Man dies after waiting four hours in an ambulance outside  hospital

A MAN died after spending more than four hours in an ambulance awaiting admission to a hospital, in the first confirmed death relating to the practice of "ramping".

Documents obtained by The Courier-Mail under Right to Information laws show that the man was admitted to Nambour Hospital's emergency department only after he "deteriorated and he became unconscious".

On the night he died the hospital's emergency department was "under extreme capacity", the documents show. Ambulances were forced to "ramp" queue with patients on board.

The report into the man's death shows handwritten notes indicating he was in the care of Queensland Ambulance Service from 6.20pm before being "brought directly to resus (resuscitation) bay" at 10.30pm in May 2010.

The man had been diagnosed as category three or "urgent" after complaining of abdominal pains. Category three patients are supposed to be treated within 30 minutes.

Later there were "apologies for ramping and circumstances of death" along with "condolences to family".

The revelations came as Health Minister Lawrence Springborg announced a major shakeup of the state's hospitals from January 1.

Hospitals will be banned from diverting ambulances to other facilities when emergency departments are full.

Emergency patients will also increasingly be transferred from ramped, or queued, ambulances into specialised hospital waiting rooms overseen by new senior nurses, helping mitigate the risks of poor supervision.

Mr Springborg pledged to adopt all 15 recommendations of the Metropolitan Emergency Department Access Initiative, headed by emergency physician David Rosengren, who warned the performance of state emergency departments had rapidly declined.

The union representing ambulance officers said ramping was still a major problem but the new measures to combat ramping announced by the State Government yesterday would "save lives".

"In a cardiac arrest, seconds count," United Voice Queensland Ambulance State Councillor Craig Crawford said.  "Most hospitals are running at extreme capacity at the moment but these new changes should turn it around."  Mr Crawford said banning hospitals going on bypass would make a "huge difference" in Brisbane.

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New submarines urgently needed  -- the existing ones are so bad

The cheeky headline last week from Defence media read "HMAS Farncomb celebrates successful sinking at RIMPAC" and I quietly cheered for the crew of the submarine for sinking their target ship during the 22-nation exercise off Hawaii.

The maintenance and sustainment issues that have dogged our Collins Class submarines must be very challenging on the morale of our dedicated submariners and this was a rare glimpse of what the sub can do.

But then came the following day's announcement from Defence, HMAS Farncomb had suffered a minor flood while at periscope depth after a hose split and the vessel was forced to surface. Farncomb was now returning to Pearl Harbour for repairs.

Farncomb is no stranger to this kind of incident as the boat and its crew had two separate emergencies last year.
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In August it lost both its propulsion motor and emergency back up in deep water off the Western Australian coast. The second, a few months later in the South China Sea, involved a build up of toxic gases that had the crew wearing oxygen masks and blowing its emergency ballast tanks for a rapid ascent.

In May last year another Collins Class submarine, HMAS Dechaineux was forced to return to Singapore for repairs after breaking down on its way to a training exercise, also in the South China Sea. It was the only submarine due to participate in the 5-nation exercise and the embarrassment was amplified when the Navy News published a pre-written account of its daring exploits on the presumption nothing could go wrong.

More concerning was the 2003 incident with HMAS Dechaineux off the Western Australian coast when the submarine had a burst seawater hose which allowed a flood ingress of 15 tonnes of water in 9 seconds just when the vessel was at its deepest diving depth.

The bravery and skill of HMAS Dechaineux's 55 crew ensured they avoided the worst military disaster since Voyager. I have often said that submarines, along with our Special Forces, are our nation's most important force element group.

Yet this year alone we will spend close to $1 billion on maintenance and sustainment of the Collins Class with sometimes two, sometimes one, and occasionally none out of six submarines operationally ready at any one time. So depressingly bad are the figures for Unit Ready Days for the Collins Class that Defence no longer publish them – citing security concerns even though they were regularly published up until 2009.

I readily accept the problems of our submarines transcend both Labor and Coalition governments. But what the Rudd/Gillard governments and the three Defence Ministers over that period have failed to do is to get the ball rolling on the Collins replacement submarine.

In May 2009, the Defence White Paper outlined ambitious plans for 12 new submarines to be assembled in South Australia under a project known as SEA 1000, with the first to be in the water by 2025. I say ambitious because there was no detail whatsoever as to how we were going to pay for them in the White Paper and conservative estimates have the cost at $36 billion although I believe it will be closer to $50 billion.

For three years after the launch of the White Paper the SEA 1000 project sat in a file on successive Defence Minister's desks with no action whatsoever. Defence commentators and experts all began to get nervous and earlier this year the government's own funded thinktank, the Australian Strategic Policy Institute, published a damming report warning of a significant capability gap and noting inaction was not a responsible option.

The ASPI report described the gap between when all the Collins Class have been retired and the time it would take to build a replacement as ''nothing short of catastrophic'' where Australia's submarine capability would ''essentially be run down and restarted'' and there are three years ''of no submarines at all''.

The Defence Minister's recent answer to that was to repeat the announcement from three years ago that the Navy was to acquire 12 new submarines, and there was to be a $214 million 'scoping study' to look at the options.

Why wasn't that done after the White Paper launch? These past three years of sitting on their hands will come back to haunt our submarine capability long after this government is consigned to the history books. After some prodding the Minister also declared a final decision on the replacement would not be made until late 2013 or 2014 – in other words, not until after the next election. He wants to make it someone else's problem, not his.

This is all against the backdrop of our submarines being so operationally fragile that competing in exercises with allies becomes a case of going in with fingers crossed that nothing goes wrong.

We also have our submariners reluctantly leaving the Navy because they simply don't get time at sea doing what they signed up to do. We are losing some of our most experienced submariners and it is precisely that experience that has probably prevented these incidents becoming major tragedies for the Navy and the nation.

If the latest incident with HMAS Farncomb tells us anything about the state of the submarine fleet, it is that the time for talk of a replacement for the Collins Class is over.

It is now five minutes to midnight if we want a viable submarine capability to defend our island nation over the next 20 to 30 years and we cannot afford to wait any longer.

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Desalination white elephant in Melbourne

Water is the last thing Victorians need. Since the drought broke, their dams are almost 80 per cent full and they may not require desalinated water for years, although they will pay for it at a cost of $500 million a year.

So the desal plant looks like being one of the fanciest and most monumental white elephants ever to grace the PPP landscape.  It is also is a legacy of the previous [Labor party] Victorian government, and like the abortive Ararat Prison project, the private partners in the PPP are being forced to make good on their part of the contract.

In Suez's case, its joint venture with local contractor Thiess was contracted to deliver a desalination plant by June 30 - the deadline has just passed a month ago in other words.

And now, the Degremont joint venture is copping penalties of $1.8 million a day. As the state, quite appropriately plays hardball, Suez and its partner Thiess are not happy.

For Suez, it has suffered the double whammy of recession in Europe and troubles abroad. In its latest accounts, lodged last night, losses of 310 million euros ($365 million) have already been recognised on the Melbourne Desalination Plant (MDP).

The Australian parent company (Suez Environnement Australia Holding Pty Ltd or SEAH) has pumped $365 million of equity into Degremont Pty Ltd to cover its losses to date. SEAH is a 35 per cent partner with Thiess (65 per cent) in the design and construction of the MDP.

While the joint venture is facing fines of as much as $1.8 million a day for failing to complete the MDP it has, in turn, also made claims and variations of up to $1 billion to the Victorian government.  The government has rejected these claims and also refused to extend the contractual deadline.

The losses in Melbourne have caused havoc with the Suez share price.  The stock is down 30 per cent or so in the past year - against the fall of 6 per cent in the broader French market – and Suez is so desperate it got the French Ambassador to visit the Victorian Premier Ted Baillieu to see what could be done about the Degremont deal. As yet, there is no variation.

Adding to its woes, Suez debt increased by 321 million euros during the past six months despite its stated objective of reducing debt. A dividend payment of 441 million euros during the half was largely responsible for the debt blowout.

Its heavy debt levels are mirrored in the leverage levels of its rival Veolia, the other major water company on the Australian PPP scene. Both have an 'A' credit rating.

Veolia, which provides water services to Sydney, is in a similar poor financial position although at least it is selling assets to reduce its debt. A consolation prize, of sorts.

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Law protects early-term fetus, judge says

A JUDGE has rejected a man's last-ditch attempt to have his trial for killing an unborn baby thrown out, ruling the legislation was wide enough to protect the early-term fetus.  The man was accused of causing a miscarriage after he assaulted his wife, who was 15 to 18 weeks pregnant.

He pleaded not guilty in the Supreme Court in Cairns last month to killing an unborn child in December 2004 at Saibai Island in the Torres Strait.

The man was acquitted at the end of the trial, but not before his lawyer tried to have the charge thrown out after the crown closed its case.

His lawyer argued there was no case to answer as the fetus was not a child within the meaning of the law because it was too young to survive outside its mother's womb.

Justice Jim Henry rejected the argument and published his reasons for doing so on Thursday.  Justice Henry found the law did not qualify the age of unborn children covered under the piece of legislation used to prosecute the charge.

He acknowledged the matter attracted significant philosophical debate but said that had no relevance to the interpretation of this section of law.

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