Natasha Wallace Health Reporter, smh
April 11, 2008
JUNIOR doctors at Westmead Hospital have been gagged over evidence they gave at an inquiry about a lack of training, chronic computer problems in gaining access to test results and a directive not to claim overtime despite working 12-hour days.
As the registrars Lisa Phipps and Timothy Tan left the public hospital inquiry yesterday, they were hastily ushered away from the media by a senior administration staff member, who told them to stop speaking. She would not identify herself.
The Opposition spokeswoman on health, Jillian Skinner, said: "This episode shows bullying is still rife within NSW Health."
On Tuesday nurses from Nepean Hospital were also told not to speak to media but were later given permission after the Herald asked for an explanation.
Dr Phipps presented the special commission of inquiry into acute care services with a memo instructing junior doctors not to claim overtime unless it related to an emergency situation.
"It seems the way that we are getting around safe working hours is to say, 'Oh, you can work these hours; just don't claim it,' so it goes undocumented," she said.
The commissioner, Peter Garling, SC, would not release the memo.
Dr Tan told the inquiry a significant shortage of computers meant doctors often could not gain access to test results. He said doctors wasted time "having to wade through piles of X-rays" because of a lack of computers. Log-ins often did not work and computers were sometimes not connected to printers.
In other evidence, an intensive care specialist, Peter Telford, said: "We frequently find the number of critical care beds for the state is one or two. There are probably, in fact, many more, as there are in our unit, because there are patients waiting to be discharged or there are beds that cannot be adequately staffed."
He said it was getting increasingly difficult to discharge patients, thus preventing chronically ill patients from being admitted. "There are times when we discharge them by swapping them for a patient who has got critically ill in a high dependency unit, and this reflects the overall lack of beds in the system."
Understaffing was also a significant issue. "We have large periods of time where we do not have senior staff or even appropriately supervised junior staff looking after sicker patients."
Another staff specialist, Dr Therese McGee, the former director of obstetrics and gynaecology, said the department was a "consultant-free zone" because of an exodus of senior doctors to the private sector. "We will not be able to staff any maternity units within this state with consultancy cover [senior doctors], and this could happen within five years."
Pathology was also struggling.
The acting director of pathology services, Jerry Koutts, said a $5 million shortfall in spending on infrastructure made it inefficient. The big problem clinicians faced was getting bureaucrats to make a decision.
"Everyone's covering their arse, basically, and not making a decision, and we just go through these layers of hierarchy where no one is prepared to make a decision in case something goes wrong. Morale has never been lower."
Professor Koutts said he had been acting director for four years as nobody wanted the job because clinicians were given responsibility for patient care without the necessary authority.
"They're saying I won't put up with that crap."
Having an accountant with no medical background [Bernard Deady] as the director of clinical operations for the Sydney West Area Health Service was "the equivalent of appointing an accountant to be the conductor of your orchestra".
The inquiry is due to hear evidence at Wollongong Hospital on Monday.