President’s Blog: Unsatisfactory SAC 1 process demands you take action if investigated | AMA (WA)


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President’s Blog: Unsatisfactory SAC 1 process demands you take action if investigated

Friday August 26, 2022

Dr Mark Duncan-Smith, AMA (WA) President

Almost precisely one year ago, on Saturday 28 August 2021, the AMA (WA) Action Agenda 2021 was launched.

It encapsulated many of my observations about necessary fixes to the health system, deliberately established at an early stage of my presidency.

Subtitled Our Crisis Call, my opening remarks in an open letter to the WA Government stated:

“The delivery of public hospital health services in Western Australia is in an unprecedented crisis by any measure.

This is not due to “unprecedented demand” or the pandemic. Hospital activity over recent years has increased in line with expectations and COVID-19 lockdowns have, in fact, resulted in fewer emergency department presentations.

The hospital system is paying the price of a persistent shift in focus to fiscal savings and cost cutting over service delivery. This has culminated in inadequate health system capacity, poor patient outcomes, reduced safety and quality, and unacceptable wait times.”

So, a year on (and lockdown now something of a distant memory), has our 15-point agenda been realised? An ambitious (though realistic) wish list hopefully has its share of wins among the inevitable losses.

Two major items are well on their way to realisation, once our public hospital Industrial Agreement is ratified.

We asked for permanent contracts for WA Health senior doctors, arguing fixed-term contracts of five years or less were fuelling “a toxic culture of fear in our public hospital system”, contributing to poorer-quality health services outcomes and compromising doctor wellbeing.

We asked that WA Health “comply with the law and recognise entitlements and service transfer for doctors in training (DiTs) who transition to senior doctor positions, where there is no break in service”.

In addition, to “implement a system where WA Health doctors are able to retain accrued entitlements when they break service with WA Health due to the inherent nature of medical training and practice (e.g. interstate or overseas training opportunities).”

They are big and long-sought improvements to conditions. Improvements to wages are another matter but we continue to work for better outcomes in an environment of exploding cost-of-living increases.

There were two items relevant to quarantine facilities. We asked for an interim quarantine facility, as well as a Commonwealth facility.

Well, hotel quarantine has now ended and no interim facility ever eventuated, even though some basic air-gapped dongas would have done the trick. As for the Commonwealth facility, well, it’s opening any minute now in Bullsbrook. There’s already talk of it being repurposed for migrant workers. At least we’ll (eventually) have a facility available for the next health emergency that requires isolation…

We asked for 612 more public hospital beds, to bring us up to the national average. At the time we were languishing at the bottom of the table compared to other states. The Government continues to announce additions to their tally heading towards their goal of 530 new hospital beds to open by October this year. New, old, simply reopening beds previously closed, take your pick on the semantics. The Government seems comfortable with ‘beds’ in corridors.

We’d argue that the continued strain on the system suggests the beds and the budgeted money for health (our ask was 5-6 per cent per annum for four years) are simply not keeping up with demand, and leaving our doctors extremely stressed and demoralised.

One crucial ask was that investigation and reporting of Severity Assessment Code 1 (SAC 1) incidents be protected by legal privilege.

WA Health defines SAC 1 clinical incidents as “clinical incidents that have or could have (near miss) caused serious harm or death that is attributable to health care provision (or lack thereof) rather than the patient’s underlying condition or illness”.

So, a year on, can what you say at a SAC 1 investigation be used against you in a court of law……. SURE CAN !!!!
Can it be used to report you to the Australian Health Practitioner Regulation Authority (Ahpra) ….. SURE CAN !!!!
Can plaintiff lawyers get a SAC1 investigation and easily identify who doctor 1 and doctor 2 are…… SURE CAN !!!!

SAC1 Investigations are vital, but their role is to identify system faults that result in errors and then resolve those faults. In the aviation industry, plane crashes and near misses are a no-fault investigation to ensure evidence is full and frank, and thereby maximise the effectiveness of the investigation.
We have all seen the ‘throwing under the bus’ reporting of the Perth Children’s Hospital doctor based on their SAC 1 evidence. Individual doctor performance should be an HR investigation where everyone is aware of the terms of reference and consequences.

I am working with WA Health and Government to improve the investigation system, to maximise the probability of the medical system being able to be improved with said investigations.

If you are attending a SAC 1 investigation, I would highly recommend talking to your MDO first, talking to the AMA (WA), and /or consider having a lawyer present until a safer and better investigation system emerges for all. In the end, actions speak louder than words.