Academic journal article Australian Health Review

The Weakest Link?

Academic journal article Australian Health Review

The Weakest Link?

Article excerpt

THE EXTRAORDINARY COVERAGE of complaints of poor and dangerous patient care at Macarthur Health Service (Campbelltown and Camden Hospitals) has all the hallmarks of a pulp novel relentless and emotional media coverage, tragic personal stories, political intrigue at high levels and eloquent legal argument. Never before has New South Wales experienced such an event, nor most other jurisdictions for that matter. Perhaps only the coverage of King Edward Hospital in Perth comes close.

Clinicians at the two hospitals have been variously portrayed as everything from doctors and nurses who were happy to turn their backs on dying patients through to one of the many victims of a fundamental political, policy and structural failure to distribute health care resources in proportion to need. In the same vein, the local hospital-management group has been portrayed as either an incompetent and corrupt group who engaged in cover-ups, shredding documents and targeting anyone who raised concerns, or as a caring but embattled group who were doing their best to manage a continuously increasing gap between demand and supply.

Likewise, the nurses who publicly raised the allegations have been variously portrayed as either whistleblowers acting solely in the public interest, who were punished and sacked for bringing the truth to light, or as vexatious troublemakers seeking revenge on hospital managers who had previously disciplined them for bullying, harassment and/or poor clinical care.

And, as usual, the truth lies somewhere in between.

The complaints in context

The Macarthur region consists of three local government areas spread over 3000 square kilometres. The major population centre, Campbelltown, is 50 kilometres from Sydney, NSW The region is typical of new growth areas on the urban fringe. It has experienced rapid population growth since the 1970s. With a current population of about 240 000, it is now about the same size as Geelong, Eastern Adelaide, Fremantle and Southern Tasmania.

The two hospitals at the centre of the story have grown and developed considerably during that period. By 2003, the Macarthur Health Service employed 1236 full time equivalent staff (SWSAHS [South Western Sydney Area Health Service] 2004) across a range of services, including the Campbelltown and Camden hospitals. Campbelltown Hospital now has 260 beds while Camden Hospital has 72 beds (SWSAHS 2004). However, on all the evidence, the growth in the health service and its clinical infrastructure has not kept pace with the increased population demand.

The complaints and their outcomes

The initial complaints of patient care go back to June 1999. In the 4 years up to the investigation by the NSW Health Care Complaints Commission (HCCC), Macarthur Health Service treated about 100 000 inpatients. It also had 180 000 Emergency Department attendances and about 2 million other non-admitted occasions of service (SWSAHS 2000, 2001, 2002, 2003). In evidence given at various inquiries, Macarthur Health Service indicated that during this period 3500 clinical and non-clinical incidents were reported and reviewed internally.

A total of 69 cases were initially referred to the HCCC for investigation by the NSW Minister for Health based on information provided to him by a group of nurses who have subsequently been known as the 'nurse informants'. Following the dismissal of the head of the HCCC for a perceived failure to adequately investigate these initial allegations (see below), a Special Commission of Inquiry into Campbelltown and Camden Hospitals by Bret Walker SC was established. The nurse informants subsequently made additional allegations to this Inquiry. These included nine allegations that went back as early as 1992. In total, the Special Commission investigated 128 allegations (excluding duplicates). Of these, 126 were allegations of poor patient care.

The allegations represent 0.04% of hospital patients treated between 1999 and 2003. …

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