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Australian Industrial Relations Commission Transcripts |
AUSCRIPT PTY LTD
ABN 76 082 664 220
Level 4, 179 Queen St MELBOURNE Vic 3000
(GPO Box 1114 MELBOURNE Vic 3001)
Tel:(03) 9672-5608 Fax:(03) 9670-8883
TRANSCRIPT OF PROCEEDINGS
O/N 6875
AUSTRALIAN INDUSTRIAL
RELATIONS COMMISSION
COMMISSIONER CRIBB
BP2004/3200
APPLICATION FOR TERMINATION
OF BARGAINING PERIOD
Application under section 170MW of the Act
by Alexandra District Hospital for orders to
suspend or terminate bargaining period in
BP2003/6648-6650, 6652-6671, 6673-6690, 6692-6706,
6708-6712, 6714-6715, 6717, 6719-6730, 6732-6740,
6742-6755, 6757, 6760-6767, 6770-6771, 6773-6774,
6777-6786, 6788, 6790, 6792-6794 and BP2004/2216-2217,
2219, 2221-2245, 2247-2253, 2255-2257, 2259-2292,
2294, 2296-2301, 2303-2314, 2894, 2896-2908
MELBOURNE
9.33 AM, TUESDAY, 27 APRIL 2004
Continued from 26.4.04
PN1574
THE COMMISSIONER: Good morning, Mr Rathgeber. Welcome back?---Good morning.
PN1575
THE COMMISSIONER: Mr Niall.
PN1576
MR NIALL: If the Commission pleases.
PN1577
Mr Rathgeber, yesterday I was asking you some questions about category 2 patients within the hospital whose surgery got postponed as a result, you say, of the bans?---Correct.
PN1578
Do you recall those questions?---Yes, I do.
PN1579
And I asked you some questions about the individual detail of those patients and I think you were able to take the opportunity over the night to find some information and perhaps answer the questions that I asked you, is that the position?---That's correct.
PN1580
All right. Now, yesterday your evidence was that eight category 2 patients had been cancelled for yesterday's surgery?---Correct.
PN1581
When were they cancelled?---The process is usually, and I can't tell you exactly for these eight, is the day before there is a meeting to try and cancel the cases in view of the sessions, or theatre sessions being cancelled that we already knew of because the one - the one in five - or four theatre sessions were cancelled so therefore we knew there were five cases that we couldn't perform. So to give some notice to the patients, five out of the eight - this is the normal procedure - would have been cancelled earlier and then a further three on the day of.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1582
The hospital run lists, I take it, within each theatre?---Correct.
PN1583
So how many theatres are there?---We have 11 theatres at the Royal Melbourne.
PN1584
Right. And how many are reserved for emergency surgery?---It's - it should be one theatre reserved for emergency but often that is two and what we do have is what we call twilight sessions. So after the finish of the close of business, if you like, we also have twilight sessions to deal with the emergency workload and workload that overflows, if you like.
PN1585
And the other operating theatres, do they operate - all of them operate Monday to Friday?---Yes, they do.
PN1586
And some of them don't operate on the weekends, I take it?---Correct.
PN1587
How many don't operate on the weekends?---We decrease the capacity by about - I couldn't give you the exact figure but around about seven theatres.
PN1588
So you are down to about four operating on the weekend?---Correct.
PN1589
And no elective surgery on the weekends?---Some elective surgery on a Saturday morning. There would be some elective surgery.
PN1590
How does that work - is that just up to the individual surgeon who can book them in?---Correct, it is planned, it is planned surgery.
PN1591
Yes. But one or more surgeons run a list on a Saturday morning, do they?---Yeah, a number do, yeah. I couldn't give you the exact figure though. And that does vary quite considerably according to the waiting list.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1592
Now, take, for example, a urology list. I assume that at least one session is a urology session in theatre?---Mm, mm.
PN1593
That would be shared between more than one urologist?---Correct.
PN1594
And for public patients do the units work out between themselves which of the urologists are going to perform the surgery, or do they - how do they do that?---It is interesting. At the moment the Royal Melbourne Hospital is reviewing its theatre template which is aligning all our surgeons including the urologist to the theatre template. So there is a science that goes into trying to match the surgeon to the sessions. But what we find is a lot of variabilities with that as well and so therefore highlighting a given surgeon to a theatre template doesn't always fit if the surgeon is away on leave, if there is sick leave, or if there is a patient acuity issue, or change - so therefore it is - an adjustment would occur, usually the week of the theatre template being exercised.
PN1595
And that adjustment may involve a different surgeon coming in to pick up the list?---It can often involve that, yes.
PN1596
Or it may involve cancellation of patients?---Correct.
PN1597
Now, yesterday, you say eight patients were cancelled solely as a result of the bans, correct?---I said eight patients had - eight and three. So there were category 3s as well. So a total of 11 cases.
PN1598
Yes. But of the eight you say that they were only cancelled according - because of the bans?---Not totally. We have found that of the bans - related to the bans, it is between six and 10 since the bans have been implemented that we have cancelled that have been related to the bans. There will be a number of cases that due to the patient being unstable that would be a postponement or cancellation there and surgeon availability is less of an issue but has been an issue in the past.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1599
Okay. So six to 10, is that since the dispute started?---Correct.
PN1600
And that is just category 2 we are talking?---That is just - well, mainly categories 2s and 3s that we have cancelled, correct.
PN1601
Okay. So six to 10 of category 2 and 3 - - -?---Yes.
PN1602
- - - since the bans started last Wednesday have been cancelled due to the bans?---Correct.
PN1603
All right. Now, of those - why do you give a range between six and 10?---Because it is varied. Day one was six. We then, I think - if I can just refer to my notes here.
PN1604
When you say six to 10 you mean each day rather than cumulatively?---Correct. Yes.
PN1605
I am sorry, I have misunderstood your - - -?---So we had six on the Thursday, for instance, that were cancelled due to the bans. We had nine on the Friday that were cancelled due to the bans.
PN1606
And Monday?---Monday, I have got down here 11 that were due to the bans but I am not confident to say that because I was, obviously, here most of yesterday so I am not totally confident that there might have been two - because we do find that there is - and this is a very broad figure but around about two cancellations occur each day not related to bans but related to other variabilities.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1607
Yes, okay. Now, of the eight, let us assume for the purposes of argument for the moment that the eight were attributable solely to the bans, of those category 2, what operations were postponed?---There was an orthopaedic session, so that was a right total shoulder replacement. There was a carpal tunnel. There were vascular patients that were cancelled. Fem bypass was in two of those cases. There was a plastic surgery which is carcinoma of the left forearm. That was cancelled. There was another exploration for hyperthyroidism of the neck, so it is a neck surgery that was cancelled as well. And a further two orthopaedic cases that related to right total knee replacements.
PN1608
Okay. Now, taking - have any of those been re-scheduled yet?---They - what happens when we cancel they are automatically put into - time of surgery we call that which is rescheduling. And most of the cases but not all have been rescheduled for two to three weeks. Two cases are out to six months, rescheduling.
PN1609
And that process of rescheduling, who determines that?---That is mainly with the medical staff and with the, I suppose, medical and nursing staff, but particularly the consultants responsible for patients - put a priority on the patient and then re-categorise availability as well. So one of the orthopaedic patients that I have here for a shoulder replacement is rescheduled in six months but the co-morbidity of this patient is quite significant, but that would be more the problem of having the surgery than not having the surgery, if that makes sense. So that patient has been pushed out for a further six months.
PN1610
So he would be better off without the operation in some respects?---Well, that is right. There are cancellations for good reasons and this looks like a case that would be - has been already - hospital-initiated postponement has occurred four times and there could be good reasons for that.
PN1611
So that is one of the orthopaedics has been hospital-initiated postponement four times?---Yes.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1612
Any of the other patients had hospital-initiated postponements?---All of the other patients have had hospital-initiated postponements.
PN1613
In the past?---In the past.
PN1614
Yes. Well, let us go through them. Of the orthopaedics you have given one has had four, what about the other three?---The other three average one. To be honest, the other seven are one except for the vascular - one vascular case, that is a fem popliteal bypass. There were two cancellations prior, so hospital-initiated. Now, when we say hospital-initiated we prioritise that - that is the two, but there is also another category where it could be for other reasons other than the hospital and basically - there is only one orthopaedic patient for some reason has chosen not to go through with the operation. So cancelled twice by the hospital and cancelled twice by the patient.
PN1615
Right. So they have all been to the starting blocks at least once - - -?---Correct.
PN1616
- - - before?---Correct.
PN1617
This is at least their second time?---Correct.
PN1618
And surgeons have their consultants or their registrars in consultation with their consultants have determined an appropriate priority for rescheduling?---Correct.
PN1619
And that happens - - -?---On a regular basis.
PN1620
- - - on a regular basis with all elective surgery. And you would not have, as a general proposition - I withdraw that. You would have - you would be comfortable, I take it, in deferring to the judgment of the consultant that the rescheduling identified would ensure that there was no compromise of their health or life by reason of the delay?---In normal practice that is the way we go, yes.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1621
Yes. And when you say normal practice, that includes the eight yesterday?---Correct with the eight yesterday.
PN1622
Yes?---I mean - - -
PN1623
Yes, thank you. So we are really talking in that context, are we not, about the effect on the patient, about the discomfort or stress or anxiety associated with the cancellation rather than any attendant delay that might be caused on the morbidity of the patient?---Well, can I answer that question in two parts? Yes, I agree with the stress that would be placed and obviously every - most patients, if not all, and their families would be - feel that - a level of concern, stress about, particularly, the psychological preparation. As you can tell from the figures we do all these patients have been cancelled prior. Royal Melbourne Hospital, though, does not achieve the expected performance level with cancellations of category 2 and that is why we are in that position because we mainly deal with the emergency and the urgent flow of patients coming through the organisation. But if I can just add to that. We wouldn't cancel eight or in this case we had a total of 11 cancellations, eight category 2, three category 3 in a given day. And if I - would say that a normal would be, say, around about the two mark. And what happens here is, yes, the appropriate decisions are made because we clinically prioritise the patients to minimise the risk to the patient, but that is also putting the - the more cancellations we have, the more numbers, is obviously making those decisions harder.
PN1624
But still within the parameters of experience, past experience - what you are operating on now?---If they felt that, though, a category 2 patient was unstable, then we would make them urgent and just because of the - the bans wouldn't affect that.
PN1625
No?---So if there was deemed an urgent - that it needed to be reclassified and made urgent because of the patient's condition, that would be re-prioritised. And the bans aren't affecting that.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1626
No. And once that occurred they might - the re-prioritisation of that wouldn't necessarily entail unscheduled surgery - emergency surgery, would it?---No.
PN1627
It might simply entail moving sooner rather than two weeks time?---Correct.
PN1628
But it wouldn't make it and it doesn't follow that the delay increases the chance of unscheduled surgery to any appreciable extent?---Well, our waiting list is increasing each time we have cancellations. So the delay does increase but they are prioritised on the overall list. So - we are just under a thousand patients on our category 2 waiting list, so the more cancellations we have I expect that figure will go over the thousand mark and, obviously, that will be re-prioritised, that list, and that is done so on a weekly basis.
[9.48am]
PN1629
And the sort of - there are 52 weekends in the year?---I believe so.
PN1630
And a hundred and - - -?---Is that a trick question?
PN1631
THE COMMISSIONER: I hope not.
PN1632
MR NIALL: And 104 days of weekends. So 104 days in the year you can take out of elective surgery, apart from the ones on Saturday morning, you have got some - - - ?---There is - I think there is a session on the Sunday as well, but yes generally, I know where you - - -
PN1633
Generally. And you take out a significant chunk of time at Easter?---Correct.
PN1634
And you take out a significant chunk of time at Christmas?---Correct.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1635
And surgeons are known to go to Queensland in September holidays?---I can't argue against that.
PN1636
Yes, so you take out a chunk of time in that period as well?---Yes. Yes, there is a decrease over the Christmas period for about a two week period.
PN1637
So you have got these cycleable periods which feed into the waiting list, and indeed would be a significant factor in the waiting list?---Correct.
PN1638
And if you factored in an industrial action of bans of one in four over a period of a couple of weeks, it is not really a significant factor in that scheme is it?---Well, it is interesting - well, there is two parts to that. If we take Christmas period, the lead up to Christmas, and then following the Christmas period, so there is around about 10 working days that we would have a significant reduction in our sessions. But what happens in the week leading up is there is an increase in the workload dramatically in preparation for the Christmas period. So there is an endeavour by most organisations I can say, but definitely Royal Melbourne, to do that workload, and then following there is also a significant increase in the theatre activity.
PN1639
Yes, I understand. Would it be possible for the hospital, let us say the bans go for a period of time, that is a couple of weeks let us say, would it be possible to open up weekends for the balance of the year to clear the waiting list?---The problem there is that we have around about 100 EFT, so to put it another way 120 nursing staff that run the operating suites and the recovery to keep the theatre sessions, or to keep theatres operating, so it is not that easy to just turn it on, we would need for weekends just - and this is rough - but approximately an extra 20 staff to be able to increase the workload in a concentrated effort to meet the time that has been lost.
PN1640
Yes, so it really will be a matter of there will be some additions to the waiting list and there will be some re-prioritisation of the waiting list?---Yes.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1641
But both of those consequences, that is an increase in the waiting list and the prioritisation, are things that are regular occurrences that are managed by the hospital?---They are.
PN1642
And the sort of waiting lists we have now, what is the waiting list - I think the average waiting list for category 2 is 127 days?---Correct.
PN1643
I think was your evidence. Although outside the optimal perimeters for the average, you would still agree that that level of through put that you are currently achieving with an average of 127 days doesn't put patients' health, life or welfare at risk?---No, correct.
PN1644
And the reason for that is because it is manageable and managed?---Correct, at the cancellation rate of about two a day.
PN1645
Yes. Now given a - would you agree that statistically each day of the ban, that the ban continues, that is one in four, each day a single day is unlikely to make any appreciable difference on the average waiting time for division - category 2 surgery?---I did try to do some predicting modelling on this but I didn't have enough time to really measure that impact, so I really could not answer that. I would say that an isolated day I agree that would not have a significant impact. It is the accumulation of every working day that obviously at some stage that will have an impact.
PN1646
Yes, well 10 days doesn't, that over Easter doesn't - over Christmas I am sorry - doesn't have an appreciable impact. If you knocked out the 10 days over Christmas, and I understand that you have got to take into account the hump before Christmas, but if you took out those 10 days it is not going to make an appreciable difference to 127 days is it?---Well statistically I couldn't give you an answer on that, but what I can say is that we plan for that.
PN1647
Yes?---They now - the theatre template we review now takes into consideration all those fluctuations, if you like, in our theatre template to try and meet that demand.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1648
And you are currently in the short term managing the theatre template to deal with the current bans and once the bans are complete, I take it, you could also manage the template to wash out any affect that the bans might have had?---Well it depends how long the bans go for.
PN1649
But you are not in a position to sort of predict - sort of model the effect of a week of the bans, or a fortnight of the bans, or three weeks of the bans, you haven't done that modelling?---No, no, no, no. Can I just add please at this stage that, you know, Royal Melbourne Hospital mainly is in the urgent and the category 1 surgical, so its business isn't solely on the category 2s and category 3s, and that is the reason why we don't do as many category 2s and 3s in our organisation.
PN1650
Thank you. That is all I wanted to ask you about elective surgery. And I wanted to ask you some questions about accident and emergency. Can I hand this document to the witness please, and there is one to the Commission and a couple down the bar table. Now this is a document that was provided by the hospital under summons, it is called a capacity management report. Are you familiar with that document?---Yes, I am.
PN1651
That is a document that you get as part of your work?---Yes, it is.
PN1652
Yes. And this one, the top one is 12 April 2004 at 11.30?---Yes.
PN1653
Now could you tell - - -?---Is that 9.30 or 11.30?
PN1654
Nine-thirty, my mathematical error there, I am sorry?---That is okay.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1655
What is this document for?---This is a point in time picture of what the organisation looks like, particularly focusing but not solely focusing on what it looks like at the Royal Melbourne Hospital campus in relation to the capacity coming through the emergency department. It also includes areas such as hospital in the home, the transit lounge, and now day facility wards as well at the Royal Melbourne Hospital, and that is looking at the number of beds that are open, the numbers of beds that are staffed, and the number of beds that are closed mostly due to the inability of being able to meet their staff supply.
PN1656
The acute over night, that sets out all the wards within the hospital does it?---Correct, yes it does.
PN1657
And MD bed total, what does MD stand for?---That is in this case - - -
PN1658
Medical is it or, no?---Multi-day it stands for.
PN1659
Multi-days, thank you. Now 12 April was a - - -
PN1660
THE COMMISSIONER: Monday.
PN1661
MR NIALL: Monday, thank you, Commissioner. So you had had - it was Easter Monday. There were 24 beds closed on Easter Monday?---Correct.
PN1662
Yes. Is that because it was Easter Monday or is that a normal closure from Monday?---That is not unusual for the Easter Monday because of the again the elective list would have been less on that time.
PN1663
And you had none in - the multi-days doesn't include the day facility day beds?---Correct.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1664
That is a separate category, and on the Monday you had no day beds operating?---That would be true, yes.
PN1665
Now what do you do with this document when you get it, Mr Rathgeber?---Can I just say, just before answering that question, the 24 also reflects areas such as the intensive care unit, which had five beds closed as well, and that is because we, even though we have them staffed, it is to meet the demand. So at that stage obviously there were five beds staffed but there was not the trauma or the emergency through put into ICU. So that is one thing that we do is we try and match staff supply to work demand and we use this document to identify two things, what it looks like in emergency department and what it looks like on the wards, taking into account hospital demand from the emergency, the elective load, try and also on the other side of it looking at the staff supply.
PN1666
All right. Well taking ICU, now they are not the subject of any industrial bans at the moment?---Correct.
PN1667
It has got 17 open and 17 occupied, I mean, variation five, so those five are not closed beds are they?---In that case on the Easter Monday, reading this document, that would say that we haven't staffed, because we are not doing particularly the cardiac surgical list would have been cancelled on that day and we usually run about four beds related to cardiac surgery, and that can be more.
PN1668
Now do you get this document as a real time management tool, that is that you are looking at it and then you use that to make immediate decisions or is this more of a planning tool?---This is more of a planning tool. Because it is only a point in time at 9.30, those of us in health like health because it changes from minute to minute, and as soon as you get this document and, you know, if you haven't answered your e-mails, you could be two hours, or my case would be a full day, and by the time you have read it obviously it is retrospective and it is too late to make decisions on. What we do use it is trying to get a trend of what it looks like within the organisation, and so we meet on a Tuesday morning at 7.30 as a task force to review all this information and it is collated for that purpose.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1669
The documents I have given you started at 12 April and go through to 22 April, but it is only 21 and 22 April which might be affected by industrial action, correct?---Correct.
PN1670
Now going through - if you go to 13 April - in emergency access it has got the number of inpatients?
PN1671
THE COMMISSIONER: I can't read it at all?---It says the number of inpatients is the first - - -
PN1672
Is it?---Well, I know that but I can't read it.
PN1673
MR NIALL: Yes, but if you go to emergency - you see the first one you know - it is a poor photocopy - but you know that will say:
PN1674
Number of inpatients.
PN1675
?---Correct.
PN1676
And the second one will say:
PN1677
Number waiting for a bed (EHOLD).
PN1678
?---Yes.
PN1679
And the next one is:
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1680
Number - - -
PN1681
- - -?---
PN1682
Number waiting for a bed in EHOLD that is greater than 12 hours.
PN1683
Okay, thank you. So on the 13th, the Tuesday, there was - how many cubicles are there?---There is 37 cubicles. I suppose the breakdown of those cubicles though is 24 that are cubicles, seven that are resusc bays, and five for assessment, so there is a total of 37 bays though.
PN1684
Okay. And EHOLD, I think you said that is the concept rather than the place - - -?---Correct.
PN1685
- - - for the whole of the emergency access department?---Correct, they will be in the cubicles though, they would be within those 24.
PN1686
When do you move out of an - why have you only got six on the 13th, six in EHOLD of 26 number of inpatients?---There used to be a statement that we used to make is, "A good emergency department is an empty emergency department," and because this is obviously in the Easter period there is more flexibility of beds available within the system so patients are transferred through to their beds. And therefore if you notice we have got six only in EHOLD, which is I would consider that very good, and we have no patients greater than 12 hours because they have been sent straight through to the appropriate ward.
PN1687
When you say, "A good emergency department is an empty emergency department," there is obviously an element of flippancy about that?---Yes.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1688
But it doesn't follow that a full emergency department is a bad emergency department does it?---That is correct.
PN1689
Nor does it follow that an over full emergency department is a bad emergency department?---I am not so sure about that one.
PN1690
Because - - -?---Well it depends what you mean. If it is an overflow then we know that we end up on by-pass.
PN1691
Yes?---We know that patient care can be compromised. All efforts are made to prevent that from occurring.
[10.03am]
PN1692
Now, if you go on to the 14th, things are going well, you have got 34 inpatients, two in EHOLD and no over 12 hours. On the 15th, it has gone over to two - five in EHOLD, 39 and two waiting greater than 12 hours?---Correct.
PN1693
That is a pretty typical day?---Again, this is a distorted week, to be honest, because of the Easter period.
PN1694
Distorted in what way?---Because you have got the public holiday on the Monday, we find that things usually start happening on the Sunday where you find it difficult to get your patients admitted. Then the Monday when the elective surgery increases and the flow of patients coming through into your organisation, and that builds up. So if you have a public holiday and less activity surgical-wise, then what can happen is that you can meet the demand for the rest of the week. So the Monday/Tuesday part of that Easter period there was decrease in theatre sessions, so as a result of that we have been able to meet the demand through the week, hopefully. Not always the case, but that is the general theme.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1695
So, in fact, these figures for the Monday, Tuesday, Wednesday are probably better than typical for Monday, Tuesday, Wednesday?---That would be correct.
PN1696
And if you go on to the next page which is 16 April, you have got seven waiting longer than 12 hours. Again that would be typical for a - well, it would be a typical occurrence to have that sort of number waiting greater than 12 hours?---Absolutely, yes.
PN1697
And probably with this week it has probably happened later in the week than it might otherwise do?---Correct.
PN1698
And although seven - 31 inpatients, 10 in the EHOLD and seven longer than 12 hours would from a management perspective be suboptimal, it wouldn't be of concern to you, would it?---The 10 is not as much of a concern as the seven.
PN1699
Yes. But when you say it is a concern, it is not a crisis on 16 April you have got seven longer than 12 hours?---It depends the mix within the seven, but as a general rule, I wouldn't be concerned with that knowing our organisation.
PN1700
Yes. This would be a manageable sort of number?---Correct.
PN1701
One that you are used to seeing?---Yes.
PN1702
And it could filter through the organisation in accordance with protocols and established priorities?---Correct.
PN1703
And on the 17th it has gone down to three?---Correct.
PN1704
Now, if I could take you through up to the 20th. You had eight in greater than 12 hours and I take it that again would be not a source of concern to you other than in the trend sense?---Correct.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1705
And finally, could I take you up to the 22nd in which you had 12 waiting greater than 12 hours; that was at 10.15. That is of a similar order of magnitude to ones that you have seen within the organisation on a regular basis?---That really does vary. Well, 12, we are certainly looking at this now though. We are looking at this and trying to prioritise the patients going from the emergency department. We will be reviewing our elective list. Hospital initiated postponements, that is what that can often relate to. Prioritising the urgent cases to go through the organisation.
PN1706
So that 12 again from a management perspective needs some remedial action - - -?---Yes - - -
PN1707
- - - cancellation of electives and steps taken within the organisation to ensure that the numbers are cleared?---Again, stating the obvious, health is more complex than that, but as a general rule, we would be looking at our theatre list and looking at whether we can also make available more beds in the system as well with our staff supply, maybe employing bank staff, agency staff, reviewing our sick leave trends. We would be trying to meet that capacity because we know we are at a tolerance level or meeting a threshold that is of concern.
PN1708
And yesterday - or Monday the 26th, what was the number - I think you gave some evidence yesterday about the number greater than 12 hours?---Yesterday again was a point in time, and I think I gave the figure that we had 27 that were waiting and approximately half of those were greater than - I think I said 13 greater than the 12 hours.
PN1709
And again I suggest that that number, although as a trend would be of concern, it is within the parameters - well within the parameters that the Royal Melbourne can operate in in providing appropriate levels of care to its patients?---Well, I think the thing is we need to look at what is happening, like, as we speak, and those numbers have increased - if I can just refer to my notes - where we have 27 in EHOLD and we have 13 that are greater than the 12 hours. So it is still staying around about the 13 number that are greater than the 12 hour waits.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1710
But people are coming and going. People are leaving that list and others are being added to it?---Correct.
PN1711
Yes. And what I suggest is that - - -?---But one of those cases though is, you know, T5 crush injury, that has been waiting greater than 12 hours on a trolley in a corridor and really, though not unstable, really should be in an orthopaedic bed that is more suited for that type of injury.
PN1712
The person - - -?---So we would take - sorry - sorry to interject, but we would not just look at numerics here, we would be looking at the more detail behind it; the patient's condition, their diagnosis, the treatment they require and the specialty of the area they need to go to. There is no such thing as a general medical or surgical ward in most organisations now and they are highly specialised, and the emergency medical nursing staff can only do so much. It is the next level of care that is important, prioritising the patient and getting them up to the wards.
PN1713
Are there beds closed on the orthopaedic ward?---Yes, there are.
PN1714
How many?---We have - I don't - no, I don't have that - sorry, can I give you that detail. Currently we have three beds closed. Can I also add - - -
PN1715
Yes?---- - - like most of our wards, they are being - they would already be prioritising the patients within theatre and also within emergency department, and there would be no hesitation in opening those wards - those beds if they felt that patient had that need to go through.
PN1716
So at the moment, in relation to the example that you have given, it is sub-optimal for that patient to be on a trolley in A and E, but it hasn't reached the point where medical staff have formed the view that it would be necessary to put that person in the ward. And if that - when that point is reached, the bed will be made available, won't it?---Yes.
**** DANIEL PATRICK RATHGEBER XXN MR NIALL
PN1717
Thank you. Now, you gave some evidence yesterday about people being on trolleys in corridors. That is not unknown at the Royal Melbourne emergency department?---We have a bad reputation that we have had patients in corridors, yes. But, can I say, that reputation is - has improved significantly, particularly in the last four months, where there are very few occasions when we have patients in corridors but over the last 12 months there is evidence that we have had patients in corridors.
PN1718
And that is consistent with what is happening in the last few days?---Correct.
PN1719
They are the only questions I have. Thank you, Mr Rathgeber?---Thank you.
PN1720
THE COMMISSIONER: Thank you, Mr Niall.
PN1721
MR NIALL: Oh, sorry, before I sit, could I tender the Capacity Management Report?
PN1722
PN1723
MR NIALL: Thank you, Commissioner.
PN1724
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1725
MR LANGMEAD: Thank you, Commissioner.
PN1726
Mr Rathgeber, you were speaking of the eight cancellations from yesterday. Were they category 2 or 3 patients?---Category 2.
PN1727
They are all category?---Yes, the eight.
PN1728
Yes?---Yeah.
PN1729
And in paragraph 27 of your statement you give the figures of waiting lists for elective procedures. Are you able to indicate what proportions of elective surgery is undertaken in relation to each category?---Well, I suppose that what we are saying, from my paragraph 27, I highlight that we have under the 50, so 43 category 1 patients, so they would be priority, they would be within a system. We have got under a thousand, 982 patients that are category 2 patients. And it varies to the number of category 2 patients that we would be able to operate on on a given day.
PN1730
Would those waiting lists, would they reflect the proportion of elective procedures which would be undertaken?---They would.
PN1731
So that if there was 43 of the total, 2500 odd - - -?---Correct.
PN1732
- - - being category 1, that is, what, about 5 per cent, I think?---That is in relation to the waiting lists, yes.
PN1733
Yes, and would the number of procedures actually performed follow a similar proportion?---No.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1734
What would those proportions be?---Because the waiting list is reflecting those that - in fact, that - the waiting list reflects only those that I have said are on the waiting list if we are able to meet - that is not including the ones that were actually operating on - during the week. So we have 140 booked sessions per week across the 11 theatres.
PN1735
Yes. Well, of those 140 booked sessions, how many of those actually, on average, goes ahead?---I couldn't give you the answer because there are postponements for the reasons that were quoted before, or stated before, so I couldn't give you an answer on that. It would vary - it is - the theatre template varies dramatically.
PN1736
Are you able to say what the booked procedures are, how many are category 2?---No, I could not.
PN1737
All categories, 1 or 2 or 3 for that matter?---Very few category 3s. So mostly category 1s, like the neurosurgery sessions would be category 1s, most of. The cardiac surgery, those sessions are category 1s. There would be orthopaedics, most of the orthopaedics would be classified as category 2. It would be very - very difficult for me to give an average answer to those type of questions. It is nearly like you want to see a theatre template, see what it looked like at the beginning of the week and then actually reflect on what actually happened during the week and it varies dramatically.
PN1738
Okay. So most of your surgical procedure - elective surgical procedures are category 1, is that right?---Well, I really - I couldn't answer it, but the majority, yes.
PN1739
Majority, yeah. And the next largest category is category 2?---Correct.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1740
And that in itself is, what, how big compared with category 1?---Well, again, it is - just re-wording the question, but it is the same thing. I mean, we do - it appears on the list that we would have around about - up to about 10 cases that would be category 2 per day and if we have one or two cancellations, that is hospital-initiated cancellations, then - at the moment I can say that we do eight. I would not like to use the word average of eight categories 2 per day, though.
PN1741
So of the 140 that are booked, about 50 you might expect to be category 2?---Could be, yes.
PN1742
Yes. And of category 3 I think you said there would be far fewer?---Far fewer, correct.
PN1743
What sort of figures would you have in mind there?---Well, if I can just take today, or yesterday, we had three - only three on the list and three were cancelled, so that is not an unusual - so it would be a third of what we normally would do of category 2s.
PN1744
[10.18am]
PN1745
Now, is it possible to exchange the procedures, as it were, so that if you have got a category 3 patient booked in, and you become aware that you have got a category 2 patient who in the opinion of the treating people consider that that person needs to be attended to more quickly than the category 3, is it possible to re-schedule the category 2 person instead of the category 3?---What would happen is if you have got a theatre session that is allocated to a surgeon, and they might do their category 1 cases, there might be some negotiation around that second case, as to whether we should bring in a category 2 that is more urgent, or that there is not enough time to get through a category 1, depends on the surgery. Like, neurosurgery would commonly do this. And so they may tag onto the end of a theatre session. They may tag on a case, a category 2 case. To answer your question, the answer is that it is constantly reviewed to optimise our theatre template and the through-put of patients.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1746
And so in order to attempt to reduce the waiting time for category 2 patients, you can manage the category 3 list and substitute category 2 patients if your waiting time is blowing out, for example?---Yes, there is a lot os strategies that are employed to meet the urgent case load, and also to reduce the waiting list.
PN1747
Mr Rathgeber, on the capacity management reports, and I am looking at the moment at the one for Thursday 22 April - and I can tell you the only reason I am looking at that one is because I can actually read the dark bits on my copy - but can you tell us what each of those wards does?---Sorry, 22 April?
PN1748
Yes, under the heading of, Acute Overnight, there is a number of what I take it are wards?---Yes, we have - - -
PN1749
Could you just tell us what they are?---Well, we have an Intensive Care Unit.
PN1750
Yes?---We have the Coronary Care Unit.
PN1751
Yes?---The 2Bs relate to cardiology patients, so it is a cardiology elective, and also the coronary care transfer of patients.
PN1752
Sorry, and coronary care?---Transfers.
PN1753
And the coronary care transfers, is that people coming from emergency surgery and/or elective?---No, that is mainly patients that have come through with chest pain that may have had a myocardial infarction, so heart attack, that require to go to Coronary Care. After the first 24 hours to 48 hours, if they are stable, they are transferred across into 2B.
PN1754
So they are admitted as emergency patients?---Correct.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1755
And then?---Stabilised, and moved into 2B.
PN1756
Okay?---2 West, or 2W, that is our cardio-thoracic surgical ward. The 3 South - and 3 South/West is to do with trauma surgery and general surgery. The 4 South is 2 ward - - -
PN1757
Sorry, that was two of those?---I just put them together, for convenience.
PN1758
They are trauma surgery?---So, trauma surgery typically goes to that area.
PN1759
Yes?---The 4 South 1 is neurology. The first one that you see in front of you is the neurosurgery, and the 4 South Neurology is the 22 bed, so it is the second ward. So it is Neurology. If I could - - -
PN1760
They are both surgical wards?---No, no, sorry. Neurology is medical patients, so typically it might be stroke patients, epilepsy. And the 4 South Neurosurgery is obviously a neurosurgery ward, so it is a surgical ward. The 5 North and 5 East is our - fifth floor basically is our oncology wards. The 6 East and 6 North is our medical wards. The major in dementia, one ward, and the other ward is Respiratory Care Unit as well. So it is not just general medical. 7 East is our renal. 7W, is 7 West, and that is our facial/maxillary surgery, neck surgery. Can get some trauma as well. 9 East is our Infectious Disease Ward. And 9 West is our Orthopaedic Ward. The MAPU is Medical Assessment Planning Unit, which is our medical ward, which is really attached to our emergency department. That is the ward I referred to yesterday.
PN1761
THE COMMISSIONER: Yesterday, as the filter?---That is right. And the SOU is Short Stay Observation Unit, which is surgical patients, again that flow through to the emergency department, or failed day surgery patients may go there as well.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1762
MR LANGMEAD: I see there is no beds closed in 7W or 9E?---Yes. That is not the case today, though. But to answer your question, that is correct on this document.
PN1763
And what is the position today?---The position today is that 7 West has 3 beds closed, and 9 East has 3 beds closed. Again, I just stress, Commissioner, this is a point in time, and that point in time was 7.30 this morning.
PN1764
Now, 7 West, that is the next surgery and some trauma?---Correct.
PN1765
So you would have elective surgery patients going there?---Correct.
PN1766
And some emergency ones?---Yes.
PN1767
Is there any pattern to the percentage, or proportion of those patients?---This ward mainly receives emergency surgical patients coming through. So usually they would go to the emergency department, because they do get a fair bit of trauma. Then it would go obviously through to the operating suite, and from the operating suite to this ward.
PN1768
And the arrangements in relation to emergency patients and the closure of beds?---No effect. There has been no effect. So that flow has been occurring within the bans that have been implemented.
PN1769
In the Oncology Wards, you didn't have any beds closed there on Thursday 22nd?---And there is no beds closed there today.
PN1770
And 3 South West?---There is no beds closed today
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1771
And of the other wards that are indicated on this sheet are closed, has there been a change in relation to any of those? Have beds ceased to be closed?---It is, as we speak there would be prioritisation of patients. And if I can take 9 East, 9 East does have a number of beds closed currently, but if a patient comes through and needs to be admitted to 9 East and is considered urgent, they will be admitted to 9 East, and whether they have got a closed bed or not the staff there will respond and open those beds. And that is why I was saying yesterday, the importance here is to maintain those relationships, because the nursing staff don't want to implement the bans, and the number one priority is maintaining patient well-being and safety. So that has been met by the Melbourne Health nursing staff.
PN1772
It is specifically a provision of the bans that that is to take place, isn't it?---Correct. It does come down to the interpretation, and I suppose the concern that I would have is the longer the bans, the more difficult some of these decisions are for the medical and nursing staff to prioritise the patients to meet the demand going through the emergency department.
PN1773
But currently it is working?---No, I wouldn't say that because we have actually - the emergency EHOLD has increased, it has doubled in the number of patients over the last week. In EHOLD patients are overflowing into corridors and this is concerning the nursing staff, beds are closed, we are putting priorities on patients. But it is on an individual patient and assessment, I would say that all endeavours are being met to meet the needs of the patient. It is the big picture stuff that is of concern.
PN1774
In the past I think you admit that the Royal Melbourne has got a history of people waiting to be admitted in excess of 12 hours?---Correct.
PN1775
Yes. And that proportion has historically varied from about a third to a quarter, all your emergency admissions, yes?---I also followed up and said that we have improved in this KPI, particularly this year, calendar year.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1776
And in relation to ambulance bypasses, Royal Melbourne has from time to time experienced instances of those?---We have had our fair share, you might say. It is, again, probably an achievement though, the department, DHS, if you like, from a watchdog point of view, have kept a very close eye on the number of bypasses that have occurred, metropolitan, and this is an area that we were definitely failing in. But in the last six to 12 months we have had significant improvements and been able to meet the level or the goals that have been established by the department. In the restriction, I have to say that now we - we increase the number of bypass obviously because of the bans, related to the bans in the last week, have significantly increased.
PN1777
How do you measure bypasses?---How do we measure them?
PN1778
Yes?---As in count them.
PN1779
Yes?---We just count them. So as they occur we put them into a spreadsheet and we count them.
PN1780
Okay?---Sorry, I am not - is that what you mean?
PN1781
Yeah. You will have to bear with me - - -?---Okay.
PN1782
Because you know far more about this than I do. So if you go onto ambulance bypass I believe that is for a limited duration?---Yeah, that is right, it has a two hour duration.
PN1783
Two hour duration. And it is subject, of course, to the provision that if somebody - if the ambulance has a critical patient they can bring them in anyway?---Particularly if it is a trauma case that is correct. So regardless of whether you are on bypass a trauma patient would still come through. It is - sorry, I should say it is - it depends. It depends how many other organisations are on bypass. If they are - say the Alfred is on bypass and we are on bypass, then there might be the call to go off bypass to meet the trauma load that is coming through.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1784
So even though you have notified the Ambulance Service that you are on bypass - - -?---Yes.
PN1785
- - - that could be reviewed in the middle of the two hour period?---Correct. It depends on what is happening in the rest of the health services.
PN1786
Yes. Now, if things changed in the hospital itself would you go off bypass anyway?---The decision to go on bypass is not made lightly, so to answer your question, no. Once we have made the decision to go on bypass, then we couldn't just turn that decision around.
PN1787
So you are locked in for two hours - - -?---Correct.
PN1788
- - - regardless of the actual situation?---Correct. What I am saying, if we thought that we could relieve the situation in half an hour to an hour we wouldn't go on bypass. We would - we would mobilise those resources, deal with the situation - the decision is not made lightly to go on bypass because we know what pressures that puts on other health agencies and we know what it means internally to our organisation as well.
PN1789
So what are the trigger points to going on bypass?---This is the tough question to answer in health. People have tried to make a formula out of it that if it is the number of patients in EHOLD, if it is the number of patients that are greater than 12, if it is the acuity of the patients coming through the emergency department, because you could - we know that at Royal Melbourne Hospital the four patients coming through that are trauma, requiring a lot of services, could put us on bypass. We also know that we could take 50 patients coming through the emergency doors at the same time and some time meet their demand and not go on bypass. It is a very difficult question to answer. We also know it relates to the staff availability and the beds that are open to meet the flow. I can't give you the formula that puts Royal Melbourne on hospital - we also know that five less beds in the system can be enough to trigger it and put us on bypass depending on the workload that is coming through the emergency department.
[10.33am]
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1790
Yes. Do you have the figures of the number of times you have been bypassed in the last week?---We were on bypass on the Thursday.
PN1791
Yes?---We had two episodes of bypass on Sunday, and I believe we had one, but I would need to confirm that, yesterday. We haven't been on bypass today. Can I also say, Commissioner, that it is interesting when you map out the bypass to what is happening in other organisations; Box Hill and the Austin went on bypass, that put pressure on the Royal Melbourne Hospital and then we ended up on bypass soon after, so it was the movement of the patient in the system that put us on bypass.
PN1792
And that is always going to be the situation when other hospitals go on bypass isn't it?---Correct, yes, that is sharing the workload.
PN1793
Yes. Regardless of whether there is industrial action taking place or not?---Correct.
PN1794
Yes. Now, Mr Rathgeber, you spoke about Easter week being better than usual, and I must say I didn't understand why this was the case, and in fact you can assist me. But we were looking at - or in response to Mr Niall's questions about emergency access - you said that Easter week was better than usual because you were doing elective surgery in a different pattern. Do you recall that?---Yes, what I was implying, I may not have said it clearly, is that the Easter period, or the Easter week, is that there is the theatre template that we had established the previous 12 months reflects that surgeon availability is less, and so that we run our theatre templates less at that period, so therefore the elective workload is often significantly decreased and it only takes one - and in this case Monday and Tuesday was a decrease in the workload - so therefore that has a flow on effect that allows us to meet our emergency demand. Also at Easter this time because we have got, thanks to the graduate nurses coming on board, Royal Melbourne Hospital has its - only has a shortfall of 30 EFT vacancy as opposed to 18 months ago we had a shortfall of 300 EFT, and so we have had our graduate nurse intake which came in in February, orientated in the March, and they were active over the Easter period so that we had more staff available, we were able to optimise our beds and cover our sick leave, and we had less elective surgery occurring so we were able to meet the emergency demand.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1795
Don't you have the - you have the emergency demand is going to be about the same anyway isn't it?---That is true, I mean, there was thoughts, not just at Royal Melbourne Hospital, that it would fluctuate dramatically, and there are some peaks but generally we know that we would see approximately 127 patients through the emergency department.
PN1796
Yes?---Can I just qualify a statement I made yesterday which was incorrect related to this particular point because I did talk about the percentage of admittance through the emergency department?
PN1797
THE COMMISSIONER: It might be useful if you wish to correct?---It is just that it is a timely - so I did say that we would admit 50 percent, up to 50 percent I think was what I said yesterday of emergency patients.
PN1798
That is right?---The true figure is 30 percent not 50. It was 50 patients that we might admit out of the 120-130 cases that went through. So if I could just - so I talk patient numbers instead of percentage at that stage.
PN1799
Right.
PN1800
MR LANGMEAD: So of the number of patients who present to accident and emergency - - -?---Yes.
PN1801
- - - you are saying that 30 percent are admitted?---Yes, it averages out to 30 percent, it can peak at, you know, in 40 percent, but it is not 50.
PN1802
Right?---Which is - excuse me - which is what I stated yesterday.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1803
What happens to the remaining 70?---They get tremendous care at the Royal Melbourne Hospital and are sent home. I mean, and that is some are sent to other facilities, like for instance if it is a patient that requires sub-acute care, they would be sent across to our other campus so there is admission on to the acute wards, there is admission into our sub-acute wards, some are sent home, not many, as hospital in the home, others we provide services such as rehab in the home and others are treated - because we get a lot of general practitioner type patients that really are assessed, treatment is given, and then they are sent home and may be referred to their GP or outpatients for further review.
PN1804
So somebody would actually see them in the emergency ward?---Correct.
PN1805
And, you know, if they have got a cut hand they might sew it up and send them home or - - -?---Correct.
PN1806
So you don't actually get admitted to be sewn up?---No, you wouldn't be admitted, no, no - - -
PN1807
No, okay?--- - - - it depends what you are sewing up.
PN1808
THE COMMISSIONER: We won't have any further information on that subject, Mr Rathgeber, please?---Okay. I will hold back.
PN1809
Please do.
PN1810
MR LANGMEAD: So when I tear my trousers I will come in and see you, will I?---Not me.
**** DANIEL PATRICK RATHGEBER XXN MR LANGMEAD
PN1811
Okay. I am still not sure I am following why it is that you are better able to move people through the emergency ward during those times when you have banked up your elective surgery?---Because if we are - say if we are doing 20 cases of elective surgery each day, as a number. I am not - don't quote me on the number. Those cases wouldn't be going ahead on a Monday and a Tuesday. So it could be 40 less cases that we need to find beds for. The average length of stay is five days so you actually, in effect, you can have about - and we know this in our - between 30 and 40 beds that are not taken up by the elective surgery load so your emergency flow can be met. But I have got to say it is more complex than that even. It is also supply and demand and the supply of nursing staff is critical to meeting the hospital demand, which is why we are here today, and the supply of nurses at the Royal Melbourne Hospital has increased significantly and so we have been able to keep our beds open.
PN1812
So at any time when you wish to move people through emergency more quickly you can accomplish that by cancelling them or postponing elective surgery?---It is not done lightly but that is one - one strategy that we employ - - -
PN1813
That is one of your management tools?---And, as I said before, that strategy is usually only two beds that we would do that for currently. Previously, Royal Melbourne would do this poorly. Go back 12 months, we would cancel more cases. Prior to the bans it has been less.
PN1814
Yes, thank you, Commissioner.
PN1815
PN1816
DR JESSUP: Yes, Commissioner, there is.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1817
Mr Rathgeber, I want to take you back to those two things that I raised with the Commissioner immediately before the adjournment last night, through which I asked you to provide some further information about the eight category 2 cancellations yesterday?---Yes.
PN1818
So that we know our baseline to start from, as it were, there were eight category 2 cancellations yesterday, were there?---Correct.
PN1819
Yes. And you have told us, I think, I am not sure that I have all eight of the conditions. You said there were two orthopaedic - I think altogether there were four orthopaedic cases, weren't there?---That is correct, four orthopaedic.
PN1820
Two to do with the knee, total knee replacement?---Correct.
PN1821
One was a major shoulder operation of some kind?---Correct.
PN1822
And the fourth one?---Was a carpal tunnel.
PN1823
What is that?---Wrist - wrist surgery.
PN1824
Wrist. Then you have the vascular procedure?---Correct. There was - you should have two vascular procedures.
PN1825
Oh, two vascular - well, that was the one I was missing. Then there is the carcinoma?---Correct.
PN1826
And then there is the exploratory procedure for thyroidism?---Correct.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1827
All right. Now - - -?---Commissioner, would it make it easier, I actually have got a single sheet that outlines these cases that were cancelled?
PN1828
Well, I would like to have a look at it first before you start giving it to the Commission?---Okay.
PN1829
Yes, I think that is something that should be shown to the Commission and you will need to give me two more copies, please. If you can make sure you keep one for yourself. Okay, Mr Rathgeber, you have produced a document which you have prepared overnight, have you?---This morning.
PN1830
This morning, yes. Well, we call that overnight. And it is headed Category 2 Patients Cancelled on 26 April Due to Union Action?---Correct.
PN1831
All right. Now, the second column from the left headed Diagnosis/Unit. Can you tell me what that indicates, please?---This is the diagnosis that the patients have come in with so example would be the first patient has come in for a right, total shoulder replacement. The unit which is in bold and underlined above, it says it is the Orthopaedic Unit.
PN1832
Yes, thank you. And the next column is the category and they are all category 2?---Correct.
PN1833
And the next column tells you the date they first went on the waiting list?---Correct.
PN1834
Does that have any relevance to the date, this particular date, that is 26 April, was booked for the procedure?---It has a relevance because it demonstrates how long they have been on the waiting list. So that is taken into consideration.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1835
Yes. So that is when they are first assessed as requiring surgery?---Correct.
PN1836
Then another column called HIP, but that is not - is that Hospital - - -?---Hospital Induced Postponement.
PN1837
Yes?---And so for hospital reasons there has been a cancellation.
PN1838
On previous occasions?---On a previous occasion. So that could be, for example, surgeon availability - an example.
PN1839
Yes. And what are CXs?---CXs are cancellations which include the hospital induced postponements and non-hospital-initiated postponements. So that could be patients or the surgeon feels they are unstable, could be other reasons as well.
PN1840
All right. Well, now, there is - case number 6 is the only one where there is a difference between those two columns?---Correct.
PN1841
So all the - other than case number 6 all the cancellations were the hospital-induced ones?---Correct.
PN1842
Yes. Well, now, I want to ask you about that. You gave us an example of a non hospital induced postponement of a surgeon's assessment of problem with stability and therefore the operation is put off on medical ground. Now what would - that wouldn't be regarded as a hospital induced postponement, would it?---Usually not because unless the patient is in hospital and found to be unstable for the surgery, then it might very well become a hospital induced. That would be more the surgeon induced cancellation.
[10.48am]
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1843
Well what would the other hospital induced postponements be for?---Surgeon availabilities can be a common one. It can also be the fact meeting the hospital demand so there could be reasons why. I mean as I said, we have about two a day normally that is meeting the demands so that could be a cancellation because of that.
PN1844
Yes, now do I understand from what you have said, that a patient will be booked in at a time in which their medical advice is they are in a condition which is stable and suitable for operative intervention, and if that changes, then I understand your evidence to be they will be taken out of the list, as it were, and deferred to a later date when they are in a suitable condition?---Correct.
PN1845
All right, now if they are in a suitable condition both as to general condition and also stability etcetera, and they are ready to go clinically or from a medical point of view on a particular day, and then that procedure is cancelled for any reason - any other reason external to the patient's condition, then what happens then in terms of their own personal condition?---Well the - obviously they are cancelled and then with their clinician involved, they are reassessed as to - and re-prioritised for a suitable time which wouldn't - the time in this case would lead to the next column which talks about time to surgery, but that is - that decision there is made with a number of factors and at the clinician's prioritisation.
PN1846
Yes, right now the next column is headed "Time to Surgery". What does that mean?---That is the approximate time until a patient will be registered on to the theatre list, so it is a rescheduling of the time according to the clinician's input as to prioritisation.
PN1847
Yes, and some of these, you say two to six weeks, in other words the actual time to wait might vary as much as 300 per cent?---Correct.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1848
Depending on what?---The reason for those is to do with the bans. That is unknown so we feel that we can get them in within two weeks, we could start scheduling some of these patients in or if they continue on, then that could be as far as six weeks so that we are trying to build flexibility in our theatre template, sessions allocation for category 2 patients to meet that demand. So that is why there is a lengthy variability.
PN1849
Yes, and then you've got the comorbidity, that means other conditions, does it?---Other factors that effect a patient's well being that could influence the operation that is occurring, so it could also be the past history or if they are overweight or if they are a smoker, other influential factors that need to be considered in making a judgment call as to the urgency of the operation.
PN1850
Well take the first one, the right total shoulder replacement, one of the comorbidity items is pain. Is that because the patient is experiencing pain with the right shoulder?---Correct.
PN1851
And is the same observation where you have got pain in each of these other items?---Correct.
PN1852
And then in the right hand column, you have clinical risk to patient and your note at the bottom is "Medical input into level of risk"?---Correct.
PN1853
And what do you mean by that?---The admitting consultant would advise the - the staff that set the theatre template as to the clinical risk to the patient at the time of assessing the patient. So we have a score between low and high. Low would mean that there is minimal risk to the patient and high would mean there is significant risk.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1854
Is that something which is a record that you have that you consulted to prepare this form or did you in fact speak to the eight people concerned for these patients between last night and this morning?---Not myself but the nursing staff that - which in this case is the pre-admission nurse unit manager which this is part of her role, she would actually have spoken with each of the clinicians in each case to get a score, so that - not in preparation for this, as general practice though, as normal practice. So all our patients have clinical risk to patient is identified so that we can prioritise our theatre templates.
PN1855
Thank you. Well, I will tender that form, Commissioner.
PN1856
THE COMMISSIONER: Mr Niall?
PN1857
MR NIALL: No objection, Commissioner.
PN1858
PN1859
DR JESSUP: Now, when you were asked questions by Mr Niall, it was in the context of the patients that had been cancelled yesterday, the category 2s and he put it to you that - and I think more or less in these terms, he put it to you that it was normal practice for there to be rescheduling in a way which ensured that the life or health of the patient wasn't compromised and you agreed with that, and he said "And that was true also for the eight cancellations yesterday" and you said "true, but I mean" and you were going on to qualify that and he went on to some other question which is - which he is entitled to do but was there something you wanted to - to add to your comment that it was true for the eight that were cancelled yesterday?---There is only so much time on the theatre template to do the work that is required and so the more cancellations
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
we have obviously all the intention in the world to re-prioritise will be met, but that doesn't mean that patients are still not going to be done later than what would be optimal. So if we are cancelling 10 cases a day and we normally cancel two, then each case after that is compromising when we can get them back on the theatre template. Even though efforts are made to reschedule it, ideally this is an area where we are failing to meet our key performance indicator of 90 days for category 2, we are at 127, that is just going to increase. What I am unable to give, because I don't know how long the bans will be on for, and the number of cancellations that will occur, what that impact will be each time - each day that goes by while we still have the bans on. So what I am trying to say, it is more - it is a game very complex. Simple question, complex answer.
PN1860
Yes, thank you. Now, I want to go on to the capacity management report but, Commissioner, as we said yesterday, we are continuing our search for documents that meet the summonses that were served and as it happens some more documents have just been delivered to the Commission which come from Melbourne Health. They relate to some of the things Mr Niall was cross-examining on, so he should have those documents. Yes, I will have him provided with a copy and we should file them in the Commission. Yes, well we have only got two sets of it at this stage. Might we perhaps be excused from filing it on the basis that we give one copy to Mr Niall and we keep the other for ourselves for the moment? It is in answer to the subpoena, Commissioner, that is why it is more complicated than it would normally be. It is only a matter of timing, I mean we will produce others to the Commission, but I am only asking what we should do with the two that we have in the Commission at the moment?
PN1861
THE COMMISSIONER: It is very clear that Mr Niall needs a copy and I apologise to Mr Langmead not being able to ensure that he is provided with a copy at the same time. You obviously need a copy, Dr Jessup, and I will listen very closely and look forward to my copy.
PN1862
DR JESSUP: Well, there is quite a few of them. It looks to me that they are all capacity management reports. They have been put into sections in the folder, a month for each section, January, February, March, April 2004 and - - -
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1863
THE COMMISSIONER: It is fine. I will look forward to reading them when I receive them, Dr Jessup.
PN1864
DR JESSUP: We won't ask you to read them, Commissioner. We are not tendering them.
PN1865
THE COMMISSIONER: Aren't you?
PN1866
DR JESSUP: No, it is just that because we are under subpoena - - -
PN1867
THE COMMISSIONER: Yes.
PN1868
DR JESSUP: - - - to produce to the Commission these documents, we have a formal obligation to file them, but - or at least to produce them.
PN1869
THE COMMISSIONER: Yes, it is up to Mr Niall.
PN1870
DR JESSUP: But for my part, I wouldn't see the need to tender them. Maybe it would be useful to tender some more recent date than the ones that are already in evidence, but that will only be a few pages.
PN1871
THE COMMISSIONER: I think that decision, Dr Jessup, given that they were documents requested by Mr Niall, the decision about that lies with Mr Niall, I would assume.
PN1872
DR JESSUP: I beg your pardon?
PN1873
THE COMMISSIONER: The decision about whether - - -
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1874
DR JESSUP: Yes.
PN1875
THE COMMISSIONER: - - - he wishes to tender any of that material which he sought on the basis of a summons, is his decision.
PN1876
DR JESSUP: It is. It is, his and ours.
PN1877
THE COMMISSIONER: Yes.
PN1878
DR JESSUP: Yes, that is true. I do that because I was going to - well (a) because they were delivered on to the bar table only a little while ago and (b) because I was going to ask the witness about the capacity management reports and if I might proceed to that, Mr Rathgeber. Have you got the capacity management report there?---Yes, I do.
PN1879
Yes, this is exhibit R6. Now I want to ask you first about the headings in the top panel of the report. The first heading is "Budget" and the total in that list is 348. Does that tell us that there are 348 beds in the hospital all together?---What that informs us is that at the beginning of the financial year 2003/2004, a decision was made by the board of management and hospital executive staff to budget, set a budget for 348 multi day beds and this spread sheet then breaks that down into the number of beds allocated per ward.
PN1880
On the budget?---On the budget in the first column.
PN1881
Does that mean that at any time there were in fact 348 physical beds in those wards. Sorry, not all in those, but as broken down into those wards?---One of the great news stories is that Royal Melbourne Hospital is now, we can say because of the staffing appointments that have occurred, we have been able to open to 345 on average prior to the dispute, and if I take Easter out of the picture. So we have increased our bed capacity closer to the budget requirement.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1882
Yes, now in paragraph 6 of your statement, you have said Royal Melbourne Hospital have 350 multi day beds and 90 day beds. That 350 was an approximate figure representing the 345 you have just given us, was it?---Correct, and what I should say is that 348 is also an average over Monday through to Sunday. We decrease our beds over the weekend. The 350, we have actually - can be 350/351 beds Monday to Friday.
PN1883
All right, now the column headed "Variation" what is that?---The variation means that first of all you have got your budgeted beds, so 348 and the beds that are open or staffed, so have nursing staff, is the next column, and the difference is the variation, it is the difference between those that are open, to those that we have budgeted for, it is the variation.
[11.03am]
PN1884
Now, looking at the last page of this, 22 April 2004?---Yes.
PN1885
The total bed variation was 19?---Correct.
PN1886
And that takes into account a figure, which I found rather startling, of minus 2 in relation to the - - -?---Correct.
PN1887
- - - MAPU?---Yes.
PN1888
Can you explain that?---Yes, I can. Sir, this is Medical Assessment planning unit, it is a combined ward with the Short Stay Observation Unit, so the two - which is just under SOU, and the MAPU combined have a 16 bed number budgeted. What we do or what the nursing staff do is flexible to meet the demand, and so if there is more medical patients require admission over the eight that is allocated they will go there, where in this case they went to 10, so it was in the negative, whereas with the Short Stay Observation Unit there is five, so the total number was 15. So to read that in its correct form you would - 16 budgeted bed, 15 open, one that is closed or unoccupied.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1889
Well now, all of these sheets have little or nothing in the comments column until we get to the last one - I am sorry, the second last one, and the last one which had some entries in the comments column about closed beds. So the first thing I notice is closed beds aren't the same as the variation column?---Correct.
PN1890
And what - are all of the closed beds the beds that are closed due to the ANF industrial action?---The - in the far right hand column where it has "closed" they are due to the bans, industrial bans, whereas the variation reflects a lot of other variabilities in the organisation. So this was our, I suppose, not attempt, this was actually monitoring the true impact of the bans and not falsifying figures that could be - look like we have got beds closed, because we have beds closed for many reasons.
PN1891
Yes, all right. So if we add up what is in the right hand column we get an idea of the beds closed due to the bans?---Correct.
PN1892
And it is obvious to that that there is a lot less than 1 in 4?---A lot less beds closed?
PN1893
Yes?---That is correct, yes.
PN1894
So - - -?---It is unlikely that - sorry?
PN1895
I was going to say, are you working towards 1 in 4 or how does this form eventually get to a case of full implementation of the ANF industrial policy?---I suppose the first thing is, I am not working towards the 1 in 4, and that the ANF members would be working towards closing the 1 in 4 if they could so with no risk to patient care. So what I am - can I just follow that through. It is very unlikely at the Royal Melbourne Hospital that they would truly be able to achieve a 1 in 4 bed closure because of the emergency throughput.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1896
Because your hospital has a very - an uncommonly high percentage of emergency admissions?---Correct.
PN1897
Yes, all right. Now, there is an entry - there is a table on this form which is headed "Day Facility", do you see that - - -?---Yes, I do.
PN1898
- - - about a third of the way down. Tell me what that is please?---This is the same day surgery, so cases that come in for day care. I suppose another way of putting it, they are not the overnight stays, they are not the multi day beds, so the patient will come in in of day of surgery, have a procedure, it may not be surgery, and then are discharged home that day.
PN1899
Now looking through this form I find there is a pattern which reflects the Monday to Friday working week in this part of the table - - -?---Correct.
PN1900
- - - is that right?---Correct. It would decrease to zero cases being done over the weekend.
PN1901
Yes. Okay. Now, if you look at the second last page on 21 April, you had a capacity of 42 in that day facility and 42 occupied?---That is correct.
PN1902
So do we understand from that that the day facility was full up on that day?---That is how I would read it, yes.
PN1903
If we turn to the next day 22 April, the capacity of 42 and zero occupied. How has that come about?---It hasn't been filled in I would say.
PN1904
It hasn't been filled in?---I would suggest it hasn't been filled in.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1905
All right. And why wouldn't it have been filled in? Have you got any explanation for that?---I need to talk to some staff about that, I would - - -
PN1906
Is it part of the bans?---No, definitely not, this area would be unaffected - sorry. There would be minimal affect in this area as a result of the bans.
PN1907
No, what I meant was, is the filling in of the form a duty which is subject to the bans?---They have prioritised the form because we are putting more information in, yes. And we have also - this was done once a shift; we have been exercising it more frequently to give us a picture, because it is only a snap picture of a point in time and we needed a more - we are collecting a lot more information now as part of the bans, it is ongoing.
PN1908
But can you tell the Commission, from your own knowledge of the fact, what are the - what impact the bans are having on the day care facility?---There has been some impact, Commissioner, but it would not be zero. There would be, for instance, the 2 East is a cardiology area, there has been minimal impact in that area. I wouldn't have the exact numbers of cases that have been done but there would be minimal impact. Some other areas could be more significant but I would have to - I don't have the data to actually report on that now.
PN1909
All right. Now the next part of the form I want to ask you about is elective access. You have explained to us what the EHOLD and everything means in the emergency access, but with regard to the elective access you have two boxes there, you have an am report and a pm report, do you not?---Yes, I do.
PN1910
And if we go to earlier pages in the form we see - I am sorry, before we do that, can you just tell the Commission what the entries are that are hard to read through the black, the first entry under the am report?---Okay, it is elective breakdown for a business day, so it is Monday through to Friday, and the first entry in the highlighted area is, it says "M Day" that stands for multi day designated surgery. And we are really getting into detail here. The designated surgery is that a given ward, to meet the elective workload, we have chosen a
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
number of strategies. One strategy is to designate a number of beds, a number of cases to that ward. So when we have multi day designated surgery that is what that reflects, the number of designated procedures or cases for surgery. And then we have multi day general surgery, that is the next row, the following row is multi day designated medical and then multi day medical, and then elective total.
PN1911
Yes. And then under the pm report?---The pm report here is again trying to reflect retrospectively what has been happening in the organisation, so it has failed day cases and that is on the current day how many cases failed, which - a failed day case might mean that they have stayed overnight, so that the procedure may be complicated or maybe the patient is not as well as would have hoped for and they have stayed overnight. And there is also direct admits current day, is the next, and that is saying that direct admits into having elective procedures. So they have had the procedure that day and they have had a direct admit, and that might be through outpatients or through the emergency.
PN1912
Elective total, so what is that the total of?---That should be the total of elective procedures that have occurred that day; in this case pm.
PN1913
So it is the - is it the total of the elective total under the am report plus the two items under the pm report?---That is how I read that document, yes. So it should - 23 plus the 1 and 4, 28.
PN1914
Thank you. Now just tell me again, what was the nature of the crush injury please, that is on the trolley?---It is a T5 and - - -
PN1915
Yes. I don't know what T5 means?---It is a thoracic level, thoracic region, and it is the fifth level, it is a vertebral - - -
PN1916
So it is a spinal issue, is it?---Spinal injury, yes. I can only give you the detail that I received, which is very minimal, and that it was a crushing injury, and that the patient was stable, medically stable, and had been within the emergency department as of yesterday and was on a trolley in the emergency department.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1917
But by that you understand that it was an injury of a traumatic kind by some external force which imposed some crushing effect on the spine?---Correct.
PN1918
Yes, thank you. Now you were asked as to whether it is possible for category 3 surgical slots, as it were, to be surrendered so that category 2 patients might otherwise miss out, can have their day in the theatre. Do you remember being asked that?---Yes, I do.
PN1919
Yes. Has that, in fact, been done at all since the bans commenced?---No, because all category 3 has been cancelled.
PN1920
Thank you. Now, Commissioner, that is all I have in re-examination, but there are two things. It would be useful to tender capacity management reports subsequent to the most recent one that you have in the existing bundle. Maybe my learned friend, Mr Niall, would consent to them being added to the tender or whatever. And the second thing is we would ask for a short break, which I think will be very short, just to have a word to the witness. Our instructions are, without having spoken to him at all, of course, since his examination-in-chief was finished, our instructions are that there might be some further evidence which he could give which would be useful to the Commission, but I need to speak to him about that.
PN1921
THE COMMISSIONER: Thank you, Dr Jessup. I will ask Mr Niall and Mr Langmead what they think.
PN1922
DR NIALL: We have no difficulty with my learned friend speaking to the witness. In relation to the capacity management report, while the matter is stood down I might just have a look through them to see whether there are any additional matters, any additional pages we wish to tender. I wish to, with the Commission's leave, ask two brief questions, and it might be convenient to do that now before my learned friend, just to clarify two matters, if that is convenient.
**** DANIEL PATRICK RATHGEBER RXN DR JESSUP
PN1923
THE COMMISSIONER: Did they relate to exhibit A6 because I was actually going to ask you and Mr Langmead whether you wish the opportunity, given you hadn't seen that document until two seconds ago.
PN1924
DR NIALL: Yes. I did want to ask just a couple of brief questions about A6 and a couple of brief questions about the capacity management report, only half a dozen questions in total. It might be convenient if I do that now, then my learned friend can speak to the witness to ask any questions about any further evidence-in-chief he wishes to call, if that is convenient to my learned friend.
PN1925
DR JESSUP: Yes, yes, indeed.
PN1926
PN1927
MR NIALL: Mr Rathgeber, have you got a six which is the category two patients cancelled on the 26th? The document that you prepared this morning, or overnight depending on one's - - -?---I have the 27th.
PN1928
THE COMMISSIONER: No, we do - 26th?---Sorry, yes I do.
PN1929
MR NIALL: The table that you prepared?---Yes, I do.
PN1930
I wanted just to clarify your evidence in relation to "clinical risked patient", that is something that is - I think your evidence was, was that is regularly done; it is not something that is done for this proceeding?---That is right, it is part of the normal process.
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1931
Yes, are you assessing risk of the procedure?---No, not totally.
PN1932
Is that one of the factors in the risk?---Correct.
PN1933
So that if, for example, I assume the right - the patient with a right total shoulder replacement, doesn't look terribly well when one looks at the co-morbidities, and therefore I would imagine would be at higher risk of serious adverse consequence of the surgery?---Yes, I have to admit when I saw this I thought the same; that the risk was the surgery, not the risk of not having the surgery. Does that - - -
PN1934
And is that the - is that what moderate to high measures - the risk of having the surgery?---No, my understanding of that column is that the clinical risk to the patient to not have the surgery. But I do admit in seeing that first one, that first case with the right total to shoulder, it doesn't make a lot of sense, because why did they put this case at six to months reschedule, and give it a moderate to a high? I think that is where - - -
PN1935
Yes?---And I cannot answer that other than saying, I think in this case, there is high - enormous amount of co-morbidity, the past history is significant, there is a high risk to the patient but I think the patient's well-being is obviously of a concern here, not the fact that they are not having a total shoulder replacement.
PN1936
Yes, so you have got moderate to high risk that, as best you understand it, would measure a whole range of risks; risks of having the surgery, risks of not having the surgery, risks of delaying the surgery?---Correct.
PN1937
And moderate to high would have been an accurate, perhaps unduly optimistic, prescription of risk last week before the bans were in place and will remain that, both probably before and after surgery?---Yes, it is very difficult with one table to make that judgment but yes, I agree.
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1938
And the vascular moderate to high, again it is not at all what risk is being measured there, is it, because the time to surgery is now two to three months, so if it was a high risk of delay, one would have thought that it would have been put in before three months time. Do you agree with that?---Can I not agree?
PN1939
You can- - -?---Because I think this is an interesting case. This relates to the vascular sessions being cancelled at Melbourne Health and this is a vascular patient having a fem popliteal bypass but has a history of a stroke myocardial infarction, subarehnoid hemorrhage. When we give a moderate to high, this is saying there is a moderate to high risk of an occlusion. So this would - - -
PN1940
THE COMMISSIONER: Of what, sorry?---Of the femoral artery, because the patient has already got a history of occlusion of other arteries; heart, brain, so the femoral artery could be involved. So there is a - I think this has been applied correctly; moderate, high risk. Why the two to three months, not two to three weeks would be the question that I would ask and that is because getting vascular time. Yesterday I couldn't answer the question, "If a patient is cancelled off the - from a category two off the theatre template, how long until they get back on?"; this is an example of where decisions that - or that are made in cancellation are not done lightly because it could be the theatre session, which is numerous issues could become involved with that, of trying to get them back onto the case. And I would say that this reflects that.
PN1941
MR NIALL: Although, the patient only went on the list on 2 March '04 and that has had two hospital initiated postponements?---Correct.
PN1942
So, it could get to the - the patient could get to the starting gate twice in a month?---And be cancelled.
PN1943
Yes?---What I would like to know of this patient is are they in hospital? Purely to see whether they are unstable. I am just going with their history, I don't have enough detail. You would really need their history, to be honest, to answer this question in detail.
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1944
You have got; in the orthopaedic in five with the right knee arthoscopy- - -?---Yes.
PN1945
The patient is a current in-patient; that is not recorded for the vascular occlusion case in three. So the position is it is very difficult to tell what affect, if any, the delay is having, and why it is a two to three month proposal rather than shorter. You have given one suggested answer - given he has two - he or she has had two opportunities to get to the theatre within six weeks; the two to three months does seem rather long, wouldn't you agree?---I do agree, but it relates to the session, the vascular session, that we have a lot of - cancellations occur because we don't have enough sessions - time allocated for the vascular cases that go through.
PN1946
But if the patient became urgent, or the treating people regarded it as an emergency, there would be no problem in fitting that patient in?---There is a fair bit of negotiation that has to go between surgeon and surgeon and that is not easy.
PN1947
But - - -?---No mate, sorry, neuro surgeon and a cardiac surgeon and a vascular surgeon will certainly debate and discuss the priority of patients to get theatre time. And if they have already had an agreement on a theatre template, they are unlikely to give up their theatre time.
PN1948
But it does happen for an emergency? And there are emergency theatres that are designated for it?---But emergency in this case would be that the patient now has got an occlusion that has extended from, say, an 80 per cent to a 95 per cent and has to be done urgently or else they will lose their leg. And so in that case that - yes, they would get a priority then. But that is making a case out of the category system and put him into an emergency case.
PN1949
All right. I wanted to ask you just some quick questions about capacity management report, and I am looking at the one for 27 April at 6 am, do you have that? The Commission won't have it.
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1950
THE COMMISSIONER: No?---Yes, I do, yes.
PN1951
MR NIALL: Did the Commission - - -
PN1952
THE COMMISSIONER: It is all right, I will listen very closely.
PN1953
MR NIALL: That sets out the number of closures as a result of industrial action in the last column, correct?---Correct, that is right. Yes, it is.
PN1954
Now, my learned friend Dr Jessup, asked you that it is not at one in four, in fact, I counted 41, but the comment down the bottom says "42 beds". So, 42 out of 348 is about one in - my maths is being sorely tested in this case, Commissioner, but it is about one in - - -
PN1955
DR JESSUP: Now, where are you looking at?
PN1956
MR NIALL: 27 April. Not in the - in the recently admitted documents answering the subpoena. Now, I just wanted to ask you; there are some gaps - it was suggested that you are not at one in four at the moment?---Correct.
PN1957
And you are about 42 out of 348, which is one in- - -?---8.5.
PN1958
8.5?---Yes.
PN1959
Thank you. You will never to get to one in four at the Royal Melbourne, will you?---No.
PN1960
Even if the bans were in force?---It is not the - to my understanding, it is not the intention of the - - -
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1961
No, but putting aside intention for the moment- - -?---Yes.
PN1962
The bans - even if you implemented the bans to the letter, you could not get to one in four of beds open, could you?---Closed.
PN1963
Closed - no, beds - one in four of beds open. Even - - -
PN1964
THE COMMISSIONER: Sorry?
PN1965
MR NIALL: If the Commission goes to the document that the Commission does have, which is exhibit R6. Go to 22 April 2004, at 10.15. Do you have that, Mr Rathgeber?---Yes, I do.
PN1966
You will see that there are a number of beds closed in a number of wards, agreed?---Correct.
PN1967
And there are no beds in ICU?---Correct.
PN1968
Well, the bans don't allow for closure of beds in ICU, do they?---Correct.
PN1969
So, and CCU, that is similar?---Correct, they are exempt.
PN1970
Wards 5N and 5E are oncology, I think you said?---Yes, they are exempt.
PN1971
They are exempt. So that takes out another 28 beds?---Correct.
PN1972
So you have already taken out 32 - about 60 beds?---Correct.
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1973
Of the 348 which are exempt?---Correct.
PN1974
In addition 3SW is a trauma ward?---That is right.
PN1975
They are exempt?---No, they are not exempt.
PN1976
Are they treating themselves as exempt, or - - -?---No, they are not.
PN1977
Okay. But there are no closures at 27 April?---Correct.
PN1978
Okay, and so even with taking those 60 beds out, it could only be one in four of the remaining 290?---Correct. So we would achieve a one in seven.
PN1979
If they were applied to the letter?---Correct.
PN1980
But your present experience is that it hasn't been applied to the letter, it has been about one in eight and a half?---I actually included, well - because you - I think you were the one that came to one in eight and a half, I just did the calculations. Because at 348, you had included them, now you are taking them out to 290, 280 beds.
PN1981
Yes?---Which mean that the best - the scenario at the moment is a one in seven bed closure of our multi-day beds.
PN1982
And that is about as much as it will go at the Royal Melbourne with the exemptions?---With the exemptions and with the relationship that we are very keen to continue with the nursing staff management that we believe that commonsense will come through, and patients will be admitted through to the wards that are urgent.
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1983
It won't get more than one in seven closed? That is your expectation?---Well, we would hope not because of the emergency throughput and then patient care could be compromised then.
PN1984
And that is consistent both with your present experience over the last few days?---Except for the weekend as I - - -
PN1985
Yes, I think your evidence is that it is back on track?---My evidence wasn't so much evidence. I was hoping we would get it back on track and there has been some movement. Patients are being admitted through the emergency department. I am concerned that the - as the bans keep going on, obviously the patient build-up in the emergency department will keep increasing. What we haven't put into the equation is the flow on of transferring and discharging patients through the sub acute area which is starting to have an affect at Melbourne Health. That is only - it was zero beds on Friday - sorry correction, it was one bed on Friday, it is now eight beds today. That will eventually have an impact where we won't be able to flow the patients through to the sub acute area.
PN1986
But it is consistent, that is, the current rates of closure and the capacity of the hospital to cope is consistent with your expectation, and it is also consistent with the nurse's bans in terms, where it says "no emergency patient will miss out on a bed", do you agree with that?---Agree that is what written. That is the interpretation that I have questioned.
PN1987
They are the only questions I have at the moment, Commissioner. I will look at these documents while my learned seeks some instructions from the witness if that is convenient. And I will let the Commission know about which documents we wish to tender.
PN1988
THE COMMISSIONER: Thank you.
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1989
DR JESSUP: And I have decided that I don't need a break after all, Commissioner, as a result of something I have been told. So, the only other thing is whether someone should tender the capacity management report subsequent to 22 April.
PN1990
MR NIALL: Our - sorry.
PN1991
DR JESSUP: In fact there is, in the folder that we have given to Mr Niall, there is even other reports on 22 April. The one you have got is 10.15, in the subpoenaed documents there is one for 2.30 in the afternoon and another one for 9.30 in the evening and so forth. So, if Mr Niall wants to tender those, he can do that, otherwise we will tender them ourselves.
PN1992
MR NIALL: I would seek to tender the - all of the management reports for the period January 2004 to April 2004.
[11.32am]
PN1993
THE COMMISSIONER: I assume there is no objection, Dr Jessup?
PN1994
PN1995
MR NIALL: I am not in a position to provide a copy to the Commission.
PN1996
THE COMMISSIONER: That is all right. I am sure Dr Jessup will as soon as he is able.
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN1997
MR NIALL: If the Commission pleases.
PN1998
THE COMMISSIONER: Dr Jessup, I think I am in a position to release Mr Rathgeber, or have you not finished, and also - - -
PN1999
MR LANGMEAD: Commissioner, I haven't seen the document which has just been tendered by my learned friend, Mr Niall. I have had a quick opportunity of asking some questions of the witness about them. I don't know whether I would have any questions of the witness. Whether we do take a very short break so I can have a look at them and make a decision then or alternatively the witness could be subject to recall. I suspect the former course is probably more desirable.
PN2000
THE COMMISSIONER: I suspect so. I will just check with Dr Jessup. Thank you, Mr Langmead. A short adjournment, Dr Jessup, rather than recalling Mr Rathgeber at a later date?
PN2001
DR JESSUP: Yes, Commissioner, that might be the best way of doing it.
PN2002
THE COMMISSIONER: Thank you, Dr Jessup. Mr Langmead, how long do you think you might need the adjournment for?
PN2003
MR LANGMEAD: Five to ten minutes, Commissioner.
PN2004
THE COMMISSIONER: May I suggest closer to 10. It is just that if we - it is a nice sort of even time if we adjourn until 11.45.
SHORT ADJOURNMENT [11.34am]
RESUMED [11.47am]
**** DANIEL PATRICK RATHGEBER FXXN MR NIALL
PN2005
THE COMMISSIONER: Mr Langmead.
PN2006
PN2007
MR LANGMEAD: Mr Rathgeber, can I ask you to look at R7, the capacity management reports, and if I can first ask you to look at the one for 23 April at 2130 hours. Do you have that?---No, I have 22 April.
PN2008
Do you not have - - -?---No, I don't.
PN2009
I see.
PN2010
THE COMMISSIONER: I don't either, Mr Langmead, so I am sorry, I can't help.
PN2011
DR JESSUP: The other copy is now being copied so we can all have other copies.
PN2012
THE COMMISSIONER: So there is only one copy here in this courtroom?
PN2013
MR LANGMEAD: There appears to be only one copy in the Commission at the moment, Commissioner, and it is Mr Niall's copy which he kindly lent me. There is only - - -
PN2014
THE COMMISSIONER: How many pages are you going to be referring the witness to, Mr Langmead?
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2015
MR LANGMEAD: Yes, I was just looking at that, Commissioner. I think there are about 10 of them, Commissioner, of which - although perhaps I will rephrase it. There are four in particular that I know that I want to ask questions about. There are 10, it appears, that supplement the ones we have already seen. If we are able to have those - - -
PN2016
THE COMMISSIONER: I was about to say would it assist - - -
PN2017
MR LANGMEAD: Copied, yes.
PN2018
THE COMMISSIONER: - - - if my associate photocopied those 10?
PN2019
MR LANGMEAD: Yes. Commissioner, while we are waiting for those documents I wonder if I might have leave to ask a question in relation to the T5 patient who is waiting on a trolley. It arises from the further questions Dr Jessup asked, although I don't know that I can probably justify them as new evidence, but I do seek leave to ask a question anyway.
PN2020
DR JESSUP: No objection, Commissioner.
PN2021
THE COMMISSIONER: Thank you, Dr Jessup. Mr Langmead.
PN2022
MR LANGMEAD: Mr Rathgeber with the T5 patient waiting on the trolley it is a - I think your evidence is that it is a matter of comfort to that patient, being that a trolley is less comfortable than a bed. It would be possible to bring a bed down to emergency, wouldn't it?---No, it is not possible because they - in the emergency department it is - it can cater for 37 bays and 37 trolleys; it wouldn't be able to cater for an orthopaedic bed.
PN2023
When you say an orthopaedic bed you are distinguishing between a - is that some special sort of bed?---Not necessarily; the size and the height will be exactly the same but the attachments that can be put on an orthopaedic bed may vary, but a hospital bed would not be appropriate in an emergency department.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2024
And why is that?---Because of the space that they take up. So that it would be - you could have hospital beds but you might decrease the capacity by 30 per cent in an emergency department compared to a trolley.
PN2025
Would you be able to fit one in a bay or not?---It would be unsafe because you wouldn't be able to work around the patient if the patient had an emergency situation.
PN2026
THE COMMISSIONER: Mr Langmead.
PN2027
MR LANGMEAD: Thank you, Commissioner. Mr Rathgeber, you have those capacity management reports?---Yes, I do.
PN2028
Yes. Do you have the one for 23 April at 2130 hours?---Is that 2.30?
PN2029
No?---2130, yes, I do.
PN2030
9.30 in the evening?---Yes.
PN2031
Yes. You will see in the acute overnight listings the comment about a number of beds being closed; do you see that?---Correct.
PN2032
Yes. There is no reasons provided for the closure of those beds there. Are you able to provide any explanation as to why they are closed?---The variation column which totals 27 - - -
PN2033
Yes?--- - - - that is the difference between the number of beds that are open to the budgeted and the far right hand column in the comments section, those beds that are closed there include industrial - really relate to the bans.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2034
So do they include - - -?---They relate to the bans.
PN2035
They relate to the bans?---Yes, that is right.
PN2036
Not to any other factor?---Correct.
PN2037
Yes. So there are 23 in total on my addition of them?---Can I just add a comment in relation to these reports that is an important, I think, that needs to be made, is that this is a point in time, only a snap picture at 9.30 and I just really want to reiterate that it doesn't reflect the 24 hour period and, therefore, they can move dramatically, the bed situation. If they - by the time you get to read them or analyse them they are inaccurate and they can - they are filled out by bed managers who are managing the whole organisation and so the accuracy of them can be questionable as well.
PN2038
I see. Now, in the 5 East ward, which is one of the oncology wards; is that right?---That is right.
PN2039
Yes. You have a variation of minus 1?---Correct.
PN2040
What is the explanation for that?---The - to meet the oncology through put there has been a need to go over the budgeted number of beds and because we are able to provide staff and to maintain patient care we did so.
PN2041
Yes?---Because oncology are exempt as part of the bans.
PN2042
Yes. Okay. Now further down the capacity management report for that day at that time there is a section called elective access?---Yes.
[12.01pm]
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2043
And there is an am report, elective breakdown for business day, and the first item is M Day designated surgery and a figure of 6. M Day general surgery 5, M Day designated medical 2, M Day medical 0. With an elective total of 13?---Correct.
PN2044
Now that reflects the historical experience of that morning does it?---The 23rd?
PN2045
Yes?---That would be retrospective for that day. Correct.
PN2046
Right. So that is what actually happened that morning?---Correct.
PN2047
Yes. And in the next column or the next - the right hand side of the page there is a CXLs. That is cancellations is it?---I believe so. Yes.
PN2048
Yes. And details appear to be the explanations?---Yes.
PN2049
Yes. And so there is two cancellations in - what is "card" short for?---It is cardiology.
PN2050
Cardiology, yes. Two cancellations because of equipment failure?---Correct.
PN2051
Yes. And then you have got a number of other codes and in each instance it is recorded as being cancelled because of industrial action?---Correct.
PN2052
We say it has been cancelled because of industrial action. Who fills these forms in?---The bed managers.
PN2053
The industrial action has not been cancellation of surgery has it?---I am sorry the cancellation?
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2054
Well, the cancellation of surgery was not something that was an industrial ban in itself? They have not said - the nurses have not said we are not going to do that procedure? Is that right?---Well, they are, in a sense they have cancelled sessions. So the number of sessions, theatre sessions, that have cancelled which has meant that obviously there has been cancellation of surgery. And on top of that there has been a closure of beds and so surgery has been cancelled as a result of the bans.
PN2055
Yes. So if it is cancelled because of a lack of beds that would be recorded as being due to industrial action?---If it is - it would be - no. If there is a lack of beds opened by our permanent staff, not related to the bans, that would not be included in those numbers.
PN2056
No, but if there are beds closed because of the bans and that has led the hospital to cancel elective surgery?---That would reflect as industrial actions closed those beds.
PN2057
Yes. And that would also be the case would it not if the hospital decided to manage its throughput of emergency patients by cancelling elective surgery in order to ensure there were sufficient beds?---Yes. That is right. As a normal process.
PN2058
And it would be, in those circumstances, attributed to industrial action, in this report?---In this report. Yes.
PN2059
Now the pm report below that - there was failed day cases of 0 and direct admits of 5. Could you explain what those entries stand for?---Yes. Okay. As I said earlier the five day case, the failed day cases, is those that require admission overnight. So if a day of procedure or day of surgery and the patient is unstable or just needs a longer period for recovery than they would stay overnight. The - - -
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2060
So these are people who you would have expected to have gone home but you have had to keep them in for some reason?---Correct. Yes.
PN2061
Okay?---The direct admits on the current day. They are patients who come in as direct admits so there the clinician or the consultant has felt that it was necessary to do, because of the urgency of the case, to have them as direct admits into the organisation. So they are not planned admissions. The are direct admits.
PN2062
And they are direct admits for surgical procedures?---That could be surgical or medical procedures. Direct admits.
PN2063
I see. Yes. And that does not break it up though?---No, it does not.
PN2064
So the break up between the am report and the pm report are reporting on different things. Is that right?---That is correct.
PN2065
Yes?---They are trying to - this is a very - we are trying to give a snap picture for retrospective analysis only of a very complex situation and try and put some of the variabilities and account for it. Such as direct admits, such as cancellations. But I have to stress this is a point in time and it is for us as management to actually improve - see where our bottlenecks are, where we can improve the processes. And we can analyse these reports to death but I stress that we don't collect them every day, every minute of every day, so therefore it is not giving you the best case scenario. It is not giving you the worst case scenario. It is only giving you a time, a point of time, in time of what that looked like in the organisation by people that are pretty well rushed trying to improve the flow. So the accuracy can be questionable.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2066
Yes. But to the extent that you have got the am and the pm reports there, providing you are taking of the relevant part, an appropriate part of the day. They do reflect an historical - - - ?---But, again, I have to stress the elective access, the am report and the pm report, comes from a whole unit itself. Pre-admission, clinic, the admitting officers, the emergency flow, co-ordinated by a central person, bed manager, who are trying to manage the demand that is coming through the organisation in elective and emergency and also the staff supply. So it is not their sole duty. In fact it is only to enter this in once per shift. In this case it is the 9.30 report at 9.30. The accuracy depends, I mean, there is many other reports attached to this. We are trying to make one report - give us all the answers and it is not possible.
PN2067
Now if I can ask you to look at the report of 26 April at 6 am? And under the acute overnight box in the right hand column under comment there is a number of closed wards, closed beds. Sorry. Now I take it from your previous comments that they are closed because of industrial action. Is that right?---Correct.
PN2068
Yes. Now what about the two. There is one in 7 West and one in 9 East. One closed (took a surgical point) - patient, sorry, - - - ?---Yes.
PN2069
- - - from OR. What does that mean?---I think this is really indicating that the bed managers are giving myself a bit more information, a bit more detail that even though they have got one bed closed on those two wards they have also taken a surgical patient from an operating room. So they have indicated that an urgent case has been admitted and the same thing in 9 East. It says one bed took a SARS patient. Well, that was a question whether it was a SARS patient. But it is indicating that they are meeting the clinical need and just giving us a little more detail. Still one bed closed but have taken another patient. Are taking admissions.
PN2070
So - and that is under the emergency arrangements is it?---Yes. These patients are - well, definitely the 9 East would have come through the emergency. The 7 West would have come, I do not know the detail, possibly from ED to theatre or to OR to the wards.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2071
7 West is the next surgery in trauma ward. Is that right?---That is correct.
PN2072
Yes. Now if I can ask you to look at the next report for that day, being 26 April at 9.30 in the evening. You have got four beds closed because of VRE. Does that mean two additional to the two closed in 6 East, for example, or is it the two that are closed are because they are closed because of VRE? VRE is an infection is it?---That is right. It is vancomycin resistant.
PN2073
Yes?---Now what the two beds, what they are again, is that we have made it clear to our bed managers to only reflect the beds that are truly closed to the bans and not to include other reasons. And the VRE patients that are reported here are beds that we have had to close because of the risk of cross infection but are excluded from that original two so they are an additional two. It is just reflecting the number.
PN2074
So where you have got a variation in 6 East of four, the explanation for that is that two are closed because of industrial action and two beds are closed because of VRE infection. Is that right?---Correct.
PN2075
Now with the short stay unit, the SOU, - - - ?---Yes.
PN2076
- - - you have variation six of which three is attributable to industrial action?---Correct.
PN2077
What is the reason for the other three? Would you know?---Two of them went to the MAPU so we realigned the beds according to priority of patients again.
PN2078
Yes?---Which is an every day practice. And one is because we actually, due to the staffing and the risk, we budgeted for 16 beds but we have only got 15 physical beds in the actual environment. So that makes up the one and the two.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2079
So no matter which the distribution is there will always only be 15 to be allocated between MAPU and SOU?---Correct.
PN2080
Okay. Now with the am report that day, now this is for yesterday - that is correct is it?---The 26th was yesterday.
PN2081
Yes?---I believe so.
PN2082
Now that is the historical experience of that day in the morning is it?---Are we talking about 26 of the 4th, the 9.30?
PN2083
Yes. Then you have got the elective access am report, elective breakdown for business day?---Well, that - this is not obviously - this is reflecting what is happening during bans. It is not a normal report that would come across that would be sent through. Is that what you? Sorry.
PN2084
I am sorry. I am just trying to clarify that what is recorded here is what actually happened yesterday?---Well, again, at 9.30 - - -
PN2085
Subject to the qualifications you said about there might be some inaccuracies?---And subject to the fact that they may not have filled in this information totally. Because if you go across from the am report it does not record there was any cancellations and we know there were cancellations. So - - -
PN2086
It has got two cancellations in my copy Mr Rathgeber?---Have you got the vascular and the neurosurgery?
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2087
Yes?---I think yesterday we recorded 11 cancellations. So it is not - I suppose what I am getting at is that we have other reports that collect the data more accurately for the department and for the organisation on cancellations. This is really very much a snap picture at 9.30 what it looks like. So I do not know how much accuracy you can put into, particularly when you get down into the elective access.
PN2088
Okay. So where it has only recorded two cancellations that is wrong?---That is correct.
PN2089
Yes?---For yesterday that is - that is incorrect.
PN2090
You said there was 11 cancellations yesterday?---Well, I think I reported that we had eight that were category two and three that were category three.
PN2091
I see. Of the ones which took place some of them it appears were clearly elective procedures. Is that right?---The ones that were, sorry, cancelled or the elective surgery that went ahead?
PN2092
The ones that went ahead?---Yes, the ones that went ahead were category one cases.
PN2093
All of them?---Yes.
PN2094
[12.15pm]
PN2095
Okay. Now, in the column - or the box, selective breakdown for the next 24 hours, that is what is booked in, is it?---That is - yes, that is giving an indication of those that are known as of 9.30 for the next 24 hours, the cases that are booked in for the previous day.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2096
THE COMMISSIONER: Previous or the following?---Sorry, sorry, the following day - correction. It is very variable this one because it is not - it is a prediction - it is not allowing for what comes through the doors overnight.
PN2097
MR LANGMEAD: Just to go back to the ones - the elective procedures which were performed. The cancellations are the eight category 2 and the three category 3 procedures - enabled you to proceed with the schedule - category 1 procedures?---Correct.
PN2098
And to ensure that you were able to undertake any emergency procedures that needed to take place?---Correct.
PN2099
Yes. Now, the final report we have is 6 o'clock this morning and that experience reported in the am report - that must relate to the previous day, mustn't it?---So this is the - well, because the - it would have to be, yes, that is correct because it hasn't occurred yet.
PN2100
And there appears to be a discrepancy at 1 in the total and variations within that of - or some considerable variations between that report and the one at 9.30 the night before?---Absolutely because it is just a spreadsheet, it is not a data base and it has collected the information at that time and it has continued on from the 9.30 with no understanding of what is actually happening during the day and those of us that read it understand that totally. Like, I mean we understand that as we go down - earlier in the day it is going to be inaccurate, so 6 o'clock is nearly - all you are really doing at 6 o'clock is getting a very quick look at the number of beds that are open and the numbers of beds that are closed and that is about all you can read within this document.
PN2101
So where does the elective breakdown come from at 6 o'clock in the morning?---The elective breakdown I would imagine is because it is a copy of the spreadsheet from the day before. It is really just - that will change as the day progresses and they report on it.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2102
So the spreadsheet at 9.30 in the evening has changed between then and 6 o'clock the next morning?---No, because - unless we know what has happened - unless there is - the cancellations would have occurred the day before, those that we know of, with the theatre template and - - -
PN2103
Yes, that is why I am puzzled, Mr Rathgeber, that there is quite different patterns of procedures which have taken place, some more marked than others, between 6 o'clock and 9.30 and I am just wondering if you had any explanation for that?---When you say - if we just take the total from the am report, being 24, and the total being 23, is that - - -
PN2104
Yes, I am not so much worried about that, I can understand there might be a discrepancy there, but you will see there is M day, designated surgery, 4 compared with three; 11 compared with 12; 7 compared with 4 and then 2 compared with 4?---Well, if I put it another way. If you get four cases come through on the night shift that require emergency admission then - through theatre, then they would be put on the theatre list and that would change those whole numbers around.
PN2105
They wouldn't be electives, would they?---Well, they would be - not so much elective but they may affect the elective numbers. So it is - you can't take elective and not look at what is happening in the rest of the organisation as well. So overnight it is more likely the emergency flow, plus I just reiterate the accuracy of that, particularly the area that you are zoning in on is questionable. The real issue here is how many cases are we cancelling?
PN2106
So what you are saying really is that what was recorded at 9.30 is probably inaccurate?---Yes, I don't - I couldn't give an answer whether it is accurate or not.
PN2107
And you don't know whether the 6 o'clock is accurate either because there wouldn't have been any elective procedures before - sorry, after 9.30 in the evening, would there?---Well, not totally. We have what we call twilight sessions. That may not be completed by that time.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2108
What time do the twilight sessions end?---Well, sometimes they can go through to 10.30. We have emergency cases that can go through all night. It depends what is happening in the organisation. I mean this report is more important from the top part with the beds that are open and closed, not so much the elective, it is a snap picture only and it can be inaccurate. I know I sound like a broke record, I am going over it; it is just that if we are looking at the cases that are booked to the cases that are cancelled, then those are the figures that we give through the department, not through the - not via this report.
PN2109
Yes. And similarly, the reports on the beds closed has come through the departments too?---Correct.
PN2110
Yes. I suggest to you they would be just as susceptible to inaccuracies?---Well, because the bed managers is responsible for managing the beds the bed numbers are unlikely to be incorrect. There may be some errors because they don't necessarily use this report to make decisions, but they record the decisions that they are making and send that on. So that is in their control - as opposed to the elective and emergency lists there is committees, there is a number of people that are involved to making those decisions, not the bed managers.
PN2111
And who makes the reports - these reports?---These reports are from the bed management with input from a number of different sources.
PN2112
Yes. Presumably the bed managers know whether the surgery took place, wouldn't they?---Well, they would know the numbers that are going through, correct.
PN2113
Yes. Thank you, Commissioner.
PN2114
THE COMMISSIONER: Thank you, Mr Langmead. Dr Jessup.
**** DANIEL PATRICK RATHGEBER FXXN MR LANGMEAD
PN2115
PN2116
DR JESSUP: Do you have, Mr Rathgeber, the capacity management report for the 27th at 6 am?---Yes, I do.
PN2117
And for the 26th at 9.30 pm?---Yes, I do.
PN2118
Yes. Just have a look at the bottom table for the 26th at 9.30 am, elective breakdown for the next 24 hours; do you see that?---Sorry, this is - my apologies, that is 9.30 pm - - -
PN2119
9.30 pm on the 26th, bottom right hand - bottom left hand table, elective breakdown for the next 24 hours. I want you to look at that box there. Have you got that in front of you?---Yes, I do. I don't have 26, sorry, so I must be looking in the wrong spot.
PN2120
THE COMMISSIONER: I have got 23?---I have 23.
PN2121
DR JESSUP: The 26th of 2130 hours?---Yes.
PN2122
Right.
PN2123
THE COMMISSIONER: Yes?---And I have 23.
PN2124
Yes. So does Dr Jessup.
**** DANIEL PATRICK RATHGEBER FRXN DR JESSUP
PN2125
DR JESSUP: Yes, exactly. Now, I want you to look also at the 27th at 6 am, elective access am report?---It says 23.
PN2126
Can you see any similarity between the totals and also the breakdowns between those two tables?---Yes, I do.
PN2127
They are the same, aren't they?---They are identical.
PN2128
Yes. Yes, that is all I have, thank you, Commissioner.
PN2129
PN2130
DR JESSUP: Commissioner, before we call the next witness we wish to tender an updated schedule of beds closed due to industrial action, which is - it is the ongoing report made from the hospitals in the various areas and regions to the Department.
PN2131
THE COMMISSIONER: Do we know its source, Dr Jessup? Who compiled the document that you are about to tender?
PN2132
DR JESSUP: It is the result of the regular reports from the hospitals to the Department. It is the Department's information as to three things: the first page, beds closed due to action; the second page, elective cases cancelled on a cumulative basis and the third page, emergency departments, patients waiting for more than 12 hours. You see it is in a similar format to a previous form which has been prepared, although the previous form I don't know had this much detail in, but it is keeping the Commission informed as to the progress of the dispute. I think we are in a position now to call Dr Allen.
PN2133
THE COMMISSIONER: Well, could we wait a moment, please, Dr Jessup?
PN2134
DR JESSUP: Yes.
PN2135
THE COMMISSIONER: Mr Niall, is there any objection?
PN2136
MR NIALL: No, but could we put it in the same category as the first one, which would be to mark it for identification, but we are grateful to our learned friends to keep us aware of what they say is the current closures, but, no doubt, Mr Solomon can prove it when he comes and gives evidence this afternoon.
PN2137
THE COMMISSIONER: Mr Langmead.
PN2138
MR LANGMEAD: Yes, I have got no objection to that course.
PN2139
DR JESSUP: I don't have any objection, but, in fact, it has - identified is one thing it hasn't been. Something is marked for identification normally when a witness says well, identified as something, but it is not necessarily evidence. This document is a piece of information which we tender. It may turn out to be right, it may turn out to be wrong and my learned friend hasn't foreclosed any of his options, but we certainly don't want to be in a position of closing our case and having the ANF say well, you didn't prove these figures. This is normal Commission practice. So what we would submit is that it should be received as an exhibit and in the - if the ANF in their case show that these figures are wrong, well, they are, of course, welcome to do so because that is part of their case.
PN2140
THE COMMISSIONER: We did mark the first incarnation of this document as exhibit A1 and it was marked for identification.
PN2141
DR JESSUP: Yes. Yes, I recall that.
PN2142
THE COMMISSIONER: That was the first one.
PN2143
DR JESSUP: I recall that.
PN2144
THE COMMISSIONER: Yes. I like to be consistent.
PN2145
DR JESSUP: Well, I don't want to follow the same - in our submission you shouldn't follow the same course this time for the reasons I have explained.
PN2146
THE COMMISSIONER: Dr Jessup, I have no difficulty with it being provisionally part of the evidence, however you want to characterise that.
PN2147
DR JESSUP: Yes.
PN2148
THE COMMISSIONER: It has - with great respect to you it has been tendered from the bar table - - -
PN2149
DR JESSUP: Yes.
PN2150
THE COMMISSIONER: - - - with assertions as to its veracity.
PN2151
DR JESSUP: Yes.
PN2152
THE COMMISSIONER: I, during the course of this matter - and I would like to record that as being in that situation rather than any of the other documentation which has come through a witness or has been verified, and that has been verified by one, and it is with no disrespect to you, but to me these two documents at this point in time are in a different category to the other material that has been tendered. So whether you describe it as marked for identification or in a different manner, I don't mind.
PN2153
DR JESSUP: Yes.
PN2154
THE COMMISSIONER: But I am with Mr Niall with respect to the provisional nature of it at this point in time.
PN2155
DR JESSUP: Yes, I accept that.
PN2156
THE COMMISSIONER: Okay.
PN2157
DR JESSUP: I accept that. I just don't want it to be treated as having only been identified; certainly provisionally tendered but one thing it hasn't been is identified because it doesn't have any independent existence other than us attempting to tell the Commission what the position is.
PN2158
THE COMMISSIONER: Is there a better phrase?
PN2159
DR JESSUP: Just accept it - mark it A, whatever it is.
PN2160
THE COMMISSIONER: A7.
PN2161
DR JESSUP: But provisionally.
PN2162
THE COMMISSIONER: Mr Niall.
PN2163
MR NIALL: That course is not objected to.
PN2164
PN2165
THE COMMISSIONER: Now?
PN2166
DR JESSUP: Now, there is some further material that we need to hand to the Commission which has been produced on summons by Northern Health. We have given our learned friend a set of these documents but we haven't yet filed them with the Commission and we will do that now.
PN2167
THE COMMISSIONER: Have both Mr Niall and Mr Langmead a copy of this?
PN2168
DR JESSUP: On the subject of Mr Langmead - - -
PN2169
THE COMMISSIONER: Yes, Dr Jessup.
PN2170
DR JESSUP: Commissioner, initially we didn't feel that it would be much of an issue, but Mr Langmead is occupying a considerable amount of the Commission's time and the question is whether he is entitled to do that. Now, his client hasn't got a bargaining period that is initiated and his client is not taking industrial action. So we don't have a case against the HSUA under subsection (3).
PN2171
THE COMMISSIONER: But aren't you - don't - doesn't the HSU have an interest by virtue of the fact that they are one of the negotiating parties contained in the employer bargaining period notices?
PN2172
DR JESSUP: Yes, exactly, and that arises under subsection (7). So I am only - I didn't want to interrupt Mr Rathgeber, but it was during Mr Rathgeber's evidence that the fallacy of my learned friend cross-examining on the industrial action became apparent to me and we wish to just say this now to the Commission so that it won't come as a surprise next time, and Mr Langmead can think of a response to it if there is one, but I think we are not going to be Mr Nice Guy about this any more because we do want to keep these proceedings moving and our position will be that the HSUA doesn't have a legitimate interest in cross-examining on the industrial action.
[12.30pm]
PN2173
THE COMMISSIONER: By virtue of your submission that it is your application pursuant to 170MW(7) - - -
PN2174
DR JESSUP: Yes.
PN2175
THE COMMISSIONER: - - - and not MW(3) - - -
PN2176
DR JESSUP: Yes.
PN2177
THE COMMISSIONER: - - - that is focussed on the HSU.
PN2178
DR JESSUP: Yes.
PN2179
THE COMMISSIONER: Thank you for warning both the Commission and Mr Langmead. I shall assume that at the appropriate time you may object and I assume at the appropriate time - - -
PN2180
DR JESSUP: Well it would have been inappropriate to try and have the argument in mid stream with Mr Rathgeber but it just seemed a suitable time to mention it. Now - - -
PN2181
THE COMMISSIONER: Okay, now, Dr Jessup, who were you planning on calling next given that you have a random attitude to your list?
PN2182
DR JESSUP: Yes, the duly awaited Dr Allen who should have been the previous one as you pointed out yesterday, but now he is the next one.
PN2183
THE COMMISSIONER: All right, would it be a suitable time to actually adjourn for the luncheon break or did you want to do your examination-in-chief and then we do that? It is just it is 25 to 1 and - - -
PN2184
DR JESSUP: Yes, well we can rise now. Perhaps if your practice is to take an hour, we can follow that practice unless there is any particular objection to that by my learned friends.
PN2185
THE COMMISSIONER: Don't know, Dr Jessup, I am sure he will let us know.
PN2186
MR NIALL: No, we have no objection to the Commission taking its customary hour for lunch.
PN2187
THE COMMISSIONER: I was actually going to round it up, Dr Jessup, if that is all right because by the time we finish deciding what we are going to do, I figure that if we return at 1.45 that would be fair enough.
PN2188
DR JESSUP: Yes, thank you, Commissioner.
PN2189
THE COMMISSIONER: Thank you, Dr Jessup.
LUNCHEON ADJOURNMENT [12.33pm]
RESUMED [1.47pm]
PN2190
MR NIALL: If the Commission pleases, just before my learned friend calls Dr Allen, can I seek leave to file in the Commission a statement of Robert Burrows who we propose to call at the appropriate time. I have provided copies to my learned friends.
PN2191
THE COMMISSIONER: And also that reminds me, Dr Jessup, I think you handed up the documents Palliative Care Unit, Broadmeadows Health Service. Was that yourself or Mr Niall?
PN2192
DR JESSUP: No, we provided them as we are bound to under the summons, but we have no particular wish to tender them.
PN2193
THE COMMISSIONER: Fine, thank you. I just wanted to clarify the status in case I needed to do something with that document.
PN2194
DR JESSUP: Yes, I understand that, Commissioner.
PN2195
THE COMMISSIONER: I couldn't recall, thank you.
PN2196
PN2197
DR JESSUP: Is your full name Peter Sydney Allen?---That is correct.
PN2198
And are you the Chief Medical Officer at Southern Health?---I am.
PN2199
Have you prepared a statement as to the basis of your evidence in this case?---Yes, I have.
PN2200
And do you have a copy of that statement with you?---Yes, I do.
PN2201
I understand you are in a position to update the statement in a number of respects?---Yes, I am.
PN2202
Well before we get to that, is there anything in the statement that you want to change or amend in any way?---There was just a - a minor change in point number 45 where the - - -
PN2203
Well, before I ask - before I ask you to do that - - -?---Sorry.
PN2204
- - - could the Commission - if I can give you the official copy of your statement, you are about to be given it now, Dr Allen, and I will ask you to make the change on that copy in your hand please and tell us what you are doing at the same time. Paragraph 45?---Paragraph 45, I am changing the waiting list for elective surgery for Southern Health from 8904 to 7900.
PN2205
Thank you. Are there any further changes?---No.
PN2206
All right, so subject to that change, is the statement true and correct?---It is.
**** PETER SYDNEY ALLEN XN DR JESSUP
PN2207
All right, would you turn to the last page on the official copy, please, you made that statement on 23 April. Would you just change that to today's date the 27th. No, I am sorry, the last page of the statement part, not the exhibit note. There should be - - -?---27th?
PN2208
Yes, the last page of the actual body of the statement and sign it please, Dr Allen. Thank you and hand that back to the Commission and I seek to tender that, Commissioner.
PN2209
THE COMMISSIONER: Mr Niall or Mr Langmead, any objections?
PN2210
MR NIALL: No, Commissioner.
PN2211
MR LANGMEAD: No, Commissioner.
PN2212
PN2213
DR JESSUP: Now, would you turn please to page - well not to page, but to paragraph 73 of your statement?---Yes.
PN2214
This shows the number of beds closed on 21, 22 and 23 April. Do you have any more recent figures than that?---Yes, I have figures for 24, 25, 26, 27 April.
PN2215
And do you have them in some printed form or is it - - -?---Yes, I do.
**** PETER SYDNEY ALLEN XN DR JESSUP
PN2216
Can you just show me what it looks like, please? How many copies of that do you have?---Only this one.
PN2217
Excellent.
PN2218
THE COMMISSIONER: I knew that was going to be the answer, Dr Jessup.
PN2219
DR JESSUP: Well perhaps it might be easier if you just read the total numbers for each of the subsequent dates starting with the 24th as shown on your table and then you can hand the document to the Commissioner?---24th 82, 25th 95, 26th 89, 27th 78.
PN2220
Thank you. Now would you hand that to the Commission, please. Could we have copies of that made please, Commissioner.
PN2221
THE COMMISSIONER: Certainly.
PN2222
DR JESSUP: And subject to those copies, I would then tender that also. Now turning next to paragraph 74, you have cancelled surgery on 21, 22 and 23 April. Do you have figures for subsequent days to that?---No, I don't have figures for subsequent days, but I do have a list of the total number of cancellations over the period 21, 22, 23, 24, 25, 26 and 27.
PN2223
Thank you, and what does that list look like? I think we have copies of that, you will be pleased to hear, Commissioner. I will get my instructing solicitor to approach the Commission with a copy of that. Now you have just presented a table which isn't headed, but it has a number of columns and conveys a range of information. Would you tell the Commission what this document does, please, Dr Allen?---This is a list of the total cancellations over the period, we are talking about 21 to 27 inclusive, of 41 patients. The first column is the categorisation of the patient using the category 1, category 2, category 3
**** PETER SYDNEY ALLEN XN DR JESSUP
criteria. The second column is the number of days that the particular patient has been waiting for surgery. The third column is a particular procedure that is briefly stated there for each particular patient. The next column is the number of hospital cancellations that have occurred for that particular patient and the last column merely highlights those three patients that are category 1.
PN2224
There is a few entries in the procedures column that are only just a series of initials. Can you put some more - throw some more light on those, please, Dr Allen?---I will try. If we go down to the fifth, "excision of" - - -
PN2225
Yes?--- - - - "basal cell carcinoma".
PN2226
Yes, thank you?---"Excision of basal cell carcinoma. Full thickness skin graft".
PN2227
Thank you?---"Intra uterine device" - - -
PN2228
Yes?---Insertion thereof no doubt.
PN2229
Yes?---"Excision of tight band. Excision of" I don't know.
PN2230
Do you know what type of procedure that would have been?---It would be a plastic - a plastic surgical procedure.
PN2231
A cosmetic procedure or a - - -?---No, it wouldn't be cosmetic.
PN2232
A therapeutic procedure?---Yes, therapeutic.
PN2233
Yes?---The next one is "carpal tunnel procedure". I don't know what the "r" is.
**** PETER SYDNEY ALLEN XN DR JESSUP
PN2234
But that is to do with the wrist, is it?---That is to do with the wrist. the release of a constriction across the wrist that causes symptoms in the fingers.
PN2235
Yes, well I think we know that "e/o" is excision of?---Yes, okay.
PN2236
So that takes us down to "tah"?---Okay, I am sorry, just before that "dilatation, hysteroscopy dilatation and curettage" back a few. "th" is total abdominal hysterectomy. "Squamous cell carcinoma and split skin graft. Removal of plate, total abdominal hysterectomy, split skin graft, dilatation and curettage, dilatation and curettage, total abdominal hysterectomy, excision of dilatation and curettage, lap chole cystectomy".
PN2237
DR JESSUP: Thank you, and these are the - these are the procedures that have been cancelled in the - by cause of the bans, are they?---That is correct.
PN2238
Yes, before we get to that, can I tender the previous document, Commissioner, please, the one that is headed "Bed Closures"?
[1.59pm]
PN2239
THE COMMISSIONER: Any objection, Mr Niall or Mr Langmead?
PN2240
PN2241
DR JESSUP: I tender also the table of procedures cancelled.
**** PETER SYDNEY ALLEN XN DR JESSUP
PN2242
THE COMMISSIONER: Is there any objection, Mr Niall and Mr Langmead?
PN2243
MR NIALL: No, Commissioner.
PN2244
THE COMMISSIONER: Thank you. How did you describe that list, as the list of procedures?
PN2245
PN2246
DR JESSUP: Now, Dr Allen, if you could turn to paragraph 78 of your statement which deals with other impacts, bypassers and various other things?---Yes.
PN2247
Have you got more recent information for that?---Yes, I have got the information for 24, 25, 26 and 27 April.
PN2248
And do you have it in that kind of format that I am holding up to you now?---Yes.
PN2249
Yes. Well, I will provide copies of this to the Commission and to the other parties as well. Now, Dr Allen, the entries for the 24th and 25 April are in the same format as the original statement, aren't they?---They are.
PN2250
But the entries for the 26th and the 27th are in an abbreviated format in handwriting?---I am sorry, yes.
**** PETER SYDNEY ALLEN XN DR JESSUP
PN2251
And can you tell me what the - do you have that, Commissioner, in front of you? Yes, thank you. If we can just make sure that - you have obviously had good training in the College of General Practitioners school of handwriting?---Correct.
PN2252
After the date 26 April you have CL?---I am sorry. That is Clayton.
PN2253
And under that, D?---Dandenong.
PN2254
Right. And so other than that the numbers fit with the columns, do they?---They do.
PN2255
That is to say, the numbers you have written in hand relate to the columns that are directly above them?---Correct.
PN2256
Now, you have got in the entry of 27 April, under the column which deals with emergency department patients waiting more than 12 hours, you have got one more than 24 hours?---Correct, 14, one, has been in the department greater than 24 hours.
PN2257
Yes. I tender that, Commissioner.
PN2258
THE COMMISSIONER: Is there any objection, Mr Niall or Mr Langmead?
PN2259
**** PETER SYDNEY ALLEN XN DR JESSUP
PN2260
PN2261
MR NIALL: Dr Allen, you are the chief medical officer at Southern Health and you are based at the Monash Medical Centre at Clayton, is that correct?---Yes.
PN2262
And do you spend all your time at Clayton?---No, no.
PN2263
You move around to the other facilities within Southern Health?---Correct, yes.
PN2264
As a chief medical officer with Southern Health is your role seen within the organisation as a clinical role?---No, it is not.
PN2265
It is a managerial role?---It is managerial role. I don't do any clinical work.
PN2266
And you oversee the clinical side?---Well, I don't oversee the operational day to day clinical work. It is more in a broader strategic and broader role.
PN2267
And you have had considerable experience in the role as chief medical officer?---Yes.
PN2268
And you have been doing that for some 20 years?---That is correct.
PN2269
So is it right to say that you haven't had a clinical role within the hospital for the last 20 or so years?---Well, no, not really. I mean one of my roles is to be the person responsible for a number of clinical departments. The allied health area is a role that I am charge of, the pharmacy, the imaging department, the pathology department, the library. So those clinical areas and clinical support areas come under my - - -
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2270
Now, for the purposes of preparing your statement to the Commission you have provided some statistics of the effect of the bans. How have you got those statistics, Doctor?---I have done that in consultation with a wide range of people.
PN2271
And the hospital I take it has been completing forms provided from the Department of Human Services directed to keeping an ongoing of the effect of the bans?---That is correct.
PN2272
And those documents have been in part I take it the basis of your statement?---Well, those documents have guided the people that have given me the - - -
PN2273
Primary statistics?---Yes.
PN2274
Now, the purpose of your statement as I understand it is to inform the Commission of the effect of the bans of the ANF, the effect they are having on Southern Health and its various establishments. Is that the purpose of your statement?---Yes, that is so. I think also the purpose of my statement is to draw together for the Commission the various parts of Southern Health which is quite a complex organisation and - - -
PN2275
And it is quite disparate in its different elements, isn't it?---Yes.
PN2276
For example, you couldn't compare Clayton with Moorabbin?---Correct.
PN2277
Clayton and Dandenong, they seem to be closer to one another but there is still significant differences between Clayton and Dandenong, aren't there?---Yes. Clayton is more like the Royal Melbourne Hospital whereas Dandenong would be more like Box Hill Hospital.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2278
Now, can I just summarise, and you will say if it is not a fair summary, the main tenor of your evidence about the effect of the bans. The first concern that you had is related to the effect on elective surgery within the facilities, would you agree with that?---I would, yes.
PN2279
And I take it that your concerns there are delays in elective surgery?---Yes.
PN2280
That might be occasioned by the bans?---Yes.
PN2281
Any other concerns?---Delays in these particular cases with the knock on effect to how it affects other cases as well, yes.
PN2282
What do you mean by that?---Well, these 41 cases come from a large group of patients, 7900, and being such a large group the opportunity for elective surgery on any one of our patients is pretty important. As you will see, the delay in patients being called for surgery is quite large.
PN2283
And your point that any additional delay is a significant matter?---Correct.
PN2284
So that is the concern you have about elective surgery?---Yes.
PN2285
And then you also have a concern about the operations on the hospital's emergency, ability to deal with emergencies. Is that also a concern of yours?---I have a concern on the effect that full implementation of the bans will have on the working of the hospital and in particular not so much the emergency patients which one usually finds are able to gain admission, albeit sometimes delayed, but by the potential for electives, the increasing amounts of elective surgical patients not being able to gain access.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2286
So your concern about emergencies is really related to your elective, concerns you have about elective surgery, that is, as the emergencies come in they will be dealt with but they may be dealt with at the cost of some increased delays on the elective surgery, is that the point?---Well, that is the major point. I think that on a statistical basis if one in four beds closed and when four in five of our beds are occupied by emergency patients there is a statistical risk that the emergency patients will also be in strife as far as gaining access.
PN2287
So the emergencies if the bans are fully implemented you said there is a statistical risk than an emergency might be compromised?---Yes.
PN2288
Do you mean in the sense that they might not get into the hospital?---Well, that they would be blocked within the emergency department and not - - -
PN2289
So get - I am sorry, Doctor?---And not gain an in-patient bed, yes.
PN2290
So you haven't any concern even if fully implemented that emergency would get into emergency department, have you?---I think an unforeseen perhaps consequence of a matter like this is the failure of people to attend the hospital because of what they see as a difficulty at the hospital and a risk that a potential patient who fails to attend because of what they hear or see is in fact sick enough to have needed to attend.
PN2291
So I take it from that answer to the question, even if the bans are fully implemented, and we will come to that in a minute, but if the patients attended emergency they will get in but you are concerned about some patients might be disinclined to attend because of perception that there is an industrial problem at the hospital?---That is correct.
PN2292
So they are the problems that you - they are the main concerns, the elective surgery, the possibility of some effect on emergency and the disincentive to patients or people that present at emergency, is that a fair summary?---Correct, yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2293
Now, the premise of your answer as I understood it was if the bans are fully implemented, that might be a convenient time, Doctor, if I take you to the bans and just ask you some questions about it. I ask that the witness be shown R4, with a copy. Now, it is not your understanding, Dr Allen, that one in four of the total beds, let us just deal with Monash for the moment, it is not your understanding, is it, that one in four beds within the hospital are to be closed, is it?---That is what it says in point A.
[2.13pm]
PN2294
Yes. Well, it says one operational bed in four will be closed on every ward unit in each public hospital including three areas, operational beds means beds that were open at 20 April, beds closed to 20 April will remain closed. Now, if you go down to paragraph C you will see there are some exemptions to apply, aren't there? They include critical care patients, do you see that?---Yes.
PN2295
And that would include ICU, would it not?---I presume it would refer to ICU.
PN2296
And also coronary care unit would be classified within that critical care patients?---Well, we would classify ICU and coronary care as critical care units.
PN2297
Yes?---We haven't been accustomed to talking about critical care patients.
PN2298
Well, I suggest that there has been no closure of critical care beds in either CCU or ICU at Monash?---Correct.
PN2299
Do you agree with that?---Correct.
PN2300
And they are exempt. So there is no question of them being closed, is there?---No, I don't believe there is but there is confusion between on the one hand beds and on the other hand patients.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2301
You are confused by that?---Well, I think the hospital is confused. I mean as you know, the critical care patients, that term wasn't in the original documentation that was forwarded to us and I think there is confusion as to whether we are talking about emergency patients.
PN2302
You know at least that there has been no attempt at Monash or any of the Southern Health facilities to close coronary care or intensive care beds, you are with that?---Yes.
PN2303
Now, oncology patients you agree also that there is also some, again just talking about Monash, there are some oncology beds or wards at Monash?---There is not an oncology ward at Clayton. There is an oncology ward at Moorabbin.
PN2304
And there are oncology patients at Clayton, aren't there?---There are occasional oncology patients at Clayton.
PN2305
Haemodialysis patients, that renal dialysis I take it. That occurs at Clayton, does it not?---Yes.
PN2306
Paediatric, does Clayton have a paediatric ward?---It does.
PN2307
And does Clayton have an obstetrics and gynaecology?---It has obstetrics.
PN2308
And that would include terminations of pregnancy?---Occasionally.
PN2309
And it also has a labour ward?---It does.
PN2310
And a neo natal ward?---It does.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2311
Now, what I suggest are that there are significant exceptions applying at Monash so that even if the bans were implemented to the letter it would not be one in four beds closed?---Correct.
PN2312
And many of what - or some at least of what you call the emergency patients would fit in with one of those exempt areas, that is, critical care, correct?---Look, I think that critical care, the patients that would be placed in critical care units would in many cases be emergency patients.
PN2313
All right. Now, you say that one of your concerns stems from the percentage of people you say - or describe as emergency patients. Can I take you to paragraph 37 of your statement, Doctor?---Yes.
PN2314
And you refer to a percentage of 75 to 80 per cent of patients being emergency?---Yes.
PN2315
Firstly, are you saying that is the average across Southern Health?---No, I am saying that is Clayton.
PN2316
I am sorry, I apologise?---Yes, yes.
PN2317
At those two hospitals it is 75 and 80. Firstly, what do you mean by emergency patient?---What that refers to is that it is a statistic that is routinely kept across the health services as to the in-patient beds and whether they are occupied by emergency as against elective patients and that information is available for all health services. In the case - - -
PN2318
So you use emergency in contradistinction to elective?---Correct.
PN2319
So you are saying 75 per cent to 80 per cent of beds at Clayton are emergency as opposed to elective?---Correct.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2320
Could I ask Dr Allen be shown the hospital services report, which is exhibit - - -?---Yes.
PN2321
Are you familiar with the hospital services report?---Yes, yes.
PN2322
It is R2, Commissioner. If I could take you to page 33 firstly, you will see that there is a glossary and there on the left hand side, second last entry, is emergency admission as unplanned admission to hospital due to unexpected illness or injury that requires urgent care. Do you see that?---Yes.
PN2323
Is that similar to the definition as to what you are using in paragraph 78 of your statement?---37.
PN2324
37, I am sorry?---No, it is not.
PN2325
Well, what do you mean by 37?---I mean by 37 the statistic that is regularly collected across all the health services and compared one versus the other which - - -
PN2326
Well, isn't the hospital services report a place where statistics are collected across all the hospitals and compared one with another?---It is one of the documents that do that.
PN2327
But this is a standard text, if I can use that description, in terms of describing and comparing hospital services within Victoria?---Yes.
PN2328
And that definition, emergency admission, would, would it not, be generally accepted as an appropriate working definition within Victorian Health?---Well, I mean it is at loggerheads with the definition that causes the 75 per cent to 80 per cent of in-patient beds being occupied by patients admitted as emergency patients. Perhaps it is at loggerheads. I think that in 37 we are referring to bed days, whereas in the emergency admission text we are referring to admissions.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2329
Is there a distinction between the number of days occupied by an emergency admission compared to the number of days occupied by elective admission?---Yes, there is.
PN2330
What is the differential?---By and large emergency admissions spend longer in hospital.
PN2331
And what order of magnitude?---Fifty per cent more.
PN2332
Now, if you go to page 8 - I am sorry, if you go to page 5, which is the patients admitted to hospital and we start with Monash Medical Centre, for the September quarter 2003 you had 21,900 patients admitted, do you see that?---No, wait a minute. This is on page 8?
PN2333
Page 5, I am sorry?---Sorry. Yes, 21,917. Yes.
PN2334
And if you go to page 8 you will see the number of admissions was 7421. The number of emergency admissions. So according to these statistics, the Government's statistics, the emergency admissions account for about 34 per cent of admissions into the hospital. Does that accord with your understanding?---Seven thousand out of?
PN2335
Twenty one?---Twenty one.
PN2336
Which my calculation is 34 per cent?---Right.
PN2337
So only a third of patients actually admitted are admitted as emergency patients?---Yes. I think on page 5 the status of the Moorabbin campus is not clear.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2338
Because Moorabbin might be included in Monash?---Yes, it could be.
PN2339
Which Moorabbin doesn't have an emergency?---An emergency, yes. So that would, you know - - -
PN2340
That may skew?---May knock a few off the page 5, mightn't it?
PN2341
Monash Medical Centre does include campus in Moorabbin you will see, so that is right, and with Dandenong the figure is 4768 emergencies over 7394 admissions, about 64 per cent?---Yes, yes, and I think that more clearly demonstrates, doesn't it, that if an emergency patient has a length of stay 50 per cent more than an elective patient then you can see that there is a different ratio when one looks at bed days occupied as against admissions for emergency as against total.
PN2342
Yes, but you are also getting a number of admissions?---And I can say - I mean when I put number 37 I didn't investigate it. I quote the figure that is used and talked about because it is important to us that figure. It shows that for Clayton and Dandenong that there are relatively few beds that are available to be taken by elective surgery. In other words, the hospitals are dominated by emergency which - - -
PN2343
Although the figure for actual patients walking in the door are about 60 per cent coming in as emergency and about 40 per cent are coming in as electives?---Yes, but then when you translate that into bed days, and I take 60 per cent. I can't do the calculations but if you took it was a 50 per cent greater length of stay for emergency that 60 per cent nudges up to sort of 75/80 in terms of bed days.
PN2344
Your position in relation to electives, I wanted to ask some questions about elective surgery if I may?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2345
You say in your statement that at Clayton you have about 30 patients, this is paragraph 40, about 30 adults and 11 paediatrics from emergency each day?---Yes.
PN2346
Now, I want you to for present purposes to ignore paediatrics because they are exempt and I just want to look at the adults for the moment. You have got 30 adults coming through emergency and down in paragraph 44 you have got 35 adult planned admissions?---Yes.
PN2347
So that suggests that it is closer to 50/50 at Clayton?---Once again they are admissions not bed stay.
PN2348
I understand that. And Dandenong. Now, of the elective entries you say for Dandenong there is about 20 adults per day. What percentage of those currently are category 1? When I say currently I mean let us take the first quarter of this year. What percentage of elective surgeries at Dandenong would be category 1?---Look, I would only be, and I am reluctant to guessing, I would say I think - I mean categorisation is a tool for sort of goal setting, but you know, patients are either requiring their elective surgery urgently, or not so urgently, or even less urgently and the difficulty with categorisation is our surgical staff and their idea of what categorisation is sometimes different from other people's and they will use the categorisation as a lever to get patients into hospital. Look, I would say a quarter of them.
[2.28pm]
PN2349
And category 2?---I would say, Dandenong we are talking about?
PN2350
Yes?---I would say more than half.
PN2351
And the balance would be category 3?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2352
And would that be similar for Monash?---No, no, there would be more towards the urgent. At Monash Clayton there is an emphasis on cardiac surgery, on neurosurgery, on vascular surgery which tends to be more urgent. So I would say that the urgent cases would be more predominant and the less urgent, the least urgent would be smaller.
PN2353
Now, you describe these categories as - I am not sure what sure your phrase was - a tool for goal setting. It is a bit more than that, isn't it, Doctor? I mean these categories 1, 2 and 3 for elective surgery have been developed as appropriate standards of optimal care in respect of a wide range of surgical procedures, haven't they?---Well, they have been but there is also controversy about them and there has been many - - -
PN2354
Well, no doubt there may be controversy but they are used in this State to prioritise surgery, aren't they?---Well, they are a factor that needs to be taken into account and if I could demonstrate that, there are certain patients, for instance on the tables of procedures cancelled that I have tabled today, that have been on the list for admission this week yet have been waiting a long, long time and that the story about those is that they are not really compared to other 7900 on the high priority but by virtue of being on so long that assumes a priority in its own right.
PN2355
Yes?---Even outside the categorisation.
PN2356
So the categories themselves, I suggest, are used throughout Victoria to set optimal surgical intervention times. Do you agree with that?---They are a major factor in that, yes.
PN2357
And within that, within the categories, the surgical and medical staff prioritise within the categories, don't they?---Yes.
PN2358
So within category 1 some are more urgent than others but it would be optimal, general speaking, to dispose of a category 1 case within 30 days?---Yes..
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2359
And category 2, again, some would be more urgent than others, but it would be optimal to dispose of all of them within 90 days?---Yes.
PN2360
But some of them blow out to considerably longer for a variety of reasons, don't they?---Yes.
PN2361
So for example, in your list, A10, which you have in front of you?---Yes.
PN2362
The first one, category 2, a laparoscopic nison fundo plication?---Yes.
PN2363
Has been waiting 422 days?---Yes.
PN2364
Far in excess of the optimal 90?---That is right.
PN2365
And it has three hospital initiated postponements, hasn't it?---Yes.
PN2366
So that suggests that that patient, although a category 2, has been accorded for whatever reason lower priority than other category 2 patients within the hospital?---Yes, unfortunately some patients get forgotten in a long waiting list as well.
PN2367
Are you suggesting the first patient is forgotten?---No.
PN2368
Are they forgotten or are you saying that the position is that over time the priority has been set appropriately but it has been allowed to reach the point where it is 422 days?---Well, I am not able to say why a patient such as that has had to wait 422 days, which does seem to be at odds with, for instance, a patient down the list who is a category 3 and is only waiting 52 days. Unfortunately we haven't been able to achieve a system whereby our 7900 patients are in order as to their priority.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2369
Well, they might be in order to their priority but might not be in order as to their number of days on the list?---Yes.
PN2370
And within category 2 on a daily basis the hospital and its surgical and medical staff regularly prioritise category 2 patients, don't they?---They select the patients for admission from their lists.
PN2371
And do they so not - they don't draw the names out of a hat I hope?---No.
PN2372
Within category 2. And they don't simply work through their category 2 list, do they?---No.
PN2373
Sequentially?---No, but they do not have a priority listing of their category 2s.
PN2374
Well, they do, perhaps not documented?---No.
PN2375
But they do apply priorities to category 2s, don't they, and that is why, I assume, the first two category 2s, each of over 400 days, whereas the next one is coming up for surgery after only 32 days waiting?---Yes.
PN2376
Because although both category 2 and both optimally should have been since within 90 days, for whatever reason there has been a variation to that optimal period of surgery with the first two, hasn't there?---Yes.
PN2377
And there has been an advancement to the third category?---Yes.
PN2378
And it is not possible to say that because the first patient of laparoscopic nison fundo implication, just because that patient has been waiting 422 days as opposed to the 90 optimal, it is not possible from that fact alone to say anything about the consequence of that delay for the patient, is it?---It is not possible to say about the urgency, no. Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2379
The patient may be in exactly the same medical condition now after just over a year as he or she was after about two months, when the person went onto the list?---Yes, they will suffer, won't they, the sort of problem of having to have waited so long?
PN2380
Well, what problem is that?---Well, I mean I think that when for those of us that have had surgery when surgery is indicated and arrangements are set in place, from that day onwards the patient is waiting and is concerned about their condition.
PN2381
Undoubtedly, Doctor. But where you have a system where there are priorities and some patients although it is anticipated and it is hoped that patients would fit within the optimal parameters, some patients exceed the optimal parameters, don't they?---Yes, that is right. That is right.
PN2382
And you can't draw too many conclusions simply from that delay itself, can you?---Well, I mean you can draw the conclusion that they haven't had their surgery.
PN2383
Yes, you can do that. But that is about it, isn't it?---And you can draw - and from the information that we have collected here you can make a judgment as to the waits that people have had and such waits will be of significance to them when they are cancelled. For instance, a person who has been waiting 1057 days and find themselves cancelled will obviously be more distressed, I would think, than someone who has been waiting 19 days.
PN2384
Well, doesn't it depend on the condition?---Well, it does. Conditions being equal.
PN2385
And the answer to that question, you have brought in the concept the effect of the cancellation?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2386
You would agree with me that that has the potential for different effects, is quite a different issue than the mere issue of delay, isn't it?---The main issue is they haven't had their surgery.
PN2387
Well, that is a delay issue. That is the main issue, isn't it?---Well, at this point in time they haven't had it and I think if someone was on the list for 693 days they may say they have never had it.
PN2388
Because when you talk about the consequences of delay in paragraph 59?---Yes.
PN2389
I suggest, with respect, that you very much overstate the position. You say that:
PN2390
As stated above, most elective surgery done at Dandenong and Clayton is urgent surgery.
PN2391
?---Correct.
PN2392
Well, it would be pretty hard to describe the first two examples you give as urgent surgery, wouldn't it?---But I don't know that I am necessarily - I am not necessarily including the table of procedures cancelled within the most of section 59, as you have pointed out.
PN2393
So you are saying that most urgent surgery is being performed at Monash in accordance with ordinary practice?---I would say that. I think that those - - -
PN2394
And - I am sorry?---Those statements in the first part of my witness statement pertain to the situation should the bans be fully implemented.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2395
But you don't say in paragraph 59, you are not tying that concept, are you, to the bans? You are simply saying delay in surgical procedures would have dire consequences for the health and you go on to say in paragraph 60:
PN2396
In most cases the consequences for waiting to give surgery at these hospitals will, depending on the length of the wait, be life threatening.
PN2397
And you to on to say that you don't anticipate that if the wait was no longer than 24 hours -
PN2398
But certainly if these types of patients were not admitted within a few days for many of them there would be life threatening consequences.
PN2399
?---I have said they have the potential to be life threatening, that is correct.
PN2400
Well, you are not saying that any of these ones that are cancelled on A10 the cancellation or the delay has been life threatening in respect of those patients, are you?---I am not - in my discussion on number 59, was it?
PN2401
Yes, 59 and 60?---59. I am referring to there to the surgical procedures at Clayton that are neurosurgical, cardiac surgical, vascular surgical, such conditions, Dandenong, gastrointestinal surgery, orthopaedic procedures, vascular surgery, some neurosurgical procedures. When I am talking about the significantly - the significant surgery at Dandenong and Clayton that is what I am talking about. The ones on this table I agree are not within that group.
PN2402
So some operations if you delay them might have dire consequences for their health?---Yes, yes.
PN2403
That is the proposition and I think most people would agree with it?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2404
But it depends on the surgery?---Yes.
PN2405
It depends on the condition of the patient?---Yes.
PN2406
And it depends on how long they have been waiting?---Yes.
PN2407
And you are satisfied that as the bans are currently being implemented the delays are not causing the sort of concerns or problems that you identified in 59 and 60?---That is correct.
PN2408
Thank you. And is it the case that similarly - well, before I move on. It is not your expectation that the bans would ever reach the point where those sort of consequences would follow at Clayton?---No, it would be my expectation that they would be reached if one took on a one in four beds being closed.
PN2409
You have also agreed earlier that it is one in four of the total hospital, is it?---Well, if I can just try and explain myself again. The difference between A, that is one operational bed in four, and C, exemptions, the exemptions apply to patients. That doesn't say that the exemptions tote up so that it is one in six.
PN2410
But you have to take that into account, don't you?---Well, you take into account. You can say that one could exclude the paediatric patients, so that is that ward taken out.
PN2411
Yes?---But it is still one in four left in the other wards, or if one takes the anti natal and post natal patients out, it doesn't close them, but it is still one in four in the others and it is still one in four in those wards that need to take cardiac surgery, or neurosurgery, or vascular surgery, the type of condition I am talking about.
[2.43pm]
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2412
Now, how many beds do you say could be closed if the bans were fully implemented?---Well, the figures that - I mean the figures that I have available to me say that we have got 560 beds at Clayton. Now, we have got about 50 paediatric beds. We have got about 50 mid beds, so that is 100. We have got, you know, some ICU and CCU and labour wards, you know, that makes another 50, so that is 150. So it is 150 out of 560 so that is 400 less, so one in four closed is 100 beds, leaving 300 open.
PN2413
And the 560 is the number open, the number of beds at Clayton?---Well, it is 560 but as you will see from my statement there were some closed prior to this event, 12 in fact. So that takes it down from 560 to, you know, 548, but then calculation of subtracting 50, 50, 50 was rough. So, you know, it is around about 400. But I quite agree with you that we are nowhere near one in four.
PN2414
Yes, and if you go to R4 which is in front of you?---Yes.
PN2415
That is the AFL industrial bans?---Yes.
PN2416
You have got admission of emergency patients about three pages in?---Yes, admission, yes.
PN2417
I think I said the AFL bans but I meant the ANF bans. The admission of emergency patients:
PN2418
It is not the intention to deny emergency care to any patient who needs it during this dispute.
PN2419
Do you see that?---Well, I can see that but if one sort of - I mean a lot of the difficulty here is the interpretation of, you know, the - I have mentioned the interpretation. Now, I think I am right in saying this says that if an emergency presents, and there is nothing about emergencies in the front page, if an emergency presents it will be admitted, but then one of the open beds will be closed such that you achieve the one in four at the sort of end of the day.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2420
But if the emergencies keep presenting they will be filled until the beds are filled, until the hospital is full?---Where does it say that?
PN2421
Well:
PN2422
It is not the intention to deny emergency care to any patient who needs it during this dispute.
PN2423
The overarching position is that emergency beds will be available to emergency patients?---Okay, but this does not say that the ratio therefore, the number of beds open will be allowed to be more than 300 in 400.
PN2424
Despite the ban, despite the closure of beds, it is clear that it is not the intention to deny emergency care to any patient who needs it during this dispute. Have you had discussions with the ANF or ANF job representatives?---No, I haven't, no.
PN2425
Has the hospital?---Yes.
PN2426
And the ANF has made it clear, have they not, that beds will be available for emergency admissions?---Yes, I think that - but you have to see that in the context of there being 300 in 400 open and, you know, to the best of my knowledge it has not been explicitly stated that if emergency admissions drive the agenda the ratio of allowed open beds will be greater than 300 in 400.
PN2427
You are a long way - - -
PN2428
DR JESSUP: Commissioner, I just want to say that it is confusing to us. I think my learned friend is cross-examining which is different to his client's own notice of industrial action. The front page of exhibit R4, if my learned friend looks at paragraph D, I think he will find that his client's statement of the way the emergency bed system operates is not the way he is proposing to the witness.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2429
MR NIALL: The position is as far as you are aware, and you might not know, Dr Allen, that emergency beds will be reserved, even if that means that less than one in four beds are closed?---Okay. I think if that had have been the intent then under the point C exemptions it would be emergency patients.
PN2430
Certainly you will accept this proposition, Doctor, that is that firstly at the moment we are nowhere near at Monash that position?---Yes.
PN2431
And secondly, would you accept that if you got to that position, that is, you closed 100 beds out of the 400 that are available?---Yes.
PN2432
That on presentation of an emergency you would expect that a bed would be made available to that emergency patient, wouldn't you?---Well, I am encouraged to hear that.
PN2433
You didn't have that expectation?---No.
PN2434
You had the expectation would be that an emergency patient would be refused?---I had the expectation that there would be a potential for an emergency patient to be refused or for the consequence of three in four to have caused the threshold for the admission of a patient from the emergency department to be potentially altered such that only those more emergency patients rather than less emergency would be admitted.
PN2435
Now, I wanted to - one of the concerns that you have in relation to the implementation of these bans is delay in elective surgery, isn't it?---Yes.
PN2436
Now, can I hand you a copy of an extract of the annual report of Southern Health for the - well, it is called extract from the annual review 2002. Are you familiar with that document, the annual review of the Southern - - -?---Yes. Yes, I believe so, yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2437
And part of that review, this is an extract, is the service activity and efficiency measures and you will see 1:
PN2438
Access, elective surgery performance 01/02.
PN2439
And the health service did 100 per cent of category 1 within the time?---Yes.
PN2440
And 70 per cent of category 2?---Yes.
PN2441
So 30 per cent, just under one in three of category 2 patients, aren't being done within the optimal - or weren't being done within the optimal time?---Yes.
PN2442
So delay from the optimal has been a significant feature of the Southern Health Care network for a period of time. Do you accept that?---Yes.
PN2443
And if you go to the health services report at page 24, you will see that at Monash Medical Centre, which includes Moorabbin, in September '03 829 cases were waiting over the nine days?---Yes, yes.
PN2444
And over on 27, at Monash Medical Centre for the September quarter, 75 per cent only of the category 2s were done within the 90 days?---Yes.
PN2445
So it has been a regular feature to have a substantial proportion of category 2 elective surgery exceeding the optimal time period?---Yes.
PN2446
And what are the reasons for that?---The reasons are the high level of usage of beds by emergency cases and the demand within the waiting lists.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2447
And the delay that is caused by those two factors does not place the health or welfare of category 2 patients at risk?---Well, I think it does.
PN2448
Well, isn't that risk managed by the hospital to ensure that appropriate priorities within category 2 are observed?---Well, I think the hospital does its best but it still is not good enough.
PN2449
Well, the hospital could always do better?---Absolutely.
PN2450
It is not optimal?---Well, I think that there are certain factors which mitigate against doing much better at this time.
PN2451
Yes?---And I mention them.
PN2452
You are not suggesting that the 30 per cent of category 2 patients in 2001 and 2, their health was placed in danger because the hospital couldn't provide its service within the 90 days, are you?---I am suggesting that their care was compromised.
PN2453
Or their care was sub optimal?---Yes.
PN2454
But you wouldn't say that their health was in danger as a result of the hospital's inability to perform in accordance with those targets?---Yes, they could be.
PN2455
Could be?---Yes.
PN2456
And that potentially is managed by the hospital, isn't it, to ensure that the category 2 patients are dealt within clinical priorities?---Well, I mean the hospital does its best but the very fact that there is patients that fall outside, as you described it, the agreed time that should happen means that patients are being placed at risk notwithstanding the hospital is trying to do.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2457
Now, one of the factors in bed closures - in delays in elective surgery is bed closures by the hospital, isn't it?---Correct.
PN2458
And the hospital has had - recent experience, it has had considerable closures of beds initiated by management, hasn't it?---Correct.
PN2459
I think you said to the Commission that there were 12 beds closed as at the commencement of industrial action on 21 April, is that - - -?---Prior to the industrial action.
PN2460
Only 12 beds closed?---At Clayton, yes.
PN2461
Now, could the witness be given a copy of JMM1 which is the exhibit to the affidavit of John Michael Morris? I think my learned friends have a spare copy for the witness.
PN2462
THE COMMISSIONER: Mr Niall, which document within that folder?
PN2463
MR NIALL: Document 14.
PN2464
Do you have that, Doctor?---Yes.
PN2465
Now, this is a memo dated November 2003 in relation to Christmas/new year arrangements?---Yes.
PN2466
And it is the case that Southern Health Care at Clayton closed beds for Christmas/new year?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2467
And that has the effect of delaying elective surgery?---Well, it is not quite as simple as that.
PN2468
Why not?---Because within the bed stock of Monash Medical Centre, Clayton, or within the bed stock of Dandenong, a certain amount of work needs to be done as per a contract with the Department of Human Services and that work is done within the beds that need to be open to do that work.
PN2469
Yes. So notwithstanding that you have got the beds and notwithstanding you have got the staff?---Yes.
PN2470
You close beds to meet your contractual obligations within the Department of Human Services?---Yes, that is correct. We keep beds open to achieve our contractual arrangement.
PN2471
And once you are on track to meet your contractual obligation you close them down so that you don't overspend?---We don't - you keep - you have the beds open that you need to have open to meet your contractual arrangements.
PN2472
Not to meet your demand?---No.
PN2473
So the hospital doesn't determine how many beds it keeps open because of how many elective surgery patients it has got on its list, it keeps its beds open to meet the contract with the Department of Human Services?---Correct, correct.
PN2474
And once you meet the contract you close beds, or you regulate the supply of beds?---Correct.
PN2475
And that has the effect of delaying elective surgery, doesn't it?---Well, it programs elective surgery.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2476
Well, it doesn't happen any faster, does it?---Well, I mean if you elected to do the work all the first half of the year and none in the second it would.
PN2477
But you wouldn't clear the list. You stop, the hospital stops when it reaches the point of its contractual obligations?---Well, it tries to program throughout the year to meet the contractual arrangements, yes.
PN2478
And if it rushed and did it all in the first half?---Yes.
PN2479
The hospital would close down and you could all go on holiday?---Well, the hospital would be in trouble if it did that.
PN2480
Yes, because the Government wants to spread it over the year?---Well, I mean we want to spread it too so that our staff are working for the year and not for six months.
PN2481
But they only want to spread a certain amount of work, don't they?---There is only a certain amount of work to spread, yes.
PN2482
Because it is only a certain amount of work that it will get paid for essentially?---Well, that is the deal.
PN2483
And part of the deal, the part of the way you achieve the deal is close beds at Christmas and new year?---At that time staff want to go on holidays, yes.
PN2484
So there is a happy coincidence, staff want to go on holidays and you don't want to be over extending your activity?---Yes.
PN2485
So can we just look at that document, document 14. Theatre closures, theatre capacity, six. That is down from how many?---Eight.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2486
Right. And ICU beds, three down from - - -?---Yes, yes.
PN2487
Down from how many?---I think it is 10.
PN2488
Okay. And in category 2 there is no category 2s between 22 December to January 11?---Yes.
PN2489
And then starting again on the 12th?---Yes.
PN2490
And then what is called service capacity realignment, is that a euphemism for bed closures, is it?---Well, I mean I think you take my point and there is no doubt that interests to keep more work occurring would call beds closing but it is in fact it is capacity alignment.
PN2491
Which means is that you align your bed numbers to dispose of the capacity that the contract gives you?---Yes, in the sort of sequence that you optimally like to have it done.
PN2492
But people don't get sick in accordance with that sort of sequence, do they?---No, you are never down to nothing.
PN2493
Now, if you go back one tab you should have what is called in-patient 24 hour bed capacity 2003, do you have that?---Is this 12?
PN2494
Yes - 13. What document do you have?---Yes.
PN2495
Is that in-patient 24 hour bed capacity 2003?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2496
So on the left hand column is all the wards within Clayton?---Yes.
PN2497
And then this document tells how they have been closed over the course of the year, is that correct, or how it has been left open?---It looks like it, yes.
PN2498
So you had in 32 north you had 26 for the 02/03 financial year?---Yes.
PN2499
And for five months that was down to 22?---Yes.
PN2500
And 34 north, for five months that was down to 22?---Yes.
PN2501
So that is each day eight beds are closed, agreed?---Yes.
PN2502
And then you have got some other closures down throughout the awards in th hospital?---Yes.
PN2503
And if you add the closures for say February what sort of total would you get?---There is four plus - - -
PN2504
Four?---33 south has gone up, hasn't it? It has gone from 19 to 26.
PN2505
Some of them have gone up and some of them have gone down?---Yes.
PN2506
And it is a frequently used management tool to close beds, isn't it?---Well, that is right, along the lines of our previous discussion.
PN2507
And I suggest that that management tool, the use of that management tool to close beds does not threaten to endanger the health or welfare of the patients of Clayton?---Well, the more work that is done the less risk to the patient.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2508
Yes, but it is all about rationing, isn't it? It is all about regulating the inflow into the hospital to meet the various competing contentions?---Yes, yes.
PN2509
One of the competing factors is the capacity that the State will pay for it?---Yes.
PN2510
And the means of regulating or rationing is waiting lists is one of them?---Well, I mean the waiting list is just that list from the patients that are to enter the hospital and occupy the beds come from.
PN2511
But you need a waiting list because you can't do them all at once?---Yes.
PN2512
And you have to prioritise?---Yes.
PN2513
And that use of the waiting list is a managed and carefully thought about process, isn't it?---Yes.
PN2514
Now, I wanted to ask you to go to tab 3 - sorry, tab - yes, tab 3, and that should be the impact report for 21 April, correct?---So I will take it out of its sleeve?
PN2515
Yes, please?---The impact report, 21 April.
PN2516
Yes. Now, if you go to the first page?---Yes.
PN2517
This is the document that Southern completes for the Department of Human Services, isn't it?---Yes.
PN2518
And you will have a look, it has got a chart or a table for 21 April for the Southern Health. The first one is hospital campus, total beds open, total beds occupied, beds closed due to action, beds closed not due to action?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2519
Bypass patients?---Yes.
PN2520
Now, you have got 24 beds due to action and 34 beds closed not due to action?---No, wait on. Clayton is six and 12.
PN2521
Yes, but across the service?---Across the service we have got 36 not due to action and 24 due to action, yes.
PN2522
So you have got more closed due to management than you have due to the ANF?---Well, wait a minute, don't blame management. They are not open because, dare I say it, they don't need to be open.
PN2523
Well, I thought the whole point, the whole problem of the ANF was that they have closed beds that needed to be open?---Well, that is true, but the beds that are closed prior to the action are closed because of the reality that the contract is in such and such a state and the spread of the work over the year is in such and such a state and the management strategy for this is that rather than have, you know, 1000 and whatever beds, there only needs to be that minus 36 open in order to fulfil the contract.
PN2524
Yes. So on 21 April the 36 beds that the health service closed didn't need to be open?---Yes.
PN2525
But the 24 beds that the ANF closed did need to be open?---Because they were impinging upon the ones that needed to be open.
PN2526
But let us go back to the 20 April?---What page?
PN2527
We will find that I think on the - does the Commission have 20 April, tab 4? Do you have that, Doctor?---Tab 4.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2528
Yes, 20 April. That is the first day of industrial action. Do you see that?---Yes.
PN2529
You had 16 beds closed not due - you had no beds closed due to industrial action and 16 beds closed at Kingston not due to industrial action?---Yes, yes.
PN2530
That is due to just - - -?---Management.
PN2531
Management. Now, I want to take you to 22 April if I may?---Where is that?
PN2532
That will be tab 2?---I am not putting these back in their sleeve.
PN2533
No, that is fine. 22 April?---Yes, 22 April?
PN2534
Yes. Sorry, I don't want the 22nd, I want the 23rd which is the first tab. I apologise. Now, on 23 April, which was the first Friday of the bans?---Yes.
PN2535
Beds closed due to action were 87?---Yes.
PN2536
Beds closed not due to action, that is due to management, were 77?---Yes.
PN2537
So throughout the facility Southern Health had closed 77 beds?---Yes.
PN2538
And that didn't cause a problem for management at the hospital, did it?---Well, when you say cause a problem, I mean it is planned.
PN2539
Well, what is the difference?---Between?
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2540
A planned closure and the closed due to the bans?---Well, that is not planned.
PN2541
Well, what is the consequences for the patient who can't get into a bed?---Well, on the planned one the reality of a contract is that a certain amount of work can be done. That means that a certain amount of work can't be done and you have pointed out the category 2s for instance that can't get done within the optimal time. That is an unfortunate reality of the public health system. Now, the difference with the beds closed due to the action is that that is not a consequence of the organisation of the health system.
PN2542
But they have exactly the same consequences, don't they?---Both unfortunate.
PN2543
Yes, and both delay?---Yes.
PN2544
And in relation to the ones closed due to management?---Yes.
PN2545
They are closed due to management but they wouldn't be closed if they presented a danger to the health of the people who want to use Southern Health, would they?---Yes, they would.
PN2546
Well, surely you would prioritise so that even with the closures the people who are in need of care can get it?---The ones in most need of care would get it. There would still be ones where there are lesser needed. Everyone that is put on an operating waiting list needs to the care.
PN2547
Yes, and you can't do it more than once so you have got to prioritise and the closure by management of beds simply means that the list will be longer but it will be manageable. Do you agree with that?---No, there will still be patients, and you have mentioned them, that are waiting longer than the requisite time according to predetermined criteria that will be disadvantaged by management's actions in sticking to its contract.
[3.13pm]
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2548
Now, on the 23rd the total closed not due to action was 77 beds in Southern Health?---Yes.
PN2549
Would that be consistent with the figure today?---Look, I don't think I have got the figure today. The figures that are in my witness statement were at that time.
PN2550
Not closed due to action but not due to action?---Yes.
PN2551
But wouldn't they be the same?---I haven't got those. I haven't got those figures.
PN2552
But they would be the same order of magnitude?---Well, I mean I am reluctant to say yes or not. I don't know.
PN2553
Now, the hospital got notice of industrial action on 17 April, didn't it?---Yes.
PN2554
Could the witness be shown R3? I have got a copy. I Southern Health a member of the VHIA?---Yes.
PN2555
And do you get the bulletins from the VHIA?---Yes, the hospital does.
PN2556
Do they come to your desk, Doctor?---I haven't seen this one.
PN2557
Well, perhaps if you go over to 25 March. It is dated 25 March and if you go over to the second page, it says:
PN2558
Members should also note that unions are entitled to take protected industrial action in early April and each employer needs to consider the nature of any contingency plan it may require.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2559
Now, was Southern Health aware in March, late March, that the VHIA was warning its members that there might be some industrial action?---I believe so, yes.
PN2560
And then on the 17th - well, what steps did Southern Health take to put in some contingency plans?---Look, I am not aware of - apart from being aware and all relevant persons being aware and being prepared in mind, I don't know that there was any specific plans put in place.
PN2561
And then on 17 April the hospital got what is called the notice under section 170MA?---Yes.
PN2562
Which told them that industrial action would start on the 21st?---Yes.
PN2563
And I have taken you to the notice which said that it would close operational beds?---Yes.
PN2564
One in four and defined operational beds that were open as at 20 April?---Yes.
PN2565
Why didn't the hospital open up all the beds that it had closed on 17 April?---Why?
PN2566
Why did the hospital - I withdraw that. Why did Southern Health not open all the beds that it had closed on 17 April?---What, as a tactic?
PN2567
Why did the hospital not open all the beds that it had closed by 17 April 2004?---I can't quite see why.
PN2568
Well, the ANF bans were only closing one in four so if you open 10 beds on the 17th that would increase the size of the bed capacity to be closed, wouldn't it, so you would get the benefit of three quarters of those beds?---Three quarters of - - -
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2569
Any increase that you put in?---Three quarters of 12 for three days.
PN2570
Well, not for three days?---For how long?
PN2571
Well, for the life of the ban. But you closed by 23 April 77 beds across the Southern Health Care network?---Look, I don't know why it didn't. I don't think it thought to do that.
PN2572
DR JESSUP: Commissioner, my learned friend again is cross-examining contrary to its clients own stated position. If you look at the section 170MO notice, paragraph 4A, it is quite clear that the stratagem to which he referred the witness would not have been open under the schedule of bans.
PN2573
MR NIALL: But the position is that Southern Health Care, Doctor, did not seek to open any beds on 17 April. Do you agree with that?---Yes.
PN2574
And didn't seek to take any steps to avoid the consequences of industrial action?---It didn't seek to open the beds.
PN2575
Well, what steps did it take?---Well, it made all its managers aware of what was in the wind.
PN2576
Now, can I take you to exhibit A9?---Have I got that?
PN2577
It is your list of bed closures, up to date list of bed closures?---Yes.
PN2578
Now, on 26 April - sorry, on 25 April there were 35 beds closed at Clayton?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2579
And on 26 April there are 28 beds?---Yes.
PN2580
And on 27 April there are 24 beds?---Yes.
PN2581
So from 25 to 27, 11 beds had been opened?---Yes.
PN2582
That had been closed on the Sunday?---Yes.
PN2583
How did that come about?---I don't know.
PN2584
Who went into those beds? Were they emergency patients?---I don't know.
PN2585
The hospital staff, hospital management had maintained communications with the nurses who were imposing bans within the facility?---The managers maintained communication with the nurses.
PN2586
And there has been cooperation in terms of ensuring that the bans - that the implementation of the bans has been minimal disruption to the extent possible?---On these figures I would say yes.
PN2587
And as at the moment at Southern Health at Clayton or Dandenong is not significantly impacted by the bans in terms of its ability to provide health services?---Well, it is unable to provide elective surgery for the patients as listed. It has been unable to and there has been an increase in the process required for patients from the emergency area to gain access to a bed.
PN2588
There have been delays in accident emergency?---There has been additions to the process that on sees.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2589
What are they?---Well, there needs to be - I mean it is not an assumption that a patient will be taken by a ward from the emergency department when there was formerly that assumption.
PN2590
But as far as you are aware everyone who has needed a bed has got one?---I think I have mentioned a case where there was, you know, an initial rejection of the patient for one reason or another by one ward and then an acceptance by the patient from the other award - to another award. Now, I am not suggesting that that was of massive significance but that is perhaps an example of the process change if you like that was in place.
PN2591
And apart from that example there hasn't been difficulties in getting patients out of accident emergency?---That is correct.
PN2592
Just pardon me one moment. Earlier in your evidence you said there was some confusion at the hospital in terms of the application of the emergency - or the application of the bans in various cases. Could the witness be shown this document, please. That is another bulletin from the VHIA to all members. Can I take it that that was received by Southern Health?---Yes.
PN2593
And that is 23 April so that is two days into the bans and it says third paragraph:
PN2594
Hospitals which are experiencing difficulties with the bans should engage in dialogue with local ANF representatives and nurses. ANF has advised that it is willing to consider the provision of relief if there is risk to an emergency case.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2595
And that accords with your understanding of how things were actually progressing at the hospitals?---But I think this is an example of the confusion. On the 17 April document there was no mention of emergencies and no mention of critical care patients. On the 21 April document there is no mention of emergency but - yes, there is a mention of emergency. There is the mention of critical care patients and then this is a further explanation which I think gives weight to the point that I made about there being confusion and I think now you have said that even if it means all the beds will be open emergencies will be taken.
PN2596
That is right?---Even if it means four out of four beds will be open all emergencies will be taken which is - - -
PN2597
And that has been the public position of the ANF, has it not?---Well, I don't believe it has.
PN2598
The document says, the one I take you to, says that it is intention of the ANF - it is not the intention to deny emergency care to any patient who needs it during this dispute?---Well, I mean I think that that statement that you have made eases my concern about the emergency patients but it doesn't ease my concern about the urgent elective patient.
PN2599
That is category 1 do you mean?---Maybe not. The urgent elective patient which is not covered in any of this.
PN2600
And the process of prioritising patients is one that goes on every day?---Prioritising elective patients?
PN2601
Yes?---Yes.
PN2602
And you would expect that to continue during the bans?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2603
They are the only questions I had, Commissioner. I tender a couple of documents, the last one first, which is the VHIA bulletin number 812.
PN2604
THE COMMISSIONER: Is there any objection, Dr Jessup?
PN2605
PN2606
MR NIALL: There is a couple of Southern Health industrial action impact reports. The first one for 23 April 2004. That is in the big folder.
PN2607
THE COMMISSIONER: Yes, I carefully filed it over here. Sorry, Mr Niall, if you could just take it slowly.
PN2608
MR NIALL: Yes. The first one is tab 1.
PN2609
THE COMMISSIONER: Mr Niall, so I don't have to keep on asking Dr Jessup the same question, are you planning on seeking to tender a number of these industrial action impact reports?
PN2610
MR NIALL: Yes, I am.
PN2611
THE COMMISSIONER: Right. Could I ask as a general question, Dr Jessup, if you have any objection to as a principle any of the Southern Health industrial action impact reports being tendered, or do you have some concerns about some specific ones? They were documents produced by - - -
[3.28pm]
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2612
DR JESSUP: No, we don't have any objection to them being tendered but we would like to know which ones are being tendered.
PN2613
THE COMMISSIONER: I am going to do them one by one but I just wanted as a matter of principle so I didn't have to ask you after every one.
PN2614
DR JESSUP: Have they all been tendered, Commissioner, have they?
PN2615
THE COMMISSIONER: No, I am about to start. I don't know how many Mr Niall wants.
PN2616
MR NIALL: Could I just identify them?
PN2617
THE COMMISSIONER: You want to tender the whole lot?
PN2618
MR NIALL: No, just 23 April at tab 1, the 21 April at tab 3 and 20 April at tab 4 and the document - would the Commission like to number those first?
PN2619
THE COMMISSIONER: There are three, Mr Niall?
PN2620
MR NIALL: Yes.
PN2621
THE COMMISSIONER: Any objection to those three?
PN2622
DR JESSUP: No, Commissioner.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2623
PN2624
MR NIALL: If the Commission pleases. The next document is the document at tab 13, in-patient 24 hour bed capacity 2003.
PN2625
THE COMMISSIONER: Is there any objection to that document, Dr Jessup?
PN2626
DR JESSUP: I don't know. I wish to re-examine on it and - - -
PN2627
THE COMMISSIONER: Is that going to affect whether you object to its tendering?
PN2628
DR JESSUP: Yes.
PN2629
MR NIALL: Perhaps I can reserve my position on that one. The next one is tab 14, memo dated 7 November 2003.
PN2630
THE COMMISSIONER: Is there any objection to this document?
PN2631
DR JESSUP: No.
PN2632
MR NIALL: And can I ask the witness one more question? Can the witness be shown - - -
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2633
THE COMMISSIONER: Hang on, do you want this marked before you do?
PN2634
PN2635
MR NIALL: Did I mark the annual report, I don't think I did that?
PN2636
THE COMMISSIONER: No, you haven't got to that yet.
PN2637
MR NIALL: I will do that next, Commissioner. The excerpt from the 2002 review report.
PN2638
THE COMMISSIONER: Yes. Dr Jessup, any objection to that?
PN2639
PN2640
MR NIALL: They are all the documents that I wish to tender, Commissioner, bar one which I am just about to ask the witness about.
PN2641
Dr Allen, do you have a document in front of you, in-patient 24 hour bed capacity 2004?---Yes.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2642
And that is similar to the document that I showed you in relation to 2003?---Yes.
PN2643
It is a document prepared by the hospital, that is Monash Clayton?---Yes.
PN2644
To describe sort of running total of the number of beds open during the months of January, February and March for this year?---Yes.
PN2645
I tender that, if the Commission please.
PN2646
DR JESSUP: Yes, well, I have no objection to that, nor to the previous one. That is to say, nor to the 2003 one.
PN2647
MR NIALL: They could go together, Commissioner.
PN2648
THE COMMISSIONER: Now, that was behind tab 13?
PN2649
MR NIALL: 13.
PN2650
PN2651
MR NIALL: If the Commission pleases.
**** PETER SYDNEY ALLEN XXN MR NIALL
PN2652
THE COMMISSIONER: Thank you, Mr Niall. Mr Langmead.
PN2653
PN2654
MR LANGMEAD: Dr Allen, can I ask you to look at R9 and in particular - I withdraw that, R9?---Which is R9?
PN2655
It is a bundle of three industrial action impact reports.
PN2656
DR JESSUP: Commissioner, I now formally take the objection that Mr Langmead doesn't have a legitimate interest in this aspect of the case.
PN2657
THE COMMISSIONER: Thank you, Dr Jessup. Mr Langmead, what do you say to that?
PN2658
MR LANGMEAD: Well, Commissioner, firstly, my client is a party to these proceedings and as such it is at large to participate fully in the proceedings in any way it sees fit. We say that as a first proposition. Secondly, in response to the suggestion that Dr Jessup made just before lunch that his application to terminate the bargaining periods of the employers in relation to the ANF and the HSUA was somehow to be confined at least in respect of the HSUA solely to grounds under 170LW(7). The application to suspend or terminate the bargaining period is actuated by section 170LW(1) so that if the Commission - - -
PN2659
THE COMMISSIONER: Are we talking about MW, Mr Langmead, or LW?
PN2660
MR LANGMEAD: Sorry, MW, Commissioner.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2661
THE COMMISSIONER: It is all right. It has been a long day.
PN2662
MR LANGMEAD: MW(1). So that if the Commission is able to suspend or terminate the bargaining period if it is satisfied that any of the circumstances set out in subsections 2 to 7 exist, or existed. The grounds that are referred to in the application would appear to relate to MW(3) and MW(7). If the Commission is satisfied that the grounds under either of those sections are made out it is entitled to exercise its discretion to terminate or suspend the bargaining periods in respect of that the employers initiated in respect of the HSUA and the ANF. It doesn't matter upon which ground the Commission is so satisfied, the result is the same, the bargaining period can be terminate.
PN2663
Now, the HSUA doesn't want the bargaining period to be terminated. It resists that. It continues to seek to reach an agreement with the employers and if the employers were successful in convincing the Commission that grounds existed under MW(3) the bargaining would be terminated, which is as I say, is something that the HSUA resists and it doesn't matter whether or not the industrial that is alleged to be being taken and the alleged effects of it is in respect of only of action by the ANF and not the HSUA. The result is the same, the bargaining period is terminated.
PN2664
The HSUA is entitled and has a direct interest in presenting argument it sees fit to participate fully in cross-examination of any witnesses, to bring forward its own evidence if it wishes in order to convince the Commission that such grounds don't exist. We say that as an absolute proposition. Secondly, in relation to the - sorry, thirdly. In relation to the employers application to terminate the ANFs bargaining periods the HSUAs position in relation to that I don't think has been the subject of any determination by the Commission. If necessary we would formally seek to intervene in those proceedings because equally we have a direct interest in the outcome of those proceedings.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2665
One would expect that if the Commission were to find that circumstances under section 170MW(3) existed in relation to the industrial action that that would convince the Commission to terminate the bargaining period, all the bargaining periods, subject of course to the course that the ANF has foreshadowed that there are no employer initiated bargaining periods. But if the Commission is convinced that circumstances under 170MW(3) exist then it isn't able to terminate all the bargaining periods. The bargaining periods that have been initiated by the ANF have the effect of bringing into the ambit of the disagreement as to what should be the subject of an agreement, or of agreements, the working conditions of persons who are not only eligible for members of the ANF but also persons who are eligible for members of, and are members of the HSUA. There is an overlapping coverage.
PN2666
I think it is correct to say an absolute overlapping of coverage. So that any termination of the ANFs bargaining periods will result in an arbitration which may result in an MX award which would bind my client's members and persons eligible to be members of it. It has a direct interest in resisting that outcome because it does not want that outcome, it wants to reach agreements. So the HSUA has a direct interest in resisting termination of bargaining periods whoever has initiated them, any attempts to terminate those bargaining periods on grounds made out under section 170MW(3).
PN2667
Similarly it has the same interest in resisting any attempts to terminate it under 170MW(7). In my submission you can't pick and choose those aspects of which part of the bargaining period you want it terminated under and against whom. I think it is reasonably clear in the learning of the Commission that you can't terminate part of a bargaining period. You are only entitled to terminate the bargaining period and the end result of any application to terminate the bargaining periods under both of the grounds that have been seemingly made out, and I don't know that they have been specifically identified in the application, but the grounds would suggest that those arguments are going to be made out under MW(3) and MW(7).
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2668
My client is entitled, I say again, to participate fully in resisting that application to terminate and to participate fully in all aspects of that case, including aspects as to whether or not the ANFs industrial action amounts to circumstances under MW(3) which would warrant termination. Hypothetically, Commissioner, you might have a circumstance where a union was quite happy to have its bargaining period terminated with the consequence that an MX award will be made which would freeze out the other union.
PN2669
Now, we of course would never expect our friends in the ANF to do that, but that is the potential consequence. So you might have a party who wants to roll over or run dead on the issue and succumb to the application of the employer. As I say, that is a hypothetical instance but nevertheless it illustrates the need and right of another party to participate fully in the proceedings and if we have a view about the ANFs industrial action which we believe needs to be put to the Commission in a way different from that of the ANF, and I don't believe I have been repetitious in any cross-examination and I would certainly intend to avoid that, but if we have an aspect which we wish to bring to the attention of the Commission which would in our assessment convince the Commission further or differently, then we, in my submission, are entitled to put that.
PN2670
Finally, Commissioner, and this is very much an after thought, but I do notice in the material that it is alleged that the HSUA is taking industrial action and I will be asking this witness about that shortly. If the Commission pleases.
PN2671
THE COMMISSIONER: Thank you, Mr Langmead. Mr Niall.
PN2672
MR NIALL: In relation to the objection of Dr Jessup we say that a party is a party for all purposes as opposed to an intervener and once you are a party you have all the rights of a party to make submissions and lead evidence in relation to the issues arising out of the application and therefore in my respectful submission Dr Jessup's objection should be overruled. If the Commission pleases.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2673
THE COMMISSIONER: Thank you, Mr Niall. Dr Jessup.
PN2674
DR JESSUP: If the Commission pleases, there are a number of issues that my learned friend Mr Langmead has raised and none of them in our submission holds water. The first is the point that Mr Niall joined with him on at the end, namely, that once you are a party to the proceedings you are a party for all purposes and you can conduct yourself entirely as you see fit. There is no such principle. Everyone is subject to the discretion of the Commission in the way they participate in the proceedings in the Commission.
PN2675
What requires parties, I use the word neutrally, what requires parties to be given an opportunity to be heard is a principle of natural justice. It is because you stand to lose something from the order to be made that you have a right to be heard and a right to general participation in the proceedings and that is the difference between a party and an intervener, because an intervener doesn't stand to lose anything from the order made in the proceedings that may have some flow on or knock on interest which needs to be protected. Now, in the present case, so far as subsection 3 is concerned, that could not be a ground upon which our clients rely because the HSUA hasn't taken industrial action.
PN2676
I don't ..... my learned friend refers to it as his most recent observation, it is something of a mystery. I am putting that entirely to one side, but we would - the submissions I make are subject to that. Now, certainly there has not been any section 170MO notice from the HSUA so it would be unprotected anyway. So that disposes in our submission of the first point. The second point is, and this came as some surprise, that our grounds are general and it is said against me that the actual application we made was an application directed at the HSUA as much as at the ANF. Well, as a matter of analysis under the Act that, with respect, can't be so. If you look at subsection 1, you may suspend or terminate the bargaining period.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2677
So the section operates on a bargaining period and you must give the negotiating parties an opportunity to be heard. Subsection 3 refers to industrial action that has been taken to support or advance claims in respect of the proposed agreement. That industrial action is the self same industrial action which negotiating parties are entitled to take under section 170ML. It is the negotiating party that is entitled to take industrial action and if it causes risk to life, safety, etcetera, under section 170MW(3) you can terminate the bargaining period of the negotiating party.
PN2678
The fact that the HSUA is a negotiating party qua the employer's bargaining period and that there is no industrial action arising under that bargaining period but they happen to be dealt with as part of the same proceedings because it is in the same industry and it is in the dynamic of the same dispute, doesn't mean that they stand at - that they are at risk I should say, of an adverse order against them from the Commission of a subsection 3 kind. So the suggestion that the grounds are general does not in our submission cut any ice.
PN2679
The other point is that they might have an interest because of the MX award that would come out, either because it would cover their members, or because if they weren't a party to it the whole thing might be set up to exclude them from it. Now, the last suggestion is fanciful, but if that is what they are concerned about then Mr Niall will no doubt make it clear that it is his client's intention. It is certainly news to us. The Commission is in the business, we submit, of giving parties a right to be heard on substantial, not theoretical or fanciful bases and we submit that if the HSUA wishes to intervene in the ANF side of the proceedings then they should make an application in the normal way showing that they have an interest in whether the ANF bargaining period is set aside.
PN2680
THE COMMISSIONER: Could I just intervene there, Dr Jessup. I have always been under the understanding that I have one application.
PN2681
DR JESSUP: Yes, you do.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2682
THE COMMISSIONER: By the employers who are negotiating parties with respect to two, or two sets of, or two bundles of bargaining period notices.
PN2683
DR JESSUP: Yes.
PN2684
THE COMMISSIONER: One whereby the employers were the initiating party.
PN2685
DR JESSUP: Yes.
PN2686
THE COMMISSIONER: And the other bundle where the ANF was the initiating party.
PN2687
DR JESSUP: Yes.
PN2688
THE COMMISSIONER: But I have got one application so there is no segmenting. There can't be. I have only got one application.
PN2689
DR JESSUP: Yes.
PN2690
THE COMMISSIONER: I don't have two.
PN2691
DR JESSUP: No.
PN2692
THE COMMISSIONER: So Mr Langmead can't in a pragmatic sense be shepherded off to one so that the HSUA could be properly heard in that one. I have one application.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2693
DR JESSUP: I am not suggesting he be shepherded anywhere, if by that you mean he leaves the room.
PN2694
THE COMMISSIONER: No, no, I meant in terms of being prevented from operating within the Commission with respect to the one application that I have.
PN2695
DR JESSUP: Well, he can and it always happens.
PN2696
THE COMMISSIONER: Yes, but what you are seeking to prevent him from doing, as I understand it, is to prevent him from cross-examining the witnesses that are being led by the employers and the Government with respect to the application.
PN2697
DR JESSUP: No, not with respect to the application. On the matter of industrial action.
PN2698
THE COMMISSIONER: I am not sure it can be segmented, Dr Jessup.
PN2699
DR JESSUP: Well, Mr Langmead could. The first thing he could do is not to ask this question which his very first question is please have a look at exhibit R9 which is the Southern Health's industrial action impact report for 23 April 2004.
PN2700
THE COMMISSIONER: Sorry, Dr Jessup, I interrupted you.
PN2701
DR JESSUP: And so that is how it is done, Commissioner. Mr Langmead is perfectly capable of knowing whether his questions relate to industrial action or not and he hasn't said that he is incapable of unscrambling the egg. He knows that he can cross-examine on matters which relate to the bargaining period to which his client is a party and our only submission is that he should be confined to that.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2702
THE COMMISSIONER: The effect of the application by the employers if it is granted could hypothetically be that there are no bargaining periods in place with respect to this dispute.
PN2703
DR JESSUP: Yes, and that is certainly what we would - - -
PN2704
THE COMMISSIONER: That is what you are seeking.
PN2705
DR JESSUP: Hope more than hypothetically, Commissioner, yes.
PN2706
THE COMMISSIONER: I am just being hypothetical, right.
PN2707
DR JESSUP: Yes.
PN2708
THE COMMISSIONER: Now, as I apprehend it, there are three negotiating parties to this dispute, whether it be on the basis of the employer initiated bargaining period notices or the ANF. There is the HSUA, there is the ANF and there is the VHIA on behalf of all of its members.
PN2709
DR JESSUP: That is a broad and generic way of looking at it but unfortunately it is not the statutory way of looking at it. There is a negotiating party for each bargaining period and section 170 something or other tells you what they are, the initiating party and the party that receives the bargaining period notice.
PN2710
THE COMMISSIONER: It distinguishes between the initiating party and the negotiating parties, yes.
PN2711
DR JESSUP: The initiating party is one of the negotiating parties.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2712
THE COMMISSIONER: Yes.
PN2713
DR JESSUP: The negotiating parties - - -
PN2714
THE COMMISSIONER: But in terms of the one application that I have, Dr Jessup, under 170MW(1), I read that as indicating that the Commission may suspend or terminate the bargaining period if after giving the negotiating parties an opportunity to be heard it is satisfied that any of the circumstances set out in 2 to 7 exist. Now, that is my job. That is what I have to do.
PN2715
DR JESSUP: Yes.
PN2716
THE COMMISSIONER: And from my perspective HSUA is one of the negotiating parties that is the subject to the application that I have.
PN2717
DR JESSUP: Yes.
PN2718
THE COMMISSIONER: And I have to be satisfied as a matter of discretion that any of the circumstances set out in 2 to 7 exists.
PN2719
DR JESSUP: Well, can I say this, if we can cut this short, Commissioner.
PN2720
THE COMMISSIONER: And I have to hear the negotiating parties about that.
PN2721
DR JESSUP: We can cut this short. We would have read the Act otherwise, but if the Commission is ruling that we are entitled to rely upon the ANFs industrial action to have employer initiated bargaining periods against the HSUA set aside or terminated, then we will accept that ruling and we will conduct the case in accordance with it and I note that that is to the effect of Mr Langmead's submission.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2722
THE COMMISSIONER: But isn't that what the effect of you seeking to terminate your bargaining period notices will do? That is, you as the initiating party, the effect of that will terminate the bargaining period notices initiated by all of the health services with the negotiating parties of the HSUA and the ANF, isn't that the effect or part of your application?
PN2723
DR JESSUP: If you are asking me other than in a rhetorical sense, Commissioner?
PN2724
THE COMMISSIONER: No, it is a dead straight question.
PN2725
DR JESSUP: Yes. Well, the answer is that not even in our wildest optimism did we think we could rely on subsection 3 against the HSUA.
PN2726
THE COMMISSIONER: No, no, you are doing it under 170MW. The Commission has discretion with respect to any of the circumstances that are set out in 2 to 7. Your application doesn't specify whether it is MW(2), (3), (5) or (7). The application is under 170MW, isn't it?
PN2727
DR JESSUP: Yes, yes. Well, the application doesn't use the magic numbers but it uses the words of the subsections.
PN2728
THE COMMISSIONER: Where?
PN2729
DR JESSUP: Paragraph 12 calls in aid subsection 3 and paragraphs 13, 14 and 22 call in aid subsection 7. I don't believe there is anything in the grounds other than - I don't think there is anything in the grounds which might suggest that any other subsection of the section is relevant and that is the way I believe I opened the case, Commissioner. I hope that the opening was of some assistance to the Commission but I believe that I made it clear that we are operating under subsection 2 and subsection 7. But again, I don't want to be
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
making a submission in which my client will be worse off than the very favourable position I perceive it might now be getting organised into as a result of Mr Langmead's submission. If he wants to expose his client to the risk of our relying upon a subsection 3 ground, then I think that our clients would probably be prepared to conduct according to those rules of engagement.
[3.58pm]
PN2730
THE COMMISSIONER: Mr Langmead.
PN2731
MR LANGMEAD: I am not sure that that means the objection isn't pursued, Commissioner.
PN2732
THE COMMISSIONER: I think you needed to have listened very carefully to what Dr Jessup said.
PN2733
MR LANGMEAD: Well I always try and listen very carefully to what Dr Jessup says, but, Commissioner, one thing I do want to say is, with the greatest respect, I think Dr Jessup appears to be operating under a misapprehension. The bargaining of period that each of the hospitals, health services have is a bargaining period with both the ANF and the HSU.
PN2734
DR JESSUP: Yes, yes, I completely accept that, no question about that.
PN2735
THE COMMISSIONER: Yes, but I think Dr Jessup says yes, that is right, but the health services, through Dr Jessup, are not trying to terminate the bargaining period with respect to HSUA on 170MW(3) grounds, but on MW(7). I think - is that in essence what you are submitting?
PN2736
DR JESSUP: That was the basis of the objection, Commissioner, yes.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2737
MR LANGMEAD: Commissioner, what they are trying to do is terminate the bargaining periods to which the HSU and the ANF are parties. Each of the bargaining periods, health service on one side, HSU and ANF on the other. Each of those bargaining periods is the subject of an application to terminate. Now, it doesn't matter on what basis you say they should be terminated, and you can't terminate them in part, you can't say, well we only want the bit that is against the ANF terminated, you can only terminate the bargaining period.
PN2738
And if you come to the conclusion that it is the ANFs actions which are causing you to act under 170MW(3) to terminate the bargaining period, then that affects us just as greatly as it affects the ANF and the employer; we are a party to that bargaining period, we are a negotiating party for the purposes of MW(1) as, with respect, the Commission has already identified, and as such we are directly subject to any order of the Commission in relation to that bargaining period. It can't be any plainer than that, with respect, Commissioner, we are a negotiating party, we are a party to these proceedings, we are party principal and we are directly affected in any outcome which might come from it. An order terminating the bargaining period will terminate the bargaining period, vis a vis the HSUA.
PN2739
THE COMMISSIONER: And, Mr Langmead, are you saying that is whether you have got industrial action, whether the termination of the bargaining period is hypothetically found by the Commission to be under 170MW(3) and as a matter of fact the HSUA has no industrial action in place?
PN2740
MR LANGMEAD: Yes.
PN2741
THE COMMISSIONER: Yes, that is what I thought you said, I just wanted to double check. Thank you. Is that clear, Dr Jessup?
PN2742
DR JESSUP: Yes, I don't have anything further to add to that, Commissioner.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2743
THE COMMISSIONER: Okay. So given Mr Langmead's clarification, Dr Jessup, do you still have an objection to Mr Langmead cross-examining poor Dr Allen, who is sitting very patiently?
PN2744
DR JESSUP: When that was being clarified I was looking at something in the Act, Commissioner, could you just reinforce that, please?
PN2745
THE COMMISSIONER: Maybe Mr Langmead might like to reinforce what he has just said.
PN2746
MR LANGMEAD: Well, I think it is in answer to your question, Commissioner, we say that the Commission is able to come to the conclusion that the ANFs industrial action could constitute circumstances under 170MW(3) which would permit the Commission to exercise discretion to exercise the bargaining period in respect of the relevant health service and the ANF and the HSUA, even though the HSUA was not taking industrial action. That would be the effect of you coming to that conclusion and exercising your discretion to so terminate the bargaining period.
PN2747
THE COMMISSIONER: So, basically, Mr Langmead, you are saying that if the bargaining period is terminated it applies to all of the negotiating parties who are part of that bargaining period notice, whether they are taking industrial action or whether they are not.
PN2748
MR LANGMEAD: Yes, because you can't terminate part of a bargaining period, with respect, Commissioner.
PN2749
THE COMMISSIONER: Or you can't terminate it with respect to one negotiating party versus another.
PN2750
MR LANGMEAD: Well, no, no.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2751
THE COMMISSIONER: I think that is what you are saying.
PN2752
DR JESSUP: Yes, I am content with that, I won't press the matter.
PN2753
THE COMMISSIONER: Thank you, Dr Jessup. Mr Langmead.
PN2754
MR LANGMEAD: Thank you, Commissioner.
PN2755
Dr Allen, have you got exhibit R9?---Which one is that?
PN2756
They are the collection of industrial action impact reports.
PN2757
THE COMMISSIONER: Sorry. It is the one behind tab 1 or?
PN2758
MR LANGMEAD: It is tabs 1 through to - sorry, I think it is - - -
PN2759
THE COMMISSIONER: And there is 3 and 4.
PN2760
MR LANGMEAD: - - - 1, 3 and 4, thank you, Commissioner.
PN2761
THE COMMISSIONER: Yes.
PN2762
MR LANGMEAD: Dr Allen, the document under tab 3 indicates that as - - -
PN2763
THE COMMISSIONER: That is with respect to 21 April.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2764
MR LANGMEAD: I am sorry, tab 4, which is 20 April.
PN2765
THE COMMISSIONER: Hang on, just slow down.
PN2766
MR LANGMEAD: Have you got that, Dr Allen?---Yes.
PN2767
Yes. The number of beds closed not due to action is 16. You see that?---Yes.
PN2768
Yes. And then the next day it - the number in that category has risen by 20 to 36?---So we now go to 3, aren't we?
PN2769
To tab 3?---It rose to 36.
PN2770
Yes?---Yes.
PN2771
And that was on the 21st?---Yes.
PN2772
And then come the 23rd, which is the tab 1, it has risen to 77?---Yes.
PN2773
Yes. I think you said, in answer to Mr Niall, that you thought this was a response to the contractual situation of the health care service. Is that right?---Well, no, I think I said I didn't know why it had gone to 77, but I was talking in the broad sense that the beds that are allowed to be open relate to the contractual arrangement.
PN2774
Yes. Because, Dr Allen, it seems a peculiar coincidence that at the same time as the ANF is starting to close beds the employer is starting to close them as well. It is almost as though it is a response, isn't it?---Well, I mean, I am like you, merely reading the reports in front of me which state the facts as reported to the person that is collecting this information.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2775
You can't explain why - - -?---I don't know, no, I don't.
PN2776
Now, if I ask you to look at the tab 1 document?---The 23rd.
PN2777
Yes?---Yes.
PN2778
And there is a page - the fourth page in, which has got 13 of 14 at the bottom of it?---13 of 14, yes.
PN2779
Yes. Now you see that it has got industrial action details there?---Yes.
PN2780
And it says, in the third column it has got ANF and HSUA. The HSUA entry seems to be under the status of new. Is that right, that how you read the form?---Wait on - yes.
PN2781
Yes. And then the fourth column it says, work bans?---Yes.
PN2782
What work bans are they?---I don't know.
PN2783
All right. Did you know that the HSUA was taking industrial action?---No. No, it says, if work bans specified in nature and impact, on page 2, doesn't it? Is that helpful?
PN2784
Does that assist you in any way, Dr Allen?---Well, I am looking for page 2. No it doesn't. I don't know if page 2 is here, is it?
PN2785
There is - the following page is numbered 14 of 14, which is, as you would expect, is the sequential one?---It doesn't look as if 2 of 14 is here.
**** PETER SYDNEY ALLEN XXN MR LANGMEAD
PN2786
You are unable to explain that, Dr Allen, okay. Now there is another page which is 5 of 14. Found that?---Yes.
PN2787
Yes. And you see that there is what appears to be existing work bans and bed closures by HACSU number 2 and ANF. Now HACSU number 2 is the Victoria number 2 branch of the HSUA, you know that, don't you?---Yes.
PN2788
Yes. Do you know anything about these work bans or bed closures?---No, I don't.
PN2789
Yes, thank you, Commissioner.
PN2790
THE COMMISSIONER: Thank you, Mr Langmead. Any re-examination, Dr Jessup?
PN2791
PN2792
DR JESSUP: At Southern Health what is the critical aspect of the work bans, the bed closures - when I say critical, what is the aspect of them that stops you performing the procedures that were cancelled in that document that you tendered? Is it the limit on operating sessions, as such, or is it the bed closures or something else?---Well these procedures, these 41 procedures were identified by the theatre complex as being cases that were not to go ahead.
PN2793
Yes?---So that is the limiting factor in these cases.
PN2794
Yes. Was the reason that they didn't go ahead because of that paragraph of the bans which says that 1 in 4 surgical procedures would be cancelled, or was it because there would not be a bed for the patients to go into after their operation?---I believe it was the paragraph (e) that says that 1 in 4 booked sessions or equivalent.
**** PETER SYDNEY ALLEN RXN DR JESSUP
PN2795
Yes, thank you. Now you were asked by Mr Niall about the relative degrees of urgency and so forth of these procedures on this list, which is exhibit A10, Commissioner, and the amount of time that they had been waiting. I noticed from the list that there are three category 1 procedures that have been cancelled?---Yes.
PN2796
And they are all hysteroscopies?---Correct.
PN2797
D and C, what is a D and C?---Dilatation and curettage.
PN2798
And do you know the purpose of these procedures?---These procedures would generally be performed in - for women who had abnormal uterine vaginal bleeding, whereby the potential was there for them to have an endometrial uterine carcinoma, cancer of the uterus.
PN2799
Yes. And - - -?---So this is a diagnostic procedure to either diagnose or exclude a cancer of the uterus.
PN2800
Now those having been cancelled, are you able to say what then happened to them?---Well, they will be - need to be put back into the pot, if you like, with respect to re-booking, to be re-booked for re-booking.
PN2801
Yes. I noticed that in the column headed "HIP" - - -?---Yes.
PN2802
- - - each of them has a "1" entered?---That means this is their first cancellation.
PN2803
I see. So wherever there is a "1" in that column it is referring to the cancellation - - -?---That is correct.
**** PETER SYDNEY ALLEN RXN DR JESSUP
PN2804
- - - due to this industrial action?---That is correct.
PN2805
And likewise, with respect to the others, would they be re-booked at some point?---Yes, they will all go back into the pool of 7900 patients in order to come up again.
PN2806
Yes, thank you. Yes, that is all, thank you.
PN2807
PN2808
DR JESSUP: Our next witness is Ms Williams. Might she be called, please?
PN2809
MR NIALL: Could I just ask what time the Commission proposes to rise this afternoon?
PN2810
THE COMMISSIONER: I hadn't planned to go much beyond 5. I don't know what Dr Jessup's view is apart from preference. If it was a perfect world, sit till midnight, but -
PN2811
MR NIALL: We won't finish the case today, but we will finish the case tomorrow.
PN2812
THE COMMISSIONER: I am just wondering, actually, yes, it is clear we are not going to finish the witness evidence let alone anything else today. In terms of whether we finish tomorrow I was going to ask the parties as to whether there were any additional witnesses that Dr Jessup wished to call and secondly, whether Mr Niall, you were going to call any?
PN2813
MR NIALL: We are going to call Mr Burrows.
PN2814
THE COMMISSIONER: Apart from - - -
PN2815
MR NIALL: And possibly one other which we will know tonight, but certainly one, but even allow - I am not sure whether Mr Langmead intends to call any evidence.
PN2816
THE COMMISSIONER: I hadn't got to Mr Langmead, sorry.
PN2817
MR NIALL: But assuming - I think it is a safe assumption that Dr Jessup hasn't got any more witnesses other than the seven that he has indicated, we will complete the case tomorrow, I would submit and there will be some legal argument and submissions. I am not sure of what order of time that might take.
PN2818
THE COMMISSIONER: Okay, so in terms of your assertion that this matter will be finished tomorrow, what sort of timing is that assumption based on, Mr Niall.
PN2819
MR NIALL: That we would finish the witness evidence some time after lunch, not long after lunch, perhaps at lunchtime and then it would be submissions. In my submission, rather than sitting late today, perhaps call this witness with evidence-in-chief, time would be better spent for us, at least my side of the bar table in preparing submissions so that there is no interruption between the close of evidence and submissions tomorrow and the Commission might be assisted by that, that it won't be time wasted.
PN2820
But if we sit early to say, perhaps, conclude the evidence-in-chief of this witness, we would then use that time to prepare submissions so that we could go straight into it tomorrow and there wouldn't be a gap, and we would finish tomorrow even if it required sitting a bit late. If the Commission pleases.
PN2821
THE COMMISSIONER: Mr Langmead?
PN2822
MR LANGMEAD: Firstly, Commissioner, I don't at this stage anticipate the HSUA will be calling any evidence. Other than that, I would support Mr Niall's suggestion and suggest that we would be better off taking advantage of an early finish so that we could prepare for tomorrow.
PN2823
THE COMMISSIONER: Dr Jessup?
PN2824
DR JESSUP: First if I could clarify what Mr Niall is actually suggesting. If he is suggesting that we shouldn't sit beyond 5 o'clock, then I don't think I would press for anything different. If he is suggesting that you should rise now, well we would ask you to sit until 5.
PN2825
THE COMMISSIONER: Mr Niall was doing a hybrid. He was suggesting evidence-in-chief of Ms Williams and then rising until tomorrow.
PN2826
MR NIALL: That is right, Commissioner.
PN2827
MR LANGMEAD: And that is what I thought I was supporting, Commissioner.
PN2828
DR JESSUP: Well, I don't think the evidence-in-chief would go beyond about 10 minutes or so and the difficulty is that we have only done one and a half witnesses today and there is a further three witnesses on our list, plus Mr Burrows and a possible fifth.
PN2829
THE COMMISSIONER: I actually have a concern. Witness evidence will be concluded tomorrow, but I am not actually confident on our current rate of moving forward that the submissions and the legal arguments will have been concluded tomorrow. Because there is a limit as to how long we can all sit.
PN2830
DR JESSUP: Yes, well yes I - well as far as how far we get tomorrow, Commissioner, we will do the best when we get to it in the circumstances.
PN2831
THE COMMISSIONER: I understand that. I am just being pragmatic, Dr Jessup.
PN2832
DR JESSUP: Yes.
PN2833
THE COMMISSIONER: We have done one and a half witnesses a day, in essence.
PN2834
DR JESSUP: Well if we are going to get anywhere near finishing the evidence tomorrow, which should be the first goal - - -
PN2835
THE COMMISSIONER: Yes, absolutely.
PN2836
DR JESSUP: - - - then we really need to use a bit more of today in our respectful submission. That is our thinking on this matter.
PN2837
THE COMMISSIONER: Yes, I mean I would wish to conclude the witness evidence tomorrow and then final submissions on - I have lost track of the days, Thursday, is that right?
PN2838
DR JESSUP: Yes.
PN2839
THE COMMISSIONER: Thursday morning.
PN2840
DR JESSUP: Yes.
PN2841
THE COMMISSIONER: Which is longer than I had anticipated for this matter but we haven't actually been sitting around drinking lattes.
PN2842
DR JESSUP: No, well - - -
PN2843
THE COMMISSIONER: The parties are arguing over half an hour.
PN2844
MR NIALL: Look, I am content to follow Dr Jessup's course. We will start - we will sit until 5 o'clock.
PN2845
THE COMMISSIONER: Thank you, that would be appreciated.
PN2846
PN2847
DR JESSUP: Is your name Jennifer June Williams?---Yes.
PN2848
And are you the Chief Executive Officer at Austin Health?---Correct.
PN2849
Have you prepared a witness statement to form the basis of your evidence in this case?---I have.
PN2850
And do you have a copy of that with you?---I have it with me.
PN2851
Is there anything in it which needs to be changed?---No.
PN2852
Would you turn to the last page, please, page 6. I just want you to sign that, please, and amend the date to today's date which is - - -?---Signed my copy.
PN2853
THE COMMISSIONER: Dr Jessup?
PN2854
DR JESSUP: I am sorry, yes, we will get the copy that the Commissioner has and sign the Commission's copy and amend the date so that it shows it was signed on 27 April?---27th.
PN2855
Thank you, Ms Williams. There is a couple of other things in a moment. I tender that, if the Commission pleases.
PN2856
THE COMMISSIONER: Is there any objection, Mr Niall?
PN2857
**** JENNIFER JUNE WILLIAMS XN DR JESSUP
PN2858
DR JESSUP: Ms Williams, you have spoken in your statement about the effect of the bans imposed by the ANF, haven't you?---Yes.
PN2859
I just want to ask you whether you are aware of the actual mechanical process by which these bans are enclosed. Can we take bed closures, how, when and why and by whom is a particular bed closed in the way these bans work their way through the hospital?---Is the question do I understand that?
PN2860
Yes?---Yes, I do understand how that happens, yes.
PN2861
Well tell me what happens?---Well, on the first day of the - of the industrial action, each of the wards were to identify either existing vacant beds or patients that would be discharged during that day and after that discharge that bed would be closed until each ward got to one in bed - one in four beds that were closed and that went on right throughout Austin Health on the three hospital campuses.
PN2862
And what staff were making the calls in that regard at the ward level?---Well the staff were following the direction that came out from the ANF and the local ANF representative would go around the hospital and check on discharges and check on the number of beds that were closed as well as the local ward staff doing it.
PN2863
Yes, all right, now have you got some updated figures of procedures that have been cancelled or deferred as a result of these bans?---I have got figures of yesterday in terms of surgery and yesterday there were 18 elective patients that had been cancelled.
PN2864
And what - - -?---But that does mask a larger number of cancelled; patients that aren't being booked because of the action so it actually understates the total number of patients that are in fact being impacted by these bans.
**** JENNIFER JUNE WILLIAMS XN DR JESSUP
PN2865
Were these 18 - 18 on yesterday or 18 up to and including yesterday?---That was just in a single day.
PN2866
Just the one day?---Correct.
PN2867
And were there any of those category 1?---Yes, there were - yesterday there were five category 1 patients that we had to cancel.
PN2868
Are you able to tell the Commission the nature of the condition or procedure that was involved in each of those?---Yes, I have got some summary information on each of the five patients.
PN2869
Would you tell the Commission that, please?---Yes, these are patients that have been assessed by their surgeon that they are category 1 needing surgery, therefore with 30 days. The first patient is a patient that needed - had a nasty wound and needed a wound debridement and they were put on the waiting list on 20 April and we had to cancel them so they have not had their surgery and they are booked for 28 April.
PN2870
That is tomorrow?---Correct, so they have had a delay in their surgery. The second patient is an excision of a sarcoma, which is a type of cancer. This patient went on to the waiting list on 20 April and has been re-booked for 29 April, so has had a delay in their surgery as we have had to juggle more urgent patients on to the list prior to this patient having his surgery. The third patient, is a patient requiring a prostate operation. It is either cancer or it is a benign enlargement. This is a very complicated patient who has had five previous cancellations because the patient has been medically unfit so it has been very difficult to get this patient fit enough for surgery and has been cancelled previously because they have been medically unfit. The patient was ready for surgery yesterday and unfortunately had to be cancelled because we didn't have a bed for the patient. I don't have a date for when this patient can be re-booked at the moment. The fourth patient was a vaginal hysterectomy and a removal of one ovary and this patient went on to the waiting list on 5 March, is quite a
**** JENNIFER JUNE WILLIAMS XN DR JESSUP
serious case, has a what is called a stage 3 prolapse of the uterus which is external to the body and the patient has been re-booked for 10 May. It is a very complicated patient and has had three previous cancellations because this person has been medically unfit so unfortunately this woman has to wait longer for their surgery. And the fifth patient was another gynaecological patient that required a DNC and hysteroscopy. This patient went on to the waiting list on 30 March and has been re-booked for 24 May.
PN2871
And do you know what is the purpose of the hysteroscopy in this instance?---The purpose will be exploratory and about 5 per cent of patients undergoing this procedure will have cancer diagnosed as a result of it. So this patient is potentially going undiagnosed with cancer due to the delay in surgery, yes.
PN2872
Yes, now do you have any up to date figures as to the total number of bed closes at Austin?---The total number of bed closures as of yesterday were 77 across the three hospitals.
PN2873
Yes, thank you, and the - do you know of some time which you would please identify, how many of those waiting in emergency department have been there for more than 12 hours?---Yes, in fact I was speaking to the medical director of the hospital at 4 o'clock and the Austin Hospital is currently on bypass and the system across Melbourne is increasingly getting grid locked. The Alfred Hospital has been on bypass today and Royal Melbourne has been on bypass today and we have what is called HUES (?) which is an early warning system which a hospital will alert the ambulance service that they are about to go on bypass, and we have had St Vincents on HUES twice today, we have had Frankston on HUES twice today and Royal Melbourne had two HUES before it actually called a bypass. So there is a lot of stress in the emergency departments across metropolitan Melbourne. So Austin has now been on bypass three times during this industrial dispute with the one that we are currently on bypass. So the emergency department is completely full. All of our cubicles are occupied. Our two resuscitation bays are occupied with critically ill patients. We have an ambulance on its way to the Austin and we have seven patients who have been waiting over 12 hours trying to get into a bed. We just, at 4 o'clock, some relief with a couple of those patients going up to the ward, but the department is still full at the moment with patients.
**** JENNIFER JUNE WILLIAMS XN DR JESSUP
PN2874
Is there any other respect in which you wish to bring your statement more up to date or add anything to what you put in your statement?---No, I think in terms of detail, that is - that represents the current status.
PN2875
Thank you.
PN2876
PN2877
MR NIALL: If the Commissioner please. Ms Williams, you are the Chief Executive Officer of Austin Health. I take it you are based at the Austin?---My office is at the Austin. Correct.
PN2878
Yes. And the Austin and the Heidelberg Repatriation Hospitals, they are co-located aren't they?---No. They are a kilometre apart. They are two separate hospitals. There are three hospitals that comprise Austin Health. It includes The Royal Talbot.
PN2879
Thank you. And you have been there since November 1997 and before that you were a director of the Department of Human Services?---Correct.
PN2880
Do you have medical qualifications?---I do not. I have got a management background.
PN2881
Right. Thank you. And when you worked with the Department of Human Services was that in the - which sort of side of the Department was that. The health side?---In the health side. Correct.
PN2882
Now for the purposes of preparing this report, this statement I am sorry, I take it that you asked or arranged for the statistics to be collated of the effect of the bans within the Austin?---I did.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2883
And that was across the three campuses?---Yes.
PN2884
Now the issues, if I could summarise them for the Austin and when I say Austin I am referring across the campuses, are identified in your statement and the two areas, I take it, are the emergency department and the impact on elective surgery. They are the two major areas of concern for you?---They are. Both of those areas though impact the whole hospital because the wards are obviously impacted by the problems relating to both surgery and the emergency department.
PN2885
The hospital is very much a process isn't it? People come in through accident and emergency and a proportion, significant proportion, go into as in-patients - - - ?---Flow through.
PN2886
- - - in wards. And it is a constant process of people coming in and leaving?---Correct.
PN2887
And the hospital tries to get the balance right between the demands that come in. Keeping patients in and then discharging them when they get out?---Yes.
PN2888
Now in terms of the emergency department the issues, I take it, are one; whether patients can get in to the emergency department?---Yes.
PN2889
The second one is whether they can get triage. That is assessed and treated immediately they arrive or within an appropriate time. Do you agree?---Yes.
PN2890
And the third - getting out for those who have been admitted. The third aspect of the emergency is to get them into a ward?---Appropriate treatment and timely transfer to their final treatment place. Yes.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2891
Now putting aside for the moment, we will come to a hospital bypass, there is no ambulance bypass I am sorry. There is no problem with patients getting in to the emergency is there?---In terms of just getting in the front door?
PN2892
Yes?---No. There is not a problem in that.
PN2893
And the triage times during the period, the currency of the bans, are within normal parameters?---I have not seen those so to be quite honest I could not answer that specifically based on having seen the data for the specific triage times during this strike.
PN2894
And the time it takes to get in, in ordinary circumstances, by ordinary I mean before the bans, the time it takes to get from emergency into a ward fluctuates. There is not one standard for a patient is there?---Each hospital has a target.
PN2895
Yes?---And our target is in excess of 95 per cent of patients are expected to be transferred to a ward, if the decision has been made to admit them, from the time of triage. And we typically do perform within those parameters of the low 90 per cent submission within 12 hours. Yes.
PN2896
All right. So the target is about 95 per cent and you get within about - you get about 90 per cent?---Yes.
PN2897
So 10 per cent are staying longer than, on average, longer than 12 hours?---In general. Yes.
PN2898
And that period of staying longer than 12 hours would usually be associated with periods of high demand in emergency?---Both high demand in emergency and bed block are the two issues that prevent orderly transfer of patients. Or blockage within the department. Yes.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2899
And the causes of bed block are what?---The causes of bed block are simply not enough beds to admit patients into and lack of flow through the system either to home or to rehabilitation of aged care or to Royal District Nursing Service or Hospital in the Home or other potential parts of the service system to care for these patients.
PN2900
Now we will come in detail to the effect of the bans shortly but since last Wednesday what has been the percentage of through put of patients getting in, out of emergency into a ward in less than 12 hours?---I have got the figures that DHS reports across all of the hospitals that show, you know, that we have ten waiting more than 12 hours - - -
PN2901
Yes?---- - - on the 26th, four on the 25th. So I have those figures.
PN2902
Yes?----Presumably you have got them as well.
PN2903
Yes. We have been given copies of those?---Mm.
PN2904
They are actual numbers aren't they? They are actual - - - ?---Numbers of patients. Yes.
PN2905
The question I asked you was do you know the percentage of through put. See the target you get is not a, is not an absolute number target is it?---No.
PN2906
You do not have a target to get?---No, it is monthly.
PN2907
It is a percentage?---The figure yesterday was in the low 80 per cent so there has been a deterioration.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2908
Well, when you say there is a deterioration there is a variation between yesterday's target and the average. Would you agree with that?---Between yesterday's target?
PN2909
Yesterday's result and the average?---Well, it is calculated cumulatively so the figure I would be quoting is the month to date which would include the component of the bans.
PN2910
I am sorry?---Yes. And so - you do not calculate the figure daily. You calculate it on a - - -
PN2911
Yes. Well, that was the question I was just coming to?---Yes.
PN2912
So for the month of April you are tracking at about 80, low 80 per cents?---Low 80 per cents. And normally low 90 per cents.
PN2913
Yes. And that is of April - we are now at the 27th and I think that figure was from yesterday the 26th. And of that there would be about five days of bans?---Last Wednesday. Correct.
PN2914
Yes. So you are not in a position to say how the last five days, or six days, has compared firstly with April as a whole? In terms of percentage of patients getting through - do you think less than 12?---I do not have those figures in front of me - - -
PN2915
Yes?---- - - but the figures, the figures that I have seen, indicate that there was a deterioration during this last week period as a result of the ban.
PN2916
A deterioration in the monthly figure?---Which has pulled the figure down from the low 90 per cents to the low 80 per cents.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2917
Yes?---I am sorry am I understanding what you are saying?
PN2918
Yes?---I mean - - -
PN2919
Yes?---I would have thought be definition with the bans through the week it has pulled it down by approximately 10 per cent.
PN2920
And notwithstanding the monthly figure would be in the order of 90, 95 per cent, the daily figures would fluctuate quite significantly within that wouldn't they?---They do. Yes.
PN2921
So some days, particularly where there is low demand, you would expect a very high percentage of patients getting through. In fact 100 per cent getting through in less than 12 hours?---Yes.
PN2922
What days of the week would you expect to see that sort of figures? Earlier or later in the week?---The beginning of the week tends to be - - -
PN2923
Better?---- - - the harder. No. It is busier on Mondays, in particular, and, you know, during the middle of the week it is a little bit easier. But it is variable as well. So while there is a seven day pattern it is variable by day of week as well.
PN2924
Now in terms of elective surgery you have given some - 18 elective procedures have been cancelled to date?---I think you are referring to my affidavit now.
PN2925
No. The evidence that you gave in answer to - - - ?---Of today. Was 18. Correct.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2926
Was that - I might have misunderstood your evidence. Was that just for today or was that the cumulative figure?--- No. 18 is today. From the theatre report.
PN2927
Okay. Right. And how many surgical procedures were performed today?---I do not have that figure I am sorry.
PN2928
And the effect of the bans generally is that elective surgery has been postponed?---Yes.
PN2929
Now before coming to the bans in detail I want to take you to paragraph 12 of your statement. And you say:
PN2930
In my experience for every 24 hours that these bans remain in place Austin Health's capacity to deliver adequate health services will diminish and this will have an enormous impact on welfare in a variety of ways.
PN2931
And you set out the ways below and that is principally delays in admission to emergency and effect of elective surgery. Correct?---Yes.
PN2932
Now when you say "in my experience for every 24 hours" what experience are you drawing on there?---Well, I was in my current job during the last industrial action - - -
PN2933
All right?---- - - so I have some experience of that.
PN2934
And that last industrial action was the one that took place in 2001. Is that the one you are referring to?---Correct. Yes.
PN2935
And there were bans of a similar type introduced back in 2001. Bans on a certain number of beds and bans on a certain number of theatres. Is that right?---That is right. They were very similar.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2936
And back in 2001 was it the case that there were less beds in Austin Health than there are now open?---Look, I would think there would have been more beds open but I - - -
PN2937
Back in 2001?---Yes. Because we have done some, you know, obviously some analysis of the organisation. I think there probably would have been a slightly higher number of occupied beds back then but I do not have factual recall of those figures.
PN2938
Okay?---The reason being in the last two years there has been a lot of effort to develop non bed based services so that we divert patient from in-patient beds to Hospital in the Home, day treatment, day surgery and other models of care because we have demand pressures on the hospital so - - -
PN2939
And has that permitted you to close beds?---So that has enabled us to operate on a smaller number of staffed beds and typically a higher through put through those beds with a reduced length of stay.
PN2940
Certainly the number of nursing staff available at Austin is greater now in 2004 than it was in 2001?---I believe that is correct. Yes.
PN2941
Quite a significant difference?---I would not put a fine point on it without looking at the figures - - -
PN2942
Yes?---- - - but, yes. The last EBA there were additional nurses that resulted as from that dispute.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2943
In many - would you agree that in, firstly as a result of the increased number of nurses, and secondly as a result of the change of the patterns of servicing that you have just referred to, the hospital is better placed to cope with bed closures as a result of the industrial action than they were in 2001?---Well, in one respect I think you could argue that they are better placed. But I think offsetting against that if you have got an overall increase in demand on hospitals which across the State is about three per cent a year and in Austin Health we have had a significant increase in emergency overnight work year on year. So if you look, for example, at the quarterly report there is a 12 per cent increase in overnight emergency patients at Austin Health year on year. And if you look year to date it is about 14 per cent. Now that is not general across other health services but that is putting enormous pressure on our hospitals. So it is, I think, arguable that we are having trouble - we are having more trouble coping now because we have got a higher presentation rate of emergency patients than we would have had three years ago which was your proposition. Three or four years ago, which was your proposition.
PN2944
So you are not in a position to say one way or the other. You anticipate it would be roughly the same sort of response?---I would not even them out the way I think you are trying to do subjectively. A 14 per cent increase in your overnight emergency patients, which the Austin has had to deal with, is a huge increase in patients which has put enormous pressure on the hospital. And these bans are coming on top of a year where we have had this quite exceptional growth in emergency. And as I think you would understand emergency patients are not patients you can turn away. So you have got to treat them one way or another and find a way to get them into your health service.
PN2945
All right. Now as a result of the implementation of the bans there has been some bed closures. Would you agree that it has been the expressed intention of the AF not to deny access to the hospital for an emergency patient as a result of the bans?---I understand that is the intent but that has not been the outcome.
PN2946
Firstly, let us deal with the intent. Can I ask you to look at this document please? Well, I will deal with it - this is an updated dated 23 April from Austin Health, and I wanted to just look at the paragraph under the heading "Management of Industrial Action":
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2947
As described above it is anticipated that industrial action will continue, Austin Health is committed to ensuring that patient care is not put at risk, that emergency, medical and surgical patients are treated as required.
PN2948
Now pausing there, Austin Health still has that commitment?---We have that commitment, yes.
PN2949
Yes, and we believe - that is Austin believes, that this is also the ANF's attention - intention, and that was the belief from 23 April, and that is still your belief; that that is the intention of the ANF?---I believe that is, yes, their intention, yes.
PN2950
I tender that, if the Commission pleases.
PN2951
THE COMMISSIONER: Is there any objection, Dr Jessup?
PN2952
DR JESSUP: No, no, Commissioner.
PN2953
PN2954
MR NIALL: And, could the witness be shown R4, please. This is a statement from the ANF detailing the industrial bans. Have you seen that document before, or document - - -?---I have seen this document, yes.
PN2955
And but I - two pages in, there is a document headed "Admission of Emergency Patients Including Reserved Emergency Beds". Have you seen that document before?---I don't believe I have read this page before, no.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2956
Right, well if you will see in paragraph 1 - not see it - but, it is said there that:
PN2957
It is not the intention to deny emergency care to any patient who needs it during the dispute.
PN2958
And that is your understanding of the intention of the ANF?---The impact is different from the intention.
PN2959
All right, we will come to impact. Now, when the Austin got notice of the industrial action on 17 April and the form that it would take, did Austin Health take any steps to prepare itself for the industrial action?---Yes, we did.
PN2960
What did you do?---We held a meeting of all the senior managers and senior clinical managers to develop a plan to minimise the impact on patients.
PN2961
Yes. Did you do anything else?---And there has been regular meetings each morning to review surgical lists. There is a meeting which is either at 8 am or 2 pm each day to examine the current status and to try and unblock blockages and to manage as best we can. There is an inordinate amount of attention going into trying to ensure as best possible, a service can be provided during these bans.
PN2962
And the nurses employed at Austin Health have been cooperating in that process?---Certainly there has been some good cooperation, but there has also been some frustration in getting patients in who are seen by some clinicians as being emergency patients, which the nurses or the local ANF person is not agreeing that they are an emergency patient. And today, for example, with these patients in the emergency department, there was a three hour discussion where there was a considerable number of people taking up in a discussion with the ANF rep, debating on whether this patient was an emergency patient or not, and all this time the patient was waiting in the emergency department while these discussions went on. So there is argument and debate over what represents - what is an emergency patient, and whether a particular patient is deemed to be an emergency patient.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2963
And the outcome of that debate today?---In some cases - - -
PN2964
The particular example that you spoke of?---In some cases, a bed is open to allow the patient to move into it, in other cases that does not happen.
PN2965
In the particular example that you spoke of, the bed was opened as a result of those - - -?---I was talking about the seven patients that were waiting more than 12 hours. There was a discussion over those seven patients.
PN2966
There was - - -?---And some of those got into a bed, and others have remained in the emergency department.
PN2967
And ultimately the decision as to whether or not the patient is an emergency patient, has rested with the combination of the treating medical practitioner and the nursing staff, hasn't it?---Well, the nurses are gate-keeping the beds. So, in this case the medical staff were putting forward why they felt the patient warranted to be considered as an emergency patient and the nursing staff were arguing the patient shouldn't be considered an emergency patient and were not allowing the patient to be admitted to the bed.
PN2968
And if ultimately, if the medical staff have insisted that the patient is an emergency patient, they have been admitted, haven't they?---I don't know of a situation where the medical staff has overridden the nurses.
PN2969
Well, do you know any - how many situations do you know of where, as a result of a nurse or an ANF job rep getting the final call, so to speak, that a person has been denied access to a bed on the basis that they are an emergency?---Well, that is occurring daily.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2970
And how many today, do you say that - that there has been a discussion?---I can't - there were seven patients - there was a discussion around the seven patients and I can't tell you how many of those seven eventually they convinced the staff to open the bed. But I was advised that some of the seven staff - it was agreed after this three hour discussion they would open the bed to let the patient into the bed but others have remained in the emergency department. I cannot give you the split of the seven patients.
PN2971
So, for some of those seven beds, closed beds were actually opened. Is that your evidence?---I assume that an extra bed was opened, but I can't tell you specifically.
PN2972
Yes. so in respect of some of those seven, beds were opened, and in respect of others, beds weren't opened but they would be moved in when an open bed became available, wouldn't they?---You would hope that would be the case.
PN2973
Well - - -?---But I can't make assumptions.
PN2974
Well, no one has been discharged from emergency who would otherwise be admitted. Have they been?---I don't know.
PN2975
Well, no one has - - -?---It does happen, it does happen that patients - you know, we have one patient in the emergency department right now who has been there 40 hours. Well, it might be that eventually that patient never gets to a ward because their treatment is completed within the emergency department because they have been frustrated in getting into a bed.
PN2976
And what is the - - -?---So that patient might spend its entire length of stay in the emergency department.
PN2977
What is the condition of the patient who has been there for 40 hours?---I don't have the details of that patient, but right now we have a patient who has been there 40 hours.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2978
The person who has been there for 40 hours, it is the case, is it not, that that person is an elderly person awaiting an aged care bed, who would not otherwise be admitted to an acute bed within the facility?---No, I am sorry, I have no information about that patient.
PN2979
Now, in paragraph 40 - paragraph 8 of your statement you refer to, as at 21 April, 45 beds were closed for reasons other than industrial action by nurses. Now, which facility were those beds in, or were they in a combination of beds?---The 45 were a combination of the Austin Hospital and the Heidelberg Repatriation Hospital. It was the Easter closures that we are referring to.
PN2980
And how many were at the Austin?---I don't have that at my fingertips, I am sorry. It is in material that I was subpoenaed for though, I believe.
PN2981
All right. Easter - the hospital has an Easter close period?---Slow down.
PN2982
Slow down? And as part of that slow down, 45 beds were closed?---Correct.
PN2983
Over how many weeks were they closed?---It was over a three week period. Today there are only 20 beds that remain closed as a result of that. So, on Monday a ward at the Heidelberg Repatriation reopened to its normal numbers, minus the one in four closures.
PN2984
Yes, so yesterday, that is the 26th, 45 beds reopened?---20 - - -
PN2985
Sorry?---25 of the 40 reopened, yes.
PN2986
And they were the Austin beds, were they?---Heidelberg Repatriation Hospital.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2987
They were the - so yesterday on the 26th, 25 beds reopened and then the ANF closed one in four, correct?---Yes.
PN2988
Correct?---Correct.
PN2989
Yes. Was there any reason why those beds weren't opened on 20 April?---The staffing rosters had not been set to open those beds. You talk about pre-strike, is that the point you are making?
PN2990
Yes?---Yes, no.
PN2991
Because the staff and roster hadn't been set?---Well, the rosters were set and they were not - there were no staff to open the beds.
PN2992
That was 25 of the 45, but when is it intended to open the other 20?---I don't have the figures, I am sorry.
PN2993
But that is planned, is it?---It is - it will be planned, yes.
PN2994
And that will come - - -?---But I don't have the dates as to precisely - they are across a number of wards at the Austin, so I don't have that detail in my head.
PN2995
Yes, and that is just part of the plan - - -?---Easter slow down.
PN2996
Or the end of the Easter slow down?---Yes.
PN2997
If that is a convenient time, Commissioner.
**** JENNIFER JUNE WILLIAMS XXN MR NIALL
PN2998
THE COMMISSIONER: Thank you. Ms Williams, we shall be adjourning until 9.30 in the morning, so I shall see you back at that time. That is it.
ADJOURNED UNTIL WEDNESDAY, 28 APRIL 2004 [4.56pm]
INDEX
LIST OF WITNESSES, EXHIBITS AND MFIs |
DANIEL PATRICK RATHGEBER, ON FORMER OATH PN1574
CROSS-EXAMINATION BY MR NIALL PN1574
EXHIBIT #R6 CAPACITY MANAGEMENT REPORT FOR MELBOURNE HEALTH, ROYAL MELBOURNE HOSPITAL, FROM 12 APRIL TO 22 APRIL PN1723
CROSS-EXAMINATION BY MR LANGMEAD PN1725
RE-EXAMINATION BY DR JESSUP PN1816
EXHIBIT #A6 CATEGORY 2 PATIENTS CANCELLED ON 26/04/2004 DUE TO UNION ACTION PN1859
FURTHER CROSS-EXAMINATION BY MR NIALL PN1927
EXHIBIT #R7 THE CAPACITY MANAGEMENT REPORTS FROM JANUARY 2004 UNTIL APRIL 2004 PN1995
FURTHER CROSS-EXAMINATION BY MR LANGMEAD PN2007
FURTHER RE-EXAMINATION BY DR JESSUP PN2116
WITNESS WITHDREW PN2130
PROVISIONAL EXHIBIT #A7 BEDS CLOSED DUE TO ACTION 22/04/2004 TO 26/04/2004 PN2165
PETER SYDNEY ALLEN, AFFIRMED PN2197
EXAMINATION-IN-CHIEF BY DR JESSUP PN2197
EXHIBIT #A8 WITNESS STATEMENT OF PETER SYDNEY ALLEN DATED 27/04/2004 PN2213
EXHIBIT #E9 BED QUOTAS PN2241
EXHIBIT #A10 TABLE OF PROCEDURES CANCELLED PN2246
EXHIBIT #A11 UPDATED LIST FOR THE 24TH TO 27/04/2004 PN2260
CROSS-EXAMINATION BY MR NIALL PN2261
EXHIBIT #R8 VHIA BULLETIN NUMBER 812 PN2606
EXHIBIT #R9 SOUTHERN HEALTH'S INDUSTRIAL ACTION IMPACT REPORT FOR 23 APRIL, 21 APRIL AND 20/04/2004 PN2624
EXHIBIT #R10 MEMORANDUM, DATED 02/11/2003 REGARDING CHRISTMAS/NEW YEAR ARRANGEMENTS AT MMC CLAYTON PN2635
EXHIBIT #R11 TWO PAGE EXTRACT FROM SOUTHERN HEALTH'S ANNUAL REVIEW 2002 PN2640
EXHIBIT #R12 IN-PATIENT 24 HOUR BED CAPACITY 2004 AND 2003 PN2651
CROSS-EXAMINATION BY MR LANGMEAD PN2654
RE-EXAMINATION BY DR JESSUP PN2792
WITNESS WITHDREW PN2808
JENNIFER JUNE WILLIAMS, AFFIRMED PN2847
EXAMINATION-IN-CHIEF BY DR JESSUP PN2847
EXHIBIT #A12 WITNESS STATEMENT OF JENNIFER JUNE WILLIAMS DATED 27/04/2004 PN2858
CROSS-EXAMINATION BY MR NIALL PN2877
EXHIBIT #R13 NURSE ENTERPRISE BARGAINING AGREEMENT STATUS UPDATE NUMBER THREE DATED 23/04/04 PN2954
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