*The contents in this blog relates to legislation in New South Wales.
The NSW Parliamentary Inquiry into health outcomes and access to health and hospital services in rural, regional and remote New South Wales (‘the Inquiry’) was established on 16 September 2020. Since then, the Inquiry has received over 700 written submissions. It has held public hearings in regional towns and heard shocking evidence about the state of our healthcare system.
In this series, we will follow the Inquiry and look into the evidence heard at each public hearing.
Recently, the Inquiry travelled to Taree where it heard from a number of key figures within the Manning Great Lakes community, including doctors from Manning Hospital and the CEO of the Hunter New England Local Health District, Michael DiRienzo. Manning Hospital services a large number of patients from the Manning Great Lakes region, a region which includes Taree, Forster, Tuncurry, Gloucester and Barrington. The region has a population of close to 100,000 people. The evidence was clear that at present, the health services do not meet the needs of the large community. There were many sad stories of poor outcomes. As one general practitioner, Dr Simon Holliday, giving evidence said, “Houston, we have got a problem.”
What is clear from the Inquiry’s recent visit, is that the people on the ground in Taree agree about the issues that Manning Hospital faces, which we explore below.
Lack of local services
Dr Nigel Roberts is the Director of obstetrics and gynaecology at Manning Hospital although he appeared as a private individual. In his written submission, he said that when he moved from Queensland to Taree in 2015, he was shocked that Manning Hospital did not have a public obstetrics outpatient clinic.
While Manning Hospital has since established some outpatients and ante-natal clinics, Dr Roberts gave evidence that the facilities are sub-par. Manning Hospital does not have any outpatient clinics for general surgery, general medicine or orthopaedics (other than a fracture clinic). Put simply – he said the lack of outpatients clinics means that patients in Taree and surrounding areas have to pay for those services from a private physician or they go without necessary treatment.
The Inquiry also heard that ear, nose and throat services in the region are presently only available two to three days per month, with ENT surgeons coming from Gosford and Port Macquarie to operate on particular days. This means that patients with urgent issues have to travel to Newcastle, Port Macquarie or even Sydney for timely treatment. For patients with ‘non-urgent’ issues, they wait months or years for treatment.
In addition, there was a call for 24 hour radiology and pathology services to be provided at Manning Hospital. The fact that such services are not already provided at Manning Hospital beggars belief.
Manning Hospital lost its T1 Trauma category around ten years ago. This means that trauma and significant emergency cases are taken to the John Hunter Hospital in Newcastle or to Port Macquarie Hospital. There was a call for appropriate funding and resourcing to be released to allow Manning Hospital to treat trauma patients. This would mean that patients in emergency situation would be treated more quickly than if they had to be transferred to Newcastle or Port Macquarie, potentially leading to saved lives and more availability of ambulances within the Manning Great Lakes region.
Lack of staffing
The Inquiry heard that there is a huge issue with attracting and retaining doctors and nursing staff to Taree and outlying communities.
Former nurse Eddie Wood, now the President of Manning Great Lakes Community Health Action Group (“the Action Group”) said, “We’ve got the situation now where we’ve got cleaners in the emergency department who are sitting with patients who may be confused, demented, and they’re sitting with them.”
Dr Seshasayee Narasimhan, who is the only cardiologist within the Manning region said he regularly works 80 hours per week or more. He expressed his frustration that he is unable to provide the expected level of care to the community and his patients as he is the only cardiologist in the area and due to the lack of up to date resources, like a cardiac catheterisation lab.
Michael DiRienzo, the CEO of Hunter New England Local Health District, conceded that there is difficulty in attracting and keeping doctors across the entire district. Without permanent staff, hospitals rely on locums (ie. doctors who visit for a specific, usually short, period). This is expensive and chews into a significant portion of the hospital’s budget. He noted the significant difficulty in attracting and keeping ENT surgeons in Taree. At the time he gave evidence, Mr DiRienzo said the Hunter New England Local Health District was hoping to work with Mayo Private Hospital to secure the services of an ear, nose and throat surgeon to work across both hospitals.
A group of doctors at Manning Hospital made written submissions to the Inquiry. They said that “There are significant risks to patients as a result of understaffing and inadequate skill-mix, including compromised safety and diminished quality of care; increasing morbidity (incidence of disease) and mortality (death rate); and an increased occurrence of adverse or sentinel events (injury or death resulting from a health care intervention, not the underlying condition of the patient).”
Reliance on VMOs and Locums
Dr Roberts criticised the current model in hospitals which favours the appointment of Visiting Medical Officers (“VMO”). A VMO is not employed by the hospital. They are a private practitioner who is contracted to work and operate at a public hospital. While they operate and admit patients to public hospitals as public patients, they see those same patients in their private rooms and can charge private fees.
Specifically, Dr Roberts said he had been “intimately associated with the exposure and investigation of the now disgraced Obstetrician and Gynaecologist, Emil Gayed.” Dr Gayed was an obstetrician and gynaecologist who worked in public hospitals throughout NSW including at Manning Hospital. When his misconduct was uncovered, it was discovered that he had inappropriately performed surgeries and treatments on hundreds of women. Dr Gayed was ultimately found guilty of professional misconduct and was disqualified from practice. An inquiry was called by NSW Health into Dr Gayed’s conduct, which found a number of shortcomings across a number of different hospitals, including the Hunter New England Local Health District. You can read more about Dr Gayed’s matter here and here.
The disastrous outcomes suffered by Gayed’s patients were not appropriately investigated by Manning Hospital management, which only further perpetuated the cycle and allowed Gayed to keep operating under the radar. Dr Roberts believes that with appropriate governance and oversight, Dr Gayed’s conduct would have been discovered and stopped years earlier. Alarmingly, Dr Roberts gave evidence that after he began investigating Dr Gayed’s conduct, his concerns were dismissed by hospital administration. There was one instance of the investigation into a patient’s preventable death being downgraded from SAC1 (the most serious level) to SAC3, which classifies “minor harm” to a patient. This meant the appropriate internal investigations and reporting steps were not taken.
An example given of a lost opportunity was that in a recent major project at Manning Hospital, an existing car-park was demolished only for a new car-park to be rebuilt on the same site which provided an additional 12 car spaces. Witnesses expressed frustration that the significant funding for that project could have been better spent on health services.
Dr Narasimhan told the Inquiry that Manning Hospital had a new renal and oncology service. However, he said the local nephrologist was not consulted when the ward was being planned. He viewed this as a missed opportunity to get input from the very practitioners who would be using the ward daily.
The need for services appropriate to the area
The Manning area is particularly vulnerable as it has a higher rate of indigenous, ageing and lower socioeconomic population than the rest of NSW. Funding did not account for that, meaning that services are not tailored to those areas of the population. The Action Group specifically called on preventative health clinics for indigenous communities and a palliative care ward to cater for the ageing population.
In addition to the above, the Inquiry received a submission from One Door Mental Health – Great Lakes Mental Health Carer Support Group calling for a dedicated mental health facility at Taree. The submission said “Currently there are no mental health services in the Great Lakes area other than Community Health which is only available during business hours by referral to a case worker or the Psychiatrist weekly for people on a community treatment order. The closest support service available is Flourish (only for NDIS clients) and Parramatta Mission for those without a NDIS package, located in Taree. The travel time for people living in the Great Lakes area can vary from ½ hour to 1 1/2 hours by car. No train service is available in the great lakes and bus services are very limited. The nearest mental health hub is at Port Macquarie which comes under a different area health service.”
The Action Group highlighted that patients had to travel long distances from smaller towns, such as Gloucester, to Taree. In emergency situations, or obstetric situations, this was certainly not ideal given the danger of navigating poor country roads especially at night.
What is obvious is that the issues that need to be considered and addressed by the Inquiry are varied. There is no one-size fits all approach that can be adopted as each rural and regional area faces its own issues in accessing health services.
It is clear from the evidence presented at the public hearing that there is a problem at Manning Hospital that has persisted for some time. Some problems are slowly being addressed, but until the situation improves adverse outcomes for patients continue.
As Dr Roberts said, “…regional residents of New South Wales are forced to pay for the same care that their city cousins enjoy for free or they have to travel hundreds of kilometres for that care or worst of all they go without the care altogether.”
Get in touch
At Turner Freeman, our medical negligence team has fielded many enquiries in relation to poor healthcare from many rural hospitals and facilities, including Manning Hospital. We know the issues faced by rural and regional patients are different to those faced by patients in the city.
If you are concerned about your treatment in a rural or regional hospital, get in touch with us. We have specialist medical negligence lawyers throughout NSW who will assess your case and provide personalised advice regarding your legal entitlements. Our medical negligence lawyers are located across NSW including in our offices in Parramatta, Sydney, Wollongong, Newcastle and Toronto.
Our Newcastle-based solicitor Lidia Monteverdi knows and understands the issues faced by residents in the Hunter New England Local Health District. She is available to travel throughout NSW and can be contacted directly on (02) 4925 2996.
 Submission No. 6
 Submission No. 678
 Submission No. 168
 Submission No. 249