Deaths Report: WDHS says findings ‘not an accurate reflection’

The Hamilton Spectator – October 22, 2015

HAMILTON Base Hospital has achieved one of Victoria’s “poorest results” for its death rate of babies born prematurely but the finding “does not accurately reflect performance over recent years”, according to Western District Health Service.

A Victorian Department of Health analysis of perinatal deaths between 2008 and 2012 found that babies born between 22 and 32 weeks gestation at WDHS were 80 per cent more likely to die than the state average.

The report stated that “in interpreting these ratios, conclusions cannot be drawn about avoidability of any of these deaths”.

The report was published in August but The Age newspaper highlighted some of its data this week in an attempt to link other hospitals with a major investigation into baby deaths in Bacchus Marsh.

A review into 10 baby deaths over two years at Djerriwarrh Health Service,
Bacchus Marsh found that seven of the deaths may have been preventable.

Since the review was released earlier this month a number of women, families and former staff have come forward with allegations of clinical incompetence and bullying at Djerriwarrh.

The Age described WDHS as one of a number of Victorian hospitals “on par with or worse than Bacchus Marsh.”

A statement from the offi ce of Victorian Health Minister Jill Hennessey said all Victorian perinatal deaths over the past seven years had been reviewed “and no other health service has been identified as being of concern”.

“Sadly, no pregnancy or birth is completely risk free, and complications
sometimes arise unexpectedly during labour or after delivery,” the minister’s statement said.

“However, latest figures show that Victoria’s perinatal mortality rate is
one of the lowest in Australia.

“The Government has put in place a range of new measures across the
state to ensure the safety of maternity

Though the perinatal report concerned the health outcomes for all babies,
WDHS only had a data entry for babies born at between 22 and 32 weeks gestation.

Babies born at this stage of a pregnancy are defined as “very” or “extremely” preterm and babies born at 22 weeks are unlikely to survive.

The Spectator understands that less than five babies born after 32 weeks gestation have died within 28 days  of birth at WDHS between 2008 and 2012.

That low number of deaths is the reason why WDHS did not receive an
analysis for deaths during treatment of routine pregnancies.

A statement from WDHS said it provided “a quality learning environment and has established processes in place to monitor the outcome of all births, including all perinatal deaths”.

“A medical specialist reviewed the perinatal deaths that occurred at WDHS between 2006 and 2011 and made a number of recommendations that have been actioned.”

The report, ‘Victorian perinatal services performance indicators
2012–13’, stated that health services that performed below average with
health outcomes for babies and mothers “must understand the extent
of suboptimal performance issues and address these”.

Pregnancy terminations and “deaths due to congenital anomalies” were not counted in the data, which was adjusted for the size of each hospital.

According to the report, 230 women gave birth to a total of 232 babies at WDHS during 2012.

WDHS chief executive Rohan Fitzgerald said he recognised the importance of the report as a measure over the period, but it did not accurately reflect the Health Service’s performance over recent years.

“The (gestation standardised perinatal mortality ratio) is an internationally recognised measure of perinatal mortality that includes all deaths, including extremely premature babies, still births and newborn deaths. It does not assess the potential avoidability of any of the deaths,” he said.

“I am deeply saddened for any family that goes through the experience of
losing a baby during labour or after a delivery.

“With every birth our aim is to reduce the risks for both mother and baby as far as practical, although we know that in some cases the risks remain high.”

Despite Ms Hennessy’s statement that no health services were a concern
in regards to baby death rates, the Victorian Government will move to
establish new reporting mechanisms and specific targeting of regional
pregnancy outcomes.

A state-wide perinatal autopsy service will be established along with perinatal morbidity and mortality committees in each region.

“This expert committee will review any perinatal death occurring in that
region every three months,” the Health Minister’s statement said.
“The Department of Health and Human Services will review all of the state’s perinatal services to identify if any improvements can be made.”

Australia’s medical practitioner registration board, AHPRA, which is
in charge of handling complaints about doctors and surgeons, will get a new notification service to automatically inform health services about
investigations into their staff.

“Staff at all health services which provide maternity services will
be required to undertake intensive training, including one led by the Royal
Women’s Hospital, to help them better identify, address and alert risks during birth,” the Health minister’s statement

“A new state-wide perinatal plan will
be developed”.

Mr Fitzgerald said he had confi dence in his team to provide high quality
maternity services to the local community.

“I am confident that we have the staff, systems and processes in place
to support the delivery of safe and appropriate obstetric care to women in
our region,” he said.

“I would encourage any women that have concerns about any aspect of their care to contact Western District Health
Service direct.”

The WDHS community liaison phone number for WDHS is 5551 8583 and
AHPRA’s phone number is 1300 419 495.

Doctor Payment Plan Defended


The Hamilton Spectator – August 01, 2015

HAMILTON Medical Group has defended its new ‘pay on the day’ policy for GP appointments, which was announced last Saturday and will take effect on September 28.

The clinic has pointed to a freezing of Medicare rebates to GPs since November 2012, under both Labor and Coalition Governments, as a partial reason for its payment policies.

A statement from Federal Health Minister Sussan Ley said doctors should not use the rebate freeze as an excuse to unfairly increase prices.

The clinic’s announcement was heavily criticised on Facebook and it also reignited a long-running debate about the local availability of bulk bulling for GP visits.

The clinic stated via an advertisement in The Spectator that “in view of the Government freezing of the Medicare rebate, in order to sustain a medical service and attract doctors to come and work in Hamilton, the Hamilton Medical Group will be changing its billing policy.”

From Monday, September 28, 2015 full payment will be required for all consultations on the day of service

“Rebates can be paid directly into your account on the same day.”

At the time of publication, 158 comments had been posted on the ‘I’ve Lived in Hamilton, Victoria’ Facebook page listing issues with Hamilton Medical Group’s payment policies.

There were also messages in support of the clinic, including one popular comment that asked locals to consider “how lucky are we to live in a country that allows us to access medical treatment for many issues”.

Prior to the ‘pay on the day’ policy announcement, The Spectator had asked users of its own Facebook page about their opinion of bulk billing.

A number of users said the non-bulk billed cost of repeated GP visits, often because of having multiple children or a chronic illness, was a major issue.

Hamilton Medical Group board chair Dr Dale Ford told The Spectator that the new payment policy would have exceptions for financial hardship and was not the only medical clinic to adopt similar measure.

“We are going to try to move to a ‘pay on the day’ policy,” he said.

“The reason for that is: as a result of what happened in recent months and years the amount of money outstanding has increased significantly and we are trying to move to have ‘pay on the day’ whenever possible.

“We understand that sometimes it’s not going to be possible, but that will also be part of the policy.”

For many families facing multiple GP visits, there has always been calculation of whether it would be cheaper to drive to Penshurst, Coleraine, Portland or Warrnambool rather than attend a non-bulk billed appointment in Hamilton.

One woman who contacted The Spectator said she considered herself to be one of the “working poor” and was battling the cost of GP visits while managing a chronic illness.

“I have many friends with young children who simply can not afford to go (to the doctor),” she wrote.

The Hamilton Medical Group states on its website that it is “a private medical practice, not a bulk billing clinic.”

Dr Ford said that despite this policy there was a “significant percentage of consultations that are bulk billed” as the option was at the discretion of doctors.

“Bulk billing is becoming far less common in the medical community because there has been no increase in any bulk billing rebates since November 2012,” he said.

“And that has been the stated intention of this Government that there is no increase in rebates from now into the distant future.

“The issue with that, for not just this practice but every other practice, is that costs clearly continue to increase.

“Our rent, the utility fees, the wages, insurance, materials, accreditation go up in the medical sector by an average of 10 per cent per year, and that’s been the case since November 2012.”

Dr Ford said the clinic wanted to “be a part of the community” and make arrangements for people in difficult circumstances.

“We do our best to look after those people that have issues, but at the same time we don’t want to abandon our approach to be a quality practice, which means getting the best doctors that we can to work here and delivering the best standard of care we can,” he said.

Dr Ford described the cost impact on poorer people of managing a chronic illness as a “national issue”.

“Is there a better way of trying to organise it? I’m sure there is but we don’t get to make the rules, we have to live by them,” he said.

“If the rebates had continued to keep pace with inflation since 2012 this may be a different story.

“This has been a political decision that I can only see as being an attempt to reduce the amount of bulk billing.”

The Spectator asked Wannon Federal MP Dan Tehan to comment on bulk billing issues in Hamilton but he referred the query to the Federal Health Minister’s office.

A statement from Ms Ley said the ‘temporary GP rebate pause’ shouldn’t provide an excuse for any unfair “sneaky price increases”.

Ms Ley’s statement said Health Department modelling suggests the rebate for GPs would only be $0.65 lower in 2015/16 and $2.10 lower in 2017/18 under the freeze.

“At the end of the day, doctors are in control of what they charge patients and I expect vulnerable and concessional patient to continue to be protected” Ms Ley said.

“I have also made it clear that I am open to reviewing the rebate indexation pause in the future as part our ongoing work with doctors and patients to reform Medicare.”