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medicSA
M A G A Z I N E O F T H E A U S T R A L I A N M E D I C A L A S S O C I AT I O N ( S O U T H A U S T R A L I A ) I N C .
Good news for mums
and bubs in WCH move
Mandatory reporting • Thai cave diving hero: 3 generations of medicos
Maternity services • SA eating disorder services • A vision for health?
Medical education • Working to eliminate nuclear threat • Life stories Volume 31 Number 6
December 2018
GP REFERRED MRI
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Contents 6
3 President’s column
News & views
4 News & views
Mandatory reporting
8 Maternity services
Doctors need to be able to seek
12 Bullying treatment for health issues
14 Eating disorders with confidentiality whilst also
SA services preserving the requirement for
16 Vision for health? patient safety. Health Ministers
18 Indigenous health are failing to listen …
19 Membership
Why join the AMA
20 Medical education
24 Council news
9
25 AMA(SA) dispatches
Cover
26 Event
Retired members lunch
WCH move welcomed
28 Nuclear war
by AMA(SA)
Eliminating threat After years of advocacy for a
31 Inside the AMA co-located Women’s and Children’s
Hospital with the new Royal Adelaide
32 Public health
Green spaces
Hospital, the AMA(SA) welcomes the
Government’s latest step along
35 Medico-Legal Dinner
that road.
40 Motoring
42 Whither history?
44 Life stories
38
47 Orthopaedic health
Profile
49 Vale
Prof Doug Henderson
Three generations of
50 Life as an intern
doctors: the Harris family
Dr Richard Harris became a
52 Reflection
household name for his efforts
55 Pathology corner
during the Thai cave rescue earlier
56 AMA(SA) history this year. But did you know that
60 In practice his father almost drowned as
67 Practice notes a small boy?
Australian Medical Association medicSA Disclaimer
Neither the Australian Medical Association (South
(South Australia) Inc. Editorial
Australia) Inc nor any of its servants and agents will
Editor: Dr Philip Harding
AMA House, Level 2, 161 Ward Street, have any liability in any way arising from information
Managing Editor: Heather Millar or advice that is contained in medicSA. The
North Adelaide SA 5006 Director of Policy and Communications: Eva O’Driscoll statements or opinions that are expressed in the
PO Box 134 North Adelaide SA 5006 magazine reflect the views of the authors and do
Cover image
Telephone: (08) 8361 0100 not represent the official policy of the Australian
Architect: GHD Woodhead
Medical Association (South Australia) unless this
Facsimile: (08) 8267 5349
Advertising is so stated. Although all accepted advertising
Email: admin@amasa.org.au material is expected to conform to ethical standards,
Heather Millar 0409 196 401
Website: www.amasa.org.au such acceptance does not imply endorsement by
Production the magazine.
Executive Contacts Typeset and printed for the AMA(SA) by
All matter in the magazine is covered by copyright,
Douglas Press Pty Ltd. ISSN 1447-9255 (Print)
President and must not be reproduced, stored in a retrieval
ISSN 2209-0096 (Digital)
A/Prof William Tam: president@amasa.org.au system, or transmitted in any form by electronic or
Unsolicited material: mechanical means, photocopying, or recording,
After hours: (08) 8361 0100
Unsolicited editorial material should be sent to the without written permission.
Chief Executive AMA(SA) c/- the Managing Editor no later than six Images are reproduced with permission under
Joe Hooper: (08) 8361 0109 weeks prior to the target month of distribution. limited license.
medicSA DECEMBER 2018 1
heading
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2 medicSA DECEMBER 2018
William Tam President’s Report
Health is a solution, not a problem
A
s I write this, the KordaMentha We also need sound data to drive even in the Parliament, it is almost as
reports are making waves, health policies and service planning. though Health – and our health system
and the Opposition is making We have seen too many decisions – is presented as a problem. It’s not a
much of what they hold, and the driven by poor or poorly understood problem, it’s a solution.
implication of handing responsibility data, or inaccurate comparisons or
It is not perfect. But every day it is
to a consultancy to “turn around” benchmarks. That’s why the AMA(SA)
making things – and people – better.
CALHN’s financial situation. has been calling for an independent
Whether that is repairing broken bones
clinical data analytics entity that can
For an $18 million contract it is or damaged bodies; picking up the
sit independent of government and SA
hoped the plan will deliver savings aftermath of major trauma; or getting to
Health, and provide sound information
of $41 million by mid-next year, and the root of chronic disease.
and analysis for sound decisions.
$101 million and $134 million in the There are things we need to fix in
years following. On the agenda are The need for better workforce planning,
our health services, in our institutions
“improving the efficiency of care”, highlighted in the report, is something
and in how things are done. We are
in particular “unnecessarily long” the AMA(SA) has been talking about
no orphans there. But we are ready
hospital stays; better workforce for years.
to do that and we are ready to do
planning; and increasing financial What we don’t want to see, is for that in a way that is constructive.
controls and accountability. morale in our public system to We doctors like to fix things; it
Reading some of the rhetoric about continue its current trajectory. Cuts, is what most of us get up for in
reconfigurations, reforms, shiny new the morning.
what is planned and what is hoped, I
problems, and hoary old ones, have
cannot help hearing echoes of some of The AMA, both at state and national
been adding up.
the phrases, promises and objectives levels, is engaged in solutions. In
of the failed Transforming Health It’s not all doom and gloom though, public health, in policy, in law, in how
exercise. Of course, that was a much and one of the risks in focussing on the health system works, and beyond
different branding exercise, with bright the fixes we want, the fixes we don’t, it. If you are an AMA member, you
colours in place of shades of grey and and the fixes someone has determined have a part in those solutions. You
blue, colourful pictures, a summit and we have to have, is that we – including need them, your patients need them,
a slogan. This one is more of an those in charge, and the public at and we need you. Your ideas, your
austerity sell, but still ... large – lose sight of the great bits. priorities, and your membership dues.
And there are plenty of them. The AMA is not government funded.
The AMA(SA)’s take on all this, so We are independent. We are beholden
far, has been that while we are in We have amazing people in our system
to no one except our members and to
favour of efficiency, it must not be at delivering fantastic care to patients,
nothing except the ideals we uphold
the expense of patient care. We don’t through all this. As doctors, we strive
and promote, and the public trust
want bed closures or a reduction in to do better, and we will. With help;
that is afforded us.
services to the community. We also without it; or in spite of it.
strongly hold that if you are talking Whether or not you are a member
At the AMA(SA), our messages to
about improving efficiency, that of the AMA makes a difference. It
the government and Department are
needs to be driven by clinicians – makes a difference for you, and
to do this with us, not to us. Work
for us. It is something you yourself
doctors and others in the health with those who are on the front lines
can do for any of the many issues
team – not accountants. delivering care to patients on how
that concern you and the AMA as
our system can do better, and what
Doctors know what is working well and well. They will be many. If you are
comes next.
what isn’t at their services, and they not a member now, please join today:
want to see improvements. Too often, Too often, when we pick up the amasa.org.au. If you are a member,
they are not listened to. newspaper, or in our workplaces, or thank you!
medicSA DECEMBER 2018 3
AMA(SA)
heading
Council Service cut will hurt the
Office Bearers
President: A/Prof William Tam
young, vulnerable and
Vice President: Dr Chris Moy
Immediate Past President
victims of abuse
Dr Janice Fletcher
T
Chair he AMA(SA) has spoken out in
Dr David Walsh support of funding for important
services that play a crucial role in
Ordinary Members helping the young and vulnerable in our
Dr Michelle Atchison, Prof Randall Faull, state, with SA doctors rallying in a public
Dr Matthew McConnell, Dr Clair Pridmore, petition to SA Health Minister Stephen Wade.
Dr Rajaram Ramadoss, Dr John Williams,
Dr John Woodall Not-for-profit SHINE SA has provided sexual
health and relationship wellbeing services
Specialty Groups
since its establishment in 1970, but has
Anaesthetists: Dr Perry Fabian faced years of funding cuts: this year, a
Dermatologists: Dr Jeffrey Wayte further 9.5%. In response, the service has
Emergency Medicine: taken the difficult decision to close its clinics
Dr Thiruvenkatam Govindan in Davoren Park and Noarlunga (two of only four) and its city-based HIV counselling service.
General Practitioners: Dr Bridget Sawyer
Obstetricians and Gynaecologists: “The AMA(SA) recognises that SHINE SA has made a difficult decision; we would like
Dr Jane Zhang them to be able to reverse that decision,” said AMA(SA) president A/Prof William Tam.
Orthopaedic Surgeons: Dr Jeganath Krishnan “We are calling on the State Government and Health and Wellbeing Minister Stephen
Paediatricians: Dr Patrick Quinn Wade to continue to fund these essential community services at SHINE SA.”
Pathologists: Dr Shriram Nath
“SHINE SA has been soldiering on in the face of successive funding reductions, including
Physicians: Dr Nimit Singhal
under the previous government, stretching as far back as 2012. These cuts hurt. The
Psychiatrists: Dr Tarun Bastiampillai
situation is now critical. What may to government be a short-term saving will have longer-
Radiologists: Dr Nicholas Rice
term costs – financial and human. GPs and O&G doctors, among others, are extremely
Surgeons: Dr David Walsh
concerned, and we urge the government to hear those concerns and work with SHINE SA
Regional Representatives on a well-funded plan to protect the future of these important services,” A/Prof Tam stated.
Northern: Dr Philip Gribble
“The new State Government has shown leadership in health for children and young people
Public Hospital Doctors by funding meningococcal vaccinations to protect them from this devastating disease. But
Representative STIs and unplanned pregnancies can also have huge repercussions on young people’s
Dr Andrew Russell lives and health,” A/Prof Tam said.
Doctors in Training representative
Dr Hannah Szewczyk
Student Representatives
University of Adelaide: Mr Simon Cousins Mental Health Services Plan
Flinders University: Ms Mekha John
P
AMA(SA) Executive Board lanning is underway by the Office of the Chief Psychiatrist and the South
Mr Andrew Brown, Dr Guy Christie-Taylor, Australian Mental Health Commission to develop a new SA Health Mental
Mr John McLaren, Dr Chris Moy, Dr John Health Services Plan, to be delivered to the Government by March 2019.
Nelson, Dr Peter Sharley, A/Prof William Tam Feedback has been sought on such issues as access to mental health services;
AMA(SA) Office: Key Contact defining best practice in mental health care; partnerships within and outside
Chief Executive: Mr Joe Hooper Government services; inpatient and community-based recovery and rehabilitation
services; wellbeing, prevention and early intervention; and workforce.
Federal Councillors
The AMA(SA) is making a submission and welcomes ongoing feedback from
A/Prof William Tam (State Nominee)
members on this important area. Our past advocacy has included a broad scope,
Dr Chris Moy (Area Nominee SA/NT)
Dr Matthew McConnell (Specialty Group including the need for increased mental health beds; rural mental health services;
Nominee: Physicians) appropriate home-like accommodation for people with severe chronic, transitional
and acute mental health problems; measures for young people; and, in the wake of
© istock/gradyreese
The AMA(SA) office is located at Oakden, three purpose-built facilities for people with severe behavioural problems
161 Ward Street, North Adelaide. associated with dementia, mental illness and impairment.
You can contact us by telephone on
(08) 8361 0100, by fax to (08) 8267 5349 Members with any feedback are encouraged to contact us at policy@amasa.org.au.
or email to admin@amasa.org.au.
4 medicSA DECEMBER 2018
heading
Dr Philip Harding
AMA responds to National
Rural Generalist Taskforce Editor’s
recommendations LETTER
T T
he AMA has submitted its response to the 19 recommendations of the he perils of ignoring or failing to learn
National Rural Generalist Taskforce to Prof Paul Worley, the National Rural from history are the stuff of philosophical
Health Commissioner. The AMA supports the development of a National Rural and political catchphrase; but for such
Generalist Pathway and its submission will inform further development of the National lessons to be learnt, it is first necessary to
Rural Generalist Pathway (NRGP). document and make available and visible the
history itself. Hence the monuments which
The key points of the AMA submission were: have been constructed and documents and
• strong support of the NRGP as a means of improving health outcomes of our rural volumes written throughout human history. For
and remote communities and in supporting improved recruitment and retention in the AMA in South Australia, two recent events
these areas have bought this into sharp focus. Most recent
• access to training in rural and regional areas will be key to the success of the program is AMA(SA)’s move into its new offices and the
problem of cataloguing and storing, let alone
• support for rural generalists to build upon high quality general practice with extended exhibiting, the enormous collection of portraits,
skills, including emergency medicine, in response to the needs of the community documents and other memorabilia in Newland
• support for recognising rural generalism as a subspecialty within general practice House going back to the early days of the SA
• continuity of employment for the duration of the training contract to provide stability branch of the BMA. Fortunately our Historical
and certainty to doctors on the Pathway Committee, now chaired by David Fenwick,
has put a lot of hard work into this task and
• conditional support for reform of the General Practice Rural Incentive Program, this issue of medicSA marks the launch of their
provided this comes with additional funding so that no GP or practice is financially website, as detailed in the article on page 56,
worse off. which includes a synopsis of Peter Kreminski’s
The AMA provided in principle support for rural generalist access to non-GP MBS account of the committee’s activities going back
rebates on the basis there is continued discussion and consultation with regard to almost a century. The other event of significance
defining scope of practice and credentialing. has been the closure of the old Royal Adelaide
Hospital which, because of its long history, has
the largest repository of medical documents,
Failing to prepare for the health photographs, artefacts and other memorabilia
in the state. This material has largely been
effects of climate change risks
rendered safe by the RAH Heritage Committee
and is in storage at the Hampstead Centre, but
as a matter of government policy not one item
Australian lives of this collection has so far found its way to the
new hospital, inspection of the walls of which
will reveal no clue as to its long heritage at the
I
n late November, the Medical Journal of Australia and The Lancet published a major original site.
assessment of progress on climate change and health in Australia, the MJA-Lancet As described on page 42, there are a couple
Countdown. This report found that “Australia is vulnerable to the impacts of climate of outstanding exceptions: the Cedar Prest
change on health, and that policy inaction in this regard threatens Australian lives”. stained-glass window from the hospital chapel
The Australian Medical Students’ Association (AMSA), the peak representative body has been saved as a result of the efforts of a
group of dedicated and persistent nurses; and,
for Australia’s 17,000 medical students, joined with the Medical Journal of Australia,
at a more profane level, the legendary Jolly Bar
The Lancet and the Royal Australasian College of Physicians to develop a brief for
has been relocated to a hotel near the nRAH,
Australian policymakers in response to the report’s findings. but the big picture is that South Australia needs
“Climate change affects human health in a number of ways, from the spread of tropical and deserves a Health and Medical Museum.
Representations for this have been made to
disease, increasing regularity of natural disasters to decreasing food security, all of
the highest level of government and need the
which have consequences for human health,” AMSA president, Ms Alex Farrell, said.
strong support of all concerned.
One of the brief’s key recommendations was that all Australian medical school curricula
should be updated to include the impacts of climate change on human health. This is
necessary in order to build the health sector’s capacity to help prevent and respond to
the health impacts of climate change, the brief’s authors wrote.
medicSA DECEMBER 2018 5
news & views
Mandatory reporting: Australian Health
Ministers failing on a promise
In November 2017, the COAG Health Council gave an undertaking to amend National Law so “that
doctors should be able to seek treatment for health issues with confidentiality whilst also preserving
the requirement for patient safety”. Unfortunately, despite the AMA and other groups responding
to the consultation process with a united voice about how to achieve this, proposed changes to
National Law appear likely to fail on this promise. Dr Chris Moy reports.
P
rof Steve Robson’s
moving article1 in
MJA InSight on 22
October 2018, in which
he revealed how close he
came to taking his own
life during internship, made plain the
current problem: doctors are often
reluctant to seek appropriate
medical care because of a fear of
mandatory reporting.
A doctor who is unwell, and their
treating doctor, require certainty about
the threshold at which reporting should
occur, and that this threshold needs
to be set at a level which provides
adequate leeway for appropriate
medical care to be sought.
Due to a lack of clarity, treating doctors
often interpret the current National
Law as setting a low threshold for the
mandatory reporting of unwell doctors
that they may see. As a result, and
in seeking to limit their risk, treating
doctors sometimes apply a ‘guilty until Instead, by allowing treating doctors Health Ministers had chosen not to listen.
proven innocent’ approach in reporting to begin from an ‘innocent until proven Instead, they proposed an unproven
situations where there is a low level of guilty’ position, but still requiring them approach relying on setting a standard
risk. It is understandable that an unwell to hold to ethical and professional threshold for mandatory reporting to be
doctor, faced with uncertainty in their responsibilities to not place the public at expressed in legislation in each state.
understanding of the law and, more risk, WA legislation led to an increase in
During a further consultation period,
mandatory notifications from 12 in 2011-
importantly, uncertainty about how a Health Ministers yet again failed to
12, to 37 in 2015-16. This may well be
potential treating doctor will interpret heed advice from the AMA that any
because doctors who require treatment
the law, might be reluctant to seek such legislated threshold – the ‘line in
are more confident in seeking it, knowing
appropriate medical care – too often the sand’ – for mandatory reporting
that they will be fairly and consistently
with tragic consequences. would need to be unambiguous to be
judged in regard to their risk.
of any benefit.
In response to the declaration by
The AMA’s advice was supported by
the COAG Health Council, the AMA Essentially, the proposed legislation
major medical groups and also Kim
argued strongly for national adoption recently revealed in Queensland –
Snowball’s 2014 Independent Review
of the Western Australian model, the first state ‘off the block’ – sets a
of the National Registration and
where there is no legal obligation for threshold of “substantial risk of harm”
Accreditation Scheme (NRAS) for
treating doctors to make mandatory for reporting, while requiring the treating
health professionals which was
notifications, or a ‘WA-lite’ model, doctor to make a “holistic assessment”
© istock/AJ_Watt
commissioned by the Health Ministers’
where cases of sexual misconduct of risk: an overall assessment about an
own Advisory Council.
require reporting. Both offer certainty in unwell doctor’s conduct relating to the
practical application while showing no However, it became clear at the April impairment including, for example, their
evidence of reduced patient safety. 2018 Health Council meeting that the acceptance of treatment.
6 medicSA DECEMBER 2018
news & views
The AMA has responded that the ‘material’”. Although these Explanatory room, with time pressures and the
Queensland Bill, as it currently stands, Notes have some weight in law, weight of responsibility of deciding
fails to remove ambiguity or improve the reality remains that doctors the future of a colleague, needs
on the current regime. For while are unlikely to comb through such simplicity and certainty about a
“substantial risk of harm” raises the documents, or rely on education fair threshold at which they need
bar on the probability of harm for material provided by the Regulator, to report.
reporting, it provides no certainty particularly when they realise that
with respect to the level, or severity, the real ‘line in the sand’ will only be The AMA will continue to strongly
of the harm to be considered. For determined when we see how the law advocate for a change to the
example, does the proposed definition is applied in future cases. proposed Queensland Bill that,
encompass a situation where there is under COAG processes, will dictate
a substantial risk of the unwell doctor A doctor who is unwell, the laws in all remaining states
and territories (except WA). However,
causing a low level of harm (such and their treating doctor,
as inconveniencing a patient due to if the Bill is passed without alteration,
rescheduled procedures, or a delay in require certainty about Health Ministers will have cast
the writing of reports)? the threshold at which doctors adrift again in the same
sea of uncertainty about mandatory
So, the AMA has argued that, as a reporting should occur, reporting that we are currently
minimum, the legislated threshold
test should be “substantial risk of
and that this threshold forced to sail in.
substantial harm”– therefore defining needs to be set at Dr Chris Moy is AMA(SA) vice
both the likelihood and level of harm a level which provides president and chair of the federal AMA
required for a mandatory report. Ethics and Medico-legal Committee.
adequate leeway for
Inexplicably, the Explanatory Notes
attached to the Queensland Bill “make
appropriate medical
it clear that only serious impairments care to be sought. References:
that are not being appropriately treated 1 doctorportal.com.au/
are intended to require reporting” Health Ministers have failed to mjainsight/2018/41/learn-from-me-
and that “harm would have to be consider that a doctor in a consulting speak-out-seek-help-get-treatment
AMA(SA) calls for halt on mandatory
drug treatment Bill for young people
T
he AMA(SA) has called on and the SA Network for Drug and as a care model is widely
the government to put a Alcohol Services, and the statements acknowledged across multiple
halt on the controversial and made previously by the Commissioner sources.”
flawed mandatory treatment Bill that for Children and Young People,
among others. “The AMA(SA)’s overwhelming
it has put to the Parliament, which
would allow for mandatory (court- preference is for well-resourced
“The mandatory youth treatment voluntary treatment services,
ordered) detention and treatment
Bill currently before Parliament is a including more early support,
for children for up to 12 months – deeply flawed response. This is
with the capacity to extend further. education and intervention. We need
not the way to help young people
It does not require the child or young to do more on prevention. We need
grappling with drug-related issues,”
person to have been charged with to invest in proven measures. A Bill
said AMA(SA) president A/Prof
an offence. to introduce mandatory detention for
William Tam.
vulnerable young people is certainly
The AMA(SA) has been in strong “Aside from the basic premise of not an answer.”
agreement with other professionals mandatory treatment being morally
and key agencies who have problematic, importantly there isn’t Following a concerted advocacy
opposed the Bill, including the the medical evidence to support push around the last sitting day
Law Society of SA, the Guardian that it works for patients with drug for the year, just as medicSA went
for Children and Young People, addiction. In fact, the lack of to press, debate on the Bill was
SACOSS, Uniting Communities evidence for mandatory treatment adjourned to February.
medicSA DECEMBER 2018 7
news & views
Maternity services must be obstetric-led
and collaborative: AMA advocacy steps up
The AMA has made a submission to the Commonwealth Department of Health and Ageing on the
proposed new National Maternity Services Strategy.
F
ederal AMA president, Dr Tony obstetrician – is the safest for mothers and circumstances, after assessment by an
Bartone, said that the AMA is babies, and optimises a range of other obstetrician or GP obstetrician.
adamant that national maternity health outcomes.
“GPs are often the health professionals
services must use a collaborative care
“Obstetrician-led or GP obstetrician-led who start the conversation with women
model that is led by obstetricians or
care means that, at a minimum, there about having children. GPs are best placed
general practice obstetricians.
will be initial assessment by either an to provide continuity of care for women
Dr Bartone said that best-practice obstetrician or GP obstetrician, and before, during, and after their pregnancies.
maternity care in the 21st century is assessment and regular review during GPs are especially important in providing
provided by a multi-disciplinary team of labour. Models of care should not result in whole of maternity care for women in rural
health professionals. situations where obstetricians only become and remote communities.”
“Obstetricians are the leaders and, along aware of a labour problem once it has Dr Bartone said that significant additional
with midwives, are the key carers, but the become acute or serious. Women should Federal Government funding will be needed
team also includes general practitioners, be encouraged and supported to make to ensure safe, high-quality maternity
anaesthetists, psychiatrists, obstetric their own choices. services across Australia.
physicians, pathologists, haematologists,
“But they should be fully informed The AMA submission is at ama.com.
paediatricians, and nurses,” Dr Bartone said.
about the risks and benefits of each au/submission/ama-submission-draft-
“Current evidence supports that this model model as it relates to their own specific strategic-directions-public-hospital-
of care – led by an obstetrician or GP health situation, pregnancy, and maternity-services.
8 medicSA DECEMBER 2018news & views
WCH move welcomed by AMA(SA)
After years of advocacy for a co-located Women’s and Children’s Hospital with the new Royal Adelaide
Hospital, the AMA(SA) has welcomed the latest step along that road by the current State Government.
A
fter building speculation about
the future location of the new
Women’s and Children’s Hospital,
the western end of the biomedical
Precinct has been recommended as the
preferred site for the new WCH by the
Taskforce set up to plan for the move.
Lindsey Gough, CEO of the Women’s and
Children’s Health Network, said the site
meets all the criteria to ensure the needs
of South Australian families are met for
years to come.
“The site is an ideal position, co-locating
the new WCH alongside the Royal
Adelaide Hospital (RAH) and within the
world-class Adelaide BioMed City,” Ms
Gough said.
As this issue of medicSA goes to press,
the taskforce is just days away from A/Prof William Tam. “We started talking investment in the future health care of our
finalising its report to government, due by about it in the lead-up to the 2010 women and children.”
18 December. The report will include the state election and it has been on our list
bed numbers and service profile, which Of course, it will be crucial that doctors
ever since.
will be of particular interest to doctors. and others involved in delivering care
“It has been a long journey to get here have a key role in the planning of the new
SA Health has reported that the Taskforce but we are tremendously glad to see this Women’s and Children’s Hospital.
worked with health planner Carramar to vital component of our health system
establish the size of the new hospital, “We are all aware of the experience of
moving forward,” he stated.
the new RAH and the issues that arise
and is confident it can be accommodated
“There are many great things to say about when clinicians are ignored,” said A/Prof
on this site. Architects GHD Woodhead
our current Women’s and Children’s Tam. “I hope the expensive mistakes
provided additional advice on a range of
Hospital, but it is an aging structure with of the past will not be repeated with
sites identified by the Taskforce, which
clinical service limitations. The most the planning of this important asset,
used an agreed set of evaluation criteria
critical issue that co-location addresses which will serve the future healthcare for
to analyse the options.
is that, in emergencies, pregnant women women, babies and children in this state
Advice from Adelaide Airport has need access to specialist care they can’t for decades to come.
reportedly confirmed the height of get on the present site. Co-location of
“We also think it is timely that a new
the building is in line with flight path the complete WCH package alongside
WCH stimulates a rejuvenated focus on
guidelines, allowing for the site to be the RAH will provide significant safety
a broader vision for children and young
a viable option. Further work on the improvements for women, babies and
people, including dusting off the previous,
indicative cost estimate is ongoing and children, as well as other benefits. Clinical
abandoned work on a child health
expected to be completed early in the safety has been the AMA(SA)’s consistent
services plan for SA. We need a plan for
first half of 2019. message and we are pleased our
children and young people that covers
message has been heard.
The AMA(SA) sees the interim the spectrum from hospital to community
announcement as a welcome step “In fact, co-location is increasingly the care, including prevention and early
towards the government’s promise to norm, and what other services aspire to. intervention,” he stated.
deliver a new Women’s and Children’s There is much to be gained from it, and
The AMA(SA) will be reading the
Hospital co-located with the RAH, this really is an exciting opportunity,” said
Taskforce’s final report with great interest,
Architect: GHD Woodhead
as promised in its pre-election policy A/Prof Tam.
when it is published, and members with
platform. In fact, the move has been
“We have been hearing a lot about comments or feedback are encouraged
Liberal policy for some years now.
costs and the affordability of health to get in touch with us at president@
“The AMA(SA) has been advocating for lately; these need to be managed, but amasa.org.au. Further information about
this move across five presidents’ terms of we are urging the people of South the taskforce can be found at www.wch.
office,” said AMA(SA) president Australia to view a new WCH as an sa.gov.au.
medicSA DECEMBER 2018 9heading 10 medicSA DECEMBER 2018
heading medicSA DECEMBER 2018 11
news & views
Young people on bullying:
report from SA Commissioner
for Children and Young People
In the December 2017 issue of medicSA, we reported on the work of SA’s first Commissioner for
Children and Young People Helen Connolly. The Commissioner’s role was one that the AMA(SA) had
lobbied hard for. Now, she has presented a new report – The Bullying Project, what South Australian
children and young people have told us about bullying – to the Minister for Education.
A
key objective of the SA see changed to make life better in South schools, parents and themselves to
Commissioner for Children and Australia,” Helen said. prevent and respond to bullying,” the
Young People is to position children Commissioner explained.
“The issue of bullying was raised in the
and young people’s interests, development
context of what children and young The report seeks to place the views of
and wellbeing front and centre in public
people want to see changed and what children and young people front and centre
policy and community life and to advocate
they wanted me to prioritise in my work. in developing solutions to bullying.
to decision makers to change laws, policy, They also discussed it in the context of the
systems and practice in favour of children “At the moment bullying – especially in
importance of friendships, acceptance,
and young people. relation to young people – is taking up a
equality and wellbeing.
lot of airtime: on the radio, print and online
When the AMA(SA) met with her late “Before I could ‘do something’ to stop media, at schools, communities and in all
last year, the Commissioner had been bullying I needed more detailed information houses of Parliament,” Helen said.
conducting ‘listening tours’ across the directly from children and young people on
state, meeting children and young “However, the discussion is missing one
bullying. I therefore embarked on a ‘bullying
vital element, the voices and views of
people in a range of venues from shelters project’ to find out what bullying looks and
children and young people and what they
to youth groups to schools … to talk to sounds like in 2018.
think the solutions are.”
them about the issues that matter
“I wanted to be clear about what ‘it’ is they
to them. The report is a result of the Commissioner’s
wanted me to stop. I wanted to be able to
consultations with almost 300 children and
“I met with over 1400 children and young inform decision makers what children and
young people in schools and FLO agencies
people who shared with me what is young people consider bullying is and to
across greater Adelaide this year. It also
important to them and what they want to find out if they had ideas about solutions for
comes after she took part in a roundtable
discussion with the Attorney General’s
Department on bullying in South Australia.
The bullying report is available here:
ccyp.com.au/reports.
Bullying report facts
• Bullying has been recognised by the
United Nations Committee on the
Rights of the Child as a form of ‘mental
Foot and Ankle violence’. This type of ‘mental violence’
can affect children’s health, wellbeing,
Dr Gayle Silveira Orthopaedic Surgeons safety and security.
• What is different about bullying today,
Leading a multi-disciplinary team
related to its ‘24/7’ nature, is a result
dedicated to the treatment of the of social media and technology …
foot and ankle. participants who felt bullying was worse
discussed this in relation to the severity
of the impact on their mental health as a
22 Walter Street, North Adelaide result of increased bullying.
T: 8334 5900 F: 8267 2776 • Participants suggested anti-bullying
E: info@specialistcentral.com.au programs need to include information
Dr Linda Ferris www.footandanklecentre.com.au
on ‘the consequences of bullying’,
‘depression’ and ‘mental health’,
including ‘suicide’.
12 medicSA DECEMBER 2018news & views
New commissioners appointed: for aged
care, and Aboriginal young people
Australia’s first Aged Care Quality and Safety Commissioner has been appointed to lead the new and
independent Aged Care Quality and Safety Commission; while a new South Australian Commissioner
for Aboriginal Children and Young People has also been appointed.
Australia’s first Aged Australia. A Bill to establish the Commission New SA Commissioner
Care Quality and Safety is currently in Parliament. for Aboriginal Children
Commissioner and Young People
Ms Anderson will oversee the approval,
Highly respected and April Lawrie has been
accreditation, assessment, complaints
experienced health sector appointed the inaugural SA
resolution, monitoring and compliance
leader, Janet Anderson will Commissioner for Aboriginal
of Commonwealth-funded aged care
oversee establishment of the Aged Care Children and Young People, tasked
providers, reporting directly to the
Quality and Safety Commission, as it with developing policies and practices
Minister for Senior Australians and
prepares to start intensified compliance to improve the safety and wellbeing of
Aged Care.
monitoring from 1 January 2019. Aboriginal children and young people. Key
Ms Anderson has extensive management areas of focus for the role include improving
The new Commission will have a budget experience, particularly in the health sector, health, education, child protection and
of almost $300 million over four years, including leadership roles at state, territory justice outcomes.
employing dozens of additional senior and Commonwealth levels.
compliance officers. The new position has been created to
She was first assistant secretary, monitor, advise and advocate on systemic
The new Commission will integrate and Health Services, in the Commonwealth and individual issues for Aboriginal children
streamline the roles of the current Aged Department of Health 2012-2015, and and young people.
Care Complaints Commissioner and the director, Inter-Government and funding
Australian Aged Care Quality Agency. Ms Lawrie has an outstanding track record
Strategies in the New South Wales
of policy development and implementation
From January 2020, it will also incorporate Department of Health 2006-2011.
across government and strong connections
the Department of Health’s aged care For the past two years, Ms Anderson has within the state’s Aboriginal communities
compliance responsibilities. held the positions of deputy chief executive and organisations.
and acting chief executive of the Northern
The new Commission is a key part of the Most recently, she has been leading
Territory Department of Health.
Australian Government’s response to the the development of the Education
recommendations of the Carnell-Paterson In 2009, she was awarded the Public Department’s Aboriginal Education Strategy
review of failures at the Oakden Older Service Medal for outstanding work in and has also had senior roles at SA Health
Persons Mental Health Service in South health policy development and reform. and the Attorney General’s Department.
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medicSA DECEMBER 2018 13focus
Strengthening the ‘weakest link’ in SA’s
eating disorder services
SA can have a specialist eating disorder service that is among the best in the world, write A/Prof
Stephen Allison and Emeritus Prof Ross Kalucy.
T
he AMA(SA) called for SA’s contrasts with the distinct spike in support helps the young person to
specialist eating disorder services admissions among young women maintain her treatment gains.
to have a strong focus on youth with eating disorders.
health (‘Defragmenting specialist youth The Flinders eating
The reasons behind the youth spike
eating disorder services’, medicSA, disorder program
in eating disorders are complex with
Nov 2018, pp14-15). This call is The eating disorder program at
both genetic and environmental
important, because the acuity of eating Flinders Medical Centre (FMC) has
factors playing a role in the increased
disorders such as anorexia nervosa is always had a strong focus on youth.
risk after puberty. One powerful
highest amongst young people. Girls The architectural design of FMC was
environmental trigger for disordered
and young women aged 15 to 24 made fortunate for youth transitions with the
eating is weight-related peer-teasing
most (58%) community mental health Ward 4E paediatric unit and the Ward
amongst girls. Peer behaviours,
contacts, and required most (57%) 4G eating disorder unit being close
including jokes about a victim’s
hospital admissions for eating disorders and friendly neighbours. Both clinical
weight and social exclusion, increase
during 2015-16, according to the groups supported the youth transitional
the risk of strict dieting especially
Australian Institute of Health program for eating disorders through
among girls with a genetic vulnerability.
and Welfare. shared care and attendance at each
Peer teasing among boys takes
Professor Pat McGorry from the different forms, and produces different other’s ward rounds. As a result, there
National Centre of Excellence in Youth outcomes, although disordered eating was good continuity of care across
Mental Health at the University of and the use of drugs for weight loss both the FMC outpatient and inpatient
Melbourne highlighted the peak in appear to be on the rise among programs for adolescent patients
eating disorders in youth, and argued boys. More speculatively, recovery or aged 17-18.
that clinicians and services should partial recovery from eating disorders The combination of paediatric and
adopt a focus on early intervention among young women after age 25 adult psychiatric treatment available at
(‘Paying the Price’, Butterfly Report, might be related to changes in the FMC is particularly important for early
2012, p1). Effective early intervention social environment, with the breakup anorexia nervosa.
requires strengthening the ‘weakest of the female peer networks that help
link’ in our public mental health system, FMC’s eating disorder program
maintain disordered eating.
which is the transition from child and also emphasised shared care with
adolescent to adult services at age The combination of GPs who provide the foundation for all
17-18. This service break occurs during treatment of youth eating disorders.
the period of peak acuity for anorexia
paediatric and adult GPs are well suited to the task, because
nervosa when young women are most psychiatric treatment there are no age barriers in primary
at risk of hospitalisation. care, and full integration of the physical
available at FMC is and mental health aspects of treatment.
The youth spike in particularly important for But in return, GPs require eating
disorder specialists who can provide
eating disorders early anorexia nervosa.
continuity and availability, especially
Eating disorders might in fact be
across the period of peak acuity in
the paradigmatic youth mental Effective treatment for early anorexia
youth when management crises are
health conditions that require the nervosa is also socially based. It
more frequent.
strongest transitional services in emphasises the role of parents, who
later adolescence. They appear to are helped in systematic ways to Starvation has profound physiological,
conform more closely to the youth encourage their child to eat, in order emotional and cognitive effects
model than chronic conditions such to restore her health and wellbeing. that interrupt the normal course of
as schizophrenia and bipolar disorder, These family-based treatments can act adolescent development. The first and
where acuity and service activity begin as a counterweight to the behaviour most important issue is the restoration
to rise in youth, but peak much later of female peers that promotes dieting of normal eating and weight – a gradual
in life. Admission rates for all specialist and weight loss. Favourable treatment process that parents are well placed
inpatient psychiatric care are highest in outcomes rely on the strength of to encourage, but in some instances
mid-life with a peak for patients aged parental influence, and family based requires either paediatric or adult
35 to 44 years with similar admission treatments are useful until later medical inpatient admission, both of
rates for males and females, which adolescence. Over this period, parental which are available at FMC. With weight
14 medicSA DECEMBER 2018focus
restoration and a post-pubertal
physical status, the young person
reencounters the physical and
emotional changes of adolescence,
KordaMentha makes waves
and individual psychotherapy can help
L
her to reflect on and respond to these ate November saw the release by the State Government of what it
developmental demands. described as a ‘turnaround plan’ for central Adelaide hospitals, in
response to CALHN’s budget woes. Advisory firm KordaMentha has
More recently, FMC’s eating disorder produced a ‘diagnostic review’ and ‘recovery plan’ and has the contract to
program has expanded into SA’s deliver the first stage of the plan, costing $18 million and tasked to save $41
Statewide Eating Disorder Service, million by the middle of next year and ‘restore a balanced budget by 2021’,
which has a well-functioning youth with savings of $101 million in FY20 and $134 million in FY21.
model of care. There is now the
opportunity to add the last piece of the The AMA(SA) has stressed that while it is in favour of efficiency, this
puzzle with SA Health commissioning must not be at the expense of patient care: we would not want to see
a new statewide service for the bed closures or a reduction in services to the community. Also that
family-based treatment of early efficiency should be driven by clinicians and informed by sound data –
anorexia nervosa. As the AMA(SA) such as through the AMA(SA)’s proposed, independent clinical
recommended, this additional service analytics entity.
should be integrated with the “In one fell swoop CALHN has a new CEO, new governance arrangements
Statewide Eating Disorder Service, with a new Board, and now a report by an investment advisory firm on how
which will then be able to offer to do better,” noted AMA(SA) president A/Prof William Tam. “It looks like
specialist treatment for patients across we will be grappling with a fair bit of uncertainty at an already extremely
the entire life span. Internationally, it challenging time.”
is recognised that specialist eating
“Further, KordaMentha had just four weeks for the ‘Diagnostic’ phase of its
disorder services should be ‘ageless’,
work on what is a major undertaking. Health services are complex and
without a fixed service barrier at age
interrelated. We would think, more than a four-week exercise.”
17-18, so they can offer ‘seamless’
treatment for young people (Guidance “We also note that the diagnostic report states that ‘the current activity
for commissioners of eating disorder and financial budget processes result in inaccurate and unachievable
services, Joint Commissioning Panel for budgets’. In this context, is it surprising if there are budget overruns?”
Mental Health, 2013). This ideal is now A/Prof Tam said.
achievable in SA.
Concerningly, the initial statements from the government and CALHN around
A/Prof Stephen Allison is a consultant the KordaMentha report were somewhat demoralising for staff who are
child and adolescent psychiatrist striving every day already to deliver the best care to patients. We hope this
and Emeritus Professor Ross Kalucy changes, and urge the government and SA Health to work with those who
is consultant psychiatrist, College are on the front lines delivering care to patients on how our system can do
of Medicine and Public Health, better, and what comes next.
Flinders University.
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medicSA DECEMBER 2018 15key priorities
A 2020 vision for health?
We have a new government that continues to advance its pre-election policy agenda, but there
is quite a road ahead. Various reforms and changes are on the way, but the AMA(SA) wants to
see more from the government than just delivering on its pre-election checklist and the day-to-day
business of governing after that point. What would you like to see in place for 2020?
I
n the lead-up to this year’s state a disadvantage when it comes to access emphasis on equity of service provision.
election, the AMA(SA) released its to health care. Early intervention and prevention services,
People-First Health Strategy for South in particular, must target those at greatest
People living in regional, rural and remote
Australia, outlining key priorities for action risk and must include pre-conception and
Australia often struggle to access health
by government. Post election, we again prenatal services.
services that urban Australians would
underlined top themes and some tangible
see as a basic right. These inequalities >> The AMA(SA) calls for a Child Health
fixes in a pre-budget wishlist for what
mean that they have lower life expectancy, Plan as a key priority, and the government
next, beyond the first 100 days.
worse outcomes on leading indicators must hold firm to its promise of a new, co-
We are glad to see that the government of health, and poorer access to care located WCH, and get the planning and
has been acting in some of these areas, compared to people in major cities. consultation right.
but it is clear there is much more to do.
The AMA(SA) continues to call for a
An overview of just some of what we have
significant budget increase for rural and
Older South Australians,
been talking about this year is below, but
regional clinical services, infrastructure mental health, rights
we will be glad to hear from members on
what you think needs saying and doing
and workforce, including teaching and & wellbeing
training, and grants for rural medical The reports into Oakden highlighted
now, as the rubber hits the road on what
research. Some steps have been taken galling failures in our state’s care for older
will soon be year two under the new
but more is needed. people. Oakden was the only service in
Liberal Government. What would you like
to see from this government by 2020? >> The AMA(SA) calls for a significantly SA providing services for people with
increased budget for rural and regional severe behavioural and psychological
The right care: clinician- clinical services, infrastructure and symptoms of dementia and others
needing similar care, such as those
led, clinically informed workforce, including teaching and
with brain damage through alcohol
professional development.
decision-making and drug use.
The new State Government has embarked Children and young people: It is vital that the issues identified in the
on its restructure of the SA health system
with the introduction of regional health investing in the future Oakden reports are addressed and the
Children have been left behind in recent right services and protections put in
boards. The government has stated
that its new model will improve clinical health policy. The best care of children place to ensure that vulnerable older
involvement through clinical engagement and young people in this state requires South Australians receive safe, caring,
strategies, and health professional a co-ordinated and planned approach. appropriate care. The number of such
representation on boards. More is needed. The AMA(SA) has long advocated for a patients is expected to grow significantly
Child Health Plan to guide future services over the next 10 years, requiring urgent
Our health system must make much and investment. It should address planning to ensure they can be managed
better use of the clinical expertise in SA child health issues, including obesity, with safety and dignity.
Health and beyond it, to inform policy development and learning, behavioural
and practice. In particular, we also need We also need better dementia care
problems and mental health, with a focus
better data to inform better decisions by pathways overall, including for the transfer
on prevention; it should involve both SA
government and policy makers, and on between hospitals and aged care, and
Health services and other government and
the ground in our health services. better interfacing between the public
non-government services; and it should
system, and aged care and the private
>> The AMA(SA) calls for a Clinical be clinician-led.
sector. Better use of data would also
Analytics Institute, and more clinician-led A plan was previously under development support this. The need in this area is only
decision-making across the system. for several years, but shelved. It is going to grow in the future: the time to
time to reinvigorate planning for children act is now.
Rural and remote and young people so that the very
>> The AMA(SA) calls for three purpose-
health: No South positive move of a new, co-located
built facilities for people with severe
WCH can sit within an overall plan for
Australian left behind young people.
behavioural problems associated
Approximately one in five South with dementia, mental illness and
Australians live outside the greater As part of this process we need a detailed impairment, and specialist training for
Adelaide metropolitan area but statistically, clinician-led review of hospital and staff caring for elderly patients with
many of these South Australians are at community services for children, with an behavioural problems.
16 medicSA DECEMBER 2018You can also read
