Thursday, 23 February 2012

Knock-ons & hospital passes

Many people say rugby union is a violent game with the chance of serious injuries. But as a former player (about 100 years ago) and an obsessed fan of the game, I say you have to get things into perspective. (irony)

While it is certainly true the game is an aggressive sport, I doubt it is any more violent than our daily lives, today. In fact I would say it is less so because there are some pretty strict rules around the conduct of players during a game and pretty strict penalties are handed out for infractions.  Furthermore the game doesn’t involve anyone who doesn’t want to play.

I think it is also important to acknowledge that violence need not be of a physical nature to still be violence and frequently the non physical violence causes the most hurt. Quite apart from the obvious examples of child abuse, partner abuse and elder abuse that our society seems to be plagued with, there are plenty of examples of corporate abuse of staff, customers and investors.

Take our spectacularly failed finance companies as an example. Aorangi Securities, Belgrave Finance, B’On Financial Services, Bridgecorp, Capital & Merchant Investments, Dominion Finance Group, Five Star Consumer Finance, Hanover Finance, Kiwi Finance, Nathan’s Finance NZ, National Finance 2000, and South Canterbury Finance are just the ones who have been investigated by the Serious Fraud Office. There have been 38 others and they have all violently upturned the lives of many thousands of people who were naive/trusting enough to entrust them with their savings and investments. In many of these cases, if not all, investors’ money was treated like a piggy-bank for the directors. It is quite noticeable that few of those appearing before the SRO are destitute. For many of their investors, however it is a much different story.

Some might say investments by their nature are risky and those people were among the lucky ones who had some money to invest unlike many others who are just scraping by on a day by day basis. But a lot of these people were those ‘Mum & Pop’ investors Jianqi and his motley mob have been telling us will snap up our state assets when they go under the hammer. Many were just trying to ensure they wouldn’t need to rely on the state to make ends meet when they retired. What has happened to these people is far worse than a smack in the nose when the scrum goes down.

But the corporates and the scumbags living in (insert your favourite notorious suburb here) are just the beginning. Even more random violence and injury is caused by those in the public sector and those who pull their strings.

Our so-called social welfare services seem more geared towards warfare than welfare. ACC wriggles every which way it can to avoid paying for the treatment of people who through no fault of their own are injured. We all know of people who have fought long and hard to get assistance for rehabilitation and medical care (and I use that last term advisedly).

Our main social support organisation Working Hindrance to Innocent New Zealanders goes out of its way with various doorkeeping measures to ensure none but the totally useless get any meaningful assistance whatsoever ........unless of course you are the type of person who specialises in (metaphorically) kicking down doors and kicking arses, and can understand their regulations better than them. Which doesn’t take a lot of doing most of the time.

But ACC and WINZ are just babies at this game, really. The real masters of the cruel and unusual treatment doctrine are the masters of our glorious third world health system. This is a system so cumbersome that it can often barely manage to get out of its own way.   

Now while I am bagging the health system, I should qualify that by saying that for the most part I am not including the real health professionals. Most of them are very good, although there are some useless clock-punchers among them as well. But primarily it is the dweebs in offices on more money that most of us who dream up strategies to ensure they are able to sing from the same round sheet as the Minister.

Under the stewardship of the current incumbent (I’m sure there’s a good anagram possible there); we are told of great improvements every other week. Toenail’s grinning mug is plastered all over compliant rags trumpeting such things as how the DHB is getting more elective surgery done than ever and how nobody has to be on the waiting list longer than six months. This all sounds very encouraging. At least it would if it was even slightly true.

The reality is that people all over New Zealand are being denied timely medical interventions so Toenail and his mates can boast about how efficient they are. How does that work? It’s quite simple really. First of all they set the bar for a specialist referral high enough to exclude anyone who is not extremely ill. So rather than deal with an emerging problem, they choose instead to wait until it has not only emerged, but also gone to the second or third stage of its development. Hence a man with varicose veins that cause regular attacks of acute pain, cramps at night and eczema is told he will have to wait until he develops ulcers before he qualifies for so much as an examination by a vascular specialist. This keeps the patient off the waiting list and enables the DHB to report back to the Vile one that they are up to date with all their elective surgery. It might seem like a small point here, but I can’t help feeling varicose vein operations to relive pain and prevent thromboses don’t really sound like elective surgery to me. I would have though elective surgery would be just that. Something you want to do, but don’t need to.

The other waiting list trick the DHBs are fond of is the one where older people are kept waiting interminably, unless they can find themselves someone to advocate forcefully for them. This tactic appears to be a cynical ploy to keep them out of the system in the hopes they will fall off the perch before the need arises to do something about them.

However for those who manage to navigate their way through all the chicanes and blind alleys and scoop up all the golden apples along the way face another danger; admin mayhem. It would seem the hospitals are so busy trying to keep within the confines of what the DHBs want to report back to their shiny suited Minister that they are dropping the ball sometimes in a most alarming way.

According to the report released this week by the Health Quality and Safety Commission, there were 377 ‘serious and sentinel events in NZ hospitals last year. While that is not a huge number as a percentage of patients seen (2.7 million), it still works out to an average of more than one every day and I’ve no doubt every one of them was serious to the patients involved. The most common events that fell into this category were falls which probably suggest a lack of proper health and safety and/or supervision of vulnerable patients – the very sort of thing one would expect when work levels are high and manpower numbers are not.

The report says 86 of these people died though not necessarily as a result of the ‘events’, which seems a rather pointless statistic to publish. I would have thought it would be more worthwhile to find out how many did die as a result and print that. But we can’t upset the Minister’s plans, can we?

But there were also 25 medication errors which I find completely unforgivable and 11 cases of wrong patient, site or procedure which is really scary. But worst of all there were the 108 clinical management events which is DHBSpeak for wrong diagnoses or treatment.

If you think these figures aren’t too bad, consider this: a sentinel event is only one that results in death, serious injury or disability for the patient. A disclaimer also advises the figures are not necessarily all of the events and are only those the DHBs chose to voluntarily report.

I don’t know about you, but I think I might have to dig out my old rugby boots again. God knows it can’t be any less safe on the field.

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