Page 2672 - Week 07 - Tuesday, 29 June 2010
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be downgraded?” “No.” As the minister answers in relation to that line of questioning, “No, but of course there will be conversations, as there have to be, between the hospital and surgeons in order to manage appropriately the categorisation of patients.”
You go to what is now a complete misuse of the proposed document, the draft for discussion, the policy position, which Dr Bryan Ashman puts. Dr Bryan Ashman, as head of surgery, has a fundamental responsibility to manage the list. He must have discussions. He must seek to deal with issues and pressures that are part and parcel of the problem. These are the beliefs, the findings, the views, of the head of surgery, the person in whom is entrusted some responsibility for appropriately managing the list. What are the issues that he identified in February this year? This is what he says, and this is what he was seeking to respond to. This is his honest belief of a circumstance that applies at the hospital, and these are his words:
Many Requests for Admission for category 1 conditions are not clearly conditions that might deteriorate quickly to the point of an emergency.
Common sense suggests that category 1 conditions should be life or limb or organ threatening. The head of surgery continues:
Several surgeons have many category 1 patients on their waiting list yet continue to submit category 1 RFAs in the knowledge that they are not able to offer treatment in the 30 day time frame. Some even give the impression that “it’s not my problem, it’s up to the hospital to sort it out”. Some surgeons are unwilling to take up extra operating time offered to them to accommodate their category 1 requests. Many surgeons resist or refuse requests to downgrade … when it is obvious that the condition has been inappropriately categorised.
Those are the problems that the head of surgery identified. Is there a suggestion by the Liberal Party today that there should be no effort at seeking to address those problems, that there should be no conversation to seek to address those problems identified by the chief surgeon? Of course there should have been conversations. Of course there should be inquiries. Of course there should be testing of whether or not the categorisation is appropriate. But, as always, and in every instance that the minister has responded to a question, done media or actually sought to explain, it has always been put by the minister that the decision maker is the clinician. It is the clinician responsible for his or her patient who makes the decision about the urgency of any surgery in any instance. It is clear. It is there on the record. It has been the consistent position put, and it must be the position. Is there a suggestion, seriously, that the minister or the hospital or some other person, other than the person with clinical responsibility for a patient, would be making those sorts of decisions? What nonsense. What absolute nonsense to suggest that somebody else within the system, within the hospital, within the administration, is making clinical decisions on a patient that they have possibly never met and never will meet.
It is a preposterous suggestion. The draft policy leaves all of the decision making in the hands of the clinician, the person who makes the clinical judgement. Of course, there is an acknowledgement in the administration of a hospital that somebody somewhere has to maintain a watching brief and is required to answer the questions that should be asked in relation to the division of those resources that we have available.
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