by S Lowe for 5THE FM’s newsonline wattlerangenow
Photos by Belinda Elton
The Public Meeting, July 31st to save our hospital services attracted 650 people from Millicent, Penola and the surrounding district, filling the Millicent Civic Centre to capacity. Mayor Peter Gandolfi Wattle Range Council appointed CEO Peter Harriott as Chair due to being slightly under the weather with loss of voice, but he was able to welcome those attending and open the meeting. Mayor Gandolfi re-enforced his belief that Jayne Downs had misled the community with her statement to council in June, that no services would be diminished at the Millicent Hospital when a letter had been produced to the contrary.
First guest speaker Don Gilberston was Chair of the Hospital Board that was sacked by Country Health SA, and he drew clear comparisons between a hospital managed by a board and a hospital run by CHSA. The most important difference being the board communicated with the doctors and community. They managed the budget and also introduced services as they could. He said that repairs are done by Adelaide tradesperson now, reducing work for local businesses, so the damaging effect were widespread. He said they were also unable to source their own funds held by CHSA>
“Country Health SA drove a wedge between the GP’s and the hospital,” he said.
Mr Glen Brown, former CEO of Millicent Hospital and current HAC member (Health Advisory Committee) said that the 10 year plan developed in 2009 for 2010-19 included:-
- Emergency - to be maintained and enhanced
- In-patient – to be maintained
- Obstetrics - to be maintained
- Medical - the same to be maintained
Describing the lack of communication between CHSA and HAC, he said, “it came as a complete surprise to learn that obstetrics were to close, we (HAC) were not privy to the negotiations.”
In the 10 year plan, Millicent did not ask for anything out of the ordinary, we just asked for services to be maintained, but we have lost chemo, dialysis, and now obstetrics and this is no help to doctors trying to recruit.
“It is obvious that we have lost control – enough is enough.” He called upon the Mayor to re-visit the 10 year plan and maintain and enhance the wellbeing of the community.
Hon Rob Lucas MLC Shadow Health Minister arrived having just driven through the pines from the Mt Gambier Airport and as by way of light relief, next speaker Mr Bill Murray quipped that he hoped Mr Lucas was not pregnant while making that dangerous trip, like our pregnant woman will have to now.
Mr Murray Chair of the Penola Medical Support Group described the past few years as traumatic.** Years when doctors became scarce and the community decided they needed an action plan, hence they formed a support group to assist with attracting doctors to the area. They adopted a constitution and decided on a vision so the community had a clear focus of what they hoped to achieve. He also said that Penola shared the same frustrations as Millicent when the hospital ceased being managed by a board and run by CHSA -the same lack of communication and consideration by CHSA. He suggested that Millicent consider a similar option in establishing a support group.
“Mr Lucas let the doctors have a say, bureaucrats are not medical people, and we need a clear vision about our health services.”
Dr Stephan VanEeden GP Partner Medical Clinic Millicent – “despite continued assurances by CHSA that our services were being maintained, services have been downgraded and so has staffing at the hospital.”
- Dialysis has been transferred to Mt Gambier
- Chemo removed from Millicent, cost of travel transferred to patient. When chemo was given at Millicent it was a regular and busy service and the patients really valued that service. It was so well used that patient had to book ahead.
- No after hours theatre no, that can be a problem because babies tend to come at night.
- Midwives shift have been reduced.
- No midwives on some shifts
- Real reduction in mental health nurses (not at hospital but part of the overall services)
- Gastroenterology stopped. It seems that when a specialist stops coming, they are not replaced and the service is stopped.
“By stopping low risk births you remove the patient from their local doctor. The Mt Gambier doctor provides the ante-natal care and local doctors have no control of their patient care. They have to travel, an additional cost to the patient, and they must travel on country roads, day & night.
When CHSA say that Millicent doesn’t have safe birthing, it is scare tactics and they want us to believe that ante-natal services will remain!
Mt Gambier Hospital has staff shortages in every department but they are not closing department there.
So the case for closing birthing in Millicent doesn’t stack up.”
Dr VanEeden addressed the second issue and that is the removal of the 2nd on-call roster. When faced with a life saving situation, you need 2 doctors but CHSA has removed the 2nd on-call roster leaving a single doctor to deal with that patient, he said/
“When we travel to Mt Gambier with a patient, we are met by 4-5 doctors at the hospital, not 1 like in Millicent.”
“What is the difference of the value of the life of a Mt Gambier patient and a Millicent patient?” he asked.
“This situation also impacts the recruitment of additional doctors. A new recruit may ask, where is my back-up and we say – you’re on your own.”
“It’s a huge stumbling block and we have been having this conversation with CHSA for 5 years or longer.”
Dr Francois Pretorius former GP Medical Clinic provided a pre-recorded address. He clearly articulates the treatment he received at the hands of CHSA, as his reason for leaving Penola. He described difficulties with CHSA in general, lack of funding, lack of assistance and no communication.
“I am sorry I cannot be there in person, even though I am not in the South East anymore and thankfully not involved with CHSA anymore, I still feel very much a part of the health services across country South Australia.”
“CHSA tactics include bullying,” he said. “Just ask Dr Jelly who was sent up from Adelaide under express orders from Helen Chalmers to rattle my cage and shut me up.”
He said that changing the current health service problems would be a huge task while CHSA were still in the driving seat but he encouraged to community to use their voice and tonight’s meeting was about pointing the finger at CHSA that we care and are prepared to make a change.
“We need to take back control of our health services.”
He described the cost of additional administration staff at the Penola Hospital now that it is run by CHSA and yet he could not get funding for an emergency bed at the Penola Hospital.
CEO Peter Harriott introduced Dr Peter Chapman CHSA , who declined to address the meeting. Dr Chapman took Jayne Downs place on the stage, while she remained in the audience, but did not take her place as guest speaker as had previously been arranged.
Rosey Radcliffe, represented Elizabeth Dabars CEO Secretary Australian Nursing & Midwifery Federation SA Branch, reading a prepared statement by Ms Dabars who was unable to attend, due to the annual conference of the ANMF in Adelaide.
“CHSA has clearly failed to discuss and consult with is or our members over the changes, it simply announced on the media,” she said. “Changes that affect your community, particularly women of your district, your hospital and our members – particularly our midwives at the hospital.”
She described the ill fated CHCare Plan and the long running dispute over the Keith hospital and said that CHSA should have learned by now that they should discuss issues with health professionals, local communities and organisations like ANMF before they make decisions to close or relocate services.
“The second concern we have is the obvious difference between the story told by CHSA and the local medical staff over the reasons for the decision to end birthing at Millicent.”
“CHSA has told us repeatedly that they wanted to enter into a contract with the medical practice that would have ensured the continuation of emergency Anaesthetic and Obstetric support to the hospital and that the doctors had refused to include these services in the contract.”
She then quoted a statement from the Medical Clinic.”……that doctors with Obstetric and Anaesthetic skills retain their strong desire to continue with the current obstetric service; however despite prolonged negotiations we have been continually advised that a contract for such a service will not be offered in Millicent. Along with our community, we urge CHSA to reconsider their decision to close obstetric services and allow our doctors to continue to provide this vital community service.”
“We have asked CHSA to clarify their position in light of these comments but they have chosen not to.”
“It is unacceptable that women in this town cannot birth in a hospital, supported by a midwife, when women in Adelaide can choose to birth at home – never mind in a hospital –with a midwife present to manage the delivery.”
Her final statement assured CHSA that should they not honour their agreement to work with the ANMF to find a model that will allow women access to such a service, they (ANMF) “will work with other stakeholders here tonight to hold them accountable for this abject failure in the management of your local health services.”
Midwives Jill and Anna received permission, (to avoid the threat of job loss) to read a prepared statement.
Midwives were not told of the closure of Millicent Obstetrics, they learned through the media.
They addressed Dr Chapman who had been quoted as saying on ABC that Millicent women had chosen to birth in Mt Gambier, telling him, that they knew that the birthing rate had been reduced by other factors, not from expectant mothers wanting to go to Mt Gambier.
**The diminishing number of births quoted by CHSA, as the reason for losing the services has consistently been given as 35, throughout the negotiations with local GP’s and in media releases, WattleRangeNow has continually tried to get a more accurate figure. The number of women transferred to Mt Gambier to give birth was never publicized but during question time this question was asked of Ms Chalmers. She replied that approximately 120 women were transferred to Mt Gambier – with appropriate staffing Millicent Hospital could have had 155 births in the last year.
The midwives said the loss of midwives would be an additional loss to hospital services if obstetrics closed and if that happened there would be no ante-natal care or post-natal care at the hospital if the midwives move on to other hospitals.
Minister for Health Jack Snelling sent his apologies for not attending, sending instead Helen Chalmers. CEO CHSA
Ms Chalmers assured the meeting that there would be no further cuts to services and at this point the otherwise receptive audience lost patience.
Her address included stats of surgical increases at the Millicent Hospital and emphasized that obstetric services need to be safe and comply with the standards set and said the local doctors had not been able to provide the necessary 365 days a year coverage to offer that service.
Ms Chalmers apologised to the midwives who learned of the closure on the radio, saying in response to the audience lack of conviction , “I know too little, too late.”
She said that the local GP’s prioritised their clinic and not the hospital and they had no ability to cover obstetric s and anaesthetics.
She said that locums provided the hospital roster for the majority of the time and the GP’s rosters were limited.
***Dr VanEeden said that the days covered, by the GP’s had to be looked at in context.“Four doctors sat at the clinic waiting to be allowed to work in the hospital since the beginning of this year; 2 of them had come to Millicent, to the country, precisely to gain hospital experience. Their time ran out and they left here, not having set foot in the hospital, as was the plan! They were not allowed into the hospital because of contract negotiations. They could have been future GP’s, they could have been future doctors here.”
Ms Chalmers emphasised the need to comply with ‘standards’ to have an obstetric service at a hospital and Millicent was unable to do this.
***in response, Dr VanEeden said in regards to the standards Ms Chalmers referred to.
Standards required to have an obstetric service include –
- Staffing must include midwife roster 24X7 – staffing is the responsibility of the employer – CHSA
- Operating room staff must be 24X7 – staffing is the responsibility of employer – CHSA
- Obstetric doctor must be within 60 minutes of need - Mt Gambier is 30 – 45 minutes from Millicent, “Why can’t they be seconded from Mt Gambier by CHSA.”
- Anaesthetic doctor must be on call – a caesarean must begin within 60 minutes of the decision to perform the procedure – “How far is Mt Gambier:?” he said
“Surely we can have some support staff from Mt Gambier?”
He explained that obstetric closure creates another problem. An obstetric roster includes an anaesthetic doctor, immediately providing a second on-call emergency doctor solving the 2nd on-call doctor.
“When there is a need we just go, whatever the emergency,” he said.
Ms Chalmers said that mothers from Robe and Kingston could go to Naracoorte to birth.
*** Dr VanEeden said in response “some weekends Naracoorte Hospital obstetrics are closed – so what do you do if you are the other side of Naracoorte and you decide to have a baby.”
Ms Chalmers said that Rural Doctors Workforce Agency was working with CHSA to secure 2 doctors for the Penola practice and had a good lead on one doctor.
She recognized Dr Milton MacArthur’s on-going contribution at the Nangwarry Clinic.
Mitch Williams MP Member for Mackillop addressed the meeting via a pre-recorded video, strongly advising the community to develop a plan and fight the decision to stop obstetric services being removed from the Millicent Hospital. He said he was suspicious of CHSA and their reasons for removing vital services from rural areas and it would make the local GP’s recruiting process to attract doctors even more difficult.
Hon Rob Lucas MLC Shadow Minister Health recalled years growing up in Mt Gambier. His mother and sisters and their families still live in the area.
“When a community is concerned about a Governments decision and such a meeting is called, I think it is up to the politician to show up.” This statement brought enthusiastic applause from the 650 strong crowd – Minister Snelling absence obvious to the audience.
He asked the meeting to channel their frustrations to the Minister and the government, not the bureaucrats, who were there to do a job and that was to echo the views of the government.
“The new Adelaide Hospital will cost us and future generations $400million over 30 years for non clinical services – not including medical staff, nurses, doctors,” he said
“I don’t believe that one large hospital can provide all the services that regional people need. And over the years we have seen smaller rural hospitals close.”
“You have stoically taken many losses of services over the years but cutting obstetrics was one step too far,” he said.
The one thing that the meeting wanted was to hear what he would say about the Millicent Obstetric Services if he became Health Minister at the next election in March 2014. They didn’t have to wait long.
His Party had given him the responsibility of making the decision and after hearing the various addresses he committed his Party to continuing Obstetric Services at Millicent Hospital if they were still operating and importantly, re-instating Obstetric Services if they had been stopped.
He added that if medical staff was lost between now and the election and on the condition that there is a change of government, his party would also commit to assisting the recruitment of additional doctors, appropriate service and “ we will give it a fair dinkum go.” he said.
The difficulty would be, not knowing what SA Health have done to the services between now and then, he told the meeting.
He also committed to meeting with the local GP’s in the coming weeks to work through some of the details.
He supported Mitch Williams’s advice that the community must fight to have services restored.
Mr Lucas has previously been involved with Penola’s medical crisis and referred to Dr Pretorius difficulties. He also said he had been involved with Mr Murray’s efforts to retain health services in Penola.
“Why is it so hard to get doctors to come to God’s own country?” he said. “30 minutes from Mt Gambier airport, why can’t we attract doctors?”
“Thankyou and good luck with campaigning.”
Mr Harriott read
- a letter from Independent Senator Nick Xenophon, sent to the people of Millicent, assuring the people that they should not have to fight for essential services and offering to assist the local doctors with their negotiations with CHSA. Mr Xenophon said he had written to the Ministers for Health both State and Federal.
- a letter from CEO Robe Council Roger Sweetman – asking Health SA to consider the people of Robe, especially the women who have no services at Millicent to give birth and Robe is another hour away from Mt Gambier.
Mr Harriott asked people to sign and send the red postcards that were at the door. They are addressed to the Premier and it’s another way of showing we want to ‘save our hospital services.’
Questions and comments”
- Colin who asked what other hospitals of similar size to Millicent were still offering obstetric services – Ms Chalmers could not remember them all but psooibly Renmark and Mannum
- Sharon – why was the second on-call removed from the roster – Peter Chapman said that CHSA could not provide 2nd on call in 62 hospitals. Ms Chalmers said that a 2nd doctor could be called if needed. He talked about the one week on, one week off contract reached between CHSA and the clinic. It was important to have an emergency dept at Millicent. CHSA committed to providing the service the 2 weeks of the month. Many hospitals have only one emergency doctors on -call he said.
- Dr Chapman said he was pleased that there would be further discussions with the clinic regarding obstetrics.
- Discussion took place between Sharon and Ms Chalmers about payment of the 2nd on call doctor and it was confirmed by CHSA that they would do so. The doctor would be paid on a fee for service basis but it depends on their availability. Would not be paid on an on-call roster though.
- 15 Specialists still coming to the hospital? – What will happen, with the cuts to staff, if there is a need for theatre staff. Ms Chalmers said that would have to belooked at.
- Vicki – will other services be brought back. eg chemo, dialysis. Ms Chalmers said that chemo service were being opened up all across the country, including Mt Gambier to save travel. New units being opened up across the state but not at Millicent
- Will we lose more services – Ms Chalmers said there would not be further losses
- Many statements were made about the dangerous country roads, fog, kangaroos, wombats, emus and trucks.
- Sam said that they had a baby 15 weeks ago, intended going to Mt Gambier but it came quickly and the baby was delivered in Millicent. The staff was amazing he said. So I am wondering if we have another one, “How will I feel driving passed Millicent Hospital with my wife in labour, and if the kangaroos, the wombats don’t get me, the stress of delivering a baby on the side of the road somewhere between Millicent and Mt Gambier will.”
- Mr Chapman was told by one mum that she had wanted to have her baby in Millicent but was sent to Mt Gambier, she had no choice not as he had said on the ABC and what guarantee is there that the midwives will be available at Millicent when the mother return for care after the birth. Ms Chalmers accepted that the midwives had through a bad time and there was work to do.
- Rob said the advisor to the Minister of Education resigned and he suggested that the people of CHSA do the same, he does not think that there is a conspiracy – they are just incompetent, so he suggested they fall on their sword.
- How can we as a community make sure that we don’t continue to lose services, whose responsibility is it, the doctors, the council or who?
- John – The figure of 35 births has been used as the reason for cutting obstetric services. Peter Chapman is quoted as saying on ABC that this figure showed that Millicent women had chosen to birth in Mt Gambier. What about women who were referred to Mt Gambier because there wasn’t sufficient staff at the Millicent Hospital, wouldn’t that have been a more accurate figure to consider before closing obstetrics. Answer – 120 were birthed in Mt Gambier from Millicent and surrounding districts.
- Nan – will CHSA commit to talking with the doctors about obstetrics. The nursing home is not being looked after well either . Money taken by CHSA without choice. – Ms Chalmers, yes CHSA will talk with the doctors about obstetrics. In regard to the nursing homes and funds she offered further opportunity to talk.
- What qualifications do the people making the decision have, over and above local knowledge.
- Mr Lucas was able to get here from a meeting in the north and the Minister was in Pt Augusta today, why couldn’t he have caught a plane and driven the same road through the pines that Mr Lucas did. Ms Chalmers described them as being from the country and having many years of experience. In answer to why the Minister did not attend – Ms Chalmers chose to nod.
Motions pre-prepared by Mayor Gandolfi and voted on by the meeting, will be sent to the Minister with an accompanying letter from the Mayor. (see below in photo gallery and in report on WRN on Fri 2/8)
Helen Chalmers said she was pleased that they would get obstetric talks back on the table with the Millicent GP’s. She also said that it was obvious what the community wanted, that the community had spoken.
Dr Chapman said that they CHSA would reopen talks about obstetrics.
Mayor Gandolfi was adamant that this community wants all services back, one by one. He also told the meeting of his disappointment that the Minister had sent a bureaucrat, not a politician to speak for him. He stressed his disappointment in this Govt and asked the people to help get seats changed in Adelaide. He thanked Mr Lucas for his commitment to continuing and/or returning obstetrics and his commitment to take this issue the Minister.
He confirmed that a senior doctor had indicated during the meeting, with the thumbs-up, that the doctors can continue with obstetrics and wish to do so.
He said that by coming to the meeting, this community had shown compassion and that we are a community that cares. He thanked Deb Kirby for her on-line petition which had great success and Judy Altschwager for her help in getting petitions and posters out into the communities across the Wattle Range Region. He acknowledged the attendance by nurses and staff, unable to speak but had attended toshow their support.
He thanked Media coverage – 5 THE FM, SE Times, WattleRangeNow, Channel 7 He reminded the meeting to sign the petition at the door, over 3000 signatures had already been collected and it will be presented to Parliament by Mitch Williams Member for Mackillop in a few weeks.
The Hon John Hill Minister for Health said via Press Release on July 31st 2008
“We won’t impose a health care plan on country South Australians that they don’t want,” Mr Hill said. He went on to say that there would be major redevelopment in many hospitals including Mt Gambier.
“….but it’s quite clear that we will need to rethink our strategy for small hospitals, given the strong support they have in rural communities.”
This comment still applies today – our community has shown strong support for our hospital and our health care, and it is time for CHSA to re-think!
Dr Stephan VanEeden. “Don’t let anyone tell you there is no solution to this problem, there is; what it needs is the will to find that solution.”