Damning report for hospital

THERE is good reason why the North Coast Area Health Service (NCAHS) doesn’t want the public to read a report by an emergency medicine expert about the state of the Grafton and Maclean emergency departments (EDs).

Alleged shoddy clinical practices by certain GPs, bullying of nursing staff by senior Visiting Medical Officers (VMOs), bad relations with Coffs Harbour hospital’s ED and a culture of overspending on unnecessary pathological tests are just a few of many inflammatory findings of the report.

One of the most shocking findings of the report, by emergency medicine expert Dr Peter Wirth, was the entrenched culture of paying locum career medical officers (CMOs) $160 an hour for their work instead of employing resident medical officers (RMOs) who could perform the same duties for about $40 to $50 an hour.

Some Grafton locums, the report states, have occupied their lucrative roles for three years.

The raw document was released to The Daily Examiner by Member for Clarence Steve Cansdell, who would not reveal who provided his copy except to say it was not Dr Wirth.

Dr Wirth, who is a Fellow of the College of Emergency Medicine (FACEM) and a strong advocate of integrated care services, worked in Melbourne, followed by more than two years at Lismore Base Hospital, before spending a brief stint at Maclean District and Grafton Base hospitals earlier this year.

He consulted with more than 14 experts in their field for his report and made extensive observations of his own.

Some of Dr Wirth’s other key findings include:

The current 44 doctor-hours per day in the Grafton ED was ‘totally inadequate, based on the workload I personally experienced’.

Based on the $160 per hour CMO rate – this amounted to $7040/day for ED doctors.

A switch to RMOs would provide 58 doctor hours in the ED for $2900/day, allowing a budget for a FACEM to co-ordinate the ED.

Nursing staff at the Grafton ED showed excellent clinical, management and inter-personal skills.

Grafton’s ED suffered a subservient relationship with Coffs Harbour emergency, and Coffs was failing to meet its contractual obligations of supplying a FACEM for two sessions per week, with poor communication, late arrivals and early departures.

Dr Wirth said in his report that the dependence on highly-paid CMOs was due to an apparent ‘inability to attract good-quality junior doctors, at least partly because of the lack of presence of more senior ED medical staff to supervise their clinical time’.

An appointment of a FACEM, Dr Wirth suggests, would solve this problem.

Though the NCAHS has denied appointing Dr Wirth to conduct the report, the document itself outlines how he had been asked in a teleconference by both Dr Jean Collie, director of Medical Services for Grafton and Maclean, and executive officer for both hospitals Dan Madden, to ‘expand’ on his ‘observations and recommendations’ after expressing some initial concerns to the executives about the Maclean ED.

A Grafton Base Hospital nurse, who asked to remain anonymous, said Dr Wirth’s recommendation of a FACEM to coordinate the ED would be welcomed by staff.

“It benefits every person in the ED – doctors, nurses and most importantly patients,” the nurse said.

Another Grafton doctor wrote to The Daily Examiner in support of Dr Wirth’s stance, but also asked for his comments to remain confidential. The doctor said Dr Wirth had been warned by senior management that as a CMO he was not covered under ‘whistleblower’ legislation.

Mr Cansdell said he released the document in the interests of the wider community.

“The CEO of the NCAHS, Chris Crawford, must take this report seriously and open up communication channels with senior clinicians with sincere resolve to ensure the Clarence Valley is not only getting better value for money, but more importantly, a superior and more responsible delivery of health care services,” he said.

“I am told that Dr Wirth attempted on three separate occasions to contact Mr Crawford to discuss this report and his concerns. Like myself, I believe he is still waiting for his calls to be returned.

“One could consider this an act of sheer arrogance, or at the least, a deliberate move to ignore this truly independent review of the accident and emergency departments at both Grafton Base and Maclean District hospitals.”

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