Grafton Base Hospital.
Grafton Base Hospital.

Calls for release of hidden report

A REPORT detailing flaws in the management of emergency departments at Grafton Base and Maclean District hospitals is being hidden by the North Coast Area Health Service (NCAHS) and the suggested solutions ignored.

These are the assertions of Member for Clarence Steve Cansdell who said he had received information from medical staff that the report, which was completed by emergency medicine expert Dr Peter Wirth, had unearthed several problems with the GBH ED including:

  • Inadequate medical staff. With only two full-time medical staff and all other doctors being locum career medical officers, locals are facing a high workload and the risk of burnout.
  • The standard of performance of the locums varies considerably.
  • No full-time Fellows of the College of Emergency Medicine (FACEM) in the ED with limited cover provided by FACEMs from Coffs Harbour.
  • The cost of maintaining a service using locums is high.

Dr Wirth’s report also points out that Grafton’s ED saw more than 25,000 patients in 2007-2008, higher than Bathurst, Broken Hill, Griffith and Shellharbour and had the ‘highest workload per medical FTE of all these hospitals’.

Mr Cansdell said he had been trying to get hold of the actual report from the NCAHS since mid-April but the service had not responded to his letter.

“The report was completed by a clinician ... an emergency expert and it made recommendations of how NCAHS can deliver far better health care at no extra cost,” Mr Cansdell said.

Some of the solutions and comments in the report, as summarised by a North Coast medical staffer, include:

  • The appointment of a FACEM at GBH to raise clinical leadership and governance. The cost of employing a FACEM can easily be justified compared to the current practice of employing high-cost locums.
  • Medical staff working in Grafton ED need to be contractually obliged to participate in continuing medical education programs.
  • The current linkage with Coffs Harbour ED is not serving Grafton ED well. More appropriate would be the forging of stronger linkages with Lismore ED to encourage staff rotation.

Mr Cansdell said the recomendations of this report, including replacing high-cost locums, who had to be flown in and accomodated, with a specialist emergency clinicians made a lot of sense.

In a response late yesterday, the NCAHS said there was no special funding paid to Dr Wirth for producing a report on the Grafton Base Hospital (GBH) Emergency Department (ED) services.

“In fact, Dr Wirth did not produce a formal report but rather provided some written feedback on his experiences and perceptions, after having worked as a Locum Medical Officer in the GBH ED,” the statement said. “The feedback provided by Dr Wirth has been discussed with him by the former network manager of the Coffs/Clarence Network and is under consideration by the NCAHS.

“In particular, NCAHS is giving close consideration to recruiting an Emergency Medicine Specialist (FACEM) to be the director of the GBH and Maclean Hospital EDs.”

The statement said the NCAHS had previously sought to recruit a FACEM for GBH ED but no suitable applicants came forward at that time.

“It is difficult to recruit Emergency Medicine Specialists due to their general preference to work in larger EDs.

“As a consequence, NCAHS has seconded an Emergency Medicine Specialist from Coffs Harbour Base Hospital to work for two days per week in the GBH ED to provide support to the other medical staff.

“Over the past eight months, NCAHS has been aggressively recruiting for permanent Career Medical Officers (CMOs) to replace Locum CMOs at the GBH and other NCAHS Hospital EDs. A number of Locum CMOs have been replaced by permanent CMOs. This active recruitment campaign is ongoing.”

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