SSWAHS and its response to complaints from the Southern Highlands: Part 2

Socrates, you might recall, posted a copy of the following email sent by a very rebellious native of the Southern Highlands, who had been waiting (and staying alive) diligently to be able to obtain a report into a series of complaints that the Health Care Complaints Commission and the Ombudsman's office thought should dealt with by the Sydney South West Area Health Service. The email is explanatory enough, one would think, and although it might be considered to be a bit tart in its consumption, is most likely appropriate given that the complainant has been waiting 11 months for the offered response, even though the investigator has never bothered to even speak with the complainant.

Today Socrates was informed that Mr Slade has been on holidays for a month (back next week), but the source at SSWAHS says that all his emails had been forwarded to Dr Bellamy, his boss, during his absence. Now that name did ring a temple bell or two in the mind of Socrates! Ah, yes!
That's the same Dr Bellamy that the tabloids in Sydney (and referred to in an earlier post), had much to say about some of her clinical practices, and who the SSWAHS Executive were so happy to appoint to the position of Director of Clinical Governance in SSWAHS. My, how the temple pool has become so cloudy up at Liverpool.


Mr Graeme Slade
Designated Senior Complaints Officer
SSWAHS

Dear Mr Slade
I have your letters addressed to me and dated 18th and 19th November 2009 in which I am assured by you that the matters about which I "complained were being, and would be, investigated and a written response would be provided to me upon completion of the investigation."

I write to inform you that I have not yet received a written response to my complaints, nor have you even made any form of contact with me, the complainant.

Mr Slade I find it surprising that this has not happened given that in the NSW Health Code of Conduct there is specific mention that complaints such as mine (or indeed from any complainant) should be dealt with in a timely manner.

I also draw your attention to the SSWAHS Policy Directive: Complaints: Management of a Complaint or Concern about a Clinician - Document No: SSW_PD2007_035, which describes the procedures to be followed in the matter of all complaints received by the SSWAHS oganisation, and in particular, the role of the Designated Senior Complaints Officer.

I can assure you that as I was not anonymous in my complaints nor did I consider them to be frivolous in nature I did anticipate that there would be some action and some response as you had stated.

The fact that there has been no apparent action or response leads me to believe that SSWAHS is failing in its adherence to both the NSW Health Code of Conduct and its own Policy as stated above.

The alternative may be, however, that you, Mr Slade, have died, been terminated, or simply decided to part company with SSWAHS. Perhaps, if you are neither dead, nor been terminated, but still work for SSWAHS you might consider responding to this email. For myself I can assure you that I am not dead, and I still want to have a written response to those several complaints.
Yours sincerely,
......................................

SSWAHS and Jan Whalan: Micro-management in action!

Socrates has acquired this little gem which demonstrates just how SSWAHS Executive like to keep a stranglehold (sorry, "finger") on the pulse of their whole organisation. This is an "out-of-office" response to an email sent in mid-2009 to Ms Jan Whalan, the Director of Corporate Services for SSWAHS and the Deputy CEO. It would not be unreasonable to suggest that with the change to the Local Area Health Networks, and the change to the current SSWAHS, Ms Whalan could very well be the new Chief Executive of the Liverpool to Bowral health service. May the Gods help us all!

From the email of Jan Whalan:

I will be on leave from 12 – 26 June 2009 (inclusive).

During this period, my emails will not be forwarded; and you should direct any enquiries to the following people:

- Accounts enquiries from suppliers/NSW Health – Candy Cheng
- Complaints management – Jacqui Clark or Belinda Woolley
- Contracts/Agreements – Belinda Woolley
- Corporate IIMS – Maria Kokkinakos
- Criminal Record Checks – Charlotte Roberts
- Data Security – Charlotte Roberts
- Discrimination cases – Belinda Woolley
- FOI Applications & questions – Belinda Woolley
- “Garling”/SCI/Caring Together enquiries – Maria Kokkinakos
- General enquiries – Erin Chadwick (to 19/6/09), then Peter Reisinger
- HRIS – Bernie Cotter
- HSS – Candy Cheng / Mark Scragg – for liaison with CE, as required
- Legal Issues – Belinda Woolley
- Payroll – Luisa Nobrega
- Privacy; Internal Reviews (FOI/Privacy) – Charlotte Roberts
- Records management – Charlotte Roberts
- Reporting Serious incidents/charges/convictions – Charlotte Roberts
- Risk Management/TMF/Insurance – Margy Halliday
- Tendering / Purchasing / Supply – Mark Scragg
- Terminations - Sign off prior to going to CE – Belinda Woolley
- Transport Services – Mark Sterrey
- WorkCover activity – Margy Halliday

Sue Cheadle can be contacted on 9515 9640; and Erin Chadwick (up to 19/6/09) and Peter Reisinger (after 19/6/09) can be contacted via the switchboard (9515 9600) for assistance.

SSWAHS and its response to complaints from the Southern Highlands

Mr Graeme Slade
Designated Senior Complaints Officer
SSWAHS

Dear Mr Slade
I have your letters addressed to me and dated 18th and 19th November 2009 in which I am assured by you that the matters about which I "complained were being, and would be, investigated and a written response would be provided to me upon completion of the investigation."

I write to inform you that I have not yet received a written response to my complaints, nor have you even made any form of contact with me, the complainant.

Mr Slade I find it surprising that this has not happened given that in the NSW Health Code of Conduct there is specific mention that complaints such as mine (or indeed from any complainant) should be dealt with in a timely manner.

I also draw your attention to the SSWAHS Policy Directive: Complaints: Management of a Complaint or Concern about a Clinician - Document No: SSW_PD2007_035, which describes the procedures to be followed in the matter of all complaints received by the SSWAHS oganisation, and in particular, the role of the Designated Senior Complaints Officer.

I can assure you that as I was not anonymous in my complaints nor did I consider them to be frivolous in nature I did anticipate that there would be some action and some response as you had stated.

The fact that there has been no apparent action or response leads me to believe that SSWAHS is failing in its adherence to both the NSW Health Code of Conduct and its own Policy as stated above.

The alternative may be, however, that you, Mr Slade, have died, been terminated, or simply decided to part company with SSWAHS. Perhaps, if you are neither dead, nor been terminated, but still work for SSWAHS you might consider responding to this email. For myself I can assure you that I am not dead, and I still want to have a written response to those several complaints.
Yours sincerely,
......................................

Socrates was fortunate enough to be sent the above email from a member of the Southern Highlands community who has been following this blog and who has been waiting patiently for due process to be followed by SSWAHS. One has to ask the question - how long is long enough, and do investigations of complaints made to SSWAHS really need to take such a long, long time?

Of other note, of course is how does SSWAHS manage to investigate any complaint without even having anything like a simple conversation with a complainant? Surely, they do not rely on just the brief detail given in a written or verbal complaint to ensure that faults are rectified and that the quality of their services are improved.

In preceding posts, Socrates has given several examples of complaints being made directly to SSWAHS, and also through the advocacy and publication of those complaints in the Southern Highland News.

It could be an interesting exercise to see if any of those affected people or their families ever received anything like a written response from the SSWAHS Executive.

SSWAHS and its neglect of Bowral Health - the Local State Member's view

SOUTHERN HIGHLANDS HEALTH SERVICES: Pru Goward - Member's question about the Bowral health services. NSW Parliament - 1st June 2009

Ms PRU GOWARD (Goulburn) [5.18 p.m.]: I draw the attention of the House to health services in the Southern Highlands. A fortnight ago the shadow Minister for Health, Jillian Skinner, spent a day in my electorate. She had heard much from me about Bowral hospital and its position at the end of the food chain as far as Sydney South West Area Health Service is concerned, so she was keen to visit and meet local residents and medical personnel to get some firsthand input. In the morning we met with a number of people concerned about the deterioration in service standards at the hospital and, following the application of the member for North Shore to the health Minister we were granted a tour of Bowral hospital with the general manager, Denis Thomas. In the afternoon we attended a public meeting I had called to meet constituents and listen to their concerns. We met a number of staff during our tour and there is no doubt our hospital is blessed by having extremely competent, hardworking and committed people working there.

Bowral Hospital has a very loyal consultative support group made up of community members who act more or less as liaison between the community and the hospital. This is a very good idea, in theory at least, but in practice, the group is bound by confidentiality and, as such, is as much controlled by the New South Wales Government as is the hospital`s general manager. The public meeting was a forum for people to not only voice their concerns but also to put forward suggestions for improving local health services. The meeting was unanimous in its support for, and faith in, the expertise and dedication of the medical staff.

Despite the flagging morale of the career medical officers, whose working conditions were changed without consultation, not a single person at the meeting-and more than 100 people were there-complained about the medical treatment they had received. What they did complain about was the appalling access to services, including the lack of psychiatric beds and the many occasions on which they were turned away and sent elsewhere. Today we heard in this House the shocking story of Gregor Gniewosz, who underwent an amputation as a result of picking up an infection in Liverpool Hospital. He also emerged from the public meeting. I refer also to the hospital`s children`s ward. The Minister for Health circulated a media release in which he stated, correctly I understand, that the new children`s ward at Bowral Hospital was on track for completion later this year. He said:

This is a tremendous result for the local community, which has been so supportive in ensuring children and their families have access to a facility that reflects today`s needs. The community has been more than supportive.

That would have to be the understatement of the year. The community forced this refurbishment. The BDCU Children`s Foundation began lobbying for this ward some five years ago. The area health service pontificated, promised, prevaricated and postponed but the foundation continued to raise money in the hope that the Minister for Health and the Sydney South West Area Health Service could eventually be dragged kicking and screaming to a point that it would provide a children`s ward with facilities that would actually contribute to the recovery of ill children. The foundation, which to date has raised $330,000, and everyone in the community who has supported and driven the concept of the new children`s ward have been a great deal more than just supportive. In the same media release, the Minister for Health said:

Local services are very important to the New South Wales community and they are the door to the excellence of the entire health system.

Again, I could not agree more. Why then has there been a determination made by New South Wales Health to direct complicated orthopaedic procedures away from Bowral Hospital? Does the Minister feel that local orthopaedic specialists are not expert enough to deal with complicated procedures or, as is most likely the case, is there a financial reason of some sort for this decision? In a notice circulated by the Ambulance Service, ambulance officers have been informed that Bowral Hospital will no longer deal with orthopaedic assessment for serious fracture injuries such as pelvis, long bones and neck of femur fractures. Ambulance officers will now have to take those patients out of the local area, probably to Liverpool. I understand that neck of femur fractures are most common in the elderly, and with a growing population of elderly residents in the Southern Highlands it beggars belief that they should be shipped out of the area, away from their support network, to a hospital located more than an hour away by car. I will not go into how long it would take to reach Liverpool Hospital by train. That is a subject for another private member`s statement.

Top-of-the-range orthopaedic specialists work at Bowral Hospital. The decision to direct complicated orthopaedic procedures away from Bowral Hospital is offensive to the local service and is an erosion of the specialist facilities we have in Bowral. The community has formed a group that is not beholden to the State Government. It will not be bound by confidentiality. It will include members of the public, medical personnel, allied health personnel and ancillary staff to help lobby the Government. It will be a force to be reckoned with. I congratulate Di Hurdwell, a local resident who stood up at the public meeting and offered to form this pressure group on what I am sure will be a great initiative.

SSWAHS and it's view of National Health Reform

SSWAHS created such a cute piece of spin for the Director-General of NSW Health to suggest what they might like to do with the Federally imposed carve-up of the current NSW Area Health Empires.

Here they used a powerpoint presentation to suggest the great achievements their Area based Clinical Divisions have launched in the old SSWAHS.

Take for example, their Population Health Area Network:

• Promoting Equity: Monitoring inequalities of health status and health service utilisation; targeted health promotion activities in disadvantaged areas.
• Focus on Primary Prevention: Critical mass enables health promotion activities to reduce risk factors.
• Regional Partnerships: Working with LGAs, Housing NSW, Landcom and other developers on urban development and regeneration.
• Promoting Evidence Based Practice: Healthy Urban Development Checklist.
  
• Population Health Based Service Planning: Population health principles incorporated into all service and facility plans.
• Capacity Building for Primary and Secondary Prevention: Health promotion traing course; Locational Disadvantage training course.

Now if anyone out there can translate that SSWAHS spin please let me know! But, can anyone see how this is meant to apply to the Southern Highlands with expanding and aging population? What does SSWAHS Population Health take us for - God's Waiting Room? And can anyone tell us what a "Locational Disadvantage training course" is meant to look like?

The other point to make is that it's been some years since we had anything like a health promotion staff member in the SSWAHS portion of the Southern Highlands. Again, a vacancy never to be filled. Is the Southern Highlands meant to be an urban or a rural area in the minds of the SSWAHS Executive, or is that little dot to the far south of the SSWAHS map on that cute presentation to the D-G still out of sight of Liverpool.

And here's the presentation of the achievements of the SSWAHS Mental Health Clinical Network:

• Improved Clinical and Corporate Governance: Standardised policies, procedures and care pathways/guidelines; Centralised application of specialist human resources across a whole network, achieving economies of scale; Timely implementation of state-wide initiatives.
  
• Improved Human Resource Management: Better recruitment and retention of staff because of clear identification with clinical specialty; Better support to registrar training especially since IMET initiative; Standardised education programs.
• Improved Service Delivery: Ability to support small community teams in rural areas; Access to intensive, Sub-specialist and Tertiary services which could not be resourced at the local or district level; Ability to promptly rotate staff to local services with urgent shortfalls; Improved planning of services and facilities to serve a regional population.

This one I really like (oh yeah!). Clinical and corporate governance. This is the SSWAHS clinical network who failed to answer the complaint of a local woman with terminal cancer until after she had died. Then said they'd tried to speak with her but unfortunately she was dead. Not laughable - just tragic.

This is the same Clinical Network who has still refused to answer some serious complaints about their failure to respond appropriately to complaints, about their service and their service providers, according to the NSW Health Code of Conduct.

This is the same network who, in 2009, had one of their Southern Highlands patients involved in the murder of another of their patients after both patients had been notified to the local service with a request to provide assistance.

Better recruitment and retention of staff is another bit of spin from SSWAHS. This is the organisation which spent an inordinate amount of time terminating, or getting resignations from, a number of clinical staff in their Area Mental Health Network.

Now, they have the temerity to say in their "Improved Service Delivery" that they have achieved the ability to support small community teams in rural areas, and their ability to rotate staff staff to local services with urgent shortfalls. Is that why they have made the Bowral Mental Health Service less effective by making part time their Welfare worker position, their Aboriginal Health worker position, and their Rehabilitation/Recovery Program Coordinator? Perhaps that fits into the plan for the SSWAHS Mental Health Network's "ability to rotate staff to local services with urgent shortfalls"! It certainly doesn't fit in with the SSWAHAS Mental Health Network's "ability to support small community teams in rural areas."

Again, from the "Improved Service Delivery" item the SSWAHS Mental Health Network states as an achievement "Access to Intensive, Sub-specialist and Tertiary services which could not be resourced at the local or district level." Well, I guess that if you mean by "access" that the local Southern Highlands Mental Health team still has to argue with Mental Health bed managers every time they have a need to transport someone with an acute mental illness to any of the inpatient facilities mentioned. The patient from the Southern Highlands could, currently, sit in the Emergency Department of Campbelltown Hospital for hours (or days) before being admitted to the hospital's Psychiatric Emergency Care Centre, or be shuffled around the other various facilities located at Campbelltown Hospital, or Liverpool Hospital, or RPH Hospital, or Concord Hospital.

However, don't think that's still a great response because if the proposed slice-up of the current SSWAHS Empire proceeds according to the LHNs that Southern Highlands mental health patient will only have access to the mental health facilities at Campbelltown and Liverpool Hospitals - so the wait just got longer and the Improved Service Delivery just went belly-up!

Go figure it! Perhaps the SSWAHS Mental Health Network should have been concentrating more on which of their so-called "Achievements" would be lost to the Southern Highlands, Macarthur, Wollondilly and Liverpool LGAs and their residents.

SSWAHS and its abuse of correct procedure and policy. Caught out again!

Isn't this archival media just wonderful. Here is another gem that Socrates has found about the way in which SSWAHS has notoriously treated its staff when they wanted to downsize their organisation.

Employer's failure to follow policies unreasonable

Article written by Deacons.

"The Commission has ordered Sydney South West Area Health Services (SSWAHS) to pay an employee 26 weeks pay on the ground that his employment was terminated unreasonably during a process of restructure within the organisation. Despite the existence of a voluntary redundancy policy which applied in circumstances of restructure, SSWAHS failed to consider this as an option for the employee and instead attempted to coerce him into accepting positions of lesser grades. When the employee refused to accept these positions the SSWAHS purported to terminate his employment for reasons relating to performance going back 6 years."

This is not the first time that SSWAHS has used these immoral strategies to force people out of their positions. One instance Socrates has heard about was in late 2008 when one of their bullies (Mr SF) told an Allied Health Professional, who had arranged to see a private client after his work hours at a SSWAHS facility, that he'd be reported to ICAC and the AHP's Registration Board for Corrupt Conduct. The AHP chose instead to resign - never to be replaced!

Socrates also met another middle manager who worked in the child and adolescent mental health field in Campbelltown. That person was highly respected as a fair and reasonable manager. When a staff member made a complaint that she was "being bullied" by the manager (who was simply asking the person to do their work) the SSWAHS response was to send the same Mr SF to see the manager and threaten them with investigations and reporting to their professional registration board. The manager chose to resign - and, as far as can be ascertained - not replaced.

It seems that 2008 and 2009 was big year for "terminations" in SSWAHS. One senior manager stated confidentially that if they couldn't get them any other way it would be by using complaints and threats against their professional status, or the "discovery" of something inappropriate in the way in which they used the organisation's computer network.

Certainly, Ms J W, of SSWAHS was known to micro manage all the discharging and terminations of staff from the organisation. But that was her idea of Clinical Governance in SSWAHS.

Perhaps this case from 2008 may be of interest to Dr Lynette Bellamy (should she keep her job) the relatively new member of the SSWAHS Executive who is responsible for the Clinical Governance of the Sydney South West Area Health Service. Perhaps it's a good enough reason for the Athenian Delphi (and other women) be asked to do these breastscreen things rather than males.

Thursday, October 30, 2008

"Targets" followed by government cancer screener set to kill woman

Breastscreen patients who get letters stating their mammograms show "no visible evidence of breast cancer" cannot be sure they are risk-free until they see a GP or have an ultrasound, a court has found. In a "controversial and far-reaching" case, Christine Ann O'Gorman, 57, was awarded almost $406,000 damages in the Supreme Court in Sydney yesterday after she sued BreastScreen NSW - an arm of the Sydney South West Area Health Service - for failing to diagnose a cancerous tumour that spread to her lungs and brain.

Ms O'Gorman, who is terminally ill, had mammograms every two years from 1994 at BreastScreen but radiologists failed to detect that a lump in her left breast had almost doubled in size between her 2004 and 2006 scans, Justice Clifton Hoeben found. After each scan, the single mother from Moorebank was issued with a letter stating her results showed "no visible evidence of breast cancer".

In his judgment, Justice Hoeben said a letter from BreastScreen was not enough for women to rely on. "I am sure that many women who participate in the BreastScreen program believe that when they receive the pro-forma letter, the presence of cancer is excluded," he said. "That is clearly not the case. The documents which those women sign before undergoing a mammogram and the pamphlets available make it clear that there are significant qualifications applicable when a 'no visible evidence of cancer' result is communicated to them."

Justice Hoeben found that, had radiologists compared O'Gorman's 2004 and 2006 scans, the change in appearance of the lump would have been detected and would have prompted further tests. Instead, Ms O'Gorman felt the cancerous tumour herself in January last year. After seeing her GP and undergoing further tests, she was diagnosed with breast cancer and after chemotherapy her left breast was removed in August last year. The cancer has subsequently spread to her lungs and brain.

Supported in court yesterday by her partner Glen and daughter Kristy, Ms O'Gorman wept when Justice Hoeben awarded her $405,990.15. Outside court, she said she did not want her negative experience with BreastScreen to discourage women from having their breasts checked regularly through the service. But she said compliance standards that urge clinics to "keep down" the numbers of women recalled to less than 5 per cent should be abolished to allow "case by case assessments". "The system has to be changed because even if they miss just one person it's wrong," she said.

In a statement, the SSWAHS said they would be "considering the judgment very carefully".

Well I guess we have all the proof we need in the previous posts in this blog that SSWAHS always considers judgements like these "very carefully" - I don't think!

SSWAHS and that "Code of Conduct" it follows.

It's a great line isn't it when an organisation can fall back on the NSW Health's "Code of Conduct" for its defence of how they manage their health services, including any complaint made about those services or senior staff of theirs.

Let's just take as an example the one mentioned in the previous post. A complainant strongly believes that there has been a systemic failure in SSWAHS. They make a complaint known to the CEO of SSWAHS on 16 November 2009 and are advised on 23 December 2009 that the matters raised would be investigated and a written response issued. We now know that either the matter was not investigated or there was nothing to report, because no written response was issued.

Okay, then - let's see what their "Code of Conduct" has to say about that.
Paragraph 1.5 Fairness in decision-making, which is on page 18 of the Code states:

• 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 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.

Paragraph 1.6 Appealing Decisions, also on page 18 states:

• 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.

Hmmm! SSWAHS, do you really think that eight or more months is about being "prompt"? Do you think that not providing any response is "open" or "fair"? Or is it perhaps indicative of avoiding "any unnecessary delay in making decisions or taking action".
And, when an individual does challenge one of your decisions, when do you "promptly inform them.... of their rights to object, appeal or obtain a review"? Perhaps after they die?