6 December 2010
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).
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The DLA Phillips Fox Health Team
New South Wales
NEGLIGENCE - surgeon carrying out varicose vein procedure - development of rare complication of lymphodoema - medical causation - failure by trial judge to analyse expert evidence - adequacy of reasons - failure to properly analyse factual evidence - breach of duty - failure to properly analyse competing medical evidence - causation - failure to provide adequate reasons for causation finding - EVIDENCE - treatment of expert witnesses - importance of expert evidence in court processes - PRACTICE AND PROCEDURE - responsibility of parties to conduct litigation efficiently - parties to co-operate in minimising expense of litigation.
In May 2003, the patient underwent a high ligation of the saphenous vein in the left groin and multiple avulsions on both legs by a general surgeon ('doctor'). At the time of consultation in September 2003, the patient had a 'unilaterally swollen leg' which failed to improve. Following referral to another doctor, the patient was diagnosed with 'a rather severe dose of lymphodoema in the left leg'. Despite some improvement, this remained permanently swollen and the patient was left with a chronic disabling condition. The patient commenced proceedings against the hospital (later dropped) and the doctor, alleging their negligence caused or materially contributed to the onset of her lymphodoema.
At the District Court his Honour held that the doctor failed to correctly diagnose the condition of pelvic venous reflux, and that she should have advised the patient of the possibility that the operation might cause the condition of lymphodoema, thus breaching her duty. The doctor appealed the decision as to liability and damages.
In relation to liability, the Court set aside his Honour's decision, finding that his Honour failed to accurately characterise the expert evidence provided and to properly analyse the factual and scientific issues. Furthermore, as the findings were never explained and were invalidated and distorted by a serious factual error, the decision could not stand. The Court also found that rulings made by his Honour caused relevant expert evidence to be ignored as the expert was thought to be 'unresponsive'. The case was remitted to the Supreme Court for a hearing on liability.
Other findings were made in relation to costs.
New South Wales. Nurses & Midwives Tribunal
Tasmania. Coronial findings
On 30 July 2008, a 79 year old woman died as a result of head injuries sustained in an unwitnessed fall from standing height. The cause of her death was subdural haematomas from this injury influenced by partial paraplegia from complicating spinal cysts and stroke.
On 14 July 2008 the woman was admitted to a hospital rehabilitation ward following partial paraplegia. A 'falls risk assessment' deemed her a 'medium risk' and appropriate treatment protocols were established. She was re-assessed and downgraded to a 'low risk'. The woman fell in her bedroom on 21 July 2008, and after her condition deteriorated she was transported to the hospital's Emergency Department. A CT brain scan showed extensive subarachnoid and subdural blood inter-cranially. After numerous intubations, she was transferred to another hospital where a subdural haematoma was removed and her brain was decompressed. The anaesthetic registrar queried a traumatic intubation by transporting paramedics. Surgery was successful however revealed a further subdural haematoma. The woman remained unconscious despite aggressive treatment in the ICU. A CT scan indicated the significant damage by the haemorrhages. The woman was extubated and later passed away.
The Coroner considered the woman's 'fall risk' may have been underestimated, and whilst not directly causative of her death, the Coroner said 'there was potential for problems to arise'. He acknowledged that the woman received timely care and commended the prompt attendance after her fall.
The Coroner recommended that the rehabilitation ward review their associated procedures, that the accuracy of daily treatment records be more closely monitored and that all health professionals ensure greater accuracy in note taking of important events in medical care.
New Zealand. Health & Disability Commissioner
National Health Act 1953 - Determination under subsection 84HA(1) (22/11/2010) - F2010L03119 - Health - This instrument determines the fee for an approved pharmacist, approved medical practitioner or an approved hospital authority who issues a concession card or entitlement card (or an additional or replacement concessional card or entitlement card).
National Health Act 1953 - Amendment determination under paragraph 98C(1)(b) - conditions (No. PB 111 of 2010) - F2010L03128 - Health - This Determination amends the National Health Act 1953 - Determination under paragraph 98C(1)(b) - conditions (No. PB 119 of 2008) to provide for changes to the conditions subject to which payment will be made by the Commonwealth in respect of the supply of pharmaceutical benefits by approved medical practitioners.
> National Health Act 1953 - Amendment determination under sections 93 and 93AA - pharmaceutical benefits supplied by medical practitioners (No. PB 110 of 2010) - F2010L03135 - Health - This Determination amends the National Health Act 1953 - Determinations under sections 93 and 93AA - Pharmaceutical benefits supplied by medical practitioners and authorised nurse practitioners (No. PB 103 of 2010) to provide for changes to the pharmaceutical benefits obtained by medical practitioners and authorised nurse practitioners to be supplied as emergency treatment and are supplied free of charge to patients.
National Health Act (Pharmaceutical Benefits - Early Supply) Amendment December 2010 - Specification Under Subsection 84AAA(2) (No. PB 119 of 2010) - F2010L03116 - Health - This Specification amends the National Health Act (Pharmaceutical Benefits - Early Supply) - specification under subsection 84AAA(2) Instrument 2009 (No. PB 30 of 2009) to list the medicines for which Pharmaceutical Benefits Scheme Safety Net entitlements will not apply when the next supply of the same medicine is obtained within 20 days.
National Health (Chemotherapy Pharmecuticals Access Program) Special Arrangement 2010 (PB No. 117 of 2010) - F2010L03139 - Health - This Arrangement facilitates the supply of chemotherapy pharmaceutical benefits at certain public hospitals to non-admitted patients, day patients and patients on discharge.
National Health (Listed drugs on F1 or F2) Amendment Determination 2010 (No. PB 112 of 2010) - F2010L03131 - Health - This Determination amends the National Health (Listed drugs on F1 or F2) Determination 2010 (No. PB 93 of 2010) to provide for allocation of drugs to the F1 and F2 formularies for the Pharmaceutical Benefits Scheme.
National Health (Listing of Pharmaceutical Benefits) Instrument 2010 (No. PB 108 of 2010) - F2010L03137 - Health - This instrument provides for the listing of pharmaceutical benefits on the Pharmaceutical Benefits Scheme.
National Health (Pharmaceutical Benefits Supplied by Public Hospitals) Amendment Determination 2010 (No. PB 114 of 2010) - F2010L03134 - Health - This Determination amends the National Health Act 1953 - Determination under subsection 99(4) (27/10/2006) to make minor consequential amendments, including moving certain pricing provisions about chemotherapy pharmaceuticals to the relevant section 100 pricing arrangement.
National Health (Price and Special Patient Contribution) Determination 2010 (No. PB 109 of 2010) - F2010L03136 - Health - This Determination revokes National Health Act 1953 - Determination under section 85B - Price determinations and special patient contributions (No. PB 72 of 2010) and provides for price determinations in relation to pharmaceutical items for which the Minister and the responsible person have not been able to make a price agreement and the circumstances in which the Commonwealth will pay the special patient contribution resulting from these price determinations.
National Health Act 1953 - Amendment Rules under subsection 99AAA(8) 2010 (No. 1) (No. PB 113 of 2010) - F2010L03129 - Health - These Rules amend the National Health Act 1953 - Rules under subsection 99AAA(8) (No. PB 49 of 2008) concerning claims for payment in relation to supply of pharmaceutical benefits.
National Health (Highly specialised drugs program for hospitals) Special Arrangement 2010 (No. PB 116 of 2010) - F2010L03140 - Health - This Arrangement provides for the supply of certain highly specialised drugs to patients receiving treatment at or from public or private hospitals having access to appropriate specialised facilities.
National Health (Paraplegic and Quadriplegic Program) Special Arrangement 2010 (No. PB 118 of 2010) - F2010L03133 - Health - This Arrangement concerns the supply of certain medicines for bowel management in people with paraplegia or quadriplegia.
National Health (Trastuzumab) Special Arrangement 2010 (No. PB 115 of 2010) - F2010L03141 - Health - This Arrangement concerns the supply of a pharmaceutical benefit that has the drug trastuzumab, to patients receiving treatment for early stage breast cancer in certain circumstances.
Health Services Amendment Regulation (No. 3) 20100 - commenced on 26 November 2010
Health Services Charitable Gifts Bill 2010 - introduced into the House of Assembly and received its second reading speech on 24 November 2010
Health Practitioner Regulation National Law (WA) Regulations 2010 - commenced on 27 November 2010 [Not available online]
Australia. Department of Health & Ageing
02 December 2010 - Celebrating Success in Indigenous Traineeships - An event on 2 December marked AFL SportsReady's 1,000th Indigenous trainee.
02 December 2010 - Health Reform Delivers More Beds and Better Care in Queensland Hospitals - Prime Minister Julia Gillard, Minister for Health and Ageing Nicola Roxon and Queensland Treasurer and Acting Health Minister Andrew Fraser have announced new funding for Queensland hospitals under the Australian Government's national health reform.
02 December 2010 - Redcliffe Gp Super Clinic Draws Closer - New health services are just around the corner for the Redcliffe community as the construction of the new, purpose-built Redcliffe GP Super Clinic continues ahead of schedule.
01 December 2010 - Funding Equipment to Fight Hearing Loss in Indigenous Children - The Australian Government is providing more than 400 pieces of medical equipment to help reduce the rate of hearing loss among Aboriginal and Torres Strait Islander children.
01 December 2010 - Making it easier to see your doctor – Boost for GP After-Hours - After-hours support from local GPs will be boosted in communities around the country following two announcements on 1 December by the Minister for Health and Ageing, Nicola Roxon.
01 December 2010 - New Medicines Available Through PBS from 1 December - Australians suffering from pancreatic cancer, prostate cancer, osteoporosis, bipolar disorder, or hepatitis C will be among those to benefit from changes to the Pharmaceutical Benefits Scheme (PBS) that come into effect on 1 December.
01 December 2010 - Pandemic Warning Decreased to Alert Phase - From 1 December 2010, Australia's pandemic phase moves from PROTECT to ALERT, signifying the end of the H1N1 influenza (swine flu) pandemic in Australia.
01 December 2010 - World AIDS Day 2010 - 1 December is World AIDS Day – an important opportunity to renew Australia's commitment to raise awareness and improve education about HIV.
30 November 2010 - Further Steps Taken to Implement Medicare Locals -The Australian Government has taken the next step in reforming Australia's health system and establishing a network of primary health care organisations – Medicare Locals – by releasing the latest draft of its planned geographic boundaries.
30 November 2010 - Mobile Phone Applications Could Help Revolutionise Health Care in Australia - Accessing a patient's record may be as easy as using a mobile phone application as the Government's investment in e-Health revolutionises health care in Australia.
30 November 2010 - Next Step for Telehealth Services for Patients - The Australian Government's investment in better connecting patients to specialist services through technology took a step forward on 30 November, with the release of a discussion paper seeking views on the most effective delivery for the scheme.
29 November 2010 - Over 1 Million Dental Checks have Teens Flashing Pearly Whites - Over one million dental checks have left Aussie teens with brighter smiles as a result of the Australian Government's Medicare Teen Dental Program.
29 November 2010 - Private Health Insurance Administration Council Members Appointed - The Minister for Health and Ageing, Nicola Roxon, has welcomed the appointments of three new members to the Private Health Insurance Administration Council.
Release of the Department of Health and Ageing's Incoming Government Brief - The Department has released redacted versions of the Incoming Government Brief under the FOI (Freedom of Information) Act 1982.
World AIDS Day 2010 - World AIDS Day is celebrated across Australia on 1 December to raise awareness in the community about the issues surrounding HIV/AIDS.
New: Rural Health Champions blog - Working in rural health is rewarding and challenging. The Rural Health Champions blog allows you to hear directly from doctors and students who share a passion for rural health. They provide first-hand accounts of personal and professional experiences living and working in rural Australia.
Private Health Insurance Circulars
Australia. Therapeutic Goods Administration
Guidance for IVD sponsors - a roadmap to market (footnotes updated)
Exporting medical devices from Australia (updated)
Transparency review of the TGA (updated and added panel membership)
Audit of medicine manufacturers (updated)
Update to Consultation Paper – Proposed amendments to the Therapeutic Goods Regulations 1990 to implement the Biologicals Framework (added revision to the proposed classifications rules)
Australia. Private Health Insurance Administration Council
10/22 01 December 2010 Standard Operating Procedure - Giving a Council Direction CURRENT EDITION 10/22 10/21 26 November 2010
New Disclosure Standard Requirements for Private Health Insurers - CURRENT EDITION 10/21
Australia. National e-Health Transition Authority
Mobile Phone Applications Could Help Revolutionise Health Care in Australia 30 November 2010. Accessing a patient's record may be as easy as using a mobile phone application as the Government's investment in e-Health revolutionises health care in Australia. A demonstration iPhone app has been developed to show how Doctors could access a patient's record easily with e-Health records including x ray results and allergies, making diagnosis quicker and safer.
Australia. Private Health Insurance Ombudsman
02 December 2010 - New factsheet: Clearance Certificates - What to do if you're thinking about transferring from one Australian health insurer to another....READ MORE
Australia. National Health & Medical Research Council
Australian Institute of Health & Welfare
Alcohol and other drug treatment services in Australia 2008-09: report on the National Minimum Data Set - Around 143,000 alcohol and other drug treatment episodes were provided in Australia in 2008-09. More episodes of this treatment were for alcohol than any other drug type, and this proportion ... Published 3 December 2010.
Age and the costs of dental care - Data from the National Dental Telephone Interview Survey 2004-06 and the Longitudinal Study of Dentists' Practice Activity 2003-04 was used to explore the relationship between age and the costs of ... Published 1 December 2010.
Self-rated oral health of adults - Adults were asked to rate their oral health in the 2008 National Dental Telephone Interview Survey (NDTIS) and this report examines their responses by various demographics including age, sex, education ... Published 1 December 2010.
Socioeconomic variation in periodontitis among Australian adults 2004-06 - The prevalence of periodontitis (inflammation of the tissue surrounding teeth) and its variation by socioeconomic status is explored, adjusting for age and sex. Data from the National Survey of Adult ... Published 1 December 2010.
Trends in access to dental care among Australian adults: in brief - The trends in dental care among Australian dentate (have some natural teeth) adults from 1994-2008 are investigated in this report, drawn from the National Dental Telephone Interview Survey (NDTIS) conducted ... Published 1 December 2010.
Trends in access to dental care among Australian teenagers - The trends in dental care among Australian teenagers from 1994-2008 are investigated in this report, drawn from the National Dental Telephone Interview Survey (NDTIS) conducted in 1994, 1996, 1999, 2002, ... Published 1 December 2010.
Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times - Australian hospital statistics 2009-10: emergency department care and elective surgery waiting times present's information relating to emergency department care in major public hospitals and public hospital elective surgery waiting times ... Published 30 November 2010.
Australian Medical Council
Australian and New Zealand medical councils signal shared future - The Australian Medical Council (AMC) and the Medical Council of New Zealand (MCNZ) have signed an agreement signalling a new stage in their 20-year history of collaboration. Click here to download the full media statement.
Australian Health Practitioner Regulation Agency
Media Release from Psychology Board - 02 December 2010 Statement from the Psychology Board of Australia
Victorian nurses and midwives renew now! - 26 November 2010
Australian Capital Territory. Department of Health
Supporting Canberra GPs Katy Gallagher, MLA November 30, 2010
Public holiday announcement Katy Gallagher, MLA November 30, 2010
Launch of Canberra's own Centre for Research and Action in Public Health Katy Gallagher, MLA November 26, 2010
New South Wales. Department of Health
Chronic Care for Aboriginal People [29 November 2010]
Greater Travel Assistance For Rural Patients [26 November 2010]
Coronial Checklist IB2010_058 30/11/2010
New South Wales. Health Care Complaints Commission
30 November 2010 - Annual Report 2009-10 tabled in Parliament
New South Wales. Bureau of Health Information
July to September 2010 (Volume 1, Issue 2) - This issue of Hospital Quarterly contains a special supplement comparing elective surgery and emergency department performance for patients in NSW public hospitals. Download main report
Northern Territory. Department of Health & Families
Kon Vatskalis - NT Health's Awards Show It's A Winning Workforce - The Department of Health and Families (DHF) and staff members have won several major workforce awards, including the title of National Employer of the Year (Government category) in the prestigious Australian Training Awards.
Queensland. Department of Health
26 November 2010 Qld Health Fellowship Winners
1 December 2010 Two weeks left to submit healthy ideas and share in $1.6 million
30 November 2010 Simple changes good for health (PDF, 54KB)
Whooping cough (pertussis) outbreak communiques
Tasmania. Department of Health & Human Services
Building Starts on North West Patient Accommodation Minister for Health 30 November 2010
Victoria. Department of Health
Statements of priorities for regional health services - 3 December 2010 - For the first time, 10 sub-regional health services in medium to large Victorian towns have agreed to a Statement of Priorities (SOP) with the Department of Health.
QualityCast series goes live - 26 November 2010 - The Department of Health's Victorian Quality Council (VQC) have released their first ever podcast series, QualityCast.
Memorandum of understanding between: the Victorian Department of Health, Mental Health, Drugs and Regions Division and the Victorian Department of Human Services, Children, Youth and Families Division in relation to Collaborative Service Delivery. August 2010 (PDF file 1.39MB)
Consultative Council for Human Research Ethics
Western Australia. Department of Health
2 December 2010 - Algal bloom warning for Flinders Bay, Augusta
1 December 2010 - Be prepared for summer heat
2 December 2010 Hames, Grylls $40.5million boost for Busselton Health Campus
29 November 2010 Hames, Marmion $1.17billion for new children's hospital
United Kingdom. Department of Health
United States of America. Department of Health & Human Services
Healthy People 2020 - Healthy People 2020 sets an ambitious, yet achievable, 10-year agenda for improving the Nation's health. Our vision: A society in which all people live long, healthy lives. Learn more at www.healthypeople.gov
HHS announces the nation's new health promotion and disease prevention agenda - The U.S. Department of Health and Human Services today unveiled Healthy People 2020, the nation's new 10-year goals and objectives for health promotion and disease prevention, and "myHealthyPeople," a new challenge for technology application developers.
Canada. Health Canada
Australian Medical Association
H1N1 Influenza Pandemic Status and Conclusion of the Pandemic Vaccination Program 2 December 2010 - 3:00pm - The Minister for Health and Ageing, on advice by the Chief Medical Officer, announced that as of 1 December 2010, Australia has moved to Pandemic Phase ALERT. This signifies the end of the H1N1 influenza pandemic in Australia. The key element of the ALERT phase is heightened vigilance for a new influenza virus or a change in a current circulating influenza virus, which may be of concern. While Australia will move to the ALERT phase from 1 December 2010, to ensure maximum coverage and use of the remaining vaccine, the pandemic (H1N1) influenza vaccine will remain freely available until 31 December 2010, when all of the stockpiled pandemic vaccine will have reached its expiry.
Sensible decision on after-hours GP care 1 December 2010 - 3:30pm - The AMA today welcomed the Government's decision to extend after-hours incentive payments for general practice until July 2013 when Medicare Locals and alternative after-hours funding arrangements are expected to be in operation. The Government will extend Tier 1 Practice Incentives Program (PIP) After-Hours Incentives for another two years. AMA President, Dr Andrew Pesce, said the funding extension would ease concerns around a possible two-year gap in funding for practices that currently provide after-hours care.
Get connected, stay respected 30 November 2010 - 11:00am - The AMA today released an online professionalism guide to assist doctors and medical students to maintain professional standards when using online social media. The guide – Social Media and the Medical Profession – was developed by the AMA Council of Doctors-in-Training (AMACDT), the New Zealand Medical Association Doctors-in-Training Council, the New Zealand Medical Students' Association, and the Australian Medical Students' Association. AMACDT Chair, Dr Michael Bonning, said today that evidence is emerging that the use of online social media can pose risks for medical professionals.
Are you maintaining professional standards online? 30 November 2010 - 11:00am - Inappropriate online activities can be detrimental to relationships with patients and colleagues, training and employment prospects, and personal integrity.
Take control of your privacy 30 November 2010 - 11:00am - Most social networking sites or blogs will have privacy settings enabling users to control (to some extent) how accessible their material is.
Consider the destiny of your data 30 November 2010 - 11:00am - Even if using the most stringent privacy settings, information on social networking sites may still be widely available, including to various companies and search engines.
Keep your friends close and others ... not so close 30 November 2010 - 11:00am - It is wise to avoid online relationships with current or former patients. Serious indiscretions may result in disciplinary action against the doctor.
Be careful about what you say and how you say it 30 November 2010 - 11:00am - Doctors have an ethical and legal responsibility to maintain their patients' confidentiality. This still applies when using any form of online tool.
Social Media and the Medical Profession 30 November 2010 - 11:00am - Introduction to Social Media and the Medical Profession: A guide to online professionalism for medical practitioners and medical students.
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