Transcript: AMA (WA) President on the state of child and adolescent health | AMA (WA)

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Transcript: AMA (WA) President on the state of child and adolescent health

Friday October 13, 2023

As reported in The West Australian (11 October 2023):

Botched medical care cost six West Australian children their lives in the past year, a threefold increase as Perth Children’s Hospital struggles to cope with old equipment and shortages of both junior doctors and specialist staff.

The Child and Adolescent Health Service annual report — tabled in Parliament on Tuesday — reveals a litany of issues plaguing the State’s flagship kids’ hospital. Most troubling was a big spike in “SAC 1 events” that resulted in the death of patients in the care of CAHS, which runs PCH and other facilities dedicated to treating children and teenagers across the State.

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

There were 25 such events in 2022-23, down from 32 in the previous year. However, six SAC 1s resulted in the death of a patient in the past year — up from just two in the previous year.

A further two SAC 1s led to “serious harm” and seven caused “moderate harm”.

The report highlights infection control failures and medication mishaps as the two leading causes of SAC 1 events, with steps taken to address both.

AMA (WA) President Dr Michael Page spoke to ABC Mornings presenter Nadia Mitsopoulos on 11 October about the findings.

Reporter: Well, the spotlight continues to shine on the Child and Adolescent Health Service, which is in charge of Perth Children’s Hospital. Now, its annual report was tabled yesterday afternoon and it reveals that errors in medical care resulted in the deaths of six children in the past financial year. Now they’re referred to as SAC 1 (Severity assessment code 1) events, where harm or death is attributable to the care of the patient, rather than their condition. The report also outlines staffing shortages, and problems with old equipment. Now this all comes at a time when there are also questions about the sexual safety of people in the mental health ward inside Perth Children’s Hospital. And that comes after claims from a 13-year-old girl that she was raped while being treated there. Now we hoped to speak to the Health Minister Amber Jade Sanderson about this. She’s not available this morning. No one is available from the Child and Adolescent Health Service either. So instead, I’ll go to Dr Michael Page, who is the WA President of the Australian Medical Association. Good morning. Thanks for your time.

Dr Page: Good morning, Nadia.

Reporter: Now, last financial year, there were 25 SAC 1 incidents. Of those, six children died. And that compares to two deaths the year before. Is that cause for concern?

Dr Page: Of course, any death of a child is a tragedy, Nadia, and it’s incredibly distressing for the families and for doctors, nurses and others involved in their care. It’s important to note that the SAC system is really about transparency, and investigating underlying causes behind incidents that occur in the hospital, including deaths, in the case of SAC 1. Just because a death arises and is reported as a SAC 1 incident doesn’t mean that that medical care or lack of medical care directly led to that death; it might have been a contributing factor. So, without further details, and certainly there’s no further details contained in the Child and Adolescent Health Service’s annual report, it’s hard to know that that those deaths directly arose as a result of failures. But they might have been contributing factors. The really important thing with the SAC system is a transparent investigation, a no-blame system such that individual staff members are not jeopardised. Because if their careers are jeopardised, if they’re at risk of personal repercussions if they report something as a SAC event, then they’re not going to report them. So, the fact that they’ve reported is a good thing because it means they can be investigated. But transparency is also important. And we don’t have a lot of detail on these particular incidents.

Reporter: OK, if we look then also at some of the other issues that were raised, and it talks about staffing shortages: junior doctors, but also specialist staff. What’s the situation there?

Dr Page: As it is across the entire health system at the moment, Nadia, the staffing shortages in the Child and Adolescent Health system, including Perth Children’s Hospital, are dire. There are not enough nurses, there are not enough doctors. That’s what we’re seeing reflected in the emergency department waiting times, the elective surgery waiting list blowouts. Potentially in the SAC incidents, although again, there’s not enough detail in the report to conclude that for certain, but those are the sorts of things that tend to happen when you’re understaffed, and if you speak to virtually anyone who works at PCH, you’ll understand they are desperately, desperately short of staff.

Reporter: What do doctors tell you about how they’re feeling and the pressure they’re under?

Dr Page: Look, they’re burning out, Nadia. We surveyed all of the junior doctors in the State earlier this year and what we found from the Child and Adolescent Health Service in particular, was that levels of burnout were very, very high, dissatisfaction was high, and morale was low. To their credit, the Child and Adolescent Health Service executive team is working on initiatives to improve the morale and the situation for the junior doctors there, but actually there’s only so much you can do without more staff. No amount of creative solutions is going to cover the fact that they do not have enough doctors, they don’t have enough nurses. The hospital frankly isn’t big enough, doesn’t have enough beds and doesn’t have enough staff.

Reporter: Even with the amount of beds, and I know that criticism has been around from pretty much the moment that hospital was built, that it probably should have been another one or two floors, even with the amount of beds there, is it still short-staffed?

Dr Page: Absolutely. Yeah, absolutely right. It is still short-staffed for the size of the hospital. There’s no doubt at all.

Reporter: How do you get them though? Because the Government’s been trying. They’ve been looking overseas, they’ve been looking over east. What’s the answer here?

Dr Page: Look, interestingly, the Health Workforce Summit that was convened by the (Health) Minister and the Director General a  couple of months ago, and is still sort of ongoing in terms of the subsequent roundtable meetings that are still happening, was really designed to find ways to make, as they put it, WA Health an employer of choice, which is, a good aim to have. But unfortunately, the summit explicitly excluded talking about financial incentives as a part of making WA Health an employer of choice. Now, you look at any mining company that’s looking for FIFO workers, I think probably financial incentives are the first lever that they pull and for WA Health it’s the last lever. So, it’s really up to government to solve the crisis using every available lever, and the short- term lever that you have is financial incentives. Other states continue to pay significant bonuses for doctors and nurses to go and work over east. Our Government is not doing that to the degree that it needs to be, and it’s not really doing it at all in the metropolitan area. So, we actually need to see financial incentives to get us through this crisis. I don’t think it’s good enough to just say, well, there is a global shortage of doctors and nurses. The fact is the people of Western Australia deserve world-class medical care, and at the moment, it doesn’t look like they’re likely to continue receiving that in the longer term.

Reporter: Some people listening to you may argue, well, most doctors get a pretty decent wage.

Dr Page: I think you need to look at benchmarks around the country. Western Australian doctors aren’t necessarily the best paid. It’s also about nursing; we need more nurses as well as more doctors. And in the end, you have a crisis that needs that needs fixing. We do not have enough doctors. We can’t get psychiatrists to work in the child and adolescent health system. We have a mental health system in the child and adolescent space that is, I don’t want to overuse the word crisis, Nadia, but it really is in desperate circumstances, and they cannot get staff to work for them. And look at what that does to families. Look at what that does to families with children with behavioural problems, neurodevelopmental problems, who cannot get a diagnosis, that can’t get care. So, we also need to look beyond the child and adolescent health system, we need to look to get to supporting general practice to assist families with looking after children with these developmental and behavioural problems. But there’s historically always a disconnect between the WA health system and general practice because general practice is federally funded. They don’t seem to want to really engage. So, we need to see better engagement between general practice and the WA state-funded health system if we’re going to help these families.

Reporter: Dr Michael Page is my guest this morning. I wonder if you agree with what he is saying. He’s the WA President of the Australian Medical Association. I mean, we talk about the mental health and of course, you mentioned the fact that it’s hard to get psychiatrists to work in that system. Huge waiting lists, up to two years now but particularly Ward 5A, the mental health ward inside of Perth Children’s Hospital, and we’ve heard allegations last week from a 13-year-old girl saying she’s been, claiming she was raped there. There’s the annual report for the Mental Health Advocacy Service, they’re talking about other incidents that have been reported. What do you know about the challenges that staff are facing there? And is there a need for stricter guidelines inside that unit?

Dr Page: I think anyone who’s worked in mental health, particularly in patient care, understands the very difficult nature of that work, the very challenging nature of working with some of the patients who are at low points of their health journey, if you like. And it can be very, very, very difficult, and that flows onto the whole dynamic of the ward. So, look, you know, obviously those allegations are dreadful, very, very distressing for the families involved. But as you say, at the moment, well, as we know, the families, I suppose haven’t necessarily opted to have the details aired. Of course, that’s a matter for them. So, I guess there’s only so much we know about what occurred and what the mitigations have been since then. But again, you know, transparency where possible is key here to improving the culture of some of these environments. But it is very, very difficult. There’s no easy answer. We all know that Graylands Hospital, for example, in the adult mental health space has been a bit of a hot potato for decades. There’s always that tension between patients who require inpatient care and the need to also try to keep patients well in the community.

Reporter: I’ll leave it there. Appreciate your time.

Reporter: Many thanks, Nadia.