had 10 more operations, including one to remove the metal plates and screws in his hip, and now needs a hip replacement. Dr Molnar had used an aqueous antiseptic to prepare the skin. "You may as well spit on the wound. This guy's life is ruined; it's tragic and it's so predictable," he said, noting that alcoholic solution could be used at most private NSW hospitals.

After a series of letters between him, the Health Department and the office of the Health Minister, Reba Meagher, Dr Molnar was given exclusive permission last November to use the solution at Westmead but not in conjunction with electrically induced heat due to the risk of fire. That ruled out 95 per cent of his operations, he said. There has been no theatre fire in NSW due to alcoholic solution, a spokeswoman for the Health Department said.

In a letter in March to the parliamentary secretary for health, Noreen Hay, Dr Molnar wrote: "I believe the situation places patients in western Sydney at significant risk of morbidity." Dr Molnar told the Herald: "Most orthopedic surgeons wouldn't operate without it, just because of the risk of infection. They're ruining people's lives. It's bureaucratic madness."

A Sydney orthopedic surgeon, Doron Sher, said that if the surgeon was appropriately educated the risk of fire was minimal. "There is evidence in the literature showing that infection rates are lower using alcoholic Betadine," he said. "I use the alcoholic solution when I get the option because I believe that you get a lower infection rate."

Sydney West Area Health Service, which includes Westmead, put the restriction down to fire risk. Northern Sydney Area Health Service did not explain why it was not used. South Eastern Sydney Illawarra Area Health Service said it allowed alcoholic preparation at all its hospitals.

The Opposition Health spokeswoman, Jillian Skinner, said: "Infection is rife in our hospitals so I would expect Reba Meagher would endorse the use of products that are considered world's best practice."

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Pregnant women 'lie' to get beds in Melbourne's better public hospitals

The "equal high quality for all" idea behind public hospitals is not mirrored in reality

DESPERATE pregnant women are using fake addresses so they can give birth at Melbourne's leading maternity hospitals. The Royal Women's and Mercy hospitals and Monash Medical Centre are sending women who are not from their areas and who do not anticipate complications elsewhere. The hospitals say they want to keep the beds for at-risk patients.

Hundreds of mothers from Melbourne's northwest suburbs have launched a protest against the Brumby Government, saying they are being shortchanged. Since October, mothers from Coolaroo, Craigieburn, Roxburgh Park and Meadow Heights have automatically been referred from the Royal Women's to the Northern Hospital in Epping if their pregnancy was expected to be straightforward. The state's other top level maternity wards - Mercy Hospital for Women and Monash Medical Centre - also direct women with uncomplicated pregnancies to local hospitals.

Women have lied to secure a bed at the highly regarded Women's. One pregnant woman, who asked not to be named, said she was scared to go to the Northern Hospital because she had suffered a miscarriage there. She had used a friend's address to get a booking at the Royal Women's.

Protest group Fair Go For Hume has bombarded Premier John Brumby with more than 460 complaints. Royal Women's Hospital spokeswoman Mandy Frostick said births at the hospital had jumped from 4600 in 2001 to 6500 last year. She said the hospital had to send women with low-risk pregnancies from the northern suburbs to the Northern Hospital. Mercy chief Stephen Cornelissen said it had a duty to care for mothers with "more complex" needs.

A Monash spokeswoman said they shared pregnancies between themselves, Casey and Dandenong, depending on circumstances. Northern Hospital maternity director Hammish Manning said they offered high-quality care. [The customers obviously don't think so]

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Catholic schools join same-sex lockout

CATHOLIC schools in Queensland have joined the crackdown against students escorting gay partners to Year 12 formals. With the formal season under way, Catholic secondary students have been reminded by their school administrators that it would be inappropriate for same-sex couples to attend major school events such as the formal. "The Catholic Church has a particular vision of family and sexuality flowing on to a responsibility to model this vision for children through formal activities in the life of the Catholic school," said Queensland Catholic Education Commission executive director Mike Byrne. "As such it is not seen as appropriate for students to attend an event such as a school formal as a same-sex couple."

Brisbane's Anglican Church Grammar School last month banned male students from taking same-sex partners to the school formal on June 19. But other secondary schools are more relaxed about who students can take to their formal. Brisbane Girls Grammar School principal Amanda Bell said the school imposed no restrictions on who pupils could take to the dance. "Guests may include male or female friends, cousins, parents, siblings, anyone," she said. "Some girls choose not to bring a guest. The school encourages the girls to invite someone who will support and enjoy this event in a positive spirit."

Karen Spiller, the principal of St Aidan's Anglican Girls School in Brisbane, said the school had "no policy" on who students could or could not bring. "We're very happy for our girls to go along and enjoy their formal in the company of their own friends and cohorts or to bring a friend or a partner," she said. "The focus is on appropriate behaviour and enjoying their relationships with their cohorts."

Queensland state high schools also have their own guidelines regarding school formals, with no restrictions on same-sex couples.

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Independent senators to flex muscles

THE Rudd Government could be forced to consider amendments to its industrial relations laws that would reintroduce individual statutory agreements, after two senators about to take balance-of-power positions in the upper house said they would consider pushing for change. It was widely assumed that statutory agreements would be phased out of the industrial relations system after the Government introduced laws allowing for them to continue only during a transitional period and the Coalition abandoned its Work Choices policy.

But anti-pokies South Australian senator-elect Nick Xenophon told The Weekend Australian fair statutory agreements would be better for higher paid workers than the common law contracts proposed by Labor. "If Labor accepts the proposition that workers earning over $100,000 should be able to strike some kind of agreement, I cannot understand why it should not be a statutory agreement that would allow them to resolve disputes quickly and easily, rather than in expensive and protracted action before the courts," Mr Xenophon said.

Family First senator Steve Fielding was also looking at ways to "improve" Labor's major industrial relations laws when they are brought into the Senate later this year. "Family First is not against individual statutory contracts per se; we were just against John Howard-style AWAs (Australian Workplace Agreements)," he said.

After bitter internal debate, the Coalition did not oppose the first stage of the Government's industrial laws in the Senate earlier this year. But Opposition workplace relations spokeswoman Julie Bishop said the Coalition would be working with the independent senators to improve the Government's second piece of industrial relations legislation. "We have been hearing very serious concerns from the business community about the impact of the second stage of Labor's laws, and we have said common law agreements are no substitute for statutory agreements," she said. "We believe Labor's laws will be fundamentally flawed and we will be working hard in the Senate to try to change them."

Despite having "buried" Work Choices soon after being elected leader, Brendan Nelson said this week Treasury advice on the possible inflationary effects of Labor's regime, revealed in The Australian this week, meant Mr Howard's approach had been right. The Government rejects the claim its approach will increase inflationary pressures, saying its laws will link wage rises with increased productivity.

In the new Senate, which technically takes effect from July 1 but will sit for the first time in August, the Government will need the support of the Greens, Senator Fielding and senator-elect Xenophon to pass legislation. A combination of the Coalition, Senator Fielding and Mr Xenophon could pass an amendment to Labor's laws.

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