Wednesday, August 12, 2009

Slap on the wrist for negligent cancer doctor

So you cannot trust even a specialist and the regulators who are supposed to protect you do nothing to stop it. Could he not at least have been fined a substantial sum or barred from anything but general practice work? His interest in patient care was obviously nil. Regulators so often let negligent and incompetent people run riot that you wonder what they are for. Even when complaints are received, it always seems to take them years to act. DO NOT rely on them to protect you from incompetents. Make your own enquiries when and where you can. And Google your own illnesses so you get an idea of what SHOULD be happening

A UROLOGIST repeatedly failed to order a biopsy for a patient who presented with symptoms of prostate cancer over four years, by which time the tumour had become aggressive and spread, an inquiry has found. William Lynch, a consultant at the Sydney Prostate Cancer Centre and Urology Sydney, has been reprimanded by the NSW Medical Board for displaying ''a serious lack of care in the management of [the] patient''.

The treatment of all Dr Lynch's patients will now be subject to an audit that will look at his history taking, recall system for follow-up of patient test results, diagnostic process and decision-making.

Last month the Professional Standards Committee found that Dr Lynch failed to monitor the patient's escalating prostate specific antigen (PSA) levels, which can indicate the presence of prostate cancer. He also failed to arrange a biopsy, which would have diagnosed the cancer and indicated how likely it was to metastasise, despite suspicious results of rectal examinations and the patient's symptoms and strong family history of the disease. When the cancer was finally diagnosed 3½ years later it was graded nine out of 10.

Dr Lynch is a director of the Australasian Urological Foundation and has published extensively on the use of minimally invasive treatments for prostate cancer such as cryotherapy, in which intense cold is used to kill cancerous cells. He consults at Sutherland and St George Hospitals as well as St George Private, President Private and the Mater Private hospitals.

A number of expert reports to the Health Care Complaints Commission said his conduct was significantly below the standard expected of a specialist of his seniority.

Dr Lynch told the committee that some of the patient's clinical notes had gone missing when Dr Lynch moved offices, but from memory, the patient had been reluctant to undergo a biopsy - an argument the patient's wife strongly rejected and the committee did not accept. He did not know why alarm bells did not ring when the patient's PSA reached a high level of 15.8 and could not explain why he failed to write detailed letters back to the patient's GP.

The committee also found that Dr Lynch had not provided any evidence of the changes he claimed to have made since the case, such as an electronic medical record system and ''triple checks'' to ensure abnormal results were followed up.


Rudd health reform ideas as crazy as Obama's

More limits on what care you can get will be coming

Barack Obama wants $US1000 billion over a decade to fund health reform. It is an unfathomable amount of money and if the drug companies and other vested interests in US medicine's vast corporate edifice fail to sink his proposal, then the seeming impossibility of financing may sink it anyway. If Kevin Rudd accepts the proposals of his own health reform gurus, he may have to ask us for what amounts to almost the same sum, per capita.

Last month the National Health and Hospitals Reform Commission estimated its proposals - with a dental health scheme, better community care for long-term conditions including mental illness, and new performance standards for emergency care and surgery - would cost at least $2.8 billion to $5.7 billion a year. Over a decade, that makes $32 billion to $64 billion. Multiply the upper end by 15 (roughly the factor by which the US population is larger), convert the currency and you reach $US800 billion.

It's no coincidence. Despite different financing regimes, both countries need to spend now to realign towards more rational health care, which keeps people well instead of just saving them when they are sick. We have identical pressures: an ageing population and the rising real cost of treating more people better for longer. Each year the use of intensive care beds (which cost $1.5 million a year to run) by those over 70 increases 14 per cent, the Australian and New Zealand Intensive Care Society says. Changing technology means more now survive previously unthinkable treatment.

While specialists want debate about limiting medical heroics for the very old and very sick, they do not want to start it. As the head of intensive care at a large Sydney hospital recently commented privately, it is ''tiger territory''. It's not hard to see why. Take Erbitux, a drug for advanced bowel cancer. It costs $US80,000 for an average extra 1.2 months of life, say doctors from the US National Institutes of Health. Calculations published last week in the Journal of the National Cancer Institute put the annual cost of extending the life of every American cancer patient by one year at the same price pro rata at $US440 billion. If you use the same formula for Australia, it's about $35 billion.

Australia does health care comparatively efficiently and well. We spend half, per capita and as a proportion of gross domestic product, what the US does - where outrageous private doctors' fees are rife and the quality of care is uneven and often woeful. We spend about 10 per cent more than Britain, but for that we get a life expectancy two years longer. It's a good start, although insufficient to hold back the twin tides of demographics and technology. Minor tweaks are not going to help in a world where a single costly breakthrough drug can bring the system to its knees.

But in the reform commission's nearly 300-page report lurks a grenade. Under the anodyne name Medicare Select is the seed of a plan that could end the generally unlimited access to medicine Australians enjoy. The Government would determine a ''mandatory set of health services made explicit in a universal service obligation'', or minimum treatment standards all Australians could expect from their health insurance, of which the Commonwealth would become just one, no-frills, provider. All services, including doctors, public hospitals and ambulances, would be covered. Private opt-in funds could supplement that legislated minimum with extras such as fancier hospitals and orthodontics, as they do now.

The key word is ''explicit''. How explicit? Australians have grown used to implicit access to medicine, a warm and fuzzy sense that in our darkest hour the system will rescue us. State public hospitals have few explicit caps on what care is offered to whom and for how long, and managers have leeway to fund unusual therapies in special circumstances. Medicare and the Pharmaceutical Benefits Scheme have more precise rules. But doctors work around them, stretching the truth to, for instance, justify dementia medication if they believe standard tests miss the subtleties of the person's condition.

Another clue to the commission's agenda is in its description of how Medicare Select might be funded: ''To aid the community's understanding of the cost of the universal entitlement to health care, it could be financed through a publicly identified share of consolidated revenue or from a dedicated levy.''

Australia spent $94 billion on health care in 2007 - a rise of 4.8 per cent (double the inflation rate) on the previous year - but fragmented among state and federal accounts and out-of-pocket payments. A single government budget item - goes the thinking - running to $70 billion and spiralling upwards, would focus the community mind. The current round of health reform talk is just the beginning. Next, we need to discuss how much medicine we are prepared to pay for, and when we stop.


The Rudd revolution in education is destined to fail

Kevin Donnelly

IF imitation is the sincerest form of flattery then Tony Blair's head must be spinning. When it comes to the federal government's education revolution, the reality is that Kevin Rudd and Julia Gillard are simply copying policies implemented by Blair when he was British prime minister. Initiatives such as early childhood education, a national curriculum and national testing, identifying under-performing schools and holding them accountable and investing in computers and information and communication technology, are all copied from British Labour.

Even the rhetoric is the same. Just compare Blair's exhortation, "Our goal: to make Britain the best-educated and skilled country in the world education, education, education", to Kevin Rudd's statement: "We need to lift our vision and start to imagine an Australia where we turn ourselves into the most educated economy, the most educated society in the Western world."

Education Minister Gillard, late last year, called on business to become more involved with schools, when she said, "I am certain that we will not achieve world-class education in every Australian school without the active support and involvement of the business community." It should not surprise that Blair expressed the same sentiment in 1999 when he said, "When people say keep business out of schools I say: the more support and involvement of the wider community, including business, in our schools the better."

That Australia's education revolution copies what has been tried in Britain over the past 12 years should not surprise. The ALP's links with Britain include one-time schools minister David Miliband advising the then opposition in the lead-up to the 2007 election. One of the most influential sources of policy advice during the Blair years was the left-wing think tank Demos. The director of Demos, Tom Bentley, after working as a senior adviser to the Victorian ALP government, now advises Gillard. Tony Mackay, the deputy chairman of Australia's National Curriculum Board, also has close ties with the British Labour, having worked with Demos and other British education bodies such as the London Leadership Centre during the Blair years.

Given that Rudd's education revolution mirrors events in Britain, the question needs to be asked: have the Blair policies succeeded in raising standards and strengthening schools? Based on the results of the most recent national tests for 11-year-olds, where two in every five children are leaving primary school under-performing in mathematics, science and English, the answer is "no".

Where there is evidence of test results improving, as noted by Alan Smithers in his report Blair's Education: an international perspective, such results are illusory. Not only have tests been made easier, but schools have also inflated results by narrowing the curriculum, teaching to the test and excluding weaker students.

Such are the flaws in Britain's national testing system, one that Australia has followed with national tests at years 3, 5, 7 and 9, that key stage three tests have been abolished and a recent report evaluating the primary curriculum argues that high-risk, one-off tests need to be wound back in favour of more teacher-directed classroom assessment.

In relation to the national curriculum, Chris Woodhead, the former chief inspector of schools originally appointed by Margaret Thatcher and reappointed by Blair, argues that subjects lack academic rigour as they are prone to politically correct fads such as personalised learning and teaching wellbeing. In his recent book Class War: The State of British Education, Woodhead also suggests the reason so many students achieve excellent examination results is because, over time, questions have been made easier and standards watered down.

Such are the concerns about the senior-school curriculum being dumbed down that a group of Britain's most prestigious independent schools has decided to abandon A-levels in favour of more academically rigorous and reliable alternatives.

As to why Blair's reforms have been ineffective and why Rudd's education revolution is also destined to fail, the answer lies in the overly bureaucratic, centralised and top-down nature of the reforms. As suggested by Woodhead: "The lesson for this failure is simple, the top-down imposition of politically inspired education reform does not work." Micro-managing schools and enforcing a one-size-fits all approach stifles creativity, innovation and denies schools the freedom and flexibility needed to achieve strong outcomes.

There is an alternative. Research into the characteristics of stronger performing education systems and schools identifies autonomy, diversity, choice and competition as central, the very things ignored by Rudd's and Gillard's education revolution.

Evidence that school choice and a more market-driven approach works is easy to find: just look at Australia's Catholic and independent schools that, even after adjusting for students' socioeconomic background, outperform government-controlled schools in areas such as literacy, numeracy and year 12 results, as well as school retention rates and success at tertiary entry.


Stupid NSW law

Couple must battle to adopt their own son

A SYDNEY couple will have to apply to the NSW Supreme Court for permission to adopt their own son, after the Family Court found that, in the eyes of the law, he was not theirs. The case involved a couple, known in court documents only as Sharon and Paul, who were unable to conceive because Sharon had been treated for cervical cancer, the Australian reports. Before having treatment that rendered her infertile, Sharon had her eggs harvested and stored. One of these eggs was later mixed with Paul's sperm, creating an embryo.

Sharon's mother, Lauren, offered to carry the embryo for her daughter. The child, known as Michael, was born in October 2008. Immediately after birth, Lauren handed the baby to Sharon and Paul, and they've been raising him ever since. The couple listed Paul as the father on the birth certificate, since he provided the sperm, while Lauren (his grandmother) had to be listed as the mother, since she gave birth.

Sharon and Paul went to court in April, to see if Sharon could formally adopt Michael. To the family's surprise, Justice Watts ruled on August 3 that not only was Sharon not the mother, but Paul wasn't the father. Under Section 60 (H) of the Family Law Act, couples who undergo artificial conception, using donated sperm or eggs are the legal parents of the children they conceive, regardless of whether they use their own sperm and eggs. A wife who undergoes assisted conception is the mother, even if it isn't her egg, and her husband is the father, even if it isn't his sperm.

Justice Watts admitted that these results were "surprising" to all parties but came about because surrogacy law in NSW hadn't kept pace with science.


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