IS WESTMEAD HOSPITAL SHAPING UP TO BE ANOTHER KING/DREW?

The management at this big NSW government hospital seems to be nearly as hands-off it was at the disgraced and now-closed King/Drew hospital in Los Angeles. Two brand new reports below plus re-runs of two previous reports -- one from yesterday and another from March 8th:

Amazing bungle at Westmead leaves family seething

"He was in agony"... a feeding tube was wrongly inserted into the lungs of Francis Wilks-Tansley, 7. The bastards should be sued for millions for what they did to the boy

THE family of a boy who almost died after a ''breathtakingly basic'' hospital bungle nine months ago is still waiting for a written apology and a change in policy to prevent other children suffering the same fate. Francis Wilks-Tansley will be fed through a hole in his stomach for the rest of his life and is unable to breathe properly after a feeding tube was inserted into his lungs - and not detected for 36 hours.

During that time the seven-year-old, admitted to The Children's Hospital at Westmead for seizures, was given water and six medications through the tube, causing him to develop a life-threatening pneumothorax, where air gets trapped in the cavity around the lungs, and his right lung to collapse. One of the drugs, sodium valproate, causes severe chemical burns to lung tissue.

Up to six staff tended to Francis, who was born partially blind, deaf and with limited voluntary movement, over several shifts before the error was discovered, despite repeated calls from his mother, Sarah Wilks, that he was in respiratory distress. A chest drain was then inserted for 17 days to remove the fluid in his lungs. ''He was in agony, in extreme pain,'' she said yesterday.

One staff member, who did not want to be named, described the mistake as ''breathtakingly basic''. Staff must draw out some contents of feeding tubes as soon as they are inserted to test for the presence of stomach acid. A drop is placed on litmus paper, which turns a vivid pink if stomach acid is present. A chest X-ray can also be used to confirm the tube's placement, particularly in heavily sedated or unconscious children.

But Dr Wilks, who has a PhD in biology, said the lamp next to Francis's bed, used to check the colour on the litmus paper, was not working, making the room dim and difficult for staff to determine if the tube had touched stomach acid or lung secretions.

A case review carried out by the hospital found there had been three attempts to insert the tube, and its blood-stained contents had turned the litmus paper pink, leading staff to believe it had been placed correctly. But it also said difficult or repeated attempts should alert staff to the need for an X-ray to check position. After the incident, staff were sent a short email reminding them of the importance of correct tube placement.

''They almost killed my son and yet haven't changed their culture,'' Dr Wilks said. ''This is not an error made by one person. It was a group of people, which means there must be a systemic or cultural problem, and I want to make sure they can't do it again. I don't want them punished; I want them educated.''

Dr Wilks, who also has three teenagers, had bought a house in Hobart the day Francis was admitted to hospital and has been commuting twice a week to be with him. Yesterday the hospital offered to reimburse her air fares and promised a new policy would be in place by the end of the month.

But she is adamant the offers were made only because she contacted the NSW Health Minister, Carmel Tebbutt, last week. ''It's been an unconscionable length of time. An apology now is worse than no apology at all. There is nothing I can do to reverse the damage done to Francis but, at the very least, the hospital needs to ensure this doesn't happen to other children.''

A spokeswoman for the hospital yesterday said staff had verbally apologised to Francis's family. She said a statewide safety notice had been issued in February and a compulsory education program was being developed for all staff inserting feeding tubes, but it was not known when it would begin. ''The hospital sincerely regrets this incident and how it has affected Francis and his family. We are not denying we made a mistake, and we are sorry about it.''

SOURCE

Patients catching lethal bugs at Westmead

FOUR patients a week admitted to Sydney's biggest hospital, Westmead, are being infected with potentially lethal golden staph and MRSA infections picked up while in the wards, hospital documents show. An investigation into where every one of the reported 2392 hospital-acquired infections, some known as "superbugs", occurred in 2008 in public hospitals showed Westmead topped the list, but other big hospitals including John Hunter, Liverpool, Blacktown and Royal North Shore were not far behind.

Experts believe the spread of infection is largely due to poor handwashing and other hygiene controls by nurses and doctors, The Daily Telegraph reports.

Official NSW Health records, obtained by Channel 9 under Freedom of Information laws, reveal the numbers of infected patients at public hospitals for central line associated bacteremia, surgical site infection, staphyloccus aureus (golden staph), multi-resistant staphyloccus aureus (MRSA) and acinetobacter baumanni.

A report on golden staph and MRSA, published in the Medical Journal Of Australia this week, reported golden staph infections can prove fatal for up 21 per cent of those infected within a month. Survivors can face having treatment sometimes over years to beat the illness.

The documents show Westmead recorded 243 infections in 2008, including 201 cases of golden staph and its antibiotic-resistant variant, MRSA.

Newcastle's John Hunter Hospital came in second with 150 infection cases, including 126 golden staph and MRSA incidents. The third highest hospital was Liverpool, which had 144 cases including 100 golden staph and MRSA cases. Children's hospitals also reported potentially life-threatening infections.

The Children's Hospital at Westmead had 31 cases of hospital acquired infection while its sister facility at Randwick, Sydney Children's Hospital, recorded 28 cases.

NSW Health Deputy Director General Tim Smyth said the likelihood of getting an infection in a public hospital was very small. The Department reported in 2008 an average of just 3.8 cases of MRSA infection for every 1000 intensive care days in public hospitals and 2.5 infections for every 10,000 bed days for golden staph bloodstream infections.

SOURCE

Unmonitored patient left to die at Westmead

Staff switch off "annoying" monitors that are there to save lives

A YOUNG mother at risk of sudden death from a brain cyst was left without a heart monitor for 20 hours before going into cardiac arrest at Westmead Hospital. Monitoring systems in the hospital's high-dependency unit were ''less than perfect'' when Rashpal Hayer died in July 2007, the NSW Coroner Mary Jerram said yesterday.

She was delivering findings after an inquest into Ms Hayer's death, which examined the failure to reattach the monitor and heard evidence of ''a 'culture' of silencing irritating alarms in that ward''.

Ms Hayer, 36, went to hospital with a severe headache. A CT scan revealed she had a colloid cyst, ''a very dangerous condition in which sudden death is known to be a possibility'', Ms Jerram said. A neurosurgeon instructed staff to monitor her closely, but a cardiac monitor was removed before a scan on July 2 and was not replaced when she returned to the ward. Ms Hayer was found in cardiac arrest at 6am on July 3. She never recovered brain function and died four days later.

Ms Jerram said nurses on the night shift and three doctors - including neurosurgical registrars - either failed to notice or saw no problem with the fact that she was without a cardiac monitor. Ms Hayer could possibly have been treated if a monitor had been fitted and sounded when she went into arrest, she said.

The inquest also heard that a finger probe monitoring Ms Hayer's pulse and oxygen levels had detached half an hour before her cardiac arrest. It should have sounded warnings.

Ms Jerram said it was possible the alarm connection to the nurses' station was not working, or that ''the alarms were deliberately silenced at some stage … not necessarily from any malice''. She accepted evidence from a nurse that the ward had a culture of ''silencing irritating alarms''.

Ms Jerram made no formal recommendations, noting that the hospital conducted three investigations into the death and had policies to remedy some of the problems highlighted.

SOURCE

Westmead public hospital bankrupt and partly closed down

Bed numbers have been slashed this week at Sydney's biggest hospital, in a round of ward closures aimed at reining in a $70 million blow-out in the region's health spending. Ten of 16 operating suites have been closed and elective surgery has been cancelled, with staff forced to take leave, sources said. Forty-three cardiology and heart surgery beds have shut since late last year, said medical and nursing staff, culminating last week in the closure without notice of the heart surgery ward - which staff found empty and locked when they arrived for work.

The unprecedented axing of about 70 beds comes after the Herald revealed in late January that Sydney West Area Health Service, which oversees Westmead, owed $26 million to creditors - more than any other region and almost a quarter of NSW Health's outstanding debt to suppliers at that time.

Neurosurgery and general surgery beds have also closed, said the sources, while casual nursing shifts have been curtailed across the entire hospital, as displaced permanent staff are redeployed into vacancies on the roster. The closures represent about 9 per cent of Westmead's total capacity, and are the biggest round of cuts at a single hospital to strike the beleaguered state health system. The chairman of the hospital's Medical Staff Council, Andrew Pesce, said the closures were by far the most severe the flagship teaching hospital had seen. "It's a quantum leap [compared with] the modest bed closures usually built around [public] holidays," Dr Pesce said.

Coming a month before Easter and without any promise that beds would reopen or surgery resume, the closures were the equivalent of an extra Christmas closedown, said Dr Pesce - referring to the practice of selectively suspending services during the holiday period to save money. "If things continue the way they are going, the morale of the place will become so low that doctors and nurses will start leaving," he said. Hospital managers were not solely to blame because NSW Health gave them "unrealistic budgets".

Public hospitals had traditionally been insulated from state spending cuts, Dr Pesce said, but NSW's wider financial crisis meant they were no longer receiving favourable treatment. Health accounts for about one-third of the state's spending, and had blown out by about $300 million at the time of November's mini-budget. Area health services were ordered to save $943 million over four years.

A spokesman for the Health Minister, John Della Bosca, declined to address the Herald's specific questions about closures, offering instead in a written statement: "There have been adjustments to bed platforms and relocations of some services within Westmead's overall funding base . Westmead has further capacity to improve bed utilisation and this is a priority for management attention in the relevant services as part of the operational strategy." He also did not answer a question about the number of patients whose elective operations were cancelled, instead insisting elective surgery was still available but saying the hospital was "under resource pressure and needs to ensure that its priorities are met but not exceeded and that all opportunities to ensure it operates efficiently are explored".

The president of the NSW branch of the Australian Medical Association, Brian Morton, said he understood patients would be moved to general wards under the care of "staff who don't have the same skills". Patients would be at risk if already overcrowded hospitals were further stressed. .. That's when mistakes happen."

The Opposition's health spokeswoman, Jillian Skinner, said the closures would endanger patients. "The evidence is quite clear that delayed treatment makes conditions worse and makes the hospital stay longer - and therefore more expensive."

SOURCE






Refugees know Kevin Rudd has opened the door

By Paul Toohey

SOME are stuck, their spirits broken and their money gone. They are unable to move. Others are just waiting for the right deal and are ready to make the journey at a moment's notice. At the mountain resort town of Puncak, two hours south of Jakarta, an estimated 400 Iraqis and Afghans, including Naghmeh and her son Milad, are scattered about in rundown inns and hotels. Most of them barely know each other but they are united by a common obsession - getting to Australia. The Indonesian authorities know they are here, as do the Australian government and agencies such as the International Organisation for Migration and the UN High Commission for Refugees. Most of them are registered as refugees with the UNHCR, and are waiting and praying for legal settlement in countries such as Australia, Canada and New Zealand.

But they say the UN moves too slowly for them. Those with the money will take their chances with the people-smugglers and book a passage on an Indonesian boat to Ashmore Reef or to Christmas Island - anywhere, as long as it is within Australian waters.

There is a surge happening, with 10 boats, carrying 542 passengers and crew, arriving in Australian waters last month alone. Another boat, carrying 55 people, was intercepted yesterday near Ashmore Reef. Observers say it is either an organic spike, or it may be that people have chosen to move before the monsoon weather sets in.

But all the people The Weekend Australian spoke to were sure of the new ground rules in Australia - that is, that anyone who makes it to Australian waters will, if they pass the health and security checks, be on the mainland with a visa within 90 days.

Samer, a 31-year-old Iraqi now living in Puncak, knows all about Kevin Rudd and his new immigration rules. "I know Kevin Rudd is the new PM," he says. "I know about him. He has tried to get more immigrants. I have heard if someone arrives it is easy. They have camps, good service and if someone arrives they give us a limited visa and after three years you become an Australian citizen."

The Howard government's Pacific Solution is dead, and they know it. That is why Australian police are working in Indonesia trying to encourage people to turn back before they arrive in Australian waters. In places such as Sri Lanka, the source of a recent wave of boatpeople after the civil war, Australia is using street theatre to spread its message about the dangers and illegality of the journey in an effort to deter people-smugglers and those who use them. In Colombo, the first failed asylum-seekers to be forcibly deported by the Rudd government, including Stanley Warnakulasuriya, face an uncertain future.

Australia funds the IOM to accommodate irregular arrivals in places such as Puncak, and to offer them the opportunity to volunteer for free repatriation. Few take it. The IOM's best estimate is that there are several thousand Afghans and Iraqis in Indonesia, trying to find a route south.

While many in Puncak identify as Afghans, they may not have lived in that country for years. One such is Ali, 18, who was born in Afghanistan but was taken to Iran with his mother, brother and sister when he was three after his father was killed by enemies. Ali says life in Iran was unbearable, and his family were never accepted into the Iranian community. "They do not treat us as friend but as enemy," he says. His family gathered the money from their dressmaking business and have sent Ali to find a path to Australia, and with any luck to bring the rest of them later.

Ali says he has never possessed an official document that identifies him. If he gets to Australia, how will he prove he is who he says he is? He does not know. "I am not Taliban," he says.

Ali left Iran seven months ago with $US5000 ($5535). He flew to Malaysia, which provides immediate tourist visas on arrival to visitors from Muslim countries. He stayed for four months, hooking up with four other Afghan teenagers. With safety in numbers, they each paid $US800 to a local agent, who brought them on a boat to western Sumatra. They island-hopped on ferries to Jakarta, where they immediately registered with the UNHCR. This gave them a modicum of security. Those who do not register can find themselves locked away in one of Indonesia's 12 detention centres.

They have no faith that the UNHCR will find a Western country to take them, so they stay in contact with a Jakarta-based Afghan people-smuggler. He is asking $US6000 to deliver them to Australian waters. It is too much money for Ali, who is waiting for the price to drop. He says he would prefer to enter Australia legally, but he is running out of time and money. "If I get a suitable price, I will take a boat," he says. "I have to go. I have to take my chances."

Migration experts in Indonesia dismiss the notion that there is a "snake-head" - that is, a major international criminal syndicate moving Afghans and Iranians from Afghanistan, Pakistan or Iran to Australia. "If there was a snake-head, we could simply cut off the head," said one source. "But it's not like that. It's the lack of any highly organised structure that is in fact its strength. It's more like a series of travel agencies."

The Australian Federal Police are working on a training program with Indonesian police to tackle the irregular migrants, as they are called in Indonesia, but it's a battle. They have identified 12 key departure points across Indonesia, but these are only temporary. Once the heat is on, the smugglers just shift location.

The Indonesian navy last month intercepted a boatload of 70 Afghans headed for Australia. They were put in a low-security detention centre on the island of Lombok. On the evening of September 23, during Ramadan, their guards were elsewhere or were looking the other way (during Ramadan, you are required to be kind to all people). They walked out the door and have now broken up into smaller, less conspicuous groups and have scattered across the islands. They will presumably try again.

During 2000 and 2001, the time of the Tampa crisis, women and children were making the journey. Now it is almost exclusively men, who hope to settle and bring their families afterwards. We did meet one rare Afghan woman, Naghmeh, 28, who was living in a decrepit motel in Puncak with her 10-year-old son Milad. She was originally from the Oruzgan province of Afghanistan but left for Iran as a child., She still considers herself an Afghan. Naghmeh, who has Asiatic features and could pass as an Indonesian, has been a refugee nearly all her life. She says her husband had hardline religious views. "I didn't want to be with him," she says. "I want to be secular."

Naghmeh says she flew from Iran to Dohar and then to Singapore. She arrived in Jakarta in January. She had paid $US6000 to an agent in Iran, which was for her airfares and boat travel to Australia. "The agent took the money and ran," she said. Naghmeh and Milad are trapped in Puncak. Many are in a similar fix, running down their money and marking time. For registered refugees, the UNHCR will eventually come through with subsistence cash - 1.77 million rupiah a month ($210). But the Afghans say it takes seven to eight months to start receiving it.

Thair, 23, is an Iraqi who fled to Syria in 2007. He is yet another male emissary, sent by his family to make his way to Australia. He says he is surviving on the UNHCR money, hoping he will be legally resettled in Australia. "You know why people take the boats?" he says. "They are waiting too long here in Indonesia. We are all registered with the UNHCR, but we wait, wait, wait. Every day I die here. I can't eat, I can't sleep. Now I want to go back home, but I cannot go back home. "I do not want to catch a boat. The ocean is not easy. I want to build my life. I want to change my life, to get married, to go to Australia."

Muhammad, 16, from Kandahar in Afghanistan, is another recent arrival. His money is running low but he is hoping to buy a passage with $US2000. He has been told the weather is turning bad and that he may have to wait three months. Some of the Afghan refugees have heard about the SIEV36 explosion at Ashmore Reef on April 16, in which five of their countrymen died. They have also heard that anyone who makes it to Australian waters is almost guaranteed fast processing. "Everybody knows about the 90 days," says Muhammad. They know little about Australian politics, but they do know something has changed. And that it is not hard to become an Australian if you can only make the crossing.

A group of Afghan teenage youths, who are yet to receive the UNHCR allowance, eat two meals a day - rice with a salad of cucumbers, onions and tomatoes. They insist we share their food. They say they want Australians to know their stories. They have many stories, but they're all the same. They are the last hope of their families back home. Ali says he wants to continue in the dressmaking trade. Matin wants to be a mechanic. Muhammad would like to study medicine, and Amir wants to be a carpenter.

These teenagers describe themselves as Muslim, but just outside their rented home, for which they pay about $100 a month, there is a small musholla, or prayer room, which is used by local Indonesians. They do not use it. They indicate, in circumspect fashion, that the last thing they're interested in is religion. It has been the cause of all their problems.

Samer, 31, says he was a photo-journalist in Baghdad and has a picture of himself in a media flak jacket with a press badge and a camera around his neck. He says he worked for One World magazine and fled after he was threatened by terrorists. He went to Syria but says local intelligence agents put the heavies on him to become a spy. "They're like Gestapo," he says, "and I could not tell them I support America." He caught a plane to Doha, and then on to Malaysia, where he applied through the UNHCR to become a refugee. "I got no help from them," he says. "They are useless." He says he was dumped in a jungle in Sumatra and caught ferries and buses across to Jakarta.

"So many Afghans here in Puncak have been cheated. The people who organise to get you on the boat are wealthy Afghans or Iraqis who live here. I met one; I didn't trust him. He says to give him $4000 and after a few days we'll move to a boat. There were no guarantees."

Thair says he has heard from friends that Australia is clean and peaceful. But for now, he doesn't know what he's going to do. He was so terrified catching the boat from Malaysia to Indonesia that he refuses ever to go on one again. Thair is afraid of going back to Iraq, but he believes taking a voluntary repatriation is his only option. "I was so stupid coming here," he says.

SOURCE





Call for a charter based on stitch-up

THE report of the consultation committee on a charter or bill of rights for Australia was released yesterday. The committee was set up by the federal Attorney-General, who favours a statutory bill of rights; it was chaired by someone who was already on the record as supporting such a bill and contained no known sceptics; and its terms of reference favoured a pro-bill of rights outcome.

To no one's surprise the committee recommended the enactment of a national human rights act, which is to say a statutory bill of rights. And down the line the recommendations are worse than any sceptic might have hoped. Calling for a federal bill of rights, the committee has recommended a declaration of incompatibility power be given to judges, no doubt inviting a challenge to this power on constitutional grounds.

On top of that it wants all bills introduced in parliament to be accompanied by a statement of compatibility, despite the fact in other countries such a requirement has collapsed into a lawyer-driven exercise that involves guessing what the judges are likely to think about the bills' compatibility with the enumerated amorphous rights guarantees.

Perhaps worst of all, it recommends a reading down provision be included, though this is described as an "interpretative provision". There is a tiny bit of genuflecting towards those who point out the awful outcomes in Britain after just such a provision was enacted. The committee recommends this provision be "more restrictive than the UK provision" (recommendation No.28).

At the same time, it also recommends a form of words (recommendation No.12) for the same sort of provision should the government decide to forswear a statutory bill of rights. This provision would then go into the Acts Interpretation Act, and its wording is almost identical to the wording in Britain, save for a rider that mimics the one in Victoria. But that rider has done nothing, as the latest case law shows, to stop the judges there from looking to the awful British precedents.

So down the line this committee has recommended virtually everything that the most fervent advocate of a bill or charter of rights (and the terminology is an irrelevant red herring) could have wanted. It will revolutionise the relations between unelected judges and the elected parliament.

Think of it as a wish list created by your typical self-styled human rights lobby group. Throw everything at the wall - a reading down provision, a declarations power, a compulsory statement of compatibility and a lot more - then see what sticks.

What you don't see is all that much intellectual rigour. We are told the reading down provision should be more restrictive than the one in Britain. We are not told what that wording should be, at least not if the goal really is to achieve a more restrictive outcome as opposed to just saying so. Any wording is apt to let the lawyers and judges have their way in the end.

Then we are told what is being recommended is the dialogue model of a charter of rights, as in New Zealand, Britain and Victoria. But that label, dialogue, as soothing as it may be to the uninitiated, is disingenuous. No one can read the case law coming out of Britain and NZ, and more recently Victoria, and think the relations between judges and legislators are aptly described as being a dialogue. As a political scientist said, it's a dialogue in the same way you'd have a dialogue if judges walked into a restaurant and ordered a meal from a legislator, which the legislator then brought then. It's that sort of dialogue.

Last point. The committee makes much of the fact it received 35,000 responses, with another 6000 odd people attending its round-table sessions. That is the same as saying it heard from 0.2 per cent of the Australian population, or hasn't heard from 99.8 per cent of us. And those it heard from were disproportionately from charter cheerleading lobby groups.

This report is entirely predictable. Indeed, it is more or less what I predicted when the committee was announced and why I refused to make a submission. It looked like a stitch-up job from day one. And nothing in the report makes me think any differently now that it's out.

Time for those of us who think this issue is too important to be left to a coterie of like-minded charter cheerleaders to speak up against this awful report and to demand that something this fundamental to our governing relations be put to us in a plebiscite orreferendum.

SOURCE





AUSTRALIAN DEFENCE DEPARTMENT UNCONVINCED BY CLIMATE DATA

The science of climate change is too doubtful to dramatically change Australia's national defence plans, according to a key adviser on the Australian Defence Force's recent White Paper. While the white paper acknowledges for the first time climate change is a potential security risk, it says large-scale strategic consequences of climate change are not likely to be felt before 2030.

A key adviser on the white paper, Professor Ross Babbage, says he is not convinced that climate change exists at all. "The data on what's really happening in climate change was looked at pretty closely and the main judgment reached was that it was pretty uncertain - it wasn't clear exactly what was going on," he said. "When you look at that data, it really does suggest that there hasn't been a major change in the last decade or so and certainly no major increase. So the sort of judgments that were required have to be fairly open at this stage."

However Prime Minister Kevin Rudd has frequently put forward the opposite view, and other security analysts believe Defence should not be debating the basic science of global warming. Anthony Bergin, from the Australian Strategic Policy Institute, says the ADF's judgement goes against most scientific conclusions. "There was no supporting evidence presented in the Defence White Paper for the judgement that there would be no strategic impacts of climate change for 30 years," he said. "It seems to run counter to most of the scientific judgements that are now concluding that impact of climate change is indeed faster and more severe than previous estimates."

In the US and the UK, security agencies and the military are providing resources to prepare for potential new climate conflicts over water, food and refugees as well as increasingly frequent natural disasters. They are also moving to ensure defence equipment will function in more extreme weather conditions. Sydney University's Professor Alan Dupont says the CIA in the US had the right approach. "They accepted the scientific forecasts of the IPCC as their starting point because they thought they were not qualified to contest the scientific issues. And I would have thought the same applied to our own defence department."

At the internationally respected Royal United Services Institute in London, Dr Tobias Feakin, the director of national security says the Australian white paper is out of step. "Climate change is already happening, so to press pause on considering it as a strategic issue, I think, could be a mistake," he said. "The time cycles for buying equipment rotate in about 20-year cycles so you need to begin to make the decisions now to purchase the kinds of equipment that you'll need for climate change world. "So to not actually acknowledge the kind of changes that we will be seeing then, I think will be quite short-sighted."

Because of long lead times and high expense, Professor Babbage says Defence moves cautiously when it comes to adopting new planning scenarios. "At this stage there isn't really the case to fundamentally change the direction of the Defence Force as a consequence of what we are so far seeing in terms of climate change, given the uncertainties that we still see in the data sets. Professor Babbage says Defence considered a variety of climate scenarios and judged Australia's current defence capabilities and force structure would cope.

He points out that Prime Minister Rudd, as chairman of the National Security Council, signed off on the white paper's conclusions.

SOURCE

NOTE: The Australian Government's Defence White Paper is available here