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"...public opinion deserves to be respected as well as despised" G.W.F. Hegel, 'Philosophy of Right'

Health system + adverse events « Previous | |Next »
August 28, 2007

Peter Martin in an op- ed in the Canberra Times refers to the adverse events in our hospitals, and the 1995 ‘Quality in Australian Health Care’ study:

Each year some 18,000 of us die in hospitals. By comparison, fewer than 2000 Australians die on the roads. The 18,000 deaths, six out of 10 of which were avoidable, were identified, along with 50,000 cases of permanent disability, in a landmark 1995 study that has never been repeated.

And yet we rarely hear about this. Unlike road deaths they are not publicly reported. Politicians confidently repeat that we have a good health system, whilst the media challenges this by focusing on waiting lists and hospital queues:

Neilhealth.jpg
Neil

Martin goes on to say that ten years later in 2005, an editorial in the Medical Journal of Australia asked whether a decade on we could "confidently state that health care is safer for patients"?

It concluded:

Unfortunately, the answer is no. It is regrettable that we have not measured the frequency of adverse events in Australia in a way that allows us to assess how we have fared since 1995; how we compare with other countries; and whether any initiatives have been effective in reducing patient harm.

It is not deemed important enough to keep these kind of figures on a national level. What we have is a fundamental failure of governance by both the State and the Commonwealth governments--separately and together --- and the lack of willingness to respond appropriately at both the bureaucratic and political levels. A curtain is being pulled over adverse events.

Professor Jeff Richardson, the foundation director of the Monash Centre for Health Economics, says that an estimated 50 Australians die in hospitals every day. Another 140 are permanently injured. Richardson describes the reported rate of preventable deaths in hospitals as "equivalent to a Bali bombing every three days". He adds that we are probably justified in thinking about those deaths in the same way as we would a casualty rate in a war.

| Posted by Gary Sauer-Thompson at 7:09 PM | | Comments (8)
Comments

Comments

Gary,
I followed the link to the Monash Centre for Health Economics' report on adverse events in our hospitals and quickly scanned it. It is stated that:

Results from the 1995 ‘Quality in Australian Health Care’ (QAHC) study suggested that the quality of health care in Australia is a problem that overshadows all others in the health sector....Sixty per cent of deaths could have been avoided....The direct hospital costs of adverse events, both fatal and non-fatal, was estimated in the QAHC study at A$900 million per annum. This was likely to have been conservative ‘as the costs of such problems arising in mental health, nursing homes, domiciliary care, day patients, and general or specialist practice outside such hospitals were not included.'

It adds that subsequent studies have confirmed the existence of a major problem and that the response to what might justifiably be described as a crisis in
Australian hospitals has been cautious and incremental.

This is awful---50 Australians dying daily and another 140 sustaining permanent injury. It's unbelievable. Why hasn't this been made public? What's been going on? The media are full of reports about the threats of terrorism but are silent about what is what was arguably the most dramatic and serious problem ever found in the health system.

Nan,
this kind of problem sure makes John Howard’s strategy of picking off the marginals with targeted announcements about hospitals look opportunistic. It really looks as if Howard is making scrappy, piecemeal policy rather than policy that is part of a coherent whole. And Tony Abbott trots along saying whatever needs to be said at he particular moment.

One obstacle to adressing adverse events iin a systematic manner is that the regulation of health practice is voluntary. The medical and nonmedical health professions set their own standards and they regulate themselves.

4 corners this week was about how the internal culture of hospitals works against change on this score. An investigation of an incompetent neurosurgeon never got to the bottom of the problems because dobbers are punished, he kept operating while under investigation, people were intimidated by his reputation. It was quite depressing.

Staff sent friends and family interstate rather than let this guy work on them, yet wheeled other patients in because that's just what had to be done.

I got the impression it would take a lot more than government response to fix the problem. It's part of our wider culture to obey medical and other professionals without question.

Self-regulation clearly doesn't work, in any industry, but I think regulation imposed from outside is only part of the answer. You also can't do anything that would drive up insurance costs.

Exposure seems to me a viable option. Though you'd have to be careful not to undermine the confidence of either the public or the professionals.

Lyn,
Sadly, I missed the 4 Corners 'First Do No Harm' programme. I see, from reading the transcript, that Chris Masters explored how has the health system responded to a range of episodes of, adverse events, bad practices and cover up. Bundaberg and Canberra feature strongly, and righly so. They are up there with Bristol.

This comment by Dr.Thomas Faunce, Lecturer ANU Medicine and Law Faculties is interesting:

The same sort of pattern, the staff talking about something going wrong, people just refusing to believe it was actually happening and various reputations being involved of the institution, of senior surgeons, so nothing happened.

What the adverse events at Canberra hospital in the late 1990s (caused by the Head of Neurosurgery Ray Newcombe) showed is that the adverse events caused by clinical competence and poor standard of practice was not picked up by the health system at Canberra Hospital, even thought the staff knew what was happening.

The issue of self-regulation arose in these diverse comments:

The concept that only a neurosurgeon can assess a neurosurgeon...the possibility of an experienced neurosurgeon, highly respected, coming to the hospital and actually being present while operations were being undertaken, patients were being treated [caused] a lot of resistance....an inquiry into neurosurgery... left the other neurosurgeons uncomfortable...There was a general unwillingness to cooperate [with an investigation by the ACT Community and health Services Complaints Commissioner]

That means the medical profession was unwilling to take the responsibility of making sure that patient safety was protected, despite the issues being those of the surgeon's competence, inadequate clinical governance and poor record keeping.

Self-regulation failed at Canberra Hospital, just as it did at Bundaberg several years latter.


It's a shame you missed it Gary. Australian Story before it was about another systemic failure in the Qld justice system. A depressing night of TV all round.

"Self-regulation failed at Canberra Hospital, just as it did at Bundaberg several years latter."

Exactly, and it fails because the internal workings, from neurosurgeons as a specialist group down to the cleaners are socialised into established patterns of habit. The hospitals themselves are only part of the problem when a profession is prepared to close ranks across the whole system.

Lyn,
what upset me about the 4 Corners was that once the Neurosurgery Unit at Canberra Hospital was under investigation by the ACT Health Complaints Commissioner the public were not informed. They were kept in the dark.

So they turned up sick at the hospital during the investigation, were operated on, and were damaged in the process. Another adverse event. Where as the ACT Medical Board? What were they doing? They must have known what was going on?

As the husband of one of these patients said:

anybody that walked into that hospital that day and from before that should've been informed that the neurosurgical department of the Canberra Hospital at that time was under investigation. And I think everybody had the right to know why it was under investigation.

The patient herself adds:
My feeling about that is that he shouldn't have even been there.

Public safety was not a central concern. It was more about the health professionals involved.

Shocking. The patients should have told before the surgery that Ray Newcombe was under investigation. And when in February 2003 Ken Patterson, the ACT Health Complaints Commissioner, delivered his findings, these were at first suppressed before being made public

And this is 2001-2003 we are talking about.


Lyn,
It is a systems problem. However, I think that there is more going on here than your account of 'being socialised into established patterns of habit, or a profession closing ranks through doctors burying mistakes. '

Despite the adverse outcomes the Royal College of Surgeons had recommended a further three years accreditation of Ray Newcombe unit. He remained at work while he maintained the confidence of his peers.That confidence was more important than adverse clinical outcomes.

The medical profession was blind to adverse outcomes, indifferent to patient safety, and willing to attack and punish the whistle blower who was actually concerned with public safety.The hospital administrators talked in terms of avoiding a witch hunt, despite the evidence of adverse events in their hospital. They had no interest in open disclosure or mandatory reporting of adverse events.

The concept of professionalism and autonomy is all skewed here. We would never let airline pilots get away with these adverse events. So why are surgeons treated differently in terms of regulation?

The comments of Dr Gerard McLaren, the whistle blower , are interesting in terms of this professionalism:

I think..I've reached the point where I've now crossed the line. I'm seen as a filthy rat because I've actually joined the cause of the patients. I've decided that you can't actually be, you know, part of the Doctor Party and the Patient Party, you're in one camp or other so from the doctor's point of view it is all over.

This is a professionalism that is not patient centred---it did not put the patient first . It 's professional ethos is about the Surgeon as God who can do no wrong. The patients are bad.

Yes Nan, that bit got to me too. That and the bit where hospital staff sent friends and rellies interstate rather than risk getting the wrong surgeon.

Gary,

I can't imagine how you could go about pulling apart the Surgeon as God thing. Or the peer thing either. How do you dismantle an aristocracy that literally holds lives in its hands?

I still think exposure is a good option. If this 4 corners episode had aired on channel 7 there'd be an uproar.