SSWAHS - Dr Victor Storm - Deaths in Mental Health Custody

Socrates notes the sentiment expressed by Dr Victor Storm about the death of a young woman in the UK mental health system. In this article published widely by the National Times last year, Dr Storm moralises on the dilemma faced by his colleagues in the UK: "There is a delicate balance between keeping someone under surveillance and giving someone the autonomy to control their own destiny."

He also then states in the same article: "To allow someone to die as this young woman died runs counter to what other clinicians and I attempt to avoid daily: an unnecessary death."

Then comes the extraordinary denial of responsibility: "Sometimes our treatment efforts are not successful. Occasionally people do kill themselves while we are trying to treat them. This may occur because an individual does not tell us what they are planning. At other times, a sensible plan of leave or community care has been decided upon but the situation changes abruptly or a person reverts to a sense of despair and does not seek further help.

Sometimes errors of judgment, or reasonable decisions made on limited information, lead to an adverse event.

Deaths occur in spite of the efforts made by clinicians because of the nature of the illness. Our tools of prediction are not precise. Human behaviour is immensely variable."

Socrates has to say: "Who should be held accountable in this case when death occurs? The medical staff who control the patient's treatment - or the patient whose mental state is deemed to be sufficiently impaired that they are involuntarily admitted to a psychiatric facility by doctors who then, presumably, accept a duty of care for the patient? In my book the very act of detaining a person under the Mental Health Act places the responsibility for the care and protection of that patient clearly and squarely in the hands of the treating doctors.

Perhaps Dr Storm, instead of pointing the accusatory finger at the flaw in the UK Mental Health Act that allowed this death to occur, should look at his actions and those of other medical staff in his SSWAHS Clinical Division, that have led to more than one unnessary death: "Sometimes a person self-harms or commits suicide when moving from hospital to home. This always leads to soul-searching by clinicians. Sometimes recriminations from families are inevitable; as clinicians, we have to accept that. But we also have a responsibility to care and treat - even if our treatment is sometimes controversial."

Victor Storm

October 4, 2009
National Times Newspaper

A young Englishwoman was allowed to commit suicide in hospital over four days. Kerrie Wooltorton had a history of mental illness and had made multiple attempts on her life. Yet it was deemed she had the mental capacity to refuse treatment.

That refusal was legally binding on hospital doctors under the provisions of the British Mental Capacity Act.

The coroner, William Armstrong, found that the doctors involved with her care had acted lawfully by not trying to save her life. Otherwise they may have faced sanction under the Medical Practice Act, been liable to deregistration and charged with assault.

''She had capacity to consent to treatment which, it is more likely than not, would have prevented her death,'' Armstrong said. ''She refused such treatment in full knowledge of the consequences and died as a result.''

Wooltorton was 26.

It is an invidious situation for health professionals to find themselves in. The matters surrounding Wooltorton's death and the coronial inquiry are disturbing. The death by self-poisoning of a disturbed and depressed young woman was sanctioned - a situation that I hope is never repeated.

Medical practice laws in Britain and NSW have many similarities, but we are fortunate that under current legislation in this state a similar situation would not receive legal sanction.

Mental capacity assessments here do not include a legal right to commit suicide in the way Wooltorton chose. If such a clinical situation were to arise in a NSW hospital, the Mental Health Act should usually be invoked and resuscitative treatment given.

Is this a draconian denial of an individual's rights? I think not. There are important reasons for us to reject the legalistic argument used in Britain.

I am a psychiatrist who has worked in mental health for 30 years. I have treated people with complex disorders who have made multiple attempts at suicide, recovered and been grateful for the ongoing care that allowed them another chance to lead a satisfying life. This experience is common for most clinicians.

To allow someone to die as this young woman died runs counter to what other clinicians and I attempt to avoid daily: an unnecessary death.

We are faced regularly with individuals who suffer significant depression and despair for extended periods. People may express a wish to die, and some might make multiple attempts on their lives, but most clinicians will try as hard and as long as they can to help ease a person's suffering and bring on recovery.

In most instances, clinical intervention is successful. Most people who seek the support of our services recover and get on with their lives. It is important for the wider community to understand that even those who suffer serious depression associated with other mental health problems generally get better, even if it takes some years.

Sometimes our treatment efforts are not successful. Occasionally people do kill themselves while we are trying to treat them. This may occur because an individual does not tell us what they are planning. At other times, a sensible plan of leave or community care has been decided upon but the situation changes abruptly or a person reverts to a sense of despair and does not seek further help.

Sometimes errors of judgment, or reasonable decisions made on limited information, lead to an adverse event.

Deaths occur in spite of the efforts made by clinicians because of the nature of the illness. Our tools of prediction are not precise. Human behaviour is immensely variable.

Families and friends suffer enormously when people commit suicide - and society as a whole is diminished. There is a place for compulsory treatment. There is a need for persistent attempts to involve depressed and disturbed individuals in some form of ongoing psychological and psychiatric care. Temporary deprivation of liberty under a mental health act may be required.

There is a delicate balance between keeping someone under surveillance and giving someone the autonomy to control their own destiny.

Sometimes a person self-harms or commits suicide when moving from hospital to home. This always leads to soul-searching by clinicians. Sometimes recriminations from families are inevitable; as clinicians, we have to accept that. But we also have a responsibility to care and treat - even if our treatment is sometimes controversial.

Even if Wooltorton had no current sense of hope, there would have been good grounds for us to work towards her recovery.

Her suicide is quite different from people who decide to cease active treatment when their lives are ending due to general debility or failure of bodily systems and there is no feasible possibility of recovery.

Her death leaves a nagging doubt: that in spite of what she said verbally and in writing, she took measures of self-harm that were not immediately fatal. She asked to be in hospital, where she could have received treatment and another chance at life.

Perhaps her non-verbal cues were missed. Her father has expressed a wish that the mental capacity law be changed. I support his wish. I am grateful no such law exists in NSW.

Associate Professor Victor Storm is clinical director of mental health at the Sydney South West Area Health Service. For help, call Lifeline on 13 11 14.

Perhaps Dr Storm would like to give another article to the National Times in which he would like to give the number of patients, actively in the care of the SSWAHS Mental Health Service, who have died in one of his mental health facilities, or while on approved leave from one, or in the care of his community mental health teams after they have returned home.

Let us see if it is only the UK mental health system that misses "the non-verbal cues" of their patients. Then I would like to see how much soul-searching by SSWAHS clinicians takes place, and what explanation has been given to the families of those who have died while in the care of SSWAHS.

SSWAHS - Dr Victor Storm and those problems of files lost in the public domain!

Socrates's internet trawl to find even more evidence of the stumbling efforts of SSWAHS to manage even the simplest tasks came up with this gripping expose by "The Age" newspaper about the time when Dr Storm was doing his best to organise the transfer of the Rozelle "asylum" to his new Concord "asylum" - the one that he thought the Liberal Party should not build in 2002!

Private files put on street for all to read

Matthew Moore "The Age"
Freedom of Information Editor
May 6, 2008

PLASTIC wheelie bins full of confidential documents were left outside Rozelle Hospital in a last-minute rush to move the hospital to its new site at Concord.

Staff records, including details of criminal convictions and personal medical histories, were jammed into the bins along with minutes of meetings and disciplinary proceedings.

A letter lying at the top of one of the bins details an altercation in January 1991 between a cleaner and his supervisor, who had asked him to clean some windows.

"Mr A [name deleted] … threw a garbage tin of rubbish on the ground and also said he would kill Mr S … [name deleted]," an exasperated manager notes.

Other documents detail the property staff members have failed to return over decades.

Records from the Child Support Agency detailing maintenance deductions the hospital was required to make for individual employees are also included in the thousand of pages of personal documents.

Anyone wandering through the open hospital grounds, popular with dog walkers, was free to leaf through decades of documents left in the driveway of the administrative and information building, which closed its doors at the site last week.

Half a dozen wheelie bins left in the driveway of the administration block were locked but six others were open or secured only with adhesive tape applied by desperate staff members unable to get enough bins to secure documents they knew to be confidential. Two of those bins carried notes headed "Confidential documents".

The notes, written by a staff doctor, Graeme Halliday, said: "To Whom It May Concern, Ive been requesting confidential paper bins for at least a week before the hospital closed but could not get any. Transport kindly delivered these on Thursday May 1st, but I didnt realise until I had filled them - they are in fact not for the disposal of confidential documents. Quite happy to return to help transfer these to confidential bins if someone can help me obtain these."

Yesterday Dr Halliday was furious the bins had been left outside the building and said he had done his best to ensure their contents were properly disposed of.

He said he had worked until midnight on Saturday trying to dispose of documents he had no time to finish packing as he had had a full patient load during preparations for the move.

He had left all the bins locked inside the building on Saturday night and was uncertain who had moved them outside.

Dr Halliday drove immediately to Rozelle Hospital when he heard the documents were outside to ensure they were secured.

In other parts of the hospital grounds staff record cards spilled from torn plastic bags before a compactor truck arrived yesterday afternoon.

The director of mental health for the Sydney South West Area Health Service, Dr Victor Storm, said only two normal bins had been used for confidential waste. The bins had been put outside by accident yesterday morning.

"Both the secure and general waste bins have since been locked away, and a collection is now expected later this week."

I suppose we should be grateful that "only two normal bins had been used for confidential waste."

There, doesn't that make us all feel better? Obviously, Dr Storm and SSWAHS seem to think so.

SSWAHS - Dr Victor Storm, and the backflip of the decade!

Socrates has noted that there has been some more interesting "spin" from Dr Storm, who now presides over his far-flung empire from his new Centre for Mental Health at Concord Hospital. This is his take on the changing world of psychiatry in 2002 when the NSW Liberal Party gave consideration to re-building a new mental health facility on the grounds of the (then) existing Callan Park site at Rozelle. At that time Dr Storm railed against the notion of building a new "asylum" for the mentally ill saying, in part, that "It completely contradicts best practice in mental health care, which supports integration of acute psychiatric care into mainstream general hospitals."

Hmmm! This is strange coming from the person now in charge of "a 400-bed hospital on the (Concord) site (which) would create the biggest stand-alone mental health facility in Australia."

I suppose calling a 400-bed inpatient mental health facility a "Centre" instead of a "Hospital" gets around the embarrasment of having achieved with a NSW Labor Government something that Dr Storm, in 2002, did not want to achieve with a NSW Liberal Government. Ah well! Come March 2011, the political landscape could be quite a different colour.

New 'asylums' no answer to mental illness

By Victor Storm
April 22 2002

A proposal, reported in the Herald, (Psychiatric care gets $80m boost in Lib health plan, April 9) to rebuild a new 400-bed psychiatric facility on the Rozelle Hospital site in Callan Park, in Sydney's inner west, should be ringing alarm bells everywhere.

A 400-bed hospital on the site would create the biggest stand-alone mental health facility in Australia. It completely contradicts best practice in mental health care, which supports integration of acute psychiatric care into mainstream general hospitals. Other Australian states and most other countries are closing their stand-alone facilities and not building new ones. Victoria, for example, no longer has freestanding psychiatric hospitals.

When people attach a huge stigma to mental illness, they prefer to lock away patients behind closed doors. We need to reduce the stigma associated with mental illness, as it affects all of us.

Mental illness is increasing in incidence and in economic cost to society.

The figures are stark. By 2020, major depression will be one of the two most prevalent diseases worldwide. Only cardiovascular disease will exceed it in numbers and in burden to society. Already mental illnesses, excluding drug and alcohol abuse, account for four of the top 10 causes and 30 per cent of the total burden of chronic disability in Australia.

The move of mental health facilities into general hospitals is not new. It has been part of mental health policy in Australia and worldwide since the 1950s. The Richmond report, published in 1983, further accelerated the move towards de-institutionalising care.

The National Mental Health Strategy includes changing the service mix from stand-alone facilities to integrated community and hospital services. It has also brought consumers, carers and clinicians closer together to improve the care given to the public.

At Rozelle Hospital, regarded as one of NSW's lead agencies in mental health-care delivery, we struggle to provide modern and safe care in buildings which date back to the 1920s. Once, thousands of patients were locked away and cared for long term in an asylum.

Many people associate long-term asylum care with tabloid horror stories. Fortunately, the findings of the Royal Commission of Inquiry into Callan Park Mental Hospital are far behind us.

Psychiatric inpatients are very ill. Mental health services all over the world are struggling to cope with patients whose illness is complicated by illicit drug use and sometimes associated violent behaviour.

While this is a challenge for all involved in the care of the mentally ill, the answer is not to reinstate the old asylums. The reasons to move the focus of care away from institutions remain sound.

Most people who live with a chronic mental illness do not want to be quarantined in large 19th-century asylums. They want access to 21st-century care in modern hospitals when they need hospital care, with the ability to live in appropriate housing, like any other citizen, for most of the time. To achieve this we need more quality supported accommodation and group homes throughout metropolitan Sydney and regional NSW.

We propose to upgrade most of our inpatient services at Rozelle service by moving them to new state-of-the-art facilities at Concord. The psycho-geriatric nursing home beds will be moved to another nearby site.

As well as reducing the stigma associated with mental illness, mainstreaming the patients allows us to treat the whole person and to attend to all relevant health problems.

As in all fields of medicine, new and powerful drugs are a major component of the treatment of most ill people. These patients require careful assessment and monitoring. They need access to diagnostic services and to treatment for other illnesses. People with mental illness often neglect their general health and it isn't until they become inpatients that we effectively manage co-existing illness, such as diabetes or hypertension. This overall treatment is best carried out in a general hospital.

We admit 2,200 patients to Rozelle each year. Each month 80 people are admitted to general hospital for care and treatment. We have to transport 100 a month for imaging and other investigations and conduct 1,500 pathology investigations. These investigations should be carried out on one site.

The proposals to move services at Rozelle to the Concord campus go a long way to addressing the hospital treatment needs. Accommodation and support services outside of hospital must also be addressed to provide people with appropriate care options.

Everyone involved in mental health foresees future care as a major challenge.

Dr Victor Storm is a psychiatrist and clinical director of mental health services at Central Sydney Area Health Service.

SSWAHS - Dr Victor Storm - The Federal Government's not the only one to ignore a significant need!

Socrates found this piece of spin by Dr Victor Storm, the SSWAHS Executive member who seems more interested in protecting his poor performing senior staff members who fail in their duty towards the consumers of their mental health services. Instead of decrying the lower Federal budget commitment to mental health, perhaps Dr Storm should be less committed to building his SSWAHS empire's infrastructure (his Concord Centre for Mental Health Services) and for machines that go "ping" he should use some of funds his Area Health Service gets from the State and Federal governments on those integrated specialist community-based mental health services that he suggests will be championed by the likes of Morris Iemma.

Socrates finds it somewhat prophetic of Drs Storm and O'Connor seemed to pre-empt the choice of the current NSW Premier in the recent selection of Morris Iemma to one of the key positions in the NSW Local Health Networks.

Budget has ignored a significant health need
Nick O'Connor and Victor Storm
May 14, 2010

Have Kevin Rudd and Nicola Roxon forgotten about mental health? You are certainly left with this impression after the budget and health reform announcements.

There is nothing in the budget for mental health. Little came out of the Council of Australian Governments negotiations except for some important but hardly central enhancements for youth mental health and expanded access to psychological services for people suffering anxiety and other high-prevalence disorders.

Mental health represents more than 10 per cent of community morbidity, yet it received only 2 per cent of the health reform funding increases.

The Senate select committee inquiry into mental health called for its budget to be 9 to 12 per cent of the health budget by 2012. This now looks impossible.

Even more concerning is the split of community services from acute hospital services and the dismantling of area health services. This could break up the integrated mental health services it has taken decades to build. That would be a catastrophe for mental health, which at federal and state levels has seen opportunities for real improvement slip away.

The COAG meeting asked for a report on mental health next year, seemingly because at the last minute the Commonwealth realised its schema for the health system - which included acute hospitals, primary and community care and a sub-acute sector - failed to acknowledge the pivotal importance of specialist community mental health services.

These clinicians care for a large number of people living with serious mental illnesses such as schizophrenia. Some work in inpatient and community settings, some do intensive follow-up and treat people in their homes and community centres.

Despite growing need in most states, and NSW in particular, these services have not been improved for decades. They are the backbone that supports young people who need continuing care and they are at breaking point.

How could this omission happen? How could some of the most marginalised in our society be ignored? Every politician in our parliaments - state or federal - knows someone who needs specialist mental healthcare. Too many don't get it.

Several steps are necessary if Australia's mental health services are not to become a disaster - a champion, a plan and three enabling conditions.

We need a champion, much like Morris Iemma was on this issue when dealing with the Commonwealth as premier in 2006.

We need agreement on the mental health priorities. Nationally, it is a complex jigsaw of human services - disability, employment, housing, GPs, hospitals, services for children, youth and older people, prevention - all have a role.

Central to it are integrated specialist community mental health services. To date, there have been four national mental health plans and still we have no coherent national plan for delivering specialist mental healthcare.

The general principles and core requirements are generally understood by consumers, carers and clinicians. We need to increase community understanding of mental health problems, and do more prevention. We need more services for younger and older Australians and recovery programs to provide intensive treatment in the community, with secure housing and employment to sustain that recovery.

The states and territories need to articulate these priorities in a 10-year plan, and implement it. And we need to manage three barriers to such a plan.

Specialist mental healthcare is best delivered when integrated, including local community services, hospitals and specialty programs. These can be aligned with the new local hospital networks but need co-ordination at state level and to be administered regionally - where tertiary services cover a cluster of local networks. There appears to be sufficient wriggle room in the COAG communique to allow for this sort of arrangement.

Mental health funding needs to be quarantined to stop its being siphoned off and the shortage of mental health nurses and doctors needs to be reversed.

Mental health is dressed up ready to go to the big health ball. She is just waiting for a strong and courageous partner.

Dr Nick O'Connor and Associate Professor Victor Storm are Sydney psychiatrists, representing the NSW branch of the Royal Australian and New Zealand College of Psychiatrists.

SSWAHS - Dr Victor Storm - The Federal Government's not the only one to ignore a significant need!

Socrates found this piece of spin by Dr Victor Storm, the SSWAHS Executive member who seems more interested in protecting his poor performing senior staff members who fail in their duty towards the consumers of their mental health services. Instead of decrying the lower Federal budget commitment to mental health, perhaps Dr Storm should be less committed to building his SSWAHS empire's infrastructure (his Concord Centre for Mental Health Services) and for machines that go "ping" he should use some of funds his Area Health Service gets from the State and Federal governments on those integrated specialist community-based mental health services that he suggests will be championed by the likes of Morris Iemma.

Socrates finds it somewhat prophetic of Drs Storm and O'Connor seemed to pre-empt the choice of the current NSW Premier in the recent selection of Morris Iemma to one of the key positions in the NSW Local Health Networks.

Budget has ignored a significant health need

Nick O'Connor and Victor Storm

May 14, 2010

Have Kevin Rudd and Nicola Roxon forgotten about mental health? You are certainly left with this impression after the budget and health reform announcements.

There is nothing in the budget for mental health. Little came out of the Council of Australian Governments negotiations except for some important but hardly central enhancements for youth mental health and expanded access to psychological services for people suffering anxiety and other high-prevalence disorders.

Mental health represents more than 10 per cent of community morbidity, yet it received only 2 per cent of the health reform funding increases.

The Senate select committee inquiry into mental health called for its budget to be 9 to 12 per cent of the health budget by 2012. This now looks impossible.

Even more concerning is the split of community services from acute hospital services and the dismantling of area health services. This could break up the integrated mental health services it has taken decades to build. That would be a catastrophe for mental health, which at federal and state levels has seen opportunities for real improvement slip away.

The COAG meeting asked for a report on mental health next year, seemingly because at the last minute the Commonwealth realised its schema for the health system - which included acute hospitals, primary and community care and a sub-acute sector - failed to acknowledge the pivotal importance of specialist community mental health services.

These clinicians care for a large number of people living with serious mental illnesses such as schizophrenia. Some work in inpatient and community settings, some do intensive follow-up and treat people in their homes and community centres.

Despite growing need in most states, and NSW in particular, these services have not been improved for decades. They are the backbone that supports young people who need continuing care and they are at breaking point.

How could this omission happen? How could some of the most marginalised in our society be ignored? Every politician in our parliaments - state or federal - knows someone who needs specialist mental healthcare. Too many don't get it.

Several steps are necessary if Australia's mental health services are not to become a disaster - a champion, a plan and three enabling conditions.

We need a champion, much like Morris Iemma was on this issue when dealing with the Commonwealth as premier in 2006.

We need agreement on the mental health priorities. Nationally, it is a complex jigsaw of human services - disability, employment, housing, GPs, hospitals, services for children, youth and older people, prevention - all have a role.

Central to it are integrated specialist community mental health services. To date, there have been four national mental health plans and still we have no coherent national plan for delivering specialist mental healthcare.

The general principles and core requirements are generally understood by consumers, carers and clinicians. We need to increase community understanding of mental health problems, and do more prevention. We need more services for younger and older Australians and recovery programs to provide intensive treatment in the community, with secure housing and employment to sustain that recovery.

The states and territories need to articulate these priorities in a 10-year plan, and implement it. And we need to manage three barriers to such a plan.

Specialist mental healthcare is best delivered when integrated, including local community services, hospitals and specialty programs. These can be aligned with the new local hospital networks but need co-ordination at state level and to be administered regionally - where tertiary services cover a cluster of local networks. There appears to be sufficient wriggle room in the COAG communique to allow for this sort of arrangement.

Mental health funding needs to be quarantined to stop its being siphoned off and the shortage of mental health nurses and doctors needs to be reversed.

Mental health is dressed up ready to go to the big health ball. She is just waiting for a strong and courageous partner.

Dr Nick O'Connor and Associate Professor Victor Storm are Sydney psychiatrists, representing the NSW branch of the Royal Australian and New Zealand College of Psychiatrists.

SSWAHS - Mr Scott Fanker and the NSW Health Care Complaints Commission

Socrates again looks at how a complaint from a dying Southern Highlands woman, supported by a concerned person, can be ignored by an unfeeling SSWAHS Executive - until after she had died. Then the complaint against one of their own was dismissed because the victim of the behaviour was now dead. How callous is that!

Mr Ian Thurgood

Director

Complaint Assessment Branch

Health Care Complaints Commission

Locked Mail Bag 18

Strawberry Hills NSW 2012

12 April 2010

Dear Mr Thurgood,

Thank you for your response to my complaint in which I act as an advocate for the late Ms B P. On the basis of the information provided in your response I wish to request a review of the decision the Commission has taken for not proceeding.

I must confess that I remain appalled at the way in which the SSWAHS has dealt with this serious complaint and the way in which it dealt with the original complaint made by Ms B P in 2007.

In respect of my complaint lodged with the Commission in November 2009 I made the following statement:

“In late 2007 or early 2008 the person affected and named above was a client of the Bowral Community Mental Health Service. She was being treated by a psychiatrist at the Browne Street Community Mental Health Service with whom she had elected to be treated while she remained residing in her home at Bundanoon. She had formed a good therapeutic relationship with that doctor who, nevertheless, requested care coordination and support be offered to the patient by the local Bowral Mental Health Service.”

In your response you note that I reported that Ms B P had reported her concerns about the alleged professional misconduct by Mrs T K, her assigned care coordinator in late 2007. I recall making a record of Ms P’s exchanges of text messages with me and placing a transcript of the messages in her file, at that time held at the Bowral Community Health Centre. I am unable to confirm the exact dates and the exact content of those text messages because I do not have access to her clinical file. I do note that I did enter the complaint in the NSW Health incident reporting system (IMMS) which would have made it available to the SSWAHS Area Executive and the Area Mental Health Service. A record of the incident and its subsequent management would be available on the electronic history of the incident held by the SSWAHS and NSW Health.

I suggest that if the Commission gained access to the clinical file of Ms BP and of the IMMS report of the alleged incident of professional misconduct they would have a better understanding and timeframe of the events associated with the original complaint made by Ms BP.

Mr Thurgood, there are some issues with the SSWAHS response which, singly and collectively, cause me great concern.

When the issue of the alleged professional misconduct was first raised by Ms B P and lodged with the electronic incident monitoring system, Mrs T K was still employed by SSWAHS. I can confirm that she was asked by me to withdraw from her role as care coordinator to Ms B P as a result of my receiving the texted information which was recorded in the clinical notes. Mrs T K was advised that this was due to a complaint received although she was not informed of the substance of the complaint. She was, however, informed that the complaint would be investigated. Subsequently, Mrs T K resigned from her position in April 2008 and commenced working for the Southern Highlands Division of General Practice, providing clinical services as a registered nurse and psychologist to the present day.

I believe the complaint made by Ms B P to the General Manager’s Unit of Bowral District Hospital on 13 August 2008 was, in part, due to the reluctance of Ms B P to continue to be care coordinated by the Bowral Mental Health Service. The fact that she may have again raised the matter of the earlier allegation of professional misconduct would be, to a reasonable person, indicative that she was not satisfied of the actions of the SSWAHS Executive in general, and of Mr Scott Fanker of the SSWAHS Area Mental Health Service in respect of her earlier complaint.

There was a meeting scheduled by the General Manager of the Bowral District Hospital in late 2007 in response of her earlier complaint. This would suggest that Ms B P’s complaint was seen as having some urgency and there was an attempt then to deal with it before Mrs T K resigned in April 2008. It does not surprise me that Ms B P postponed that meeting due to the fact that she was both emotionally and physically unwell and that she had the support of her treating psychiatrist Dr Kim Nguyen of the Browne Street Mental Health Service in Campbelltown.

With the subsequent diagnosis of the inoperable large cell lung cancer in late 20 08 or early 2009 it could be reasonably assumed that Ms B P would be less preoccupied with the complaint originally made in 2007 and the apparent lack of diligence on the part of Mr Fanker and of SSWAHS and the Area Mental Health Service to deal with the issue of an alleged serious professional misconduct made against Mrs T K.

Mr Thurgood, you note in your response that there was an emailed response to my letter to Ms B P in November 2009. You report her statement about her inoperable cancer and that she had other things to occupy her mind than pursuing the complaint. The email also indicated that her mental state was more stable and that she had been living at her home in Bundanoon since the diagnosis was made. She also makes a pointed statement about her perception of Mr Scott Fanker of the SSWAHS Area Mental Health Service and his actions and attitude to her complaint. A reasonable person could suggest that with her diminished confidence in the processes of complaint resolution in SSWAHS she would be unlikely to take up any offer made by Mr Fanker.

Finally, I find it extraordinary that SSWAHS, with its access to Ms B P’s clinical record and the electronic incident monitoring system could not respond to the Commission’s request for a response in a period of four months, but could only do so a short time after they knew of Ms B P’s death in early February in Bowral District Hospital. A reasonable person would have some difficulty in seeing any serious intent on the part of SSWAHS to deal in a timely way, with diligence and transparency with the Commission’s request for a response and for bringing some appropriate resolution to Ms B P’s first complaint in late 2007.

In summary then, I wish to make the following observations as the basis for my request for a review:

Ø It may be appropriate for the Commission to question why the SSWAHS was unable to respond any earlier than after the death of Ms B P when they appeared to have ready access to the limited information and facts that they appear to have provided to the Commission.

Ø The Commission may wish to ask the SSWAHS Area Mental Health Service why they did not use the services of their Patient Advocate, Mrs Gillian Holt, to visit Ms Pickersgill at her home or to gain further information about the complaint of 2007 and 2008. Mrs Holt lives in the Southern Highlands, is a Carer of a person with a mental illness and has regularly worked with people with a mental illness. This option of interviewing Ms B P does not appear to have been considered by SSWAHS even up to the time of Ms B P’s death in February 2010.

Ø The Commission may wish to consider whether or not SSWAHS attempted to use Ms B P’s treating psychiatrist, Dr Kim Nguyen, a SSWAHS employee who was a person of confidence to Ms B P during her treatment between 2007 and 2009 and possibly to 2010, in order to elicit an understanding of the complaint made by Ms B P.

Ø The Commission may wish to ask SSWAHS why they did not report the alleged professional misconduct of Mrs T K to the Nurse’s and Midwive’s Registration Board and to the Psychologist’s Registration Board as required by the reporting requirements of NSW Health Code of Conduct (9.1).

Ø The Commission may wish to ask the SSWAHS why Mr Scott Fanker and the SSWAHS did not show fairness in dealing with Ms B P’s complaint of 2007/2008 consistently, promptly, transparently and fairly as required by the NSW Code of Conduct (6.1).

Ø The Commission may wish to ask Mr Scott Fanker (SSWAHS)whether his decision and/or professional behaviour to Ms B P was lawful; is in line with the policies of SSWAHS; and whether his decision or behaviour can be justified in terms of public interest and whether it could withstand public examination (NSW Health Code of Conduct 1.1.1; 1.1.2; 1.1.6).

Yours sincerely,

Kevin O’Neill

Socrates reports this information for the information of all who might be concerned about the way in which this Area Health Service treats complaints by the consumers of their health services. You be the judge!

SSWAHS - Dr Victor Storm and the NSW Ombudsman's response

Socrates understands that the Southern Highlands complainant did everything requested by the NSW Ombudsman's office to try and deal with his complaints by referring them to the CEO of SSWAHS, Mr Mike Wallace, and Ms Carmel Tebbutt MP, NSW Minister for Health. With no response after 6 months what else can the complainant do but respond to the NSW Ombudsman's office and say "sorry, no response! How long should one wait?"

Following the sending of the following letter a very unsettling telephone conversation followed from a woman in the NSW Ombudsman's office. It went something along the lines of: "Although you might have a legitimate complaint against SSWAHS you no longer work for them and we have to use our limited resources on more important complaints." Okay, so what could be more important than serious complaints about senior executive staff of an Area Health Service like SSWAHS. One has to wonder whether someone higher up the food chain has leaned upon a statutory authority like the Ombudsman's Office.

Team Leader

Community Services Division

NSW Ombudsman

Level 24, 580 George Street

Sydney NSW 2000

12 April 2010

Your ref: C/2009/7806

Dear Sir/Madam,

RE: My complaint about the Sydney South West Area Health Service (SSWAHS)

I refer to my earlier correspondence and complaint lodged with the NSW Ombudsman on the 5^th and 9^th November 2009.

Having followed the recommendation provided by your office in its response from Kim Kenny on 12 November 2009 I communicated my complaints about officers in SSWAHS to the CEO of Health NSW and to the CEO of SSWAHS I have remained awaiting some informed response for the past six months. I understand that the CEO of SSWAHS has indicated that a Mr Graeme Slade would provide me with a written response upon the completion of any investigation. To date there has been no further communication from SSWAHS and nor has Mr Slade spoken with me.

I also wrote to Ms Carmel Tebbutt MP (Minister for Health), and Mrs Barbara Perry MP (Minister assisting the Minister for Health – Mental Health and Cancer) on 4 November 2009 in which I made comments about the same and similar complaints. To date I have not even received an acknowledgement of the receipt of the letters nor, obviously, any action they may have taken. In regard to the letters of complaint I was advised to forward to the CEO of Health NSW again I received no acknowledgement that they had even been received or actioned.

On 23 December 2009 I did receive a brief response from one of the persons about whom I had complained. The content of the letter from Dr Victor Storm did not demonstrate any transparency nor did it suggest that anything was done differently to that which he advised he would do in May 2009. I gained no confidence from the content of Dr Storm’s letter of 23 December 2009 that the matter of my complaint had been fully investigated objectively.

I have enclosed copies of my complaint and the responses in the hope that the NSW Ombudsman will consider the outcome worthy of further investigation.

Yours sincerely,

Kevin O’Neill

Socrates simply offers the above for your information. You be the judge!

SSWAHS, Mr Dodds and his leadership style - a sychophant in the making?

Socrates again simply publishes the response of the complainant. Of course there has been no response from SSWAHS in general, or Ms Whalan in particular.

Ms Jan Whalan

Director of Corporate Services

SSWAHS

Locked Bag 7017

Liverpool BC 1871

31 December 2009

Dear Ms Whalan,

RE: Mr Peter Dodds

Thank you for your recent response to my letter of 16 October 2009 in which I directed comments to Mr Peter Dodds and Mr W M in respect of his reported statements about the referral of a patient to myself as a private practitioner.

To be blunt, I have to say that if Mr Dodds denies making any such statement to the staff of the Bowral Mental Health Service then the veracity of his denial is questionable. Also if the matter had been investigated by SSWAHS in any transparent and independent fashion I would have expected, at least, a conversation with the person conducting the investigation. The fact that I did not disclose the person or persons from whom I received the information about Mr Dodds’s statement is perhaps understandable given my recent experience of investigations by SSWAHS.

I will, however, state that the comments were made on a Tuesday morning when the rostered members of the Bowral Mental Health Team were present and in the company of Dr R W. As I understand it, it was Dr W who first made the suggestion that a particular client be referred to my practice. I suggest that the person responsible for investigating my original complaint revisit the matter and speak with staff other than person upon who the complaint is based.

Whilst I note the supposed NSW Health policy insists that the Mental Health Service has a ”long-standing practice of providing clients who require private sector services with the names of a range of clinicians who practise in a geographical area”, I strongly doubt that this is done without “commentary or opinion...... in relation to the skills of any of the clinicians listed”. If adherence to that NSW Health policy was the case why does Dr Angelo Virgona (SSWAHS) specifically refer his patients directly to individual private practitioners in the Bowral area, when other consultant psychiatrists employed by SSWAHS have been advised that they are not to do so?

I will contact Mr M for a copy of the list of private practitioners that is used by the Bowral Mental Health Team upon his return from leave.

Yours sincerely,

Kevin O’Neill

Psychologist and

Credentialed Mental Health Nurse

SSWAHS and another way in which it deals with complaints!

Socrates offers this example of how a person making a complaint can get the brush-off from the SSWAHS Executive when they want something to go the way in which they determine it should. You be the judge!

Mr Peter Dodds

Acting Manager

Wingecarribee Community Mental Health Service

Wingecarribee Community Health Centre

Bendooley Place,

22-24 Bendooley Street

Bowral NSW 2576

16 October 2009

WITHOUT PREJUDICE

Dear Mr Dodds,

I am writing to you to advise you that I have been informed that you, in the recent past, instructed your staff (including medical staff) that you did not believe that persons who have been terminated from the Area Health Service should have referrals of clients made to them.

If this statement attributed to you is correct then I wish to inform you that it constitutes an imposition on my ability to conduct a business and carry out a trade.

I am advised the legal position is that you could be challenged in court with posing an obstruction to my carrying on a legitimate trade or business, and the likely outcome is that damages can be awarded against you.

To the current date there have been no conditions imposed on my ability to practice as a nurse registered with the NSW Nurses and Midwives Registration Board. To the current date there has been no conditions imposed upon my ability to practice as a psychologist registered with the NSW Psychologists Registration Board. The Health Care Complaints Commission has also indicated that they are not proceeding with complaints made by the SSWAHS and the client who initiated the complaint in the first instance.

Since leaving the employment of SSWAHS I have been accepted by the Australian College of Mental Health Nurses as a Credentialed Mental Health Nurse. I have also been accepted as an Accredited AHP for the Non-Directive Pregnancy Support Counselling Program and I have been accepted as an Associate member of the Australian Psychological Society.

If it comes to my attention again that you have determined a different outcome in the matter of that complaint, to the outcome stated by the HCCC and the Registration Boards, and you again inhibit the choice of clients from accessing my clinical services by making statements (such as the one noted above) to your staff I shall commence legal action against you.

Kevin O’Neill

Socrates was informed that the outcome was that Mr Dodds was asked by his manager whether he'd instructed his staff to refuse referrals to the complainant. Naturally, he said "No", even though he stated it to a room full of staff who had a different impression.

SSWAHS - Dr Victor Storm - Mr Scott Fanker: A case of smoke and mirrors?

Socrates has been informed that the complainant from the Southern Highlands did make the following response to Dr Victor Storm just ten months after he first made the complaint. Socrates can't help but note that the December response from Dr Storm bore a remarkable similarity to the one he made in May 2009 when he announced that he'd ask Mr Fanker to investigate himself!


Dr Victor Storm Clinical Director
Area Mental Health Service
Sydney South West Area Health Service
Concord Hospital,
Hospital Road
CONCORD NSW 2139


31 December 2009


Dear Dr Storm,

I refer to your letter of 23^rd December 2009 and note the brief statement in its content.

Please be advised that I do not accept your response as an adequate explanation of my complaint and, following the advice from the NSW Ombudsman, will take the matter to a higher level.

Notwithstanding the above, I believe that the headings of dispute with your finding are as follows and are evident within the NSW Health Code of Conduct:

1.1.Personal and professional behaviour: (p.10)

• Openness, honesty and accountability.

• My decisions will be fair and impartial.

1.2.Good faith: (p.10)

• I will undertake all my duties in good faith and in the spirit of honesty, correct purpose and with the best motives.
  
• I will ensure that my actions are appropriate and totally within the area of my authority.

1.3.Personal relationships with patients or clients: (p.11)

• I will not have personal relationships with patients or clients that result in any form of exploitation, obligation or sexual gratification.

1.4. Managing conflicts of interest: (p.12)

• I will avoid situations that give rise to conflicts of interest.

• I will report any actual, potential or perceived conflicts of interest to my immediate supervisors, my Health Service Chief Executive or his or her delegate at the first available opportunity, preferably in writing. A decision can then be made as to what action should be taken to avoid or to deal with the conflict.
• If I’m not sure whether a conflict exists, I will discuss the matter with my immediate supervisor to try and resolve the matter.
  

1.5.Fairness in decision making: (p.18)

I will:

• Deal with issues, cases or complaints consistently, promptly, openly and fairly.

• Act fairly and reasonably when using any statutory or discretionary power that could affect individuals within or outside of NSW Health.
• Avoid any unnecessary delay in making decisions or taking action.
• Take all reasonable steps to ensure that the information I act or decide on is factually correct and relevant.
  

1.6. Appealing decisions: (p.18)

• I will promptly inform individuals who are adversely affected by or who wish to challenge a decision, of their rights to object, appeal or obtain a review.
  
• I will also inform them how they can exercise those rights.
  

With respect, your own delay in providing a formal response to a complaint made on 23 February (with a reminder in May 2009) is appalling to say the least.

It certainly flies in the face of Fairness in decision making and Appealing decisions noted above in the NSW Health Code of Conduct.

Yours sincerely,

Kevin O’Neill

Again, Socrates does not wish to do anything other than make the case for the person who feels that there has been no clear process followed by Dr Storm and SSWAHS in dealing with complaints - a process that is clearly established by the NSW Health for all its Health Services administrators to follow.

Dr Victor Storm - SSWAHS - Complaint to NSW Ombudsman

Socrates continues to be the public voice of this complainant who stills awaits any response, formal or informal, from the Executive of the Sydney South West Area Health Service.

NSW Ombudsman

Complaints Form

Details of Complaint

Which Agency or Person: NSW State Government Agencies

Have you approached the agency or person? Yes

Please name the agency involved: Dr Victor Storm – Clinical Director, Mental Health Services – Sydney South West AHS

Please give details of your complaint:

1. On February 24^th, 2009 I spoke by telephone with Dr Victor Storm, Clinical Director SSWAHS Mental Health, in respect of a formal complaint I was lodging against Mr Scott Fanker. I did so and emailed it to Dr Storm’s organisational email address that same day.
   
2. It is my understanding that all complaints or incidents to any NSW Health organisation have to be managed on the electronic incident monitoring and management system (AIMS or IMMS). This allows senior executive staff in the clinical governance unit to note it, and also to allow for a timely response.
3. It would appear (perhaps by his own admission) that this protocol was not followed by Dr Storm.
   
4. On April 30^th 2009 I again emailed Dr Storm (with an attached copy of my complaint) stating that I had not heard from the SSWAHS about any outcome in respect of my complaint against Mr Fanker. I received a response by email from Dr Storm on May 4^th(the day of my termination) in which he stated: “Please be advised that Mr Fanker has been provided with a copy of your complaint and is being given an opportunity to respond.”
   
5. This does not indicate that the usual procedure for dealing with a complaint or incident was being followed by Dr Storm. His final paragraph stated: “I will inform you of the outcome of my enquiries, in due course.”
   
6. To the current date I had no further response from Dr Storm as to the outcome of his enquiries. What happened after you complained to the agency? My employment with the SSWAHS was terminated.

What do you want to happen for your complaint to be resolved?

1. An apology from Dr Storm and the SSWAHS for the delay in his/its investigation of my complaint.
   
2. An independent review of the complaint that I made against Mr Scott Fanker and the conflict of interest and improper conduct of his investigation of allegations made against me by a client of the organisation.
   
3. An explanation from Dr Storm as to why he failed to implement usual NSW Health protocol for dealing with complaints, that is, electronic documentation and lodgement, and review by independent persons within the organisation of SSWAHS.
   
4. I have attached copies of the original letter of complaint (Feb 2009); my follow-up email and Dr Storm’s emailed letter of May 2009.
5. The letter of complaint indicated that in my view Mr Scott Fanker engaged in an investigative interview on 22 December 2008 with a perceived (if not actual) conflict of interest.

• In that he had an abnormal relationship with the client who had made a complaint against me.
  
• On 11 December 2008 the client indicated that he had a relationship with Mr Fanker that was more therapist/client, than that of Operations Manager-SSWAHS/complainant.
  
• The client indicated in an email that by that date he’d had over 30 hours of conversation with Mr Fanker and he described Mr Fanker as his “unpaid therapist”.
  

• It is my belief that Mr Fanker should have withdrawn from the investigative process on 22 December and that the investigation was compromised by his inappropriate association with the client.
• It was only at my insistence that, at a second interview on 19 February 2009, Mr Fanker withdrew from the investigative process. My reasons for that request were made perfectly clear to Miss Belinda Woolley, Senior Legal Officer – SSWAHS, on that day.
  

Your details: Kevin O’Neill

2 November 2009

Socrates makes no comment upon this complaint except to say that one has to wonder why SSWAHS has failed to act on this long overdue complaint. You be the judge!

SSWAHS - Mr Scott Fanker - Complaint to NSW Ombudsman

Socrates continues to be the public voice of this complainant who still awaits any response, formal or informal, from the Executive of the Sydney South West Area Health Service.

NSW Ombudsman
Complaints Form

Details of Complaint

Which Agency or Person: NSW State Government Agencies

Have you approached the agency or person? Yes

Please name the agency involved: Mr Scott Fanker – Operations Manager, S-W Cluster, Mental Health Services – Sydney South West Area Health Service

Please give details of your complaint:

1. In regard to the failure of the organisation to exercise due diligence to protect their staff: During early 2008 a client (PK) of the SSWAHS organisation provided the Bowral service with a copy of his blog entry dated 13 March 2007 and titled “Triage”. This article purported to give an account of the way in which the Bowral Mental Health Service responded to their clients. It was posted to the internet and could constitute defamation.
2. It was shown to the Clinical Director, Mental Health S-W Cluster, Dr Angelo Virgona, whose only response was to laugh.
3. On December 22, 2008 I provided the Operations Manager Mental Health S-W Cluster, Mr Scott Fanker with the content of a tape recorded message by the client in which he defamed the person and reputation of an elderly staff member of Berrima Cottage (the Bowral Mental Health rehabilitation unit). To date no action has been taken to provide advice or support by the organisation to that staff member.
4. On the same date (December 22^nd), I requested Mr Fanker to offer a response to my question: “Does the Area Mental Health Service accept the “Zero Tolerance to Aggression” policy issued by NSW Health? If so, how does it intend to protect the staff of the Wingecarribee Mental Health Service from ‘Paul C’?” His response was: ”Um, no this is an interview with you, not an interview with us so I’ll read those questions and we can speak about that um outside of the interview process, anything else you want to say?”
5. At that interview I was also asked by Mr Fanker “What would you like us to do” about the threats of violence against staff (and myself) made by the client? I responded by asking the organisation to take out an AVO against the client to restrict his access to staff while he was intoxicated or otherwise threatening. I was told by Mr Fanker: “That will only inflame the situation”.
6. Between December 22, 2008 and May 4, 2009 Mr Fanker had opportunity to respond to my questions posed in the interview of December 22, but never did so. Mr Fanker also claimed to have had no knowledge of the ongoing nature of the attacks, both verbal and written by the client about the staff members and the service over a 2 year period. However, in early December the client stated in an email that he “had more than 30 hours of discussion with Mr Fanker about his issues with the staff and service. And that Mr Fanker had read all his notes, documents and history”.
7. Mr Fanker, also in an email in early December 2008, to a person being verbally attacked by the client, stated that he’d gone thoroughly through all the blog postings of the client. Those postings had commenced in early March 2007.
   
8. On Monday, January 12^th 2009 I spoke with Mr Scott Fanker about a blog posting by the client which was titled “O’Neill” and dated Sunday 11^th January. In this blog my full name was advertised in capitals, I was called (among other things) that “DOG O’NEILL”, “JOKE O’NEILL” and “that cunning sly dog O’Neill”. I asked Mr Fanker if he had seen it. He opened the blog and read it while we spoke and stated that he would attempt to have the client remove it from his blog. Subsequently, I received an email from Mr Fanker stating: “Now is not the time to ask him (the client) to remove the blog posting”. It remained on the internet for a number of days until the client’s brother removed it.

What happened after you complained to the agency? My employment with the SSWAHS was terminated.
What do you want to happen for your complaint to be resolved?

1. An apology from Mr Fanker and the SSWAHS for the delay in his/its investigation of my complaint about the lack of support for, and protection of, its staff.
2. An independent review of the complaint that I made about the lack of support and protection for staff of the Bowral Community Mental Health Service.
3. An explanation from Mr Fanker as to why he failed to implement usual NSW Health protocol for dealing with aggression directed towards staff employed within the organisation of SSWAHS.

I have attached copies of the original transcript (Dec 2008); and my original questions posed to Mr Fanker, which have to date, remained unanswered.

Your details: Kevin O’Neill

5 November 2009
Socrates makes no comment upon this complaint except to say that one has to wonder why SSWAHS has failed to act on this long overdue complaint. You be the judge!