your right to know, secrecy, freedom of information

Secrets and healthcare

The Australian media is currently running a campaign against secrecy, called 'Your Right to Know'

On Monday 21st October every newspaper in Australia published a front page covered with heavily redacted text.

This marked the beginning of a nationwide campaign involving the Nine network, News Corp, the ABC, SBS, The Guardian and the Arts and media union.

Australian journalists say they are deeply concerned about the increasing secrecy of politicians and bureaucrats.

How does secrecy relate to safe, affordable healthcare?

Sooner or later, someone in your family will need to medical treatment

A sick child will be rushed to the Emergency Department. An aging parent will fall and break their hip. A cousin will be in a car crash. Or a teenager will be struggling to cope with addiction issues. 

Then you will be exposed to the yawning gap that exists, between the political and bureaucratic doublespeak about ‘the world’s’ best hospitals’ and the chaotic and error prone reality.

A few facts about hospitals that you have never been told

Outdated computer systems

A substantial number of large public hospitals in Australia are still running computer systems on DOS. This is 40 year old technology. It is so archaic that no modern software is compatible with it. This means the information has to stay separate from any other hospital systems.

Information silos are a major cause of hospital errors.

Treatments differ substantially across different hospitals

Best practice clinical guidelines are only ‘recommended’ not legally binding. The result is that every hospital can deliver the same treatments, in a different manner.

For example in one hospital Doctors can chart chemotherapy on paper and keep giving patients the same dose, no matter how much their weight changes or how sick they become. While in another hospital a block away, Doctors can only use specialised oncology computer systems, that force them to reweight the patient before each treatment, and change the dose if their weight changes by more than 10%.

As in America, most out of pocket costs are kept hidden

The vast majority of costs are kept hidden from patients. This includes –

Individual costs like (a blood test, CT scan or surgeons consultation fees) and coordinated costs for entire treatments (admission, surgery and rehabilitation for hip replacement). 

Reports are kept secret

Comprehensive reports on hospitals performances are continuously collected by health bureaucrates, then hidden away from the unsuspecting public. You will never know if your hospital, department of Doctor is the best in their field, or the worst and currently under investigation.

Who pays for all this secrecy?

You do. Five times over.

  1. As a Federal taxpayer supporting both Medicare and the private health insurance rebate
  2. As as State taxpayer supporting public hospitals
  3. As the owner of private insurance policies (a legal obligation for people over a certain income)
  4. As the payer of out of pocket medical costs
  5. As the payer of the cost of fixing hospital errors, through programs like Federal welfare when people are unable to return to work.

Australia is the most secretive and least accountable advanced Western democracy in the world.

Greg Sheridan

Some examples of the damage secrecy can cause patients

In 2013 the peak body representing private health insurers in Australia commissioned a comprehensive report into private hospitals performances.

A grading system was used to rate the 600 private hospitals into A+++ to C—.

When it was completed, Private healthcare Australia apparently took it to both of the major parties, asking for their support to make the report available.

Politicians failed to support this move towards transparency in private healthcare, and the report has never been revealed to the public.

"There are a whole lot (of hospitals) that are C-triple-minus," Dr Armitage said. "And we just keep backing up the truck full of gold bars to pay them."

Dr Michael Armitage

Toni Hoffman was the head nurse at Bundaberg Base Hospital Intensive Care Unit. She repeatedly raised concerns about the mortality rate of the overseas trained surgeon Jayant Patel during 2002 – 2005, but was brushed off by management.

Eventually a journalist did a simple google search. He found same surgeon had faced disciplinary action for negligence in the United States.

It transpired that Australian bureaucrates had never even bothered to investigated him, before hiring him.

In 2010 Patel was finally charged with manslaughter. Hoffman’s nursing career was destroyed.

She was subsequently awarded an Order of Australia for her persistence in fighting for patient safety.

Suresh Nair qualified in Australia as a neurosurgeon in 2001.

By 2004 his cocaine addiction was so bad he self reported to the Medical Board and entered a rehabilitation program. Despite failing some of the urine testing regimes, he was released from the program in 2008.

In 2009 a prostitute who engaged in a long cocaine binge with him died. Although police went to the Doctors hospital and raised concerns with management, the Medical Board was not notified.

Suresh Nair was eventually banned from a public hospital, only to continue practising while high on cocaine, in a private hospital next door.

The only reason he was stopped from practicing, was when a second prostitutes died while on a drug binge with him and the police charged the surgeon with murder.

James Peters was a known drug addict who was allowed to continue practicing as an anaesthetist without undergoing ongoing drug screening tests.

Complaints from nursing staff about his misuse of drugs were ignored by his clinic.

It turned out he been injecting himself with some of his patients fentanyl, then sharing the same syringe with them while they were under an anaesthetic. 

Fifty-five patients subsequently contracted hepatitis C after attending the private clinic where he was employed.

A class action followed. The results have been kept secret.

Information you could easily access, if you lived overseas

In contrast, both the quality and quantity of health data published overseas is astonishing.

US News publishes a yearly list of the best American hospitals in their clinical area of expertise. These ratings are based on a wide range of metrics including Doctors own ratings of the hospitals. Wouldn’t you want to go to one of these hospitals if you were sick?

There are numerous Medical rating sites in America, discussing both consultation fees and patient experiences. A few are below –

HealthGrades

RateMD’s

Vitals.com

The American government refused to pay for avoidable hospital errors back in 2008. This forced hospitals to either clean up their act or go broke.

England has a vast range of hospital data available to the public via a program called Dr Foster. 

Dr Foster was established in 2000 – shortly before the final report of the public inquiry into the Bristol Royal Infirmary was published – to help healthcare providers identify poorly performing hospitals.

In 2015 Telstra purchased this company. And guess what? The same data available to British citizens, is not available to Australia. 

So what sort of information should Australian hospital have to publish?

Rates of avoidable readmissions to hospitals, along with the readmission diagnosis, and the hospital patients originated from. This would pick up private patients ending up in public Emergency departments after poor treatment and lack of outpatient follow up. Readmissions are an excellent snapshot of the quality of care the patient actually receive.

Rates of infected surgical wounds, along with which hospital and surgical department the patients were originally treated in. This would reveal dramatic differences in infection rates between different surgeons. It might also show some terrible infection rates after minor procedures in small privately run clinics.

The names of all computer systems being used in every department of Australian hospitals. This would sort out the sheep from the wolves. People would finally see which hospitals are still using paper records, which hospitals are still using DOS. It would also highlight which hospitals have invested in modern software to make patients journey far safer.

A snapshot of the way patients medications are being continuously changed, as they journey between home, hospitals, rehabilitation and nursing homes. This would highlight the serious lack of coordination of medications as people travel through the health system and the dangerous risk of errors this brings.

The actual way wounds are being documented and monitored in hospitals. This would I believe reveal the majority of wounds are crudely drawn on paper by nursing staff, never properly assessed and no plan put in place to heal them. This is totally unacceptable in 2019.

The results of spot checks of basic nursing care completed for all hospital patients. Dirty teeth, elderly people never taken to the toilet, dying people left lying in soiled pads, meal trays dumped on the bedside trolly untouched because no one had sat the patient up,  dirty fingernails, grubby IV sites, men unshaven, women unwashed. I have seen it all, and it is absolutely disgusting. Nursing does need to go back to hospital based training. And the ‘Princess Nurse’ syndrome really does exist. 

And finally a simple patient survey. How did we treat you? Some responses will focus on non essential items like food and ward visiting times. But a filter could easily be applied to focus on the main clinical issues. Like unnecessary delays for surgery resulting in DVT’s. Read here.

What can you do to protect yourself?

Treat hospital errors like road trauma. Sooner or later someone you know will be affected. Be on your guard.

Read blogs like Wikihospitals and share the information among your friends.

Support community groups and political parties that promote freedom of speech and transparency of government.

Take a close interest in both avoidable errors and new health technology. And when you or your family gets sick, be proactive. Contact a Doctor immediately if you feel there is an infection or a major problem. 

Don’t ever be fooled into believing that more money equally better care. The modern health industry is a bloated white elephant, full of bureaucrates, box ticking and stupid regulations, unnecessary dramas created by poor planning and  elderly people are being pushed through unnecessary tests and treatments. 

We are all paying an estimated 150 billion a year, to support our health system. Yet an increasing amount of the pie is going away from bedside care and towards the bloated bureaucracy.

Our health bureaucracy is growing faster than national employment. 

There is now one health administrator for every 3.4 hospital beds.

The only thing that will bring costs down and safety standards up, is transparency.

© Wikihospitals October 2019

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