Wednesday, October 14, 2020

The public hospitals with no doctor

The pub with no beer was a joke. This is no joke. A hospital with no doctor is not a hospital at all.

The pretence that you can rely on consulting a doctor over the net is an absurdity. There are many ways in which a doctor has to feel the patient. The nurse can no doubt undertake such a routine task as taking the patient's blood pressure but much else will be beyond her skill level. Palpation is important in dignosing a lot of medical problems and you can't pull that through a computer monitor.

The classsical solution for country medicine was to have a resident GP who was paid a retainer by the government but who could also do some private practice. That does of course run up against the reluctance of most doctors to work in country areas. But the solution to that is money. And that is where the problem lies, as is reported below

But the problem is not the total overall funding. It is funding allocation. And a major drain on funding in all States is a corpulent medical bureaucracy. Fire a few health bureaucrats and you will have plenty of funding to expand your coverage of country areas. Health bureaucrats don't cure people. Doctors do

A woman bled to death in the emergency department of a regional NSW hospital that had no doctors physically present because authorities had replaced face-to-face doctors with treatment via videolink outside business hours.

Doctors and patients have voiced anger and alarm over the moves to treat critically ill patients via teleconference in at least seven hospitals across the Western NSW Local Health District, which spans 31 per cent of NSW.

In another example of the practice, a non-verbal patient who turned up to an emergency department in central-western NSW was offered a video conference with a doctor in Switzerland.

Some postcodes targeted for the changes have large elderly and Indigenous populations and extremely high rates of disadvantage, with preventable deaths up to 31 per cent higher than the state average and mortality rates up to 94 per cent higher.

"We couldn’t believe this is what a community has to live with," said Hayley Olivares, whose mother died from haemorrhaging while being treated by a doctor over teleconference in Gulgong Hospital, near Mudgee.

Dawn Trevitt, 66, was rushed to the emergency department – where only nurses were physically present – last month with dangerously low blood pressure.

She died within an hour.

Ms Olivares, who lives in Canberra, was stunned to discover the doctor had been treating her mother remotely when it was mentioned in passing by a police officer.

She said the case was referred to the Coroner because the doctor wasn’t comfortable signing off on the cause of death, which was ultimately determined to be a gastrointestinal bleed that sent Mrs Trevitt into cardiac arrest.

Mrs Trevitt, a school teacher, has been remembered as a "lively and funny and energetic woman".

Her family is tormented over whether the outcome could have been different had there had been a doctor on site.

"I really don’t want to see another family have the same experience," Ms Olivares said.

A spokesperson for the Western NSW Local Health District said it offers sincere condolences to Mrs Trevitt’s family and would undertake a review.

Gulgong has not had a doctor inside its hospital walls since June, when the town’s doctor was informed his contract with the hospital would not be renewed by the health district.

The health district has also failed to renew the contract of Rural and Remote Medical Services (RARMS), a non-profit organisation providing doctors to hospitals at Bourke, Walgett, Lightning Ridge, Brewarrina, Coonamble and Collarenebri.

The health district put the contract to tender last month, revealing it would now allow a mix of face-to-face doctors and telehealth in the hospitals.

Under new "minimum requirements" in the documentation, doctors will have to be physically present between 8am and 6pm on certain weekdays. Video conferencing can be offered at all other times.

A doctor will have to be present at least one day a week in Collarenebri, two days a week in Brewarrina, three days a week in Lightning Ridge and Coonamble, and five days a week in Bourke and Walgett.

Walgett is the largest of the towns, with a population of 6100.

Dr Phillip Jolly works in Lightning Ridge, servicing both the medical practice as a GP and the hospital.

He warned the "dangerous and inappropriate" changes could cost lives and would take "further resources away from an impoverished health system".

Dr Jolly said the initiative appeared to be being introduced by stealth as the new normal for rural communities.

"Telehealth should be a service for places that can’t get medical staff, not a service that replaces medical staff," Dr Jolly said.

"If we’re going down the path of hospitals not having doctors physically in them, that should be a policy discussed at a political level."

Another doctor with knowledge of the system, who spoke on the condition of anonymity, said patients would have to hope to have "your heart attack between nine and five".

"It’s much easier to service Bourke from a doctor sitting there in Balmain on his bum and leave the nurses to deal with a difficult patient with half a leg cut off, or a spear in his leg, or a car accident," the doctor said.

A spokeswoman for the Western NSW Local Health District rejected suggestions the services were being cut back.

She stressed each hospital would continue to have full-time access to a doctor, whether physically or virtually, and the on-site hours were an "absolute minimum".

The aim of the tender was to secure sustainable access to medical services for the hospitals, the spokeswoman said.

"The use of innovative telehealth technology is commonplace in health facilities around the world," the spokeswoman said, noting it had been used in facilities much larger than the hospitals covered by the tender.

She said the health district had been successfully operating a virtual service to assist on-site staff for years, and it would be available to the successful tenderer.

A woman, who asked not to be named, turned up to the Gulgong Hospital’s emergency department earlier this year with a family member who was in severe pain and unable to speak.

They were put onto a teleconference with an Australian doctor who was in Geneva, Switzerland.

She said the nurses and the doctor were doing a "brilliant job", but she was concerned for non-verbal patients who did not have a relative to advocate on their behalf.

Sharelle Fellows, who has been circulating a petition against the move, stressed Gulgong was popular with tourists and grey nomads and did not have a dwindling population.

Qld election 2020: Palaszczuk’s border policy frustrates most powerful but it’s working at home

It’s been slammed by the rest of the country as “cruel”, but the Queensland Premier’s harsh border move is actually a stroke of genius.

Australia’s most powerful politicians lashed the Queensland Premier this week for her refusal to open her state’s borders to New South Wales.

The Prime Minister, the NSW Premier and NSW Health Minister have all accused Annastacia Palaszczuk of putting her own re-election bid ahead of the lives of her constituents.

And it seems a large portion of the country agrees.

But in an expansive state that covers rough outback plains and unruly tropical heat, bucking national trends flowing from the south is commonplace and people take pride in delivering shock federal election results.

“Is she for jobs or not?” Scott Morrison spat on Thursday morning, accusing Ms Palaszczuk of forgoing her primary election pledge.

“The number of people who have come back in to jobs in New South Wales since we hit the pit of that COVID-recession is a 70 per cent increase. “In Queensland, it’s 44 per cent.”

NSW Premier Gladys Berejiklian said her Queensland counterpart was unfairly shifting the goalposts on the requirements to ease border restrictions, while the boldest rant came from NSW Health Minister Brad Hazzard who said Ms Palaszczuk’s policy was simply a “political agenda”.

“The date she keeps mentioning is the date straight after the election,” he told the ABC on Friday morning. “Why would it go straight after the election? Well, there is only one reason, because she’s focused entirely on the political outcomes. She believes it’s a political advantage to her.

“This is a completely reprehensible, uncaring and cruel approach by the Queensland Premier.”

All three, of course, sit in opposing political camps to the Queensland Labor leader.

Within the Sunshine State, the Premier has been greeted at campaign stopovers with placards declaring their gratitude for holding firm.

Her management of the coronavirus crisis led to a surge in popularity from just 29 per cent in February to 57 per cent in the YouGov Poll released earlier in the week.

According to the The Courier-Mail poll, Labor now leads the Liberal-National Party 52 per cent to 48 per cent on a two-party preferred basis.

“The border policy is undoubtedly popular,” said Tracey Arklay, a senior lecturer with Griffith University’s school of government and international relations.

“There are some parts of Queensland who don’t like it as much, particularly those who live down near the Gold Coast border.

“But, in the main, the overwhelming sentiment is that it is popular.”

Dr Arklay says it isn’t a crafted strategy curated to ensure her government is re-elected, it’s a “considered evidenced based approach to how to handle this COVID-19 situation”.

She said the political agenda was more likely from the Liberal side of politics, who are lobbying to get their colleague, Opposition Leader Deb Frecklington, into the Premier’s chair.

“The absolute attack that seems to be happening on Queenslanders, as opposed to Western Australia for example, is telling,” the government relations academic told NCA NewsWire.

She said interstate political operators had a proven record of misunderstanding the “broad church” of Queensland voters, evidenced in the shockwave of support that delivered victory to the Coalition Government in the 2019 federal election.

“People up in North Queensland don’t particularly like people from Brisbane telling them what to do, let alone someone from Sydney,” Dr Arklay said.

The border policy may not have the universal support among the inner-city voters in the southeast of the state, but it has support where it matters, the senior lecturer said.

Particularly in the three tightly held seats in the northern hub surrounding Townsville where it’s widely believed the October 31 election will be won or lost.

The incumbent government holds the central Townsville electorate and Mundingburra by 0.4 and 1.1 per cent respectively, while its more dominant margin in the outer and semirural Thuringowa — 4.1 per cent — is expected to be aggressively contested by both One Nation and Katter’s Australia Party (KAP).

Dr Arklay said, if anything, the outside lobbying over the border dispute from Liberal Party elites had a damaging effect on Ms Frecklington’s campaign, whose stance on the controversial topic has become blurred.

“It’s coming across as a bit unclear,” the Griffith University senior lecturer said.

“She wanted the borders open and then she supported the borders staying shut and she is now saying the borders should be open as soon as possible.”

Brisbane transport business BajAIR can’t lure new workers

A transport business veteran run off his feet with work has been unable to find new staff despite Queensland’s unemployment rate topping 7.5 per cent.

BajAIR owner Brett Johnson, whose company builds refrigerated transport vehicles, has recorded a significant increase in work due to the Federal Government’s Instant Asset Write-off scheme.

Mr Johnson has months of jobs ahead for his 30-strong workforce, but a recent search for qualified and apprentice motor body builders and refrigeration mechanics has proved fruitless.

The 30-year veteran of the transport industry believes people are accessing JobKeeper and remaining at home for a similar amount to apprentice wages. “I advertised for qualified tradespeople and I didn’t get one application,” he said. “I got nothing, not even a response.

“JobKeeper is the biggest killer because it’s given to the wrong people.”

Mr Johnson fears the reliance on JobKeeper - paid at $1200 per fortnight until January 4 and then $1000 until March 28 - will leave thousands of people without an income when it ends.

“There will be an absolute nightmare of people who can’t find work,” he said.

If you dare to tell it like it is, you’re a racist

Mike O’Connor,

If you want to express an opinion that is in anyway contrary to what is seen as politically correct in this great land of ours, don’t expect anyone to stand up for your right to freedom of speech.

Kerri-Anne Kennerley is the latest person to incur the wrath of the self-righteous following her acceptance of an offer to play the role of Pippin in the upcoming Gordon Frost Organisation’s musical of that name due to open in Sydney next month.

Her decision was immediately denounced by prominent theatre director Richard Carroll who said that the decision to cast Kennerley demonstrated that the musical theatre industry was not willing to change.

Pardon? Well-known performer lands acting gig? Where’s the problem and what hasn’t changed?

Kennerley’s sin was to air the view on television last year that people protesting to have the date of Australia Day changed were ignoring the alleged rape of children and women in the Outback.

“Has any single one of those 5000 people waving the flags saying how inappropriate the day is, has any one of them been out to the Outback where children, where babies and five-year-olds are being raped, their mothers are being raped, their sisters are being raped. They get no education” she said.

“What have you done?” she asked of the Invasion Day protesters. “Zippo!”

Predictably she was howled down for stating an obvious truth, the announcement of her role in Pippin firing up social media harpies who immediately cried “racist!” and demanded she be removed from the show.

It seems that for voicing her views, she should now be ineligible for future employment. How dare she expose the shallowness of urban activists who rant and chant and tell each other what a great job they’re doing and through indolence, ignorance or self-absorption, do nothing about the real problems in society.

Kennerley, bless her, is not one to fold in the face of criticism. “It matters not,” she said. “I am delighted to be doing Pippin. it’s wonderful to have jobs back for the theatre industry.”

I don’t place much credence in Australia Day awards, given that they are frequently handed out to people who have merely done what they have been well paid to do but if the gong givers want to give one to Kennerley next year for having the courage to speak her mind, that’s fine with me.

The outrage, however, has not been confined to Kennerley.

Performer Gabrielle McClinton has also been given a role in Pippin, having previously appeared in the Broadway production of the same musical.

The catch here is that not only is McClinton an American but he is also black.

“This is an opportunity for the Gordon Frost Organisation to formally acknowledge the lack of inclusion in our industry and adopt cultural competency in their productions,” said the actors’ union.

“It is important GFO recognises that moving forward there needs to be a formal agreement to ensure transparency and inclusion.”

Cultural competency? What precisely is that? Sounds like racism to me, denying Mr McClinton the role because he is a black American and not an Indigenous Australian.

This is another way of saying that theatrical producers should not be free to give the job to the person they feel to be best qualified but to a local whom they believe to be less qualified.

It’s their money they are risking. Surely they should be able to decide who they hire without being accused of lacking “cultural competency.”

The Gordon Frost Organisation has said that it looked for an Australian person of colour to fill the role but it couldn’t find anyone could with the requisite level of singing, dancing and acrobatic skills.

Giving jobs to people who are not qualified to perform them doesn’t do anyone any favours.

Moves gaining traction to force companies to have gender equality on their boards, now being made mandatory in California, are equally flawed.

Once you throw merit aside, the whole system becomes debased. The only winners are the underqualified.




1 comment:

Paul said...

"Fire a few health bureaucrats and you will have plenty of funding to expand your coverage of country areas"

Which is exactly what Campbell Newman tried to do. Newman, like Kennett before him, proved without meaning to that dependency on Government, long a Labor ideal, is here and will not go away. Those on the public teat can always see the problem of dependency, but its just that its everyone else who is dependent, not they themselves personally.....until someone in politics tries to do something about it. Listen then to the wailing and gnashing of teeth.