Below is a letter from Dr Jayachandran Narayanan (Jaya) on behalf of Griffith base hospital medical staff council, published in full.
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LETTER
The members of the Griffith Base Hospital Medical Staff Council are dissatisfied with the management of the Murrumbidgee Local Health District administration for the following reasons:
1. Radiology Services
At no time at all were we informed, or our feedback sought into what would transpire if the radiology services of the regional Imaging were discontinued and another radiology service introduced. Specialists in this hospital had expressed grave concerns to the administration regarding this, and sought answers but their emails and queries remained unanswered. We were only told that we would get "the same if not better than what we already had", which turned out to be far from the truth. This has turned out disastrous for the hospital and has set us back several years.
Regional Imaging (Imed) provided Griffith Base Hospital with a full time radiologist for the last 9 years, first Dr. Ali Kyatt and subsequently Dr. Yune Kwong. Both of these radiologists were highly skilled and apart from having them onsite to obtain rapid reports they also performed several procedures which the changeover has reduced greatly. In serious trauma and life threatening situations we have had the radiologist reporting "live" while the scans ere being performed allowing patients to be transferred to the operation theatres for emergency surgery straight from the radiology department.
We went from having 4 ultrasound machines and sonographers on site (2 public and 2 private) to having only 2 in the public. Regional imaging performed a very significant number of ultrasounds, both elective and emergency for Griffith Base Hospital patients as the public side was always overbooked.
The full time radiologist apart from performing several procedures and reporting in radiology, were heavily involved in our weekly Wednesday 0800-0900 teaching sessions (first Wednesday of every month) as well as the fortnightly Breast and Colorectal Multidisciplinary team meetings (0370-0830).
They were invaluable in assisting in breast cancer surgery with hook wire placements and core biopsies, enabling us to treat these patients expeditiously. The waiting time for a breast cancer patient for planned surgery was rarely more than 2 weeks.
Mammography was available on site in the Regional Imaging rooms which is no longer available.
Once the transition to the new radiology services had taken place only then did the area health service management come down to talk to the Medical Staff Council. At that meeting they expressed their ignorance of the previous radiology services provided by Regional Imaging saying "they were not aware that Regional imaging did so much for Griffith Base Hospital patients."
This they would have known only if they had come to discuss this with the clinicians in the hospital prior to changing radiology services. Moreover the tender for for radiology services was for radiology reporting, not for all the procedural work that the previous radiologists had been doing. Sadly today we struggle desperately with a vastly inferior level of services in radiology, both with longer wait for reports as well as diminished procedural skills. Instead of having a full time radiologist we now have a floating population of radiologists changing almost every week with variable skill levels.
2. Closure of the Griffith Base Hospital Central Sterilising Supply Department
Again, clinical staff of Griffith Base Hospital were kept out of the loop till after the deed was done. The area health service management struck a deal with the St. Vincent's Private hospital to close down the Base Hospital CSSD if the St. Vincent's hospital opened one.
We were told in a special meeting with the CE of MLHD that this would be "good" for the Base hospital as they would be buying us a lot of new instruments?? Have they seen how our theatre struggles with storage capacity issues? Where is the cost saving by sending Base hospital instruments to the private hospital for sterilising? They charge way more than to do it in house. Also the Base hospital needs to have a van and special containers to transfer the instrument trays over to the private hospital for sterilising. Where is more major surgery done (such as cancer surgery etc)? - At the Base, not the private. Where is emergency surgery done? - Again, at the Base, not the private. The fact remains that the Base hospital needed an upgrade to its sterilising equipment. There was gainful employment for a few people in that department who had served faithfully for years. All a way of getting rid of job positions in the public hospital.
3. Pathology Department
The plan by NSW Pathology to institute changes in the pathology department starting with closing down histopathology, and moving it over to Wagga Wagga. Getting our pathologist, who has worked here for almost 20 years, to now drive over to Wagga Wagga every week, stating that is is "not good for him to be working in isolation". That isn't a true statement for the reason that the pathologists have an excellent network for referral of slides and specimens for second opinions. Having a pathologist on site at Griffith Base Hospital is really important for the surgical services for various reasons such as the pathologist being able to have the operating surgeons' help in cutting up the specimen to get a better idea of the operative procedure as related to the site of the lesion. Urgent processing of cancer biopsies was possible, in most instances the maximum time for urgent biopsies was 24-48 hours.
There had been a regular fortnightly Multidisciplinary Team (MDT) meeting for cancer services which included the surgeons, oncologists, nurses, radiologist and pathologist.
This is a really important part of the surgical services at Griffith Base hospital, which has been affected first by the downgraded radiology services and now with the transfer of our pathologist, it surely sounds the death kn ell of surgical oncology at Griffith. Over the last few years Griffith Base Hospital had progressed really well in breast and bowel cancer treatment with the help of radiology and oncology. As a result much greater number of breast and bowel cancer patients were being operated and treated here. Laparoscopic (keyhole) surgery for bowel cancer is being regularly performed at the Base hospital over the last 5 years.
In this, the 21st century it is unthinkable that a hospital with the responsibility to provide medical services for a population base of over 80,000 people should be moving backwards rather than forwards. The medical, nursing and other staff in the hospital work very hard to provide for this community but it is becoming increasingly difficult to continue with the diminishing level of support of ancillary services. With an increasing population, the Base hospital should be expanding both in facilities and personnel, not the other way around. How management can justify the withdrawal of services in the country where people are forced to travel really long distances defies imagination.
Our fight for staring orthopaedic services in Griffith Base hospital in the past was another example of the area health service administration's failure to provide adequate and proper health care for the community. It is simply not justifiable by any standards that there be no orthopaedic surgeon for this area. Broken bones an limb injuries are commonplace and people should not have to travel long distances to have these attended to.
The way things are going it won't be long before clinical departments start shutting down, or doing just basic work. For years we have been fighting for increasing staffing, both medical and nursing. We have been pushing for opening up of operation theatres and ward beds so as to be able to increase the number of surgeons so as to build a strong department with training opportunities but have been denied every step of the way. Our dependency on locum services has meant that a big chunk of the budget of this hospital goes into paying for much lower productivity because the locums by virtue of being here only for a short time would be less productive. Strong departments need full time staff, and this goes for other departments as well.
Griffith Base Hospital has been supported by an amazing ream of doctors, nurses and other staff over the years and by a caring community. We need to give back to this community. It is time that the powers that be were held accountable for the dire situation we find ourselves in.
The medical staff council met with the Chief Executive of the MLHD and the General manager of the Griffith Base Hospital on Tuesday 25th July 2017.
We were asked for a recommendation regarding the recent changes to the hospital histopathology department.
The following response was agreed on unanimously:
The Medical Staff Council of Griffith Base Hospital notes with consternation the proposed changes to the hospital histopathology department. It is our considered view that taking away the sole on-site pathologist from the Griffith Base Hospital will have an incremental and severely detrimental effect on the facility and the 80,000 plus population that it serves.
As collegiality and peer support are the stated reasons behind the proposed changes, we would unanimously suggest a reciprocal arrangement whereby pathologists from Griffith and Wagga spent time at both facilities on a periodic basis. This would enable the local health district to strengthen both hospital, ensure patient safety and allow residents ob both areas to receive the best possible treatment close to their homes.
Dr. Jayachandran Narayanan
Acting Chairperson
Medical Staff Council
Griffith base Hospital Griffith NSW 2680