Monday, November 27, 2006

Immovable medical bureaucracy

Jayant Patel, wanted in Queensland on manslaughter charges, was yesterday labelled a scapegoat by the investigator who first probed his work. Bundaberg Hospital Inquiry Commissioner Tony Morris QC said Dr Patel, allegedly responsible for patient deaths and hiding out in Portland in the USA, was never the problem.

The high-profile barrister, guest speaker at the Whistleblowers Australia conference in Brisbane, instead launched a blistering attack on Queensland Health. "In a strange sort of way he is almost a distraction," Mr Morris said. "Perhaps the enduring tragedy of Jayant Patel is . . . he has become a scapegoat for everything that is wrong in Queensland Health. Patel is not, and never was, the problem." Mr Morris, who was ousted as the inquiry's head after displaying "ostensible bias" against Bundaberg Hospital's managers, said bureaucratic over-administration was at the "heart of the problem". His comments yesterday were a departure from the interim inquiry report handed down in Parliament in June last year.

Yesterday he slammed Queensland Health for not implementing real reform since the Bundaberg crisis and "a bureaucracy which actively obstructs every attempt to do so". "In 2006, Queensland Health continues to recycle the self-same individuals whose apathy and dereliction produced the disaster which they are now still pretending to address."

Mr Morris singled out Bundaberg Hospital nurse Toni Hoffman for her blowing the whistle on Dr Patel. Ms Hoffman today will be presented with the Whistleblower of the Year Award jointly with Dr Con Aroney, who made disclosures about people dying on waiting lists.

Warrants for Dr Patel's arrest were issued in the Brisbane Magistrates Court on Wednesday. Detectives provided affidavits on charges, including three counts of manslaughter, five counts of grievous bodily harm, four counts of negligent acts causing harm and eight counts of fraud. Queensland Director of Prosecutions Leanne Clare will now make a formal request for extradition through Federal Justice Minister Chris Ellison.


How amazing! Public hospital stays open longer!

The NSW government will try to cut hospital waiting lists by offering patients elective surgery over the Christmas break and recalling staff early from holidays. The period that public hospitals operate at reduced capacity will be trimmed from six to four weeks this year. Clinical staff typically take leave at this time, equipment undergoes maintenance and patients often defer surgery to avoid spending Christmas in hospital.

This year, however, patients who have been waiting a long time for elective surgery or who are overdue will be offered treatment during the holiday break, Health Minister John Hatzistergos says. Mr Hatzistergos said a new government policy would ensure patients requiring surgery within 30 days would be treated appropriately. Patients with less urgent conditions would be treated within 365 days and would not have to wait more than 12 months due to reduced hospital activity during the holiday season, he said. "We're making real progress in reducing waiting times and waiting lists but there's still more work to do," he said.


Prime Minister hoses down the fast food hatred

Parents have to take responsibility for Australia's child obesity crisis, Prime Minister John Howard says. Rejecting calls for "heavy-handed" bans on junk food ads, Mr Howard called for parents to show - and teach - some self-discipline. The reasons for Australia's soaring numbers of overweight and obese people were obvious - lack of exercise and bad diet. "Fundamentally, I believe that obesity . . . the response to it does lie very much in changing lifestyle," Mr Howard said in a speech to the Heart Research Institute.

A study released by Diabetes Australia this month revealed 3.2 million people are obese and predicted the numbers would more than double by 2025. "We appear to be struggling as a nation with the challenge of obesity, something that's come upon us with alarming speed and something that is affecting all age groups," said Mr Howard. "The Government can do a lot but I do hope the community doesn't see obesity as a problem that can simply be solved by government regulation. "I think that rather misses the point that a certain degree of individual responsibility and individual self-discipline (is needed) and, particularly, an assumption again of parental responsibility and parental surveillance of the activities of children - what they eat, how much exercise they get, the balance between playing sport and other physical activity and time spent in front of the television set and on computer games."

But Mr Howard said the Government did have a role in changing attitudes through hard-hitting public health campaigns like those which targeted smoking and HIV-Aids. "Because it's only been with us for a short period of time, if we tackle it in the right fashion, there's no reason why we can't overcome it within a relatively short period of time as well."


Sydney's artificial water crisis

Everyone agrees Sydney faces a water crisis, but the city seems incapable of significant action. Today I want to celebrate a Turramurra couple who have accepted responsibility for their water use. It's a story of triumph, but also of frustration in dealing with government. To understand this, you need to see why the State Government's management of water is so deeply dysfunctional.

I have a copy of the Sydney Water Board's 1991 water supply strategy review, and have confirmed with former senior staff that it represents informed opinion at the time. It pointed out that the city's population had doubled since 1960 but its water storage capacity had increased by only 2 per cent. It said: "If measures are not taken to provide Sydney with additional storage, early in the next century there will be a real risk of serious water restrictions being necessary." The reason for this did not involve apocalyptic events such as climate change or a one-in-a-thousand-year drought. It was mundane: you cannot increase a city's population without increasing its water supply. The prediction was accurate: no steps were taken to increase storage, and water restrictions were introduced in 2003.

The review recommended that a dam be built on the upper Shoalhaven River. This was accepted but Bob Carr cancelled it when he became premier. But don't think the Shoalhaven was saved. On October 24 Shelley Hancock, the Liberal member for South Coast, told State Parliament that enormous amounts of water were being pumped from the river anyway. "In August, 78 per cent of Sydney's water supply was pumped from the Shoalhaven," she said. "In the following week [it was] 82 per cent." This had produced an "alarming drop in the water levels in the river".

The review considered large-scale recycling, which Carr also rejected. Indeed, the Government spent almost $1.6 million on lawyers to try to stop a private company, Sydney Services, getting access to its waste water. It was finally forced by the National Competition Council to negotiate with Sydney Services. In response, last week it brought in a shabby piece of legislation called the Water Industry Competition Bill. This appoints as umpire for access disputes the Government's Independent Pricing and Regulatory Tribunal, rather than the Australian Competition and Consumer Commission, which the industry wanted. The tribunal will ultimately determine the terms on which Sydney Water has to offer access to private companies. The industry does not believe the tribunal will be sufficiently independent.

Why is the Government so opposed to large-scale recycling, whether done by itself or private companies? Because Sydney Water pays a massive "dividend" each year to the Government, which it doesn't want to lose by recycling. (Recycled water costs more than dam water.) Last year the dividend was $193 million, an increase of $73 million over the previous year. To put this in some sort of perspective, the increase in Sydney Water's cash flow from normal operating activities over the year was only $26.7 million. Some of that dividend - many would say a lot of it - is money that ought to have been spent on serious recycling. But with the exception of the Rouse Hill recycling scheme, the Government has largely ignored, even discouraged, recycling, by companies and individuals.

In Turramurra, Alicia Campbell and Jason Young have taken matters into their own hands. Last year they moved into a standard two-storey house, which they had helped design. Under the Government's BASIX regulations they were required to have a 5000-litre rainwater tank. Says Alicia: "We thought, if we were going to do it, why not do it properly?" So they installed a 25,000-litre tank underground, "double-U" gutters to stop leaves getting in and first flush devices on the downpipes so when it rains the roof is washed clean before water goes into the tank. In the past year they have used 91,000 litres from the tank; the house is not connected to mains water.

Jason and Alicia, who have two small children, have also installed a system that allows them to recycle all their waste water, including sewage. This will produce about 100,000 litres of water a year. Ku-ring-gai Council has insisted they pay about $3000 for a series of tests before they can use this water for non-potable purposes, at which point they will disconnect from the sewer mains.

Michael Mobbs is the guru of Sydney's sustainability movement. He says 17,000 people have been through his sustainable house in Chippendale in the past eight years. An environmental lawyer, he advises people like Alicia and Jason, and has helped them deal with the regulatory thickets set up to discourage people from becoming self-sufficient. Mobbs says he knows of about 30 households in Sydney that have gone off the water grid. Sydney Water guesses 50 have disconnected from the sewer mains. As well as this, 27,500 residences, businesses and schools have received up to $800 from Sydney Water, for installing rain tanks with a capacity of more than 7000 litres that are connected to a toilet or washing machine.

These figures are modest in a city of so many residences. Expense is a big issue. Jason and Alicia paid about $25,000 for their independence, funded partly by savings elsewhere in the home (for example, concrete instead of wooden floors). The home builder AV Jennings has tried to sell houses with environmental features, but a company spokesman says few are prepared to pay the additional cost. Which makes Alicia and Jason's achievement all the more remarkable. She was the driving force, and at first he was concerned about costs. "But now we've done it," he says, "I'm overjoyed."


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