If one believed the Liberal Party government in the state of Victoria, the past five years have seen a miraculous reduction in the number of patients waiting for urgent operations in public hospitals, despite drastic budget cuts. There were 1,356 urgent cases on the official waiting lists in July 1993, but only 74 in January 1998.
Now the truth has begun to emerge, thanks to the willingness of some doctors to speak out. Many patients -- particularly the most seriously ill -- have simply been culled from waiting lists for financial reasons.
Doctors have leaked documents proving that they have been ordered to exclude dangerously ill patients from waiting lists to prevent hospitals being penalised by the state government. Waiting lists have been constantly manipulated to shuffle patients further down or off them altogether, so hospitals can avoid fines under the government's Elective Surgery Enhancement program.
Hospitals face a penalty of $100,000 for Category 1 patients who are not treated within 30 days, and $2,000 for Category 2 patients not treated in 90 days. Category 1 patients have cancers of the breast, bowel or brain or high risk heart conditions. Category 2 patients have brain aneurisms, possible cancers or acute hernias.
One of the leaked documents is a letter from the head of Melbourne's Southern Health Care Network, Dr Sid Allen, telling a doctor that if waiting list targets were not achievable, it was 'clinically inappropriate' to place a patient on the waiting list. In another letter, Allen told a doctor: 'The large number of patients being placed on the list may mean that the total number on the list is beyond the targets set by the department and the only way we can handle this is restricting access to the list.'
The documents were released by Australian Medical Association (AMA) state president Dr Gerald Segal, who told the World Socialist Web Site: 'The doctors are desperately trying to get their patients treated. If the hospital is penalised and goes broke, it will cut back further on the operations for the patients. A $100,000 fine is enormous, and the pressure this puts on the doctors is huge. And because the numbers in Category 2 are so large, the smaller fines soon add up.'
Segal related the scandal directly to budget cutting. He said the rigging of waiting lists would only end if $150 million more was spent on Victorian hospitals each year, because the state government spends $149 million a year less on public hospitals than the Australian average.
In fact, hospitals in all states are being starved of funds, and doctors face similar demands throughout the country. Segal confirmed this, saying: 'I speak to fellow AMA presidents and attend the federal AMA and they all tell me the manipulation of waiting lists is the norm everywhere. It is worse in Victoria because the budgetary restraints are so high.'
Segal evinced scepticism about an internal inquiry proposed by state Health Minister Rob Knowles, because many doctors would refuse to give testimony, fearing for their careers.
'Doctors are not free to comment. They are afraid that if they do they will lose their jobs. Without statutory immunity, such an inquiry is a farce. In fact, I'd be opposed to it, it is a waste of public money.'
In a radio interview, Knowles not only refused to guarantee immunity to doctors who spoke out, but issued a thinly veiled threat that doctors could be held legally liable for agreeing to take patients off lists. 'If doctors have been recategorising patients on other than clinical grounds, I'm not sure I want to be approving of that behaviour,' he said. It was a chilling indication that the government may try to launch a witchhunt against doctors.
One senior surgeon told the press: 'If patients knew that their admission forms were sitting in drawers they'd be horrified and rightly so. I have seen a booking clerk's desk drawer full of Category 1 and 2 patients' forms that have not been registered on the waiting list.
'Doctors are being asked to recategorise patients and have refused, so some waiting list clerks just go ahead and do it anyway without telling the doctor. This has happened to me.'
Doctors are right to distrust the government. When similar revelations emerged two years ago, Knowles claimed that a new computerised system would track the rigging of lists.
A patient who suffered a heart attack last year, and who is under the treatment in the Southern Health Care Network, told WSWS that worries about the standard of care he was receiving had worsened his condition.
'From the patient's point of view, if you don't know what category you are in, and you don't know what is happening to you, you tend to think it is your own bad luck about your treatment, and you become fatalistic. This is what happens in Third World countries -- I can tell you from my own experience there.
'Going to a doctor is not like going to a shop and buying something. You believe that the doctor will do everything for you. If you can't rely on the doctor, you are helpless.
'Stress about the hospital had a big input in my health condition -- underlying stress aggravated the whole thing. When I had the heart attack I learnt afterwards that they didn't tell me that a lot more could have been done.'
Cancer patient in Sofia reports on:
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[11 July 1998]