Welcome to this week's edition of Health Alert.The Health Alert is transmitted on Monday of each week (unless there is a public holiday on Monday)
Health Alert is a summary of the critical judgments, legislation, press releases and news items which have come to our attention each week. Many of the summaries will contain a hyperlink.
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Victorian Civil & Administrative Tribunal
Occupational & Business Regulation List – medical practitioners – unprofessional conduct – Health Professions Registration Act 2005 – Medical Practice Act 1994 s 3, s 45A
Shortly after giving birth at South Eastern Private Hospital, Mrs Siriwan began to haemorrhage. She passed away later the same day from post partum haemorrhage complicating amniotic fluid embolism. Her treating obstetrician Mr Lichter, and anaesthetist Dr Williams, were both found to have engaged in unprofessional conduct of a serious nature. They faced joint and separate allegations. They were jointly alleged of
- failing to assess and/or adequately address Mrs Siriwan's blood loss and haemodynamic instability;
- failing appropriately to manage Mrs Siriwan's continuing blood loss; and
- failing to address Mrs Siriwan's coagulopathy.
Mr Lichter was also alleged of inappropriately transferring Mrs Siriwan from the South Eastern Private Hospital to the Monash Medical Centre; and Dr Williams was alleged of failing to appropriately manage Mrs Siriwan's deteriorating condition before and during the transfer from the South Eastern Private Hospital to the Monash Medical Centre.
Two of the Victorian Civil Administrative Tribunal's key findings against Mrs Siriwan's Obstetrician Mr Lichter, which have general application to practitioners, are:
1. Inappropriate management when using an unorthodox method
The obstetrician inserted gauze vaginal packs in an attempt to stem the uterine bleeding. After observing the patient for approximately half an hour the obstetrician left the patient and returned to his rooms. The tribunal found that the obstetrician's management was 'woefully inadequate' because he:
- Failed to make a note of his observations in any of the relevant records';
- 'Left post-operative instructions for 'routine post-anaesthetic observations and intensive nursing' and no more' [when the patient was desperately ill], and
- 'Provided Dr Williams [anaesthetist] with no detailed handover, simply saying to him 'will you be here if anything happens in the meantime, otherwise I will be in my rooms'.
The tribunal took into account Mr Lichter's own lack of experience in performing this procedure found that he also should have remained with the patient longer or at the very least have ensures that the monitoring system set up was going to alert him if there were signs of deterioration.
2. Delayed decision making to transfer a critically ill patient
Mr Lichter decided to transfer Mrs Siriwan to a nearby private hospital for an emergency hysterectomy. He then reversed his decision and directed that she be transferred to the Monash Medical Centre.
In general comments the tribunal found that 'sufficient urgency' was not displayed to accomplish the transfer and 'too much weight was given to bureaucratic niceties.'
Further, it appeared to the tribunal that "Considerations relating to the insured status of Mrs Siriwan intruded upon Dr Lichter's reasoning processes." They found that in the circumstances of an emergency, and in light of the sentiments expressed by her husband, this was unprofessional.
The tribunal also made general comments about the conduct of the obstetrician in the proceedings.The tribunal were troubled by the Mr Lichter's tendency to lay the blame on others rather than taking responsibility himself.
Western Australia. State Administrative Tribunal
 WASAT 110 30/07/2010 LM and MM
The represented person had advanced dementia and was a resident in a nursing home. Her daughter had been appointed as her guardian. The daughter had been banned from the nursing home where her mother lived and the WA Administrative tribunal found that the relationship between the daughter and the nursing home had completely broken down. The tribunal found that the daughter could not perform her function as an objective guardian to consent to medical treatment on her mother's behalf. The Tribunal appointed the Public Advocate as an independent Guardian.
 WASAT 108 28/7/2010 SM
A person who was under a guardianship order in South Australia travelled to Western Australia for medical treatment of her foot. The Public Advocate applied for the appointment of a guardian in Western Australia to assist while the represented person was resident there.
The tribunal found that the woman was a person for whom a guardian could be appointed, as she was unable to make reasonable judgments about her person. However the tribunal was not satisfied of the need for a guardian in Western Australia because
A South Australian guardianship order is recognised in Western Australia under the Western Australian Guardianship and Administration Act 1990
On a practical level, the guardian appointed in South Australia had been able, with some difficulty, to arrange and consent to the medical treatment, the represented person's discharge from hospital and arrange for services on her behalf while she was resident in Western Australia.
- F2010L02320 - Health - These Rules amend the Private Health Insurance (Benefit Requirements) Rules 2010 in relation to Queensland and Western Australia and also reflect changes in Medical Benefits Schedule item numbers which commenced on 1 May 2010.
- F2010L02340 - Health - These Rules amend the Private Health Insurance (Complying Product) Rules 2010 by changing the amount for the Nursing-Home Type Patient contribution at public hospitals in Western Australia.
Australian Capital Territory
Health Legislation Amendment Act 2010 No. 2 - commenced on 16 August
New South Wales
Health Administration Regulation 2010(No. 427 of 2010)- Notification 13/08/2010
Public Health and Wellbeing Amendment Regulations 2010 (No. 79 of 2010) - Commencement
Assisted Reproductive Treatment Amendment Regulations 2010(No. 74 of 2010) - Commencement
Australia.Department of Health & Ageing
Private Health Insurance Circulars
Tobacco resources - List of tobacco-related resources.
Outcomes and proposed next steps: review of the access to allied psychological services component of the better outcomes in mental health care program - This report summarises the success of the ATAPS program to date, presents the outcomes of the review process and identifies key directions to refine and further improve the initiative.
Lifescripts resources - Resources to assist GPs and their practices to manage lifestyle-related risk factors
Joint TGA/PBD discussion paper on Similar Biological Medicinal Products (SBMPs) - closing date extended - A discussion paper regarding the regulation and reimbursement of Similar Biological Medicinal...
Australia. Therapeutic Goods Administration
Medical devices essential principles checklist (updated)
- Including IVD medical devices in the ARTG
- Classification of IVD medical devices
- Fees and charges for IVD medical devices
Australian Health Practitioner Regulation Authority
Media Release: Doctors urged to renew online - 19 Aug 2010 Statement from the Medical Board of Australia
SA Nurses & Midwives Registration Renewal Now Due - 16 Aug 2010 Statement from the Nursing and Midwifery Board of Australia
Australia. Private Health Insurance Ombudsman
20 Aug 2010 - New Factsheet: Mental Health - Private cover for psychiatric services, rehabilitation and psychology ... READ MORE
Australia. National Health & Medical Research Council
Australian Institute of Health & Welfare
Chronic kidney disease hospitalisations in Australia 2000-01 to 2007-08 - In 2007-08, chronic kidney disease (CKD) contributed to 15% (nearly 1.2 million) of all hospitalisations in Australia, one million of which were for regular dialysis. Indigenous Australians were hospitalised at ... Published 18 August 2010.
Australian Medical Council
Consultation on Competence-Based Education Paper- A new paper about Competence-Based Medical Education has been released for consultation. Read more...
Australian Commission on Safety and Quality in Health Care
12 August 2010 - Patient Safety in Primary Health Care
Australia. Private Health Insurance Administration Council
19 August Standard Operating Procedure - Accepting a Written Undertaking CURRENT EDITION 10/15
Australian Capital Territory. Department of Health
- ACT Health now offers best health equipment scheme in AustraliaKaty Gallagher, MLA August 13 2010.
New laws to regulate tanning units (27 July 2010) - From November, tanning units or sun beds will need to be registered as a source of radiation, amongst other changes.
ACT 2010 Health Promotion Awards (26 July 2010) - These awards recognise outstanding achievements and innovations in health promotion practice.
Training Management System Capability Policy - The TMS policy ensures that a centralised system is used across ACT Health to manage, record and report on learning and development activities. A global view of all learning and development activities across ACT Health from both internal and external providers (such as InTACT who provide training to ACT Health staff) will provide accurate data for planning of learning/training activities, measuring against key performance indicators of the ACT Health Business Plan, and meeting legislative requirements by reporting on essential education. All training, including eLearning and Self Directed Learning Packages (SDLP), conducted in ACT Health shall be recorded on the Training Management system ACT Health Capabiliti. The Policy contains a hyperlink to a Toolkit to assist ACT Health staff who wish to develop eLearning packages. All training courses, including eLearning, shall be recorded on the ACT Health Education Activity register. ACT Health-Wide - Human ResourcesCED10-023 Training Mgt System Policy(PDF File 586k) - Toolkit For Development Of Elearning Packages(PDF File 742k)
New South Wales. Department of Health
- NSW Measles Alert [20 August 2010]
- Director-General signs MOU recognising chaplaincy and pastoral care in NSW Hospitals[19 August 2010]
- Influenza - NSW Health Influenza Pandemic PlanPD2010_052 16/08/2010
- Commercial Building Energy Efficiency Disclosure (CBD)IB2010_043 17/08/2010
Queensland. Department of Health
- 19/08/2010 QIMR APPOINTS NEW DIRECTOR AND CEO
- 19/08/2010 STAFF ALL EARS AS VISITING PROFESSOR HELPS KICK-START TRIAL
- 19/08/2010 TOWNSVILLE HOSPITAL PROFESSOR A TOP FELLOW
- 13/08/2010 ROLL-OUT OF NEW SUPER-SIZED DENTAL VANS
Tasmania. Department of Health & Human Services
- Work Begins on $15 million Launceston General Hospital Car Park Minister for Health19 August 2010
- The Path to More Comprehensive Cancer Services on the North West Coast Minister for Health 18 August 2010
Victoria. Department of Health
- $7.6 MILLION FOR ABORIGINAL HEALTH IN MELBOURNE'S NORTH WEST - Wednesday, 18 August 2010 - Aboriginal Victorians in Melbourne's northern and western suburbs will have even better access to vital health services thanks to a new $7.6 million Brumby Labor Government plan.
- PUBLIC SECTOR MODEL FOR BOX HILL HOSPITAL CONSTRUCTION - Wednesday, 18 August 2010 - The Brumby Labor Government's $407.5 million redevelopment of Box Hill Hospital will be a public sector built project, Health Minister Daniel Andrews announced today.
- HENDERSON AND BAILLIEU USING FALSE EXCUSES TO BLOCK GEELONG HOSPITAL FUNDING- Wednesday, 18 August 2010 - Liberal Candidate for Corangamite Sarah Henderson has been caught out using false concerns as an excuse to refuse funding for the Geelong Hospital according to Minister for Health Daniel Andrews
- DOORS OPEN AT NEW BELMONT AMBULANCE STATION - Tuesday, 17 August 2010 - Residents in Geelong's southern suburbs have access to an even better ambulance service with the Brumby Labor Government today officially opening the new Belmont Ambulance Station.
- $265 MILLION BOOST FOR VICTORIAN HOSPITALS - Saturday, 14 August 2010 - Victorian hospitals will receive $265 million for new capital works projects and equipment as part of the historic health agreement between the Victorian and Commonwealth Labor Governments.
- Measles alert for GPs and emergency departments - August 2010 - 19 August 2010 - The Department of Health (DH) has been notified of 2 confirmed cases of measles in travellers who returned from South Africa on 3 August 2010.
Health Victoria August 2010 - Read latest edition
Western Australia. Department of Health
- 17 August 2010 Hames Goldfields nurse awarded for plan to fight post-natal depression in Brazil
New Zealand. Mental Health Commission
19 August 2010, Family, Whanau booklet available - 'When someone you care about has mental health or addiction problems' a guide for family, Whanau ... - + Read more
Canada. Health Canada
United States of America. Department of Health & Human Services
Review calls for new federal approach to medical countermeasures - U.S. Department of Health and Human Services Secretary Kathleen Sebelius today released an examination of the federal government's system to produce medications, vaccines, equipment and supplies needed for a health emergency, known as medical countermeasures.
United States of America. Centres for Disease Control
HHS/CDC Provides Additional Funding for All-Hazards State and Local Public Health Preparedness and Response- Public health agencies will receive a total of $698.2 million in the current fiscal year to help them strengthen their ability to respond to terrorism or natural disasters. (Published: 8/19/2010)
Teen Vaccination Rates Increasing Across the US - CDC survey provides estimates of coverage for adolescent vaccination at the national, state and selected local area levels.(Published: 8/19/2010)
Study Examines Heat Related Illness in High School Athletes- High school athletes are sidelined more than 9,000 days a year because of heat-related illnesses, according to a new CDC analysis. (Published: 8/19/2010)
Statement Regarding First Release of Global Adult Tobacco Survey Result by China- On August 17, 2010, China released its Global Adult Tobacco Survey (GATS) results. Many countries conduct surveys to monitor adult tobacco use, but until recently, no one standard global survey for adults has consistently tracked tobacco use, exposure to secondhand tobacco smoke, and tobacco control measures.(Published: 8/18/2010)
Australian Medical Association
Dr Steve Hambleton, Speech to the PHAA National Immunisation Conference 19 August 2010 - 5:00pm - The National Immunisation Strategy and General Practice - The AMA is a strong advocate for immunisation and it welcomes the review of the National Immunisation Strategy. It will provide an opportunity to develop a planning framework that will enable us to build on and enhance initiatives in immunisation and vaccine-preventable disease now and for the future.
Support Family Doctors campaign19 August 2010 - 4:00am - We've had a Great response to the 'Support Family Doctors campaign' and the more signatures we have to present to the government, the bigger the impact. If you have not yet signed the petition or would like to print out a copy for your patients to sign please visit our 'Support Family Doctors Website'
Time-based national access targets for public hospital emergency departments - 2010 19 August 2010 - 12:00pm This position statement sets out the principles the AMA considers should underpin the national introduction of time-based targets for public hospital emergency departments (EDs) in order that patient safety and outcomes, quality of care and the training of doctors are not compromised.
Competency-based training in medical education - 2010 16 August 2010 - 12:00pm
Telemedicine an important component of a modern health system 16 August 2010 - 1:00pm - The AMA welcomes today's commitment from Labor that, if elected, it would invest heavily in telemedicine to support and enhance health services as a part of a modern health system. AMA President, Dr Andrew Pesce, said the investment would assist doctors to better use communications technology to provide services to patients who would otherwise have limited or no access to these services. 'This is a recognition of the need to embrace communications technology to modernise our health system,' Dr Pesce said.
Privacy Resource Handbook 2010 16 August 2010 - 1:00am - The AMA has developed a Privacy Resource handbook to help doctors comply with the Privacy Act 1988. The Resource handbook is based on the Privacy Act 1988 in force as at 1 July 2010. The AMA intends to update this Resource Book if the proposed changes become law.
Asbestos remains a global health threat 15 August 2010 - 12:00pm - MJA media release - Asbestos remains a global health threat, with over two million tonnes produced in 2008. Developing countries are mining and importing asbestos for domestic use, according to an article published in the Medical Journal of Australia. Professor Peter Sly, Deputy Director of the Queensland Children's Medical Research Institute at the University of Queensland, and co-authors are calling for action to support the latest international effort to ban the mining and manufacturing of all forms of asbestos; to increase effective education of the dangers of asbestos; and to urge our legislators to increase their efforts to rid the world of asbestos-related disease.
Emerging bipolar treatments and new research are causing an upsurge in interest in the disorder 15 August 2010 - 12:00pm - MJA media release - Interest and awareness about bipolar disorder are slowly shifting, largely due to emerging treatments and research, according to an article in a supplement to the current edition of the Medical Journal of Australia. Prof David Castle, from the Department of Psychiatry at the University of Melbourne, Prof Michael Berk, from the Department of Clinical and Biomedical Sciences at the University of Melbourne, and Barbara Hocking, Executive Director of SANE Australia, examined emerging treatments for and research on bipolar disorder. Prof Castle said bipolar disorder is attracting an upsurge of interest among the general public and in clinical and research arenas, which is being driven largely by the emergence of a range of new pharmacological and psychological treatments.
Hospitalisation of patients with non-traffic injuries in NSW on the rise despite reductions in traffic injuries 15 August 2010 - 12:00pm - MJA media release - Hospitalisation rates for injuries due to non-traffic crashes among New South Wales (NSW) residents has increased over the past ten years, despite fatalities due to road crashes declining, according to a study published in the Medical Journal of Australia. Non-traffic crashes are those involving any vehicles that occur anywhere other than on a public highway. Dr Julie Hatfield and Dr Shanley Chong, from the NSW Injury Risk Management Research Centre at the University of NSW, with Dr Wei Du from the George Institute for International Heath at the University of Sydney, conducted a study to examine the trends in hospitalisation rates for injuries due to non-traffic crashes among NSW residents.
Prevalence of sleep-related breathing disorders linked to increases in obesity 15 August 2010 - 12:00pm - MJA media release - The worsening severity in sleep-disordered breathing is primarily attributable to increases in obesity, according to a study published in the Medical Journal of Australia. Dr Jeffery Pretto, Stephen Gyulay and Professor Michael Hensley, from the Department of Respiratory and Sleep Medicine at the John Hunter Hospital, Newcastle, and School of Medicine and Public Health at the University of Newcastle, conducted a study aimed at describing trends in sleep-disordered breathing (SDB) severity and whether incidences and severity changed in the Hunter New England region between 1987 and 2007. Dr Jeffery Pretto said that between 1987 and 2007, 14,648 new diagnostic sleep studies were performed.
President's email 13 August 2010 - 12:00pm - The AMA this week called on the major parties to commit to proper indexation of the Medicare Benefits Schedule (MBS) should they be elected on 21 August. We also sought a promise that there would be no further cuts to specific MBS items, as happened last year with cataract surgery, joint injections, cardiac angiography, pathology, and IVF procedures.
President's Blog, Friday 13 August 2010 13 August 2010 - 1:00pm - The next Government must make a significant investment in the MBS in order to stop shifting more and more of the cost of health care on to patients.
Primary Care Infrastructure Grant Scheme 13 August 2010 - 5:00pm - The Department of Health and Ageing is calling for applications under the Primary Care Infrastructure Grants Scheme.& Money is being made available to help GP clinics upgrade facilities and to provide new or additional facilities. Applications close on 20 August 2010. The AMA had prepared a guide for doctors considering applying.
edit Issue 71 - 16 August 2010 17 August 2010 - 12:00pm AMACDT's new leadership team; Election 2010; AMA health policy platform for Election 2010; AMA position statement on competency-based training; Online resources on doctors' health and wellbeing; Australian Curriculum Framework for Junior Doctors website resources; UN NGO conference: Advance Global Health; MJA job share noticeboard.
GP Network News Issue 10, Number 28 - 13 August 2010 13 August 2010 - 4:00pm - Let us know your views in Election 2010; Support Family Doctors petition; Support Family Doctors campaign materials; General practice lobby kit; Primary Care Infrastructure Grants Scheme - AMA guide; Healthy kids check needs stronger evidence base; AMA calls for proper indexation of the MBS and no further cuts to medicare rebates; AMA calls for action on Indigenous health;
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