The Garling Report
After ten months of hearings conducted around the state, Commissioner Peter Garling SC delivered his report containing 139 recommendations and 1100 pages in length divided into three substantive volumes.
The Government has indicated it will “consider each of the recommendations carefully and consult with the community” before deciding whether to adopt the report.
During the course of the inquiry, Commissioner Garling sat at over 30 public hearings across the state including 2 in the Hunter New England area (Newcastle and Armidale) to take oral submissions from interested persons. Over 900 submissions were received.
Background: Is there a health crisis?
During the period 2007-2008, NSW Health’s Clinical Excellence Commission received over 500,000 incident reports (defined as “an unplanned event resulting in or with potential for injury, damage or loss”: see NSW Clinical Excellence Commission Annual Report 2008).
AMA President, Rosanna Capolingua, acknowledged in November 2008 when releasing the AMA National Report card for 2008 that “about 1500 deaths a year are the result of overcrowding in hospitals”.
The Medical Error Action Group’s website notes that “about 18,000 die in Australian hospitals from avoidable medical adverse events. 50,000 others are permanently disabled”.
The NSW Health Minister, John Della Bosca, said that the Garling Inquiry had been triggered by the circumstances of the tragic death of a young patient, Vanessa Anderson, at the Royal North Shore Hospital in November 2005 and was the subject of strong criticism by Deputy State Coroner Milanovitch who conducted the inquest concerning her death.
Submissions from the Newcastle hearing
Commissioner Garling sat at the Royal Newcastle Centre at the John Hunter Hospital on 12 May 2008. The following are extracts from some of the submissions of those who gave evidence that day:
- “The John Hunter Hospital has 32 acute adult orthopaedic trauma beds. On any given day, there are approximately 20 orthopaedic patients who occupy an inpatient bed outside the orthopaedic trauma ward”
S M McNeill, Clinical Nurse Consultant
- “We have very little support for our nursing staff. We have 128 beds in the surgical wards, where we have one clinical nurse educator and one nurse educator to cover all those areas and support the staff”.
W L Goodman, Nursing Unit Manager, Orthopaedic Trauma Unit
- “ We have largely been disempowered and there are a lot of obstructions to us sometimes preventing.. outright catastrophes or crises. I think it is an expectation of the community that they are looked after by somebody who has not been awake for a couple of days”
Dr David Logan
- “Although a complication of my condition required hospitalisation in another state public hospital, on my return to Newcastle… the senior surgeon was too busy to see me, leaving it to a junior staff member to make a decision on my condition..”
Commissioner Garling was told, in a confidential hearing, about bullying within the public hospital system in the Hunter region. One individual gave evidence as follows:
“In Newcastle I was told that some administrators treat senior nursing taff like children, while senior nursing administration turns a blind eye to surgeons who bully and harass staff”
Bullying has been described as “endemic” in the report.
One of those giving evidence to Commissioner Garling at the Newcastle hearing was a client of King Street Lawyers who gave evidence about the treatment given to her son who ultimately died following complications from ulcerative collitis (cerebral thrombosis).
Submissions from the Armidale hearing
One patient gave the following evidence about treatment given at Inverell Hospital:
“I was on Warfarin and my INR levels were at twice the safe limit, but nothing furhter was done. I collapsed having a shower, and the doctor just put that down to low blood pressure… my blood pressure was extremely low, but no furhter tests were carried out. The following day, I was discharged. Despite the fact that I was worse and showing more symptoms. The doctor said I was fine to go home and recover at home. My husband actually himself decided to ring our specialist in Sydney. The surgeon spoke to the doctor at the hospital (Inverell). The surgeon said “we will have a surgical team on standby for you in Sydney. Get her down here as soon as possible”. I was actually bleeding from the heart. The doctor that was on duty did not specify to the ambulance that it was critical to get down there at any time so it actually took 12 hours to get me to Sydney.. we had to go via Coffs Harbour to pick up another patient”
L and K Appelby
Many would be shocked to know that some of the recommendations for improved clinical care were as basic as enforcing a regime for hand washing: Recommendation 88.
Other recommendations were more predictable such as that which recommended that NSW Health should encourage all hospital staff to take all reasonable measures to enhance their communication with patients”: Recommendation 60.
“Within 12 months develop a system for the detection of deteriorating patients”: Recommendation 91
“Devise ways of ensuring that adequate and clear information is provided to all patients who attend at the Emergency Department”: Recommendation 92
Further notable recommendations included support for multidisciplinary teams as key enablers of a superior health system and more accessible information and evidence so as to make better decisions.
Some commentators have criticised the lack of attention to key political criticisms of the health system such as code reds in emergency departments and waiting times for surgery: see commentary by Professor Jeffrey Braithwaite of the School of Public Health and Community Medicine at the University of New South Wales
Recommendations concerning the Hunter
Commissioner Garling made some recommendations which are specific to the Hunter region and to Newcastle in particular. Some of the recommendations have been viewed as positive for the region: others not.
One of the more controversial recommendations related to the resourcing of trauma centres. Recommendation 16 says
“By July 2009, NSW Health is to designate and resource only 3 Major Trauma Centres in the Sydney metropolitan area and one trauma centre for rural NSW which is to be in Newcastle”. It is worth noting that patients suffering severe trauma are those who are “at a high risk of having serious injury” as the result of the traumatic event (a common example being a motor vehicle accident).
In regard to the rationalisation of regional hospital services, Commissioner Garling expressed the view that the Emergency Department of the Kurri Kurri Hospital ought not to be maintained and ought to be closed. He stressed that this view was based on safety, not budgetary, issues. There has been significant community opposition to this recommendation since the release of the Garling report.
In regard to the provision of health care for children, Commissioner Garling recommended that “a special branch of health to be known as NSW Kids should be established to provide all health care for children throughout NSW in the community and in public hospitals. NSW Kids is to report to the Minister on the need and possible location of a new NSW Kids Hospital.” The John Hunter Hospital currently has 112 tertiary beds for children and treats on average about 7,550 young patients each year. The recommendation, if implemented, would certainly impact on the service currently provided.
For further information on the Garling report or any other health or medical law enquiry, please contact any member of the health and medical law team at firstname.lastname@example.org