Bureaucratic brilliance kills public hospital patients

A Westmead Hospital scheme designed to slash costs and improve performance statistics by getting patients out of ambulances more quickly contributed to the deaths of two patients, who received sub-standard care in the emergency department, internal investigations claim. Patients were placed on trolley beds in a corridor, under the care of a nurse and without supervision by a doctor or even basic resuscitation equipment, under the scheme, which continued for seven months after the first death and despite the written objections of the hospital's emergency chief.

Internal investigations into the deaths of a 64-year-old man in February 2007, and of 85-year-old Mary Redfern in October the same year, pointed to inherent dangers in the so-called Nurse Ambulance Release Team (NART) arrangements as significant contributors to both. A report into the death of the man - admitted with a lung infection, low blood pressure and low oxygen levels - concluded, "the geographical location of NART beds and the absence of allocated [doctors] to the NART beds were a contributory factor". It recommended the relocation of the release team to "a defined clinical space", with emergency equipment and medical supervision.

But the hospital's administration did not act on the advice until Mrs Redfern's death, which occurred after nurses missed the seriousness of her falling blood pressure. The hospital's investigation again blamed the release team initiative in part, concluding, "There is an inability to [recognise] critical illness ... in the NART area."

Internal emails, seen by the Herald, show hospital management rejected a demand by the director of emergency medicine, Matthew Vukasovic, for the immediate cessation of the release team system six weeks before Mrs Redfern's death. "I feel that the minimal advantages that are obtained from offloading patients on to a NART trolley are overshadowed by the patient safety issues," Dr Vukasovic wrote on September 12 to Maureen Berry, the director of clinical operations for a group of western Sydney hospitals including Westmead.

Ms Berry responded by forbidding Dr Vukasovic from ending the release team arrangements without her permission, saying this would inflate costs and off-stretcher times and would not ease crowding in the corridor - which she said would still be occupied by ambulance trolley teams. The initiative was finally ended days after Mrs Redfern's death.

Under the scheme, patients arriving at a crowded emergency department could be transferred into the care of a registered nurse - typically a part-time or casual employee on an extra shift - who worked without formal supervision by a doctor, allowing the ambulance team to return to the road. This replaced a more expensive measure in which ambulance paramedics, paid overtime rates, were based at the emergency department to offload ambulance patients. An internal memo shows the hospital expected to save more than $200,000 a year by having nurses take charge of patients - half the $400,000 cost of ambulance officers managing the equivalent service.

According to a 2006 synopsis of the policy, written by hospital administrators when they entered it for a health-care industry award, the proportion of people waiting longer than 30 minutes to be off-loaded from an ambulance fell from 30 per cent to about 10 per cent - the NSW Health Department benchmark - immediately after its introduction.

In a written response to questions, a spokeswoman for Sydney West Area Health Service, which administers Westmead Hospital, said the initiative was intended as "a way of improving patient care by providing a better, safer and cheaper alternative [to hospital-based ambulance officers]". Despite the damning conclusions of the internal reports, she said the two deaths were due to "multiple factors but not a direct result of the NART model of care".

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Drunken cop OK?

And the police brass are too arrogant even to explain the decision

POLICE have cleared an officer who had drunk at least 18 beers when he was pulled from a pub on his day off to breath-test a driver in Cunnamulla. An internal inquiry by the Ethical Standards Command ruled no action should be taken against Senior Constable Adam Reedy, despite widespread outrage and concerns by Queensland Police Minister Judy Spence. Police have refused to answer questions or provide reasons as to why the decision has been made.

Senior Constable Reedy, who was a constable in Cunnamulla on May 14, 2005, returned to the pub to finish his beer after the breath-test about 10pm. He drank rums and coke at another hotel before declaring himself on duty about 12.45am on May 15, when he tried to arrest a woman he said spat at him. An internal investigation was only ordered after it came to light in The Courier-Mail - three years after the incident.

A spokeswoman for Ms Spence said last night she was still to see the report. A two-line police statement read: "The investigation into this matter is finalised and there will be no further action taken. As this matter is finalised it would be inappropriate for the QPS to provide any further comment."

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Australian professor identifies danger genes for deadly Kawasaki disease

An Australian researcher says he has made a breakthrough which could lead to a diagnostic test and better treatment for the potentially fatal Kawasaki disease. The illness is an inflammatory condition in young children that can damage blood vessels. There are up to 200 cases in Australia each year. A team of researchers led by University of Western Australia Professor David Burgner studied almost 900 cases around the world and has identified genes which could make some children more susceptible.

Lily Allen was diagnosed with Kawasaki disease before she was two months old. She is now fully recovered, but Lily's mother Amanda says they had to wait several agonising days before a diagnosis could be made. "That was the hard thing, we knew nothing of it and it just took so long to actually diagnose it, which was hard," she said. "It emotionally and physically takes its toll on you. You wonder why your baby's so sick and her heart rate was at 180 at rest, so she was constantly in pain and having trouble breathing."

Named after the professor who first described it, Kawasaki disease usually affects children aged from six months to four years. The symptoms include fever, rash, swollen hands and feet, and peeling skin. Kawasaki disease also inflames blood vessels and can cause permanent damage to the heart.

Professor Burgner says the disease can be difficult to diagnose. "It's often mistaken for Measles or severe infections, scarlet fever or even sometimes meningitis," he said. "So this is a mysterious but very serious disease of young children. "Like many diseases we think that genetics plays a major role in deciding or determining who actually develops Kawasaki disease. "And we think this because if Japanese children move to America which has a relatively low rate, their risk remains as high as it would be if they were in Japan. "And the risk of brothers and sisters who have had Kawasaki disease is about 10 times the risk of the general population. "So we think that genes are going to be important in determining who actually develops Kawasaki disease when they're exposed to whatever it is that's triggering this illness," he added.

Professor Burgner says the findings are an important first step in understanding the disease. "Ultimately we'd like to develop a diagnostic test, that's really what the paediatricians are crying out for - a bedside or a diagnostic test for Kawasaki disease, because it's a very difficult diagnosis to make sometimes," he said. "We need better treatment because our best treatment actually fails in 5 to 10 per cent of cases to prevent damage to the heart. "It's not inconceivable. In the future we may be able to develop a vaccine to prevent Kawasaki disease and maybe that will have some impact on future risk of heart attack and things like that.

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Dame Edna to launch cosmetics line



Superstar housewife Dame Edna Everage will return to Australia next week to share her beauty secrets and launch her gladiola-inspired range of MAC Cosmetics. Dame Edna is the first Australian celebrity to have a global collection with the brand, and she will unveil her range at David Jones in Sydney next Friday at 11am (AEDT). At her only in-store appearance worldwide, Dame Edna will reveal some of the secrets behind her good looks during a question and answer session with singer Ricki-Lee Coulter.

"Sardines are one of my beauty secrets," she said. "I used to sleep with them taped to my face. But it always made a mess of my pillow, and my late husband didn't particularly care for it."

The company have worked closely with Dame Edna to ensure the packaging for the collection of glosses, shadows, lipsticks and nail lacquers truly represents the Dame. Colour inspiration has been drawn from the lilac of her hair, the red sparkle of her glasses, and the various hues found in her signature flower, the gladiola. "This collaboration is a celebration of spirit and creativity and is beyond everyone's extreme dreams," MAC senior vice president James Gager said.

Source. (In case there are some American readers unaware of it, Dame Edna is a creation of Australian mega-satirist, Barry Humphries)