Wednesday, January 02, 2013
Patient dies after overworked paramedics opt for a shift change, delaying treatment
A PATIENT has died after sick, tired and overworked paramedics opted to do a shift change instead of taking the patient straight to hospital. Documents obtained by The Courier-Mail confirmed the incident.
The ambulance union says the case is another example of cracks in a desperately under-resourced system.
The Department of Community Safety tried to cover up the incident, which revealed one paramedic was sick and both were fatigued after working past the end of their shift.
The Health Quality and Complaints Commission investigation found the chances of survival would have been greater if the patient had received hospital care sooner.
"QAS have acknowledged the care provided to (the patient) was below the expected standard, this was confirmed by the independent medical adviser," assessment officer Paul Rogers wrote on December 1, 2011.
"It is accepted that even if (the patient) was in a hospital setting at the time, (they) may not have survived. However, (their) chance of survival may have been greater."
Concerns were also raised as to why there was an attempt to "hot swap" the "fatigued" paramedics with the patient still on board, particularly when there was no crew to replace them.
Questions remain as to why this couldn't have been discovered earlier by using their radio before arriving for the crew swap with the patient still on board.
"The HQCC considers that QAS has taken reasonable and appropriate steps to avoid similar situations," Mr Rogers wrote.
In its clinical review, QAS acting medical director Ben Clarke admitted "a number of rostering reforms have occurred over recent years in an effort to control paramedic fatigue" including "hot swaps" and taxis to send them home at the end of significantly overrun shifts.
United Voice ambulance paramedic state councillor Craig Crawford said officer fatigue was still a big issue which had not been resolved.
"Our crews in busy areas are still forced to work mostly 12 or more hours without any breaks," he said.
"People who are fatigued will make mistakes (and) when you're a paramedic it's like a doctor, it means patients' lives."
The probe raised several other concerns including:
* Why the case was not Code 1, including the use of lights and sirens.
* Why the patient wasn't taken to hospital when they first called the night before.
* A perceived lack of courtesy towards the patient.
Dr Clarke apologised for any extra stress that may have been caused.
The Courier-Mail obtained the investigation report only after the department's decision to refuse access was overruled by the Office of the Information Commissioner.
But the DCS deleted information showing potential flaws in the emergency services and health system, such as how the patient died, what efforts were made to save the patient and how many hours it took to admit them to hospital.
DCS also refused to name the hospital they were queued at or the one just five minutes from the station that they couldn't get into because it was on bypass.
When asked to comment on the case, a DCS spokeswoman denied any attempt at a cover-up.
Cycle mania in "Green" Sydney
WHAT could be the nation's most expensive bike pump, costing ratepayers $4300 because it was "robust", has broken down.
It lasted on Bourke St for just three months before it began carrying an "out of order" sign urging cyclists not to use it. The model was the first of five stainless steel bike pumps that Sydney City Council bought for $21,500 to save cyclists from getting stuck with flat tyres.
A council spokesman in October said they chose the expensive design because it was a "robust model which will stand up to the demands of daily use while being weather resistant" and had been tried and tested in London.
A council spokesman said yesterday: "The bike pump on Bourke St is out of order. The spare part is out of stock and had to be ordered. It will be back in service as soon as possible."
Liberal councillor Christine Forster attacked the broken pump as "an unjustifiable waste" of money.
"It's very unfortunate that these expensive pieces of equipment, which were paid for by all ratepayers but only service the small percentage of residents who cycle, appear unreliable," she said.
"The city is spending more than $20,000 on pumps that don't work."
Meanwhile, four councillors have voted for a motion to bring in signs for cyclists to give way to pedestrians after the council took down clear warning signs at intersections and pedestrian crossings on the Bourke St cycleway.
They were replaced with small cardboard signs that cyclists can't see.
Ms Forster told a recent meeting of council that bike symbols had been repainted over the top of the existing signs "resulting in a jumbled image which could not possibly be recognised by a cyclist moving at speed".
A council spokeswoman said the intersection was a "trial format" with the RMS and that the intersection was "so far working very well".
Ms Forster said it was a "serious safety issue" and called on council to educate cyclists to give way to pedestrians, as well as develop a clear and unambiguous policy on warning signs.
Councillor Robert Kok said the council had carried out safety audits.
"At the moment we are doing all we can to improve safety on the bike network," he said.
A rocket put under a health bureaucracy
PARAMEDICS will boycott their dilapidated Sunshine branch today over safety concerns.
Twenty paramedics will abandon the Ballarat Rd station at noon in protest over the state of the 40-year-old branch.
Ambulance union secretary Steve McGhie said the paramedics would work out of the nearby St Albans branch until Ambulance Victoria fixed the unsafe workspace or found a suitable replacement.
"They have given the ambulance service and the Government many, many months to fix the problem, it hasn't happened and the paramedics at Sunshine have had enough," he said.
The Herald Sun recently revealed that WorkSafe had issued eight improvement notices to the 1970s site.
Major concerns included there were no sleeping facilities for crews working shift work, fused garage doors, cracks in walls, holes in the roof and asbestos.
An engineer's report recommended the Ballarat Rd station be demolished.
Ambulance Victoria Manager Group 6 Tony Elliott said paramedics' safety was paramount.
"We will provide any paramedic who is feeling fatigued with local motel accommodation and taxi vouchers to either the motel or their home," Mr Elliot said.
Health Minister David Davis's spokeswoman Kathryn McFarlane said the State Government and Ambulance Victoria were in discussions about the Sunshine ambulance station.
Opposition health spokesman Gavin Jennings said the Baillieu Government's inaction was putting paramedics' lives at risk.
Minister riles welfare groups
FAMILIES Minister Jenny Macklin has angered welfare groups by claiming she could live on the $35-a-day Newstart allowance.
On a day when more than 80,000 single parents were shifted from the parenting payment to the lower Newstart allowance, leaving some up to $110 a week worse off, Ms Macklin also urged single parents to return to work, saying it would be "better for the family", and their children would have better role models if they were employed.
Visiting a Melbourne hospital to promote the government's Dad and Partner pay scheme, which also began on Tuesday, Ms Macklin was asked whether she could survive on the $246-a-week payment. She responded "I could", but the question and her answer were described as "inaudible" in a transcript of the press conference later issued by her office.
A spokeswoman for Ms Macklin said the exchange had not been deliberately omitted, but the transcript had been produced from an iPhone recording of an outdoor press conference.
As a cabinet minister, Ms Macklin earns $6321 a week, 25 times the rate of Newstart.
The cost of renting alone in her suburb of Ivanhoe is greater than the Newstart allowance, with the median rent for a one-bedroom flat in her suburb at $270 a week.
Australian Council of Social Service chief executive Cassandra Goldie said evidence to three parliamentary inquiries had shown the allowance had not increased in real terms in two decades, and as a result some recipients were forced to live in "extreme poverty".
"The minister should look at the evidence of people who are actually trying to do that," she said. "The government talks about evidence-based policy, so we are urging her to look at the evidence."
Kate Beaumont, the vice-president of the National Welfare Rights Network, said Ms Macklin's comments were surprising.
"As a key minister involved in securing the historic 2009 pension increase of $32 per week, she understands the needs of people doing it tough," she said.
Ms Beaumont said Ms Macklin's comments seemed at odds with those of Labor senators who in a committee report in November called for the allowance to be increased.
The calls by welfare groups for Newstart to be lifted have been echoed by others, including the Business Council of Australia, which has warned that the lack of an increase might be entrenching poverty.
In 2010, the Organisation for Economic Co-operation and Development said the payment was so low it might not be enough to enable a person to look for a job.
The government has also faced heavy criticism for the changes that shift thousands of single parents from the parenting payment to the Newstart allowance when their youngest child turns eight.
While parents who started receiving the payment after July 2006 already face these conditions, until now those who were receiving the parenting payment before July 2006 were able to keep it until their youngest child turned 16. Ms Macklin said the changes were designed to ensure all parenting payment recipients were treated in the same way.
"What's important for people who are unemployed is that we do everything possible … to help people get into work, and that's what we'll be doing with these single parents as well," she said.
"The more people going back to work the better. It's better for the family, it's great to see mum and/or dad going … to work. Unfortunately we have far too many children growing up in families where nobody is working."
But Dr Goldie said recipients of the parenting payment were already required to seek work, and about half of them were already doing some paid work.
"The only thing that's going to change for them is a significant cut in their income support, and we oppose putting any other parent on to a payment which everybody acknowledges is already far too low," she said.
"We're talking about households with children in them. Why would we do that?"
The change will have the greatest impact on parents who work part time, because parenting payment recipients are allowed to earn more than Newstart recipients before their payments are affected.
As a result of the change, a single parent who gets no income from work will be $115 worse off a fortnight, while those who earn $400 a week from work will see their income drop by $223 a fortnight.
In August, Employment Minister Bill Shorten said he took the adequacy of the Newstart allowance "very, very seriously" and said it would be "very, very tough" to survive on the payment, but he did not commit to raising the allowance.