Page 2765 - Week 11 - Tuesday, 20 October 1992
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Then we found another bit of interesting information. When Mr Berry foreshadowed - again in the Canberra Times rather than in the Assembly, and later on in the Assembly - his methadone expansion program, in the Estimates Committee we got the actual costings for this program. Mr Berry's approach includes 350 places by 1 July 1993. That is an extra 200 - if you believe the Estimates Committee figure, and a few more if you look at the figures Mr Berry gave us today - on what we currently have. A third of those clients will be supposedly using regional centres by 1 July 1993, and they will start using the regional health centres by 1 March 1993. On my mathematics, that means that 116 of the 350 patients will be supplied through health centres. That is 39 patients per health centre. Health centres, according to Mr Berry's methadone expansion program, will be open for two-and-a-half hours each day. On anybody's calculation, that means that each patient will be seen for 3.85 minutes.
I think it is very important that everybody here understand the procedure for giving out methadone. In the health centre concept, first of all the patient has to be identified. That sounds fairly easy; but it is not, if you are seeing 39 patients in two-and-a-half hours each day. So, first of all you have to decide who is here. Because we are now charging just about everybody for our methadone, we have to collect the money and give a receipt. We then have to find the patient's card. In this sort of situation every patient has a card with his or her photograph on it, with the dose listed, with the information that anybody who is giving out such a potent substance needs to have. You have to check the photograph to make sure that it is the right person; you then have to check the dosage and the prescription.
You then have to do one of the most important things, which is to talk to the patients and establish their state of health - whether they are intoxicated or not, whether they have any other health problems. Of course, if a problem exists, you have to decide what to do. You have to counsel them, or you might refer them on to their medical practitioner. Most methadone clinics suggest that the patient should come back later. Unfortunately, that is not possible in the health centre because it is closed later. Everywhere else they say, "Look, come back in three or four hours, when you might be a bit better". That is not possible here, so we are not quite sure what we are going to tell people who are intoxicated or under the influence of another drug. But so be it.
Assuming that there are no problems - and remember that we have 3.85 minutes to do all this - we then have to measure the methadone dose and we have to get the second of the two nurses who are on duty to check the dose. We have to enter the methadone in the drug register and get the second nurse to countersign that entry. We have to give the patient the dose, with water or juice, and the patient has to consume the methadone there. Then we have to get the patient to sign the dose. And we are going to achieve this with every one of these 39 patients every day in 3.85 minutes!
Mrs Grassby rightly said in her dissenting report that the dispensing of methadone must be done with care and attention to the well-being or otherwise of the client. I could not agree more with that. But I cannot see how that procedure can be done in 3.85 minutes, for patient after patient after patient. Remember that in that procedure I have not actually taken into account the time taken for compulsory urinalysis, which is very much part of the Minister's approach. I have not taken into account the time that will be taken for the takeaway doses on Friday. What we have here is a situation where Mrs Grassby's
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