A difficult diagnosis

WHEN it comes to Tasmania’s health system, I would love to be the table-thumping commentator with all the answers.

However, I am not. The ailing system has a complexity of comorbidity beyond simple, quick fixes.

Tasmania’s hospitals are like an unemployed, homeless man who presents at emergency after having been beaten up by thugs. As nurses tend to him, they begin to suspect the ranting man is experiencing a psychotic episode, either drug-induced or part of a longer term mental health issue.

The patient’s explanation of how he sustained his physical injuries is confusing, but nurses establish that he has presented before with florid delusions and that he had eaten mushrooms he found on the forest floor under a pine plantation that morning.

One nurse recognises the patient as the victim of childhood sex abuse at the hands of the clergy while a ward of the state.

Medical staff treat his injuries, taking X-rays and blood tests to find he has a fractured pelvis and hepatitis A.

This patient’s injuries are treatable, but for an enduring result he must have a home, food and a job. That’s before possible medication and therapy for his mental health issues.

Who is to blame? The thugs who beat him up? The priests who abused him? The druggie parents too often behind bars to care for him? The patient himself for failing to take responsibility for his life?

All of the above? THERE

is no simple fix to Tasmania’s ailing health system.

I do not have the answers, but I can shed light on the problems.

Almost 20 years ago, a senior physician came to me while I was working as a reporter. In two hours in an off-the-record interview he told of an appalling situation at the Royal Hobart Hospital where his fellow specialists were resigning in droves to work interstate at better run hospitals.

I ran a story and the floodgates opened. A congaline of surgeons and physicians contacted me. Week after week, I wrote front-page stories detailing the dramas.

I was told the private and public system, with different parts funded by state and federal governments, had — like the parents and priests of the mentally ill, abused and beaten patient — created fertile ground for maladies.

Some specialists were raking in more money than the fat-cat business executives regularly pilloried in the media and were cynically exploiting loop holes in the two-tiered system.

The well-meant decision to close mental institutions in the 1980s and 1990s had added a weighty load to frontline emergency staff who were expected to deal with psychotic bouts and the like.

The state’s ageing population was raising demand for hospital resources and hi-tech medical advances meant patients now expected treatment that was simply unaffordable.

An increasingly obese population was creating insatiable demand for treatment of diabetes, heart problems and other preventable diseases.

The hospital’s building was inadequate — too small, old and poorly designed to cope with rapidly increasing demand.

Party politics, porkbarrelling and grandstanding were contributing to irrational and costly decisions.

Royal specialists confided that they believed the crumbling system may have already contributed to patient deaths.

The hospital administration was top heavy and attempts to better integrate the operations of medical units had failed. Patient details were regularly lost in the cracks.

Nurses were overworked, underpaid and taking stress and sick leave to cope.

I had a queue of sources and a briefcase full of leaked documents.

Surgeons and physicians told me stories of each other’s failings. Sources I trusted were chastised by their colleagues. There were myriad tales of fiefdoms, ego clashes and internal struggles.

It was the kind of backstabbing and finger-pointing that happens in any imploding organisation, the result of a cocktail of pressure, anxiety, failure and a growing sense of helpless despair.

At this time, I happened to suffer a life-threatening crisis that required treatment by paramedics and delivery by ambulance to the Royal.

The paramedics saved my life. They have my utmost respect. The care I received in the Royal was first class. The medical emergency was hugely significant for me but for them it was just another day at a very busy, stressful office. THE

Hodgman Government has had an easy run compared with governments past, the gloss of its spin on health has shone largely untarnished.

Health Minister Michael Ferguson should be held accountable for the current mess, but with the caveat that the ministry has been a poisoned chalice for decades.

Denouncing any state health minister is like blaming nurses for the discovery by police of our mentally ill patient prostrate, unconscious and at death’s door in the mulch of a forest plantation only hours after being discharged from hospital.

One government, however, deserves scathing criticism, that of premier Paul Lennon from 2004 to 2008. Lennon repeatedly promised a new Royal Hobart Hospital on a greenfield site and had the funds set aside for the project, $800 million from memory.

He disgracefully squandered that money and condemned the Royal to years, perhaps decades, of unnecessary turmoil.