Crisis upon crisis in South Australia's health system
by Bob Briton It takes a lot to shock people, nowadays, when it comes to news about the crisis in the health system. However, a number of developments in South Australia have managed to focus the attention of a jaded public onto evidence of a serious breakdown in services at the Flinders Medical Centre (FMC). Details of an occupational health and safety report into the hospital appeared in the media recently and have opened the floodgates on criticism and resentment in the community and among staff at the cumulative effects of years of neglect of the public health system. The report was commissioned by the Department of Human Services and contains a number of revealing recommendations. It calls for extra security guards to deal with a high risk of violence. It recommends the installation of a bulletproof enclosure for the reception desk in the emergency department. It calls for a review of the practice of placing patients on trolleys in corridors — a recipe for disaster in the event of a fire. Marie Kuhn of the Australian College of Emergency Medicine told the local press that more than 300 patients a month spent time in trolley beds in the hospital's corridors. Staff had even been obliged to label the positions in the corridor in order to keep track of patients on the computer system. The violence mentioned in the report mostly arises from a 320 percent increase in the number of mental health patients in the state in the last four years and a parallel crisis in the mental health sector. Reports of disturbed patients being shackled to beds in emergency departments for days and left to be cared for by security guards in Adelaide's hospitals have filtered out. Mental health nurses, in response to the crisis, voted to impose bans at a meeting called by the Australian Nursing Federation (ANF) last week. The physical and verbal abuse is exacerbated by the long waiting periods involved in receiving attention at FMC. Up to 28 patients at a time can spend between 10 and 30 hours in the emergency department. One in five patients spend more than 12 hours there. Letters to the Editor of the Advertiser contain regular invitations for Human Services Minister Dean Brown to come and share the experience of waiting, often in pain or discomfort, for "emergency" attention. The report warns of the effects on staff of operating services in a perpetual "disaster mode". Naturally, stress and anxiety run high among staff. Marie Kuhn also drew attention to the effects of the loss of older, more experienced staff unable to tolerate the working conditions any longer being replaced by young but very inexperienced staff. ANF State Secretary Lee Thomas talked about the guilt nurses feel at not being able to care adequately for patients. Her comments in the press followed the publication of a letter from a former full-time nurse from the FMC in the Advertiser. Carol Preiss said, "We cannot answer bells soon enough... We rely heavily on inexperienced students, relievers and families to assist... What is the point of filling beds if the patient cannot be safely cared for?" These reports of conditions at FMC are disturbing enough, but as Lee Thomas points out "We hear of similar problems to the ones Ms Preiss has described throughout the public health system, particularly at Queen Elizabeth and Lyell McEwin hospitals, and from time to time the Royal Adelaide and some private hospitals." While Human Services Minister Dean Brown seems content to rest on his laurels and to deny that conditions, particularly in the mental health services are as bad as they are being portrayed, staff brace themselves for more bad news. At the Federal level the government continues to pay out $2.5 billion per annum in private health insurance rebates-an indirect subsidy to the private system, which could be used to solve all of the problems in the public hospital system, including at Flinders. Emergencies attended by ambulances have gone up by more than eight per cent this year to almost 14,000 cases. New supplies of the drug "fantasy" are turning up on the streets of Adelaide and in the night-clubs. A stream of overdose cases is flowing through hospital emergency departments. Strange what some commentators will make of certain events. From faraway Sydney, right-wing radio personality Alan Jones recently used his TV opinion piece on Channel Nine's Today program to offer some words of wisdom on the scandalous situation at the Flinders Medical Centre. After summarising the serious threats to the staff and the appalling conditions they work under he offered his "solution". Clearly, he said, the ideologically driven support for the Medicare system has caused the current crisis [!] and there is no other way to remedy it than to compel more people to take out private health insurance. Some comments are absolutely priceless, aren't they?