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Australian Industrial Relations Commission Transcripts |
AUSCRIPT PTY LTD
(Administrator Appointed)
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 10978
AUSTRALIAN INDUSTRIAL
RELATIONS COMMISSION
SENIOR DEPUTY PRESIDENT KAUFMAN
BP2004/4285
BP2004/4286
APPLICATION FOR TERMINATION
OF BARGAINING PERIOD
Applications under section 170MW of the Act
by Metropolitan Ambulance Service and Another
for orders to terminate bargaining periods
BP2004/3776 and BP2004/3777
MELBOURNE
10.17 AM, WEDNESDAY, 28 JULY 2004
Continued from 27.7.04
PN870
THE SENIOR DEPUTY PRESIDENT: Is it Mr Parry or Mr Friend who is commencing this morning?
PN871
MR PARRY: If your Honour pleases. Having looked at our position carefully, we are not going to call any more evidence in respect of MAS. With regard to RAV, I propose that we do not proceed with RAV today. We seek to have the RAV matter heard later in the week, if that is convenient to your Honour, possibly Friday. We understand that day may be a possibility.
PN872
In accordance with that, we would seek to provide an outline of the evidence to be given in support of that by the end of today. We did advise my learned friend of this last night. We do indicate that we do take exception to a suggestion that the matters involving RAV are not urgent. As I indicated, they are of a different nature, and the sort of nature that they often involve are, for example, people with terminal illnesses that require transport to hospital. Such people with terminal illnesses are considered code 3, and therefore fall within the bans and will not be transported. Now, what that leads to is delays in the transport of those people, and we will say that that causes inevitable distress to the patients and to their families.
PN873
So that is the sort of - some of the incidents that will be led in the RAV matter. So we say there are urgent circumstances to matters of that nature. So our application with regard to the RAV matter is that it be adjourned to Friday. That we will provide the outlines of evidence, as we indicated, and we would seek that the matter be heard and determined in that way.
PN874
THE SENIOR DEPUTY PRESIDENT: Looking through the documentation overnight, am I right in thinking that the new industrial action in respect of RAV is not the same as that in respect of MAS?
PN875
MR PARRY: That is so.
PN876
THE SENIOR DEPUTY PRESIDENT: Yes, thank you, Mr Parry.
PN877
MR PARRY: If your Honour pleases.
PN878
THE SENIOR DEPUTY PRESIDENT: Mr Friend.
PN879
MR FRIEND: Thank you, your Honour. As far as we are concerned, in relation to the RAV matter, we do not actually accept the example my learned friend has given, a person who is terminally ill would be upgraded to code 2 and transferred, notwithstanding the bans.
PN880
We appreciate that there is nonetheless a need for expedition in hearing of the matter. Friday is a difficulty for us because Mr Morris will be unavailable, and he is an important person to be here from our point of view to give instructions.
PN881
THE SENIOR DEPUTY PRESIDENT: And why is he unavailable?
PN882
MR FRIEND: He has another arrangement, your Honour.
PN883
THE SENIOR DEPUTY PRESIDENT: Well, is that an arrangement that is so important that it cannot be moved?
PN884
MR FRIEND: Well, I am instructed that that is the case, your Honour. But we would be prepared to be available on Monday. I am not clear, your Honour, that the two days are in the circumstances likely to give rise to such an important - - -
PN885
THE SENIOR DEPUTY PRESIDENT: No, it is a matter of the Commission's availability, Mr Friend. I commence sitting on a Full Bench on Tuesday, I think, for the remainder of the week. That is the difficulty.
PN886
And that is a matter that I cannot move. I can make myself available on Friday by moving some other commitments, but the Full Bench matter is immutable.
PN887
MR FRIEND: That would be Friday and Monday then, your Honour?
PN888
THE SENIOR DEPUTY PRESIDENT: Yes.
PN889
MR FRIEND: Yes, but your Honour is anticipating two days?
PN890
THE SENIOR DEPUTY PRESIDENT: Well, possibly two days, yes.
PN891
MR FRIEND: Well, your Honour, I think the position could be that if we need to call Mr Morris, then he would be available on Monday, and we would be able to accommodate that, and we will just have to do the best we can.
PN892
THE SENIOR DEPUTY PRESIDENT: Yes, I am just indicating my difficulties.
PN893
MR FRIEND: I understand that, your Honour, but I wanted to explain the position, and seeing that that might be a way of at least accommodating people as best as possible.
PN894
THE SENIOR DEPUTY PRESIDENT: Yes.
PN895
MR FRIEND: Now, your Honour, I think given what my learned friend, Mr Parry, has said now, it falls to me to open our case in relation to the MAS matter.
PN896
THE SENIOR DEPUTY PRESIDENT: Yes. Well, just before you do, you can take it from me that I will try to move my Friday matters, and commence the RAV matter on Friday, but I will formalise that over the luncheon adjournment and let the parties know.
PN897
MR FRIEND: Your Honour, I want to spend a few minutes opening the case, because we want to redirect the Commission's focus to what we submit are the real issues of the case.
PN898
MAS come here seeking termination of our bargaining period, and they seek it on the grounds set out in 170MW(3)(a) and your Honour, of course, as has been indicated, will need to be satisfied that that ground exists. You will then be in a position to exercise a discretion whether or not to terminate the bargaining period.
PN899
Now, your Honour, yesterday Mr Parry accused me of jumping to my feet and saying that there was no danger to the health or safety of the public, but ignoring the word "welfare". And it is true that on that occasion - I didn't jump to my feet, I think I was answering a question of your Honour's - I didn't mention the word "welfare". It appears that MAS relies particularly on that word in relation to the way it puts it case. But there was a more significant omission by Mr Parry in the way he put the words of the subsection. And to use a vernacular expression, and it is an apposite one in these circumstances, it is the verb, and the verb is endanger. It is not affect, nor yet adversely affect: it is endanger, your Honour. It is a strong word.
PN900
In due course, your Honour, I will expand an argument based not only on that provision, but on the objects of the Act, and the International Conventions which provide the constitutional foundation for these provisions. To show that merely affecting the health, safety or welfare of the public is not enough: you would have to endanger it.
PN901
Now, your Honour has seen the bans which are currently being imposed, and they are set out behind tab 6 of the folder which was handed up, and which is exhibit A1 in this matter. It appears that reliance is particularly placed upon three matters. Number 17:
PN902
All urgent and emergency patients will be transported to the closest hospital emergency department irrespective of bypass status unless for reasons of patient request or compliance with straight trauma guidelines.
PN903
Reliance was also sought to be placed, as I understood it, on the Group B bans, which is the new ones which commenced on Monday. Now, what your Honour needs to bear in mind is that first ban I referred to, number 17, has been in place since 4 July. So there has not been urgency about dealing with that until Monday of this week.
PN904
Now, on Monday of this week, Group B bans came into place, bans numbers 1 and 2. My learned friend did not take his witnesses, except for the first witness, in any detail to those bans, but the operative part of them appears to be, as far as MAS is concerned, the transport of patients to closest available hospital unless they refuse transport. No triage as services not required, or no ambulance care required.
PN905
Now, those documents set out the formal nature of the bans, but what your Honour has to be concerned with is what is actually happening. Also contained in the folder are the bulletins sent by the union to its members who are the persons who are imposing the bans. The first of those is contained at tab 7. Your honour will see, and this is something that goes through all of the documents of this nature, on the second page, on the page that is marked 1 of 5, Action 1 Free Ambulance Service, and under that a note:
PN906
In circumstances where the patient is time critical and the patient is in a life threatening emergency situation and every second counts, then members are expected to vary or ignore the following actions in the best interests of the patient. In the above circumstances members should continue to focus on the needs of the patient to achieve best patient outcomes. It is expected that this disclaimer will affect less than 5 per cent of all cases.
PN907
So something in 1 in 20 are expected not to be made subject to those bans. Now, there has not been a great deal of evidence, in my submission, given about how the bans having an effect, and how that aspect of the bans has been applied.
PN908
In the present case we have to look at the realities of the situation. We are not comparing a well resourced public hospital system with one which is subject to bans. We are comparing a system which is not functioning well; which is dysfunctional and under-funded, and which is stretched at all levels. One of the things that is done to try and ease that a little is to transfer work from the hospitals to ambulance paramedics by hospitals going on bypass. When a hospital goes on bypass, the paramedic has to take the patient further away, and then usually bring the patient back to the closer hospital. In many cases patients of the non-bypassed hospital will be simply dealt with in a preliminary way, awaiting transfer to the hospital which was bypassed.
PN909
There are questions involved about the effect on the community of that scheme. If one can say that there are harmful effects on the population by reason of not considering bypasses in some cases, one can equally say that there are harmful effects on a population by having bypasses. We will come to that in the evidence in due course. There are a multitude of factors here that have to be taken into account, and your Honour will have to have a picture of how the whole system works, to understand whether in truth the industrial action taken is endangering anyone in any way at all.
PN910
Now, the evidence that will be given will consist of evidence from Mr Morris, who will give evidence about the bans themselves, the negotiations for an agreement which have taken place, dispensations from the bans which have been given in certain particular instances, the general dispensation from the bans, the way that they operate and are intended to operate, and the way that such bans have operated historically whenever they have been put in place since 1995.
PN911
A number of serving ambulance paramedics will also give evidence. Mr Gary Becker.
PN912
THE SENIOR DEPUTY PRESIDENT: Gary?
PN913
MR FRIEND: Becker, B-e-c-k-e-r. Mr Robert Ferguson, Mr John Taplin, Mr Peter Norbury, and Mr Mick Stephenson. Their evidence will show that the effect of the application of the bans is not harmful, does not endanger anyone. That really the bypass system in hospitals is nothing more than shifting deck chairs on the Titanic, and that in any event it is applied inconsistently. That where someone needs to go to a hospital, or a particular hospital because of the treatment needs of that person, that is where they go. That what is being caused by the bans is some administrative inconvenience to hospitals in respect of low acuity patients. But that one of the effects of that is that ambulance paramedics, instead of sitting with patients for half-an-hour, or an hour, waiting for a nurse or doctor to arrive, are back on the road in a much shorter time, and available to take emergency calls.
PN914
All of these matters, your Honour, will have to be balanced, firstly in relation to your Honour reaching a state of satisfaction as to whether there is endangerment, and also in respect of the exercise of discretion. Your Honour, one document that has come to our attention overnight, what is called the rules of engagement during MAS dispute from Cabrini Hospital. I will hand up a copy of that to your Honour.
PN915
Now, Cabrini Hospital is of course a private hospital, which has a private emergency department. If your Honour reads that document, you will see that it is perfectly possible to make arrangements and to put into place a rational and effective means of dealing with any difficulties which might arise out of the bans.
PN916
PN917
MR FRIEND: Would you state your name and address, please?---Yes. Rodney Morris (Address Supplied)
PN918
And your occupation?---I'm a Union Secretary, the LHMU Ambulance Section.
PN919
And how long have you held that position?---Since about 1995.
PN920
Yes. Prior to that what was your occupation?---I was an Ambulance Officer.
PN921
And for how long were you an Ambulance Officer?---I was employed by Metropolitan Ambulance Service since 1977.
PN922
And did that work include operational ambulance duties?---That is correct, yes.
PN923
Yes, all right. Now, have you been engaged since 1995 in negotiations for enterprise agreements with the Metropolitan Ambulance Service?---Yes, I have. This is the fourth set of negotiations.
PN924
During the course of those negotiations has your union taken industrial action?---Yes, we have.
PN925
Is that on every occasion or only some occasions?---No, it's been on every single occasion.
PN926
And what sort of bans did you take in respect of those, what sort of industrial action did you take in respect of those negotiations?---There's been a full range of bans but they are not dissimilar to the bans that are in place at the present.
**** RODNEY WILLIAM MORRIS XN MR FRIEND
PN927
And in respect of those bans, has there previously been a termination of your bargaining period by the Commission?---No, there has not. I think there's been applications to the Commission but those applications did not succeed.
PN928
Now, in respect of the current matter, when did you commence negotiations with MAS?---In about February of this year.
PN929
And that was to lead up to the expiry of the agreement on 1 June?---That is correct. The 1 June was the expiry and the provision put in place in the previous enterprise agreement that there was a six month window of opportunity before the expiry date.
PN930
Now, those negotiations, who were they with?---They were with middle level ambulance managers from both Metropolitan Ambulance Service and Rural Ambulance Victoria and from one bureaucrat from the Department of Human Services.
PN931
Now, can I ask you were the negotiations conducted jointly with MAS and RAV or just all separately?---No, they were always joint negotiations except for when we might have had a meeting to do with a separate particular matter but generally they were joint meetings.
PN932
And you say there was a departmental officer from Human Services?---That is correct.
PN933
At what level?---Certainly not a decision-maker, that was made clear to me.
PN934
And who was that?---A Mr John Burn.
PN935
And from MAS - I am sorry?---Mr John Byrne, B-y-r-n-e.
**** RODNEY WILLIAM MORRIS XN MR FRIEND
PN936
And from MAS?---From Metropolitan Ambulance Service, Ms Melissa Land is a negotiator; Mr Mark Rogers was a negotiator. There has been a range of people from MAS but not the Chief Executive Officer and not any of the Executive Directors.
PN937
Did the people you were negotiating with ever indicate to you whether or not they had authority to reach agreement?---It was very clear to me and made very clear that they had - certainly had authority to reach agreement on the wages component which is the public sector offer of 12 per cent over three and a half years. They had no authority to reach agreement on any other matter.
PN938
Do they have authority to negotiate on other matters?---Certainly not on the significant parts of our claim which is for extra ambulance resources and also for the skills allowance.
PN939
And how often have you had these meetings?---Meetings were held since February, at least once or twice a week. Sometimes the meetings would go all day.
PN940
And you haven't reached agreement on those issues?---Well, we never reached agreement on the major issues because there has been no meaningful discussion on the major issues. It was made clear to us that they were not decision-makers and they were not empowered to discuss it with us.
PN941
Now, in the current circumstances you had put new industrial - new protected action on in respect of MAS, is that right?---That is correct, yes.
PN942
Now, that is explained in the document which I read to his Honour in opening, the first set of actions, a bulletin from the union to members of 10 June. Do you have a copy of that with you?---No, not the 10 June one, no.
**** RODNEY WILLIAM MORRIS XN MR FRIEND
PN943
Just hand that up to you. Your Honour has that - - -
PN944
THE SENIOR DEPUTY PRESIDENT: That is at tab 7, is it?
PN945
MR FRIEND: Yes. Now, can I ask you to turn the page and look at the note on the second page?---Yes.
PN946
What is the purpose of that note?---The purpose of the note is, in 1995 when we took our first protected industrial actions it was very clear to myself that there was a possibility ambulance paramedics taking actions would in fact create some harm to the community. That was certainly a possibility and was a possibility we sought to avoid at all costs and all circumstances. So it was made clear in 1995 and ever since that whenever industrial actions are put in place that if a paramedic assessed the patients needs were paramount and if any action might have an adverse effect on a patient, then the bans were to be ignored and the patient care was to be administered in full.
PN947
And does that rider only appear on that bulletin?---No, it appears on every bulletin that we have published in which industrial action is taken. Can I just clarify that?
PN948
Yes?---We are very aware that when we put words to paper that there may be some people who read the words and have a different interpretation, so we made it really clear that the words we put down could not be misunderstood. And the fact is we are empowering - the whole being of being a paramedic is to protect public safety, that is what the profession is about, it is about looking after patients, caring for patients, looking after their interests. Their interests and the interests of the union are identical in that respect. It is about the professionalism of paramedics. We do nothing to harm that professionalism. And I was making it very clear in there that no paramedic should misunderstand that or think that they could take an action that might otherwise please the union.
**** RODNEY WILLIAM MORRIS XN MR FRIEND
PN949
Yes, right. Well, in relation to the bans, the first one which is really complained of is number 17 in the most recent list:
PN950
All urgent and emergency patients will be transported to the closest hospital emergency department irrespective of bypass status unless for reasons of patient request or compliance with State Trauma Guidelines.
PN951
Now, it has been suggested that places additional pressure on emergency departments and hospitals on bypass. Do you have any comment on that?---Yes, I do. I don't believe that to be the case. I don't believe it does place undue pressure on them at all. In fact, what it does is, it frees up ambulances to respond to people in the community who need an ambulance under emergency situations. The reality is that once a patient arrives at a hospital, then the patient is triaged immediately no matter how busy they are. And when I say "immediately" I mean within the first minute or two. And if they are not triaged in the first minute or two they are still in the care of the ambulance paramedics. And once they have been through the triage system the patient is then safe. If they are a high category patient, then they will be cared for by that hospital and the hospitals have the ability to do so, including when the resuscitation cubicles are full because patients can still be resuscitated on an ambulance stretcher and it is much safer to do so on the ambulance stretcher, inside the hospital environment, than it is to do so on the ambulance stretcher in the back of an ambulance. The ambulance vehicle is very constrained. In the ambulance vehicle there is only room for one or two attendants, in the hospital environment you can have the full medical team of about 10 people.
PN952
Yes?---Once the ambulance paramedics unload their patients to the hospital and clear the hospital they are then available to go and save a life in the community, a life that may not otherwise be saved if the paramedics are tied up doing non-urgent work or a transport to another hospital.
PN953
Well, are there enough ambulances?---No, there are not.
**** RODNEY WILLIAM MORRIS XN MR FRIEND
PN954
Are there delays in people receiving ambulances?---Yes, there are, and there are unacceptable delays.
PN955
What is the time frame that people are supposed to receive an ambulance in?---I can answer it in two parts. If a person is in a time-critical emergency and they need am ambulance they really require that ambulance in about six or eight minutes.
PN956
Yes. And what is the goal, is there a goal that MAS has?---There is. The goal has been deemed to be unattainable so the ambulance service tries to get people there in about 13 minutes in 95 per cent of cases. But they certainly don't meet the clinical needs of the patient in the community. If I was the person to have the heart attack and if I had been unconscious and on the floor, after about 13 or 14 minutes I am not so sure that I really want someone coming to me.
PN957
Yes. And if ambulances bypass the nearest hospital, does that lead to delays in them going back on the road?---It certainly does. If the ambulance bypasses the nearest hospital and goes to another hospital. For example, in the - what we heard yesterday - patients on the peninsula in Melbourne, for example, go to the Frankston Hospital because it is the only close hospital they have to them. If they bypass Frankston it is another half hour up the road to either Monash Medical, unless they are on bypass and that is a common occurrence, if they are on bypass they usually have to go to the Alfred. That can lead to the situation where there are no ambulances on the peninsula to respond to the next emergency, and the next person who has a car accident or has a heart attack, just dies of that.
PN958
So what is the effect of the hospital bypass system on ambulance availability?---The hospital bypass system reduces significantly ambulance availability.
PN959
Now, you heard evidence yesterday from Dr Kelly about a situation at Western General. Were you aware of a particular situation at Western General, that was the 13 July?---Was the 13 July - was that the one where they called the code yellow?
**** RODNEY WILLIAM MORRIS XN MR FRIEND
PN960
I think so. That is the one I am referring to?---Because of the gas leak? Is that the one?
PN961
Are you aware of a situation where there was a code yellow because of a gas leak at Western General?---Yes, I am. Yes, I am.
PN962
How were you made aware of that?---I was - from memory, it was a Sunday. I was rung at home by a senior ambulance manager, informed of the situation. I immediately said that the industrial actions wouldn't apply to that hospital by paramedics and that if anyone questioned that they should ring me immediately. And gave my phone number.
PN963
Have you given - do you recall a situation where a patient who had a laminectomy discharged himself from hospital?---Yes, I am.
PN964
Was that during the period of the bans?---Yes, it was. A couple of days ago.
PN965
And what was the circumstance that you became aware of that in?---Well, it was a patient who had had a laminectomy, should have remained in hospital. Certainly, my understanding is the treating doctors wanted that patient to stay in hospital. The patient was desperate to get to Mallacoota, discharged himself from hospital - - -
PN966
Which hospital?---I am sorry, I just - - -
PN967
Was it in Melbourne?---It was a Melbourne hospital, yes.
PN968
So he wanted to get to Mallacoota?---He wanted to go to Mallacoota, yeah.
**** RODNEY WILLIAM MORRIS XN MR FRIEND
PN969
And so how did you become aware of it?---I became aware of that - raised by an ambulance paramedic at Mallacoota who wanted that patient cared for, believed the patient should have been flown to Mallacoota to provide appropriate patient care, it would not be reasonable for that person to lay in the back of a - their own vehicle, their own sedan, which was what they were intending to do, and we made arrangements for that patient to be flown to Mallacoota. And that was outside of the bans but we certainly made those arrangements.
PN970
Now, you have also heard evidence from Dr Kelly about 99 per cent staffing levels during the bans. Do you have any comment on that?---Yes, I do. I think it is absolutely outrageous that within the hospital system that they only staff the 99 percent and expect the ambulance service to pick up that other 1 per cent. The 1 per cent may not seem to be much but when the hospitals are experiencing their local crisis because the numbers are flowing into the hospitals, and that could be triggered off by weather, the full moon, anything can trigger off a peak workload, and those peak workloads happen on daily and weekly bases. And I think they have forgotten that the ambulance services are drawing from the same population of people and they also experience their peak workload at that same time and the ambulance service doesn't have the capacity to pick up the slack in the hospital system. And that is the basis of our claim. We are claiming on the government. They provide more vehicles and more paramedics so that the ambulance service does have the resources to do that work, because we understand that work may need to be done.
[10.54am]
PN971
Now, we heard some evidence about, or at least some statements from the bar table about 000 calls. Are you aware of any policy within the Government or MAS about what happens with 000 calls?---Yes, I am. It is Government policy and previous government policy that anybody who rings for an ambulance is entitled to have an ambulance, and ambulance paramedics have no right to refuse to transport that patient to hospital.
PN972
So how is it - sorry?---Sorry.
**** RODNEY WILLIAM MORRIS XN MR FRIEND
PN973
How is it that sometimes people are not transported to hospital?---Well, what - if I can just say the - when the previous Kennett government brought the new Integraph system in, they brought in as a way of controlling and dispatching ambulances. They also brought it in to make that system work a system called AMPDS, which is Advanced Medical Priority Dispatching System. They also brought in what was known as the dispatch grid. The Integraph call-takers, and now ECV call-takers go through a pro forma system but - and after they have taken the details from the patient or the potential patient, and that system determines that an ambulance will be sent, and that an emergency ambulance will be sent. Now, everyone of those requests for assistance from the community has an ambulance sent to them. When the paramedics arrive there, there is an expectation on the paramedics that if the patient did not require an ambulance that the paramedic will then use their wit and their guile to try and convince the patient to have some other solution to their problem; and paramedics do that really well. The problem is that takes a lot of time and the paramedics takes enormous risk on themselves when they do that. They take a risk for the patient and a risk for themselves. Having said that, the paramedics are highly trained in that skill. But ultimately the paramedic has got no right not to take a patient to hospital if the patient wants to go to hospital.
PN974
PN975
THE SENIOR DEPUTY PRESIDENT: Yes, Mr Parry.
PN976
MR PARRY: If your Honour pleases. Mr Morris, I think you commenced your evidence by saying that there had been previous applications in this Commission to terminate bargaining periods. Do you recall giving that evidence?---I recall some of it. I am not saying I recall all of it. I remember being in front of Senior Deputy President MacBean.
PN977
Right?---But that was a while ago.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN978
There was a decision where the application didn't succeed. That had nothing to do with bypass bans, did it?---No, it didn't.
PN979
No?---No.
PN980
And, indeed, last time when there was an application before the Commission, again that had nothing to do with bypass bans, did it?---No, I don't think it did.
PN981
No. Thank you. Now, the negotiations that you refer to, I think you have given evidence that they commenced in February and I think, as you have said, there were representatives of MAS present?---That is correct.
PN982
There were representatives of RAV present?---That is correct.
PN983
And there was also Mr Burns?---That is correct.
PN984
And you are aware that Mr Burns has been involved in negotiations with other health unions?---I believe that to be true.
PN985
And he has been involved in the resolution of those matters with other health unions, hasn't he?---I understand that to be true. I have no first hand knowledge but I understand that to be true.
PN986
Yes, and these negotiations commenced in February and there was exchanges of documents in April?---That is correct.
PN987
Your union produced a document. The Government and ambulance services produced their own documents?---Yes.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN988
And I think how many claims do you have in total as against the services: 60, 70?---I haven't got a count of the number but I do have the content.
PN989
Well, roughly, 60?---A significant number of claims.
PN990
Well, is 60 a fair - 60, 70?---If you count it as 60. I haven't got a count. I can't tell you, but it is a significant number of claims.
PN991
It is more then 50?---I can't say that but I can count them for you, if you like.
PN992
Right?---There is 23 claims against the ambulance service. There is 23 clauses and some of those clauses have got subclauses dealing with the details of the clause.
PN993
Quite a number. Now, your union took unprotected action in April, didn't it, in support of its claims?---You will have to refresh my memory. What unprotected action was that?
PN994
Bans on paperwork?---Yes, I believe that was true, yes.
PN995
So that was action whilst there was a certified agreement in force for which you didn't provide any attempt to protect; that was the position, wasn't it?---Correct.
PN996
And that was with the authority of your union?---Yes, that is correct.
PN997
And that came to the Commission?---Yes.
PN998
And your union was involved in conciliation?---Yes.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN999
Correct?---Yes.
PN1000
And there was a process agreed for furthering negotiations?---That is correct.
PN1001
And your union lifted the bans?---That is correct.
PN1002
And that process that was agreed then was followed?---I believe so.
PN1003
Well, you know so, don't you?---Well, I believe so.
PN1004
Now, you have presumably kept up with the developments in the health sector generally?---I am aware of some developments. I am not saying I am aware of all developments.
PN1005
Well, generally your union's bargaining position has been broadly aligned with the health sector, hasn't it?---No. Our union's bargaining position has been broadly aligned with the ambulance sector. It is not aligned with the health sector at all.
PN1006
I see. You are aware that there were other resolutions reached in the negotiations in around May on, for example, nurses?---Yes, I understand that nurses got to maintain their nurse/patient ratio, something that hasn't yet been achieved within ambulance.
PN1007
And soon thereafter there were further offers put by the services to your union, wasn't there?---What further offers?
PN1008
An offer put on 9 June 2004?---You will have to refresh my memory of what that offer was.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1009
In respect of increased wages?---I am not aware of an offer of increased wages.
PN1010
I see. You have continued to meet up to when; when was your most recent meeting, last week, last Tuesday?---I don't remember it - right now I just don't remember our most recent meeting. Can you refresh my memory?
PN1011
Well, do you recall there being a MAS specific meeting last Monday?---Yes, I do, yes.
PN1012
And you attended that?---Yes.
PN1013
And various other - the representatives of the services and the Government attended?---Yes.
PN1014
And there was an RAV specific meeting last Tuesday?---That is correct.
PN1015
Right. Now, your claim is still, as I understand it, for the package of matters that you have pursued throughout?---Yes, not necessarily the full package but certainly there is a suite of things in there that we are pursuing, yes.
PN1016
Have you formally dropped any of the claims?---No, we have not. We have indicated to the Government that there are key areas that would need to be satisfied before I could put it back to members, and those key areas have not been satisfied.
PN1017
So your position is still to pursue the entire claim?---Absolutely.
PN1018
And you received a letter last Friday regarding a meeting with Mr Lee, the Director of Industrial Relations in the Department of Human Services?---Yes, I did.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1019
He requested a meeting, didn't he?---That is correct.
PN1020
And you haven't met with him, have you?---No, I have not.
PN1021
No, and he rang you on Monday morning seeking a meeting, didn't he?---That is correct.
PN1022
And he sought that meeting to take place on Monday if he could?---That is correct.
PN1023
And he nominated a time and place, and you didn't attend?---That is correct.
PN1024
THE SENIOR DEPUTY PRESIDENT: What is Mr Lee's position again, please?
PN1025
MR PARRY: Sorry, the Director of Industrial Relations in the Department of Human Services.
PN1026
THE SENIOR DEPUTY PRESIDENT: Thank you.
PN1027
MR PARRY: He is a fairly serious and senior officer, isn't he, in the public sector?---But not empowered to address our claim, and he made that clear to me in a telephone call.
PN1028
I see. Now, the industrial action that you have - I think you have a folder in front of you, do you, with the industrial action that you pursue?---Yes, I have.
PN1029
You commenced to give these MO notices I think on 7 June?---Yes.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1030
And that industrial action, I think there was some 17 bans came into existence on 12 June?---I think that is correct.
PN1031
And your practice is to accompany these notices with explanatory bulletins, isn't it?---That is correct. The notices are for the employers and for the Government and for the Commission, and the bulletins are for members. It covers the same ground but it is put in a language that is understood readily by members.
PN1032
Yes. These bulletins don't just serve the purposes of advising members. They are to put the employers and everyone else on notice of exactly what is going to happen?---They are bulletins to members.
PN1033
Yes?---They are distributed to members.
PN1034
Yes, but it is intended to give notice to others as well as to what the industrial actions actually will involve, aren't they?---The notice to others is by virtue of the first letter that was sent out, and that is sent out in advance always. So we send that letter out which is the notice to others. And then we follow up at some time later with a bulletin to members.
PN1035
Right. Well, the first notice, the first bulletin you put out, do you have a copy of that; I think - - -?---No, I don't.
PN1036
- - - my learned friend took you to it?---Not of - of this one here, the 10th of the 6th? Yes.
PN1037
The 10th of the 6th. They, I think the second paragraph says - - -
PN1038
THE SENIOR DEPUTY PRESIDENT: Where do I find - yes, I see the date.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1039
MR PARRY: I am sorry, it is in tab 7, your Honour.
PN1040
THE SENIOR DEPUTY PRESIDENT: Yes, I have got tab 7. I was looking for the date. It is at the bottom on the right hand corner. I have just found it.
PN1041
MR PARRY: Yes.
PN1042
THE SENIOR DEPUTY PRESIDENT: Yes.
PN1043
MR PARRY: I think as it says in the second paragraph:
PN1044
These industrial actions have been endorsed by the state council and are designed to encourage the Government and the services to make a serious offer to settle our EBA claims.
PN1045
Do you see that?---Yes, I do.
PN1046
And that is actually the position, isn't it; these industrial actions that you notified them were designed to put pressure on certainly the Government, weren't they?---Exactly, yes.
PN1047
And the third paragraph reads:
PN1048
Members should read all 17 industrial actions closely and apply the actions strictly as written.
PN1049
?---That is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1050
So you expect and you direct your members to do precisely what the bans say?---Exactly, yes.
PN1051
Now, following this industrial action, the position was that there had been further meetings and agreement hadn't been reached?---That is correct.
PN1052
Right?---That is correct.
PN1053
And you then, or your union then decided to up the ante, to escalate the industrial action, didn't it?---That is correct.
PN1054
And it then - I think we have the second set of industrial actions, stage 2?---That is correct, stage 2.
PN1055
Stage 2, and stage 2 notices indicate new actions, one being - do you have a copy of the - - -?---No, I don't, not the stage 2.
PN1056
You don't have a copy of the stage 2. Perhaps I will provide you with a copy of that material, Mr Morris?---Thank you.
PN1057
Do you have one yet, Mr Morris?---No.
PN1058
Not yet?---Not yet.
PN1059
THE SENIOR DEPUTY PRESIDENT: This is at tab 5, is it?
PN1060
MR PARRY: Yes, your Honour, it is at tab 5.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1061
THE SENIOR DEPUTY PRESIDENT: I think I have Ms Russell's copy because I didn't have page 3 of 4 - or page 3 of 3.
PN1062
MR PARRY: The 29th of - yes, that is right. I am sorry, that is what I intended, 29 June?---The copy I have got has only got two pages out of three.
PN1063
THE SENIOR DEPUTY PRESIDENT: That was my problem, too, yesterday?---Maybe if I could swap with Ms Russell.
PN1064
I am just having a photocopy made of that third page?---Thank you very much.
PN1065
MR PARRY: I think we can find one, your Honour. I think Mr Morris has one.
PN1066
THE SENIOR DEPUTY PRESIDENT: Do you have that now, Mr Morris?---Yes, thank you.
PN1067
Yes.
PN1068
MR PARRY: Now, the new actions notified - the first two actions notified were at number 5:
PN1069
Participation and co-operation with the hospital early warning system is banned.
PN1070
Right?---That is correct, yes, yes.
PN1071
And the second one is that:
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1072
All urgent and emergency patients will be transported to the closest hospital emergency department irrespective of bypass status, unless for reasons of patient request or compliance with state trauma guidelines.
PN1073
Now, if I could take you to the bulletin which accompanied this, that is - do you have a copy of your bulletin of 1 July 2004?---No, I don't think I do.
PN1074
THE SENIOR DEPUTY PRESIDENT: That is at tab 8, I take it.
PN1075
MR PARRY: It is at tab 8, yes, your Honour.
PN1076
[11.10am]
PN1077
If I could take you to page 3 of 4. You broadly understand, presumably, the operation of the HEWS and bypass systems, Mr Morris, don't you?---Yes, I do. I have a broad understanding. Not a first hand knowledge, but certainly a good second hand knowledge.
PN1078
Well, you know that the hospitals in the emergency departments make assessments of whether they need to go to HEWS or bypass status?---Yes, I do.
PN1079
And you know that that is an assessment made by the senior doctors and nurses in the emergency department?---That is correct.
PN1080
And they then, if they go to HEWS status they move people around in the hospital?---That is correct.
PN1081
And the Ambulance Service cooperates with that, and tries to minimise the number of patients that it brings to the emergency department?---That is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1082
And if that is unsuccessful in avoiding bypass, then the hospital goes to bypass?---That is correct.
PN1083
And bypass is a system which I think, in effect, says the house is full, we don't want any more patients: correct?---They are the words I heard you use yesterday. Yes, that is correct. That is their little insular decision at that local level.
PN1084
It is their decision, isn't it?---At the local level, yes.
PN1085
The emergency department level?---Yes, but at that very local, very limited, that one hospital level, that is the decision they make.
PN1086
And you understand it is made by the senior medical and nursing staff in the emergency department, don't you?---Yes, I do, but I also understand that they have no knowledge of the ability of the Ambulance Service to take on the extra workload at that time. And they have no knowledge of whether the taking on of that workload would constitute a threat to public safety at that time.
PN1087
Well, as best you would understand it, these people in the emergency department, their primary concern is what is going on in the emergency department, and its capacity to deal with further patients, isn't it?---That is correct, but they don't seem to - they clearly don't have the responsibility for the greater Ambulance Service or the greater population in the community. That is a responsibility borne by the Ambulance Service, and by Ambulance paramedics.
PN1088
Now, you are aware that these senior emergency doctors and nursing staff, having made that assessment of bypass, for example, they ring the emergency control room?---That is correct.
PN1089
And they have a direct line to the DTM, don't they?---That is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1090
And that is a Duty Team Manager?---Duty Team Manager.
PN1091
And that Duty Team Manager is not a clinician?---No, the Duty Team Manager can act in that role, but the Duty Team Manager is not the clinician.
PN1092
But the Duty Team Manager is somebody that moves the resources around?---Responsible for resources, yes.
PN1093
And they, for example, match the workload for the ambulances, don't they?---That is correct.
PN1094
Now, the DTM, having got this call, and you are aware it is a fairly brief call, aren't you?---I have no knowledge of whether it is brief or not. I can't answer that.
PN1095
You don't know any of the detail that is provided by the hospitals as to when they go to bypass status, do you?---No, I don't.
PN1096
You are aware that the DTMs log that bypass status in the computer system?---Yes, I am aware it is logged.
PN1097
And I think your bulletin refers to the CAD system?---That is correct. Computer Aided Dispatch.
PN1098
And that is a computer system, and what goes into the computer system is a record that the hospital is on bypass?---That is my understanding.
PN1099
And that computer system, there is a screen before the emergency control operators?---Yes, that is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1100
And so that is an indication to the emergency control operators, and it is also an indication to the DTM that that hospital is on bypass and patients should not go there?---That is my understanding.
PN1101
And also that enables the dispatchers to warn the crews that the hospital is on bypass?---That is correct.
PN1102
And also the DTM, there is a whiteboard, and the DTM puts it up on a whiteboard in the emergency control room?---I believe that to be the case.
PN1103
And what he puts up on that whiteboard is, St Vincent's on bypass?---That would sound reasonable. St Vincent's is on bypass virtually every day, yes.
PN1104
All right, then. Western General on bypass?---Probably a daily occurrence.
PN1105
Do you know that?---That is my understanding from what I learned in this Commission yesterday.
PN1106
What you know of the level of bypass was assisted by what you heard in the Commission yesterday?---Yes. I have a sound knowledge of bypass. I have been a paramedic for many years, and this is nothing new. I heard yesterday that there are about 1800 cases per annum between four hospitals.
PN1107
Well, let us stay with what happens when a hospital goes on bypass. The M System. What is the M System?---I have no knowledge of the M System.
PN1108
So once a hospital goes on bypass, there is something on the whiteboard and something in the computer system. Is the paging system used as well?---I don't know.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1109
You don't know?---I don't know. I suspect that it is. I suspect the pager messages are sent out that tell crews that a particular hospital is on bypass.
PN1110
Now, in light of that understanding that you have, let us just work out what your bans are designed to achieve, and what they do so achieve, Mr Morris. Firstly, no MAS member will participate with the Hospital Early Warning System?---Yes.
PN1111
THE SENIOR DEPUTY PRESIDENT: Where are you reading from at the moment?
PN1112
MR PARRY: I am sorry, your Honour, I am reading from the bulletin, on page 3 of 4.
PN1113
Now:
PN1114
No MAS member will participate with the Hospital Early Warning System.
PN1115
Right?---Yes.
PN1116
Now, that operates at two levels, doesn't it? Firstly, that operates at the level in the control room?---That is correct.
PN1117
Whereby the DTM, who is a union member?---Probably.
PN1118
Almost certainly?---I think there might be one or two who are not.
PN1119
Out of how many?---Out of a dozen.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1120
There might be one or two?---There might be one or two who are not, and there are other people. There is clearly no MAS member, because we were very aware there are other people who can take those details. And other people do take those details.
PN1121
But the DTM won't record a hospital going on HEWS status: correct?---If they are a member, they won't. That is correct.
PN1122
They won't put it in the computer?---That is correct.
PN1123
They won't page?---That is correct.
PN1124
They won't put it on the whiteboard?---That is correct.
PN1125
So the dispatchers have no knowledge that that hospital is seeking HEWS status?---That is correct.
PN1126
Secondly - - -?---Well, they could have knowledge. The Metropolitan Ambulance Service is very capable of putting a person who is a non-member, or a Group Manager, into that role and doing that function.
PN1127
Very good, because then we go to the second stage where these bans operate, that is, out in the field, where the actual guys driving the truck have got this advice, no member will participate with the Hospital Early Warning System. That means even if MAS gets by, and somehow notifies the drivers out there, they are not going to take any notice of that: isn't that the position?---Exactly.
PN1128
Let us just go to the next part of this:
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1129
No member will answer the HEWS/bypass direct phone line, take HEWS/bypass details -
PN1130
Perhaps I will stop there. There is such a direct phone line, isn't there?---That is correct, and it now goes through the management. It goes through the Group Manager, Mr Peter Swan.
PN1131
Well, when this ban came into force, the DTM wouldn't answer the phone, right?---That is correct.
PN1132
So a hospital, a call coming from a senior nurse or the senior emergency doctor saying the hospital is full, the emergency department is full, we can't take any more patients, that call is not going to be answered by the DTM following union instructions?---That is just not correct.
PN1133
I am sorry?---Not correct.
PN1134
Right, so let us just work through what it means when you advise them, no member will answer a HEWS/bypass direct phone line?---Can I say, I wrote those words. It says, "No MAS member" We gave 72 hours notice of these protected actions, advised the Ambulance Service of these actions, discussed these actions with the Ambulance Service, and they put in place, or they should have put in place a work-around. And my understanding is they did put a work-around in place, even though I have no first-hand knowledge, but my second-hand knowledge is that Group Manager Peter Swan took all these phone calls, and this phone line was diverted to his number.
PN1135
We will get on to Mr Swan shortly. The position was that you notified that the DTM would not answer the call, didn't you?---That is correct, yes.
PN1136
And that has been the position, that the DTM will not, if a union member, answer the call?---That is my understanding.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1137
And that is your intent?---That is the intent as well.
PN1138
Now, the next part of it is, if will not answer the phone, take HEWS/bypass details. So if by some mischance the union member picks up the phone, and somebody on the end says, I want to notify bypass status, the DTM will say, no, I am not going to take the details: correct?---I don't think that would occur. First of all, I don't think they would take the phone call for a start, but if they did take the phone call, they would transfer it through to Mr Peter Swan, who is doing that work.
PN1139
They won't take any HEWS details?---That is my understanding.
PN1140
They won't enter HEWS/bypass details in CAD or the M System?---Yes.
PN1141
You don't know what the M System is?---No, I don't. I think it is - - -
PN1142
Well, why did you write it here?---Because that was the information given to me by the people who wanted to initiate the action, and that was the Duty Team Managers.
PN1143
Or not use a hospital because of claimed HEWS status. So this is designed to make sure, isn't it, that the details of the status of the hospital don't get passed out to the field, to the ambulance officers driving?---Absolutely. That is exactly what this is about. What it is, we are not allowing the hospital burden to be transferred on to the Ambulance Service or the Ambulance paramedics in the field. We have the Ambulance paramedics in the field to deal with their patients, and get the best patient outcomes for their patients, free of the stress of the hospital system.
PN1144
Yes, well, we understand what your public position on that is, Mr Morris. Now, with regard to the intent. So it operates at two levels, doesn't it? It operates at, firstly, the level that your members are not going to pass this material details out?---That is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1145
And if it does get passed out, if by chance a driver finds out about it, the driver is to ignore that, and simply attend at the hospital regardless of HEWS or bypass status?---That is the essence of our grievance: they are not drivers, they are ambulance paramedics, they are MICA paramedics, they are advanced life support paramedics. They are not drivers.
PN1146
Yes, but you don't agree that is the way the bans operate: correct?---The way the bans operate is the paramedics are protecting their patients.
PN1147
Yes, I understand. And the second ban - and I am still referring to your notes - is the closest hospital/no hospital bypass action, also known as increased paramedic availability action, all urgent and emergency patients are to be transported to the closest hospital emergency department. And that, in effect, says bypass is irrelevant. The status of bypass is irrelevant. The patients are simply to be taken to the nearest hospital?---Absolutely. There is a clash of cultures going on here. The ambulance culture and the patient care culture is always take the patient to the closest hospital. Every time a patient is not taken to the closest hospital, the patient is put at risk, and ambulance paramedics are put at risk.
PN1148
THE SENIOR DEPUTY PRESIDENT: So, Mr Morris, does that mean these bans are not being imposed to support your bargaining position, but they are being imposed for another reason?---Commissioner, they are being imposed to support our bargaining position, but they are also bans that should be in place all the time, and have always been in place in the past. The training of ambulance paramedics, and I trained in 1977, but the training even as recently as this year is still, always take your patient to the closest available hospital. Paramedics are excellent at giving patient care, and they are experts, and I support them in that, but they cannot do what doctors and nurses in a hospital setting can do. And they do not have - in the individual ambulance vehicle you do not have the full skill sets that are available in a hospital.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1149
MR PARRY: Now, the intent of these bans is to put pressure on the hospital, isn't it?---The intent of these bans is to put some pressure on the Government, and educate the Government that if they are going to be relying on Ambulance paramedics and Ambulance services to pick up the hospital shortfall, then they are going to have to resource the Ambulance Service and provide paramedics to do that work. Otherwise, if they don't, the Government is threatening public safety.
PN1150
Yes, I just want to work my way through that. Pressure you want to put on the Government, it works like this, doesn't it? You put pressure on the emergency departments in public hospitals, and by putting pressure on emergency departments in public hospitals, that, as you see it, puts pressure on the Government?---No. We are putting pressure directly on the Government by exposing to the Government, and to the community, the deficiencies in the system.
[11.25am]
PN1151
Yes, you recognise don't you that hospitals, I withdraw that, that ambulances continuing to attend at hospitals that have full emergency departments puts pressure on that emergency department?---No, I do not accept that at all.
PN1152
You do not accept that. Right. So you do not accept - - - ?---No, can I just say that emergency departments are not more important than the patients in the community that they serve. It is not about the convenience of emergency department or that hospital budget. They have a public safety function and they have got a community to serve. The people who come off the Peninsula and who live around the Frankston area have only got the Frankston hospital as a destination to go to. That is where their records are. That is where their care is delivered. They do not get care anywhere else. They go off to another place and are baby sat for a while but ultimately their treatment is delayed and then they are returned back to Frankston.
PN1153
Mr Morris, the intent of the upgrading of your bands was to put pressure on the government wasn't it?---Correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1154
And the way you saw it of putting pressure on the government was to have ambulances continuing to deliver patients to full emergency departments on bypass?---Correct to an extent.
PN1155
Correct. And you know that when ambulances continue to turn up to emergency departments there will be inevitable delays for those patients?---Not necessarily.
PN1156
It is a good chance isn't it?---Well, what type of delay are you talking about. If it is a code one patient and it is going into a hospital they will be triaged immediately and they will be seen and attended to immediately.
PN1157
There might be - - - ?---If it is a priority patient they will be attended to and seen and nothing changes with regard to that.
PN1158
You recognise that increasing the number of ambulances, or sending ambulances, to hospitals on bypass is inevitably going to increase waiting times in emergency?---Not for any priority patient.
PN1159
What about a category two patient? It might?---Well, category two patients should still be in the hospital. We heard evidence yesterday that that category of patient are the most likely to die. The most likely to miss out or be mis-triaged.
PN1160
Your pressure on the government comes from putting stress on patients and staff in emergency departments doesn't it?---That is absolutely not true. First of all - - -
PN1161
And that is the result of your - - -
PN1162
MR FRIEND: Well, let the witness finish his answer please.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1163
MR PARRY: - - - bans isn't it?---That is absolutely not true. Our bans take the stress off patients and put patients where they want to be which is in the closest available hospital. The one with their records. In regards to the staff that is an artificial device of the government and of the hospital administration. They have recourse to VANC and they have recourse for agency staff and they can bring them in at any time they same as they would today if there was a disaster, if there was a train accident, if a plane fell out of the sky. They would cope by bringing staff in. The fact that they choose not to bring staff in when they have their peak workloads at particular days or particular weeks is their commercial decision. It has nothing to do with patient safety and patient care.
PN1164
You have gone public on a number of occasions in the last couple of months haven't you Mr Morris?---Yes, I have.
PN1165
You speak to the media quite often?---Yes, I do.
PN1166
You try and get your message across in the media as to how you intend to put pressure on the government don't you?---I am open about what we do. Yes.
PN1167
Right. Do you recall speaking or giving a press statement on 30 June at the time when you went to this second level of bans which led to news items?---I certainly did not give a media conference or anything on 30 June. I do not believe that I did. I probably responded to a media inquiry.
PN1168
Did you say that in respect of the bans that were proposed on around about 30 June to start on 4 July that the bans proposed included reduced co-operation with public hospitals?---I do not remember saying that.
PN1169
All right. Well, perhaps if I could hand you a document which is where a newsreader quoted you and said - perhaps you have a look at it?---Can I say that is not a quote from myself and that is just their interpretation of a conversation that I probably had on the telephone.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1170
All right. So when the newsreader said - he says, and I quote:
PN1171
More work bans are proposed from Sunday including reduced co-operation with public hospitals and more restrictions on non emergency transport.
PN1172
Is that an accurate quote or not?---No, that is not a quote at all from me.
PN1173
Did you say words to that effect?---I have said words but I cannot say - they are certainly not words that I would have said. I would not have said those words. I think there is words underneath that I may have said. But they are not words that I would have said. Okay.
PN1174
All right?---I would have said:
PN1175
More restrictions on non emergency transport.
PN1176
That is probably true but the rest I would not agree.
PN1177
Don't you accept that the bans that you notified did evidence reduced co-operation with public hospitals?---Depends on what you mean about co-operation. It is not a co-operative relationship between the ambulance and the hospitals. It is a co-operative relationship to do the best thing by each of the patients. The focus has got to be on the patient care. As the hospitals focussed on the patients in the emergency department and that is supposed to be their primary focus of care so that occurs within the ambulance service. And that is given by paramedics and by the ambulance system to the limit of its resources.
PN1178
Do you accept that the bans that I have taken you to that commenced in early July evidence reduced co-operation with public hospitals?---No, I don't.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1179
Now soon after the bans came into force the - it became the position, didn't it, that the group manager being a non union person at MAS was advising hospitals and staff direct that the hospitals were on bypass?---That is my understanding.
PN1180
And this made you very unhappy didn't it?---No, it did not.
PN1181
Right. Perhaps if I - - - ?---It is an entitlement. They have an entitlement to do that.
PN1182
I see. Perhaps if I could hand you this bulletin dated 7 July 2004?---Thank you. Yes?
PN1183
Does your Honour have a copy of that?
PN1184
THE SENIOR DEPUTY PRESIDENT: I don't think so. I have one of 1 July and then the next one seems to be 24 July.
PN1185
MR PARRY: No, these are separate bulletins from those that appear in the - - -
PN1186
THE SENIOR DEPUTY PRESIDENT: No. No. I do now. Thank you.
PN1187
MR PARRY: Are you familiar with this document?---Yes, I am.
PN1188
This letter, this bulletin of the union, sets out a letter sent to the CEO of MAS?---That is correct.
PN1189
And it is setting out a letter that was sent by you?---Yes, that is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1190
And it describes what a group manager had been doing operating out of MAS Doncaster. And the fourth paragraph sets out what he did?---Yes, that is correct.
PN1191
That is he caused messages to be sent on the paging system stating that particular hospitals are on bypass?---Yes.
PN1192
Now you have no problem with that?---No problem with that at all.
PN1193
Right. Further the group manager has then rung the hospital and told the staff that MAS crews are on the way to that hospital and that the crews have been told that the hospital is on bypass?---That is correct.
PN1194
You do not have any problem with that?---I have a major problem with that.
PN1195
I see. So you have a problem with the manager of MAS telling the hospital that notwithstanding they are on bypass status ambulances may well turn up because of the bans?---No, that is not the issue at all.
PN1196
Right. You do not have a problem with that - telling - - - ?---That is not the issue.
PN1197
It seems to be fair on the hospital that they know that even though they have notified bypass status ambulances might still turn up?---I think the hospital is entitled to be told that. I have no problem with that at all.
PN1198
Right. The next paragraph of your statement, of your letter:
PN1199
Crews and patients have then faced confrontation and conflict at the hospital.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1200
?---Yes.
PN1201
That was your understanding of what was happening wasn't it?---That was my understanding of what was being caused by the MAS manager.
PN1202
It wasn't just the crews that faced confrontation and conflict was it?---Yes, it is crews and patients.
PN1203
Yes, it was the patients. The people who were in these - - - ?---Absolutely. Can I say that is the reason for this letter and this reason for the bulletin. Crews, ambulance paramedics, and their patients were being faced with conflict caused by the action of a MAS manager.
PN1204
THE SENIOR DEPUTY PRESIDENT: And conflict would also have been faced by the staff at the emergency department would they not? They were part of the conflict were they?---No, Commissioner. What was occurring here was the MAS manager was not only telling the hospital - - -
PN1205
No, answer my question Mr Morris. The conflict that was occurring was occurring at the hospital when ambulance crews arrived. And I take it that the conflict was between ambulance crews and hospital staff saying you cannot come here and the ambulance was saying we are coming here. Was that the nature of the conflict?---Yes, it was. The conflict was - - -
PN1206
Thank you. Yes, Mr Parry.
PN1207
MR PARRY: And you then, over the page, required that it be ensured that only MAS DTMs and clinicians working at Tallyho have the authority to send pager messages to all crews. That was what you demanded of MAS?---That is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1208
PN1209
MR PARRY: Now MAS replied to this?---No, they didn't. Not that I recall. I do not believe I received a reply.
PN1210
Perhaps if I could hand you this document. It is an e-mail?---Yes, I wrote to Mr Sassella who is the Chief Executive Officer and I got an e-mail in response from another officer.
PN1211
Right. So we will leave aside the forwarding bits up the top. Further down there is - I think starting with "Greg, 8 July, re " and then it goes across:
PN1212
Re 7 July letter.
PN1213
MAS wrote back to you didn't they?---Yes, they did.
PN1214
And they said that they would continue to utilise the paging and communications systems as required. Right?---That is correct.
PN1215
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1216
MR PARRY: And you sent out a bulletin in respect of this, didn't you - of 9 July 2004?---You will need to refresh my memory.
PN1217
Yes, I will. If we can hand that to the Commission?---Thank you.
PN1218
Now do you recognise this bulletin?---Yes, I do.
PN1219
The one you set out?---Yes, I do.
PN1220
And it refers to the - I think the earlier bulletin?---It does.
PN1221
And, as you say in the second paragraph, that bulletin identified that MAS Group Managers were scabbing on paramedics?---Yes.
PN1222
Just to stop there?---Yes.
PN1223
You describe the actions of the group managers, by contacting the hospitals and paging the ambulance officers, as scabbing?---For those particular group managers, yes, I do.
PN1224
Right. And you say that their actions, to continue, were:
PN1225
Actions designed to undermine the hospital bypass protected industrial action.
PN1226
Right?---That is correct.
PN1227
And your concern was that was MAS was doing was trying to make the system work and have bypass respected, wasn't it?---No, that is absolutely incorrect.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1228
All right. So those - - - ?---If you look at the first dot point on the second page you go to the heart of the matter. If you care to ask me about that you will find out what all this correspondence is about.
PN1229
And you go on and say:
PN1230
Further, it identified that MAS was setting up a climate of increased conflict and hostility at hospitals.
PN1231
?---That is exactly what I am saying and that is exactly the point of this correspondence.
PN1232
And you then go on and referring to the letter in the third - fourth paragraph, referring to the email, and said:
PN1233
Many members have contacted the AEA stating that MAS are still sending out the pager messages.
PN1234
Do you see that?---Yes, I do.
PN1235
Those are pager messages to ambulance officers, advising the bypass status, correct?---Yes, it is.
PN1236
Right. Now, just to continue the position with the paging - your second - the most recent set of bans have addressed this problem, haven't they. They have banned taking any notice of pager messages?---Exactly. So we can stop this occupational violence.
PN1237
So we can stop MAS advising the officers, via the paging system, correct?---That is not correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1238
That is the result of the new ban, isn't it?---No, that is not correct. What then result of the new ban is, is so that we can stop MAS advising the hospital officers that they have told the paramedics that the hospital is on bypass because that is the cause of the conflict. Because the hospital officers are primed to believe that because the paramedics have been told, they therefore will not come there, and if they do come there they are being wilful and that causes the conflict, and MAS are deliberately putting their employees into situations of conflict, and when MAS do not make that advice the employees suffer no hostility and there are no conflicts.
PN1239
Just to clear this up with what is the most recent ban, and I - perhaps I am jumping a little ahead of myself here, Mr Morris, but in - do you have a copy of the bans of 22 July 2004?---Yes, I think I do. Yes.
PN1240
Right. 22 July and I think it is page 4 of 4 - that is where we are in the new bans - New Actions and Amended Actions?---Yes.
PN1241
Ban 10?---The pager communication is banned.
PN1242
Yes. This addresses this problem doesn't it?---Yes.
PN1243
As you said?---Yes, it protects paramedics.
PN1244
Well, it prevents MAS Management advising them of the status of hospitals, doesn't it?---No, it does two things; it protects paramedics so that MAS management - so that the hospital staff are not in the position to be told that the paramedics have been told that the hospital is on bypass so that they do not face that increased hostility that has resulted on that communication.
PN1245
So you leave the ambulance officers in the dark, don't you, as to the status of the hospital?---Absolutely and that is the - - -
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1246
Yes?---That is what protects them.
PN1247
Their ignorance protects them?---Absolutely.
PN1248
I see. And also another ban is email communication - in Ban 11 - email communication between MAS Management, team members, clinical support officers and duty team managers, is banned?---That is also correct.
PN1249
That is also to keep people in the dark, isn't it?---No, it is not.
PN1250
I see?---It is to protect the duty team managers and the clinicians from those manager above them who direct them to break the bans when they do not want to break the ban; but they do not want to be put in the situation of refusing to take a directive from their superior officer.
PN1251
I see. Now if I could hand you a document which is dated 18 July. I am sorry, your Honour, I would tender the - - -
PN1252
THE SENIOR DEPUTY PRESIDENT: The bulletin of 9 July?
PN1253
PN1254
MR PARRY: If your Honour pleases. Mr Morris, you have read through that?---Yes, I have.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1255
That sets out some of the public pronouncements you made?---Yes, that is correct.
PN1256
At that time, and those pronouncements were also reported in the Sunday Herald Sun of 17 July - sorry, 18 July - 17?---That could be true.
PN1257
And around this time you were considering upgrading the industrial action?---Yes, I think that is probably correct.
PN1258
Well, at that stage you were I think to go through this document, fourth line down:
PN1259
Ambulance Employees Australia General Secretary, Rod Morris, said it was crunch time.
PN1260
?---Yes.
PN1261
And you did say something to that effect?---I think so, yes.
PN1262
And:
PN1263
Unless we get a significant movement by Tuesday, we will strongly increase our industrial campaign.
PN1264
?---That is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1265
All right. So you were considering strongly increasing the industrial campaign?---That is correct, I was. This is immediately - this is the weekend before the meetings you referred to earlier, but we had a meeting with the Metropolitan Ambulance Service on the Monday and a meeting with Rural Ambulance Victoria on the Tuesday. We were seeking to get them to move. In all previous meetings they said they were not empowered to discuss the key parts of our claim. We make it really clear we will continue to be happy to meet with them but they would need to address our claim. We went to the meetings on the Monday and Tuesday. They did not address our claim.
PN1266
All right. Now, just to move through your quotes here. You refer to bans on transporting patients; you refer to transports from higher to lower levels of care; or it does not quote you there, but then it does quote you, and this is the quote:
PN1267
Hospitals will start to bank up as a result. There will be bed blockages and a blow out in elective surgery waiting lists, Mr Morris said.
PN1268
Do you see that?---Yes.
PN1269
Fair quote?---Probably a fair quote. I cannot comment, but it is probably a fair quote.
PN1270
It was the intent of your Union, at this stage, to achieve that, wasn't it?---No, it was not.
PN1271
No?---It was the intent of my Union at that stage to capture exactly this - get a quote in the paper so we bring this to the public's attention. I mean journalists and unions play the media game.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1272
Yes, I understand you play the media game but I just want to understand whether what you are saying to the media is correct or not. And I am assuming that when you say, "Hospitals will start to bank up as a result; there will be bed blockages and a blow out in elective surgery waiting lists", that is what you intended to happen?---That is what does happen on - virtually on a daily basis in the hospital system.
PN1273
You intended to make the situation worse, didn't you?---I intended to put a spotlight on it.
PN1274
You intended to make it worse?---I intended to put a spotlight on it.
PN1275
THE SENIOR DEPUTY PRESIDENT: But you knew that the bans would have that result, did you, Mr Morris?---No, I do not believe that the bans will have that result. I think what we have been doing is spotlighting the inadequacies, the current and pre-existing inadequacies of the system.
PN1276
Yes. You have answered my question. You do not believe that the bans will have that result.
PN1277
MR PARRY: But, following up on that, in the next line it quotes you again:
PN1278
We intend to exert a fair amount of pressure on the Government, through the hospital system, but we will not ban a patient being taken to a hospital with a higher care level, he said.
PN1279
Again, a fair quote?---Look, I - the sentiment is correct, I cannot say that they were the exact words. I am not sure.
PN1280
The sentiment is correct in that you did intend and continue to intend to exert pressure on the Government, by putting pressure on the hospital system?---Yes.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1281
Yes. Thank you.
PN1282
THE SENIOR DEPUTY PRESIDENT: Whilst we are on that, Mr Morris, can you just explain to me to ensure that I understand it, the ban that says:
PN1283
All patients will only be transported to a higher level of care and no patients will be transported to a lower level of care.
PN1284
What - how does that work?---What happens is we become aware, for example, the one that I became aware of was a patient in Wodonga Hospital - and it is a perfectly adequate hospital but the patient needed a procedure that was not available in that hospital so we are more than happy to transfer the patient from that hospital to another one. The patient eventually came down to the Alfred where that level of care was available. But paramedics do not have the resources - not in the Emergency Ambulance Service, have the resources to do either hospital transfers. The Kennett Government privatised all that work and set up a non emergency ambulance system.
PN1285
Sorry, just so - I think I now understand it - the ban will not - is on transporting a patient to a hospital where a lower level of care is required for that patient, is that it?---Yes, if it is a routine.
PN1286
Yes, I understand that?---If it is a routine patient - - -
PN1287
Thank you?---Yes.
PN1288
MR PARRY: My question about exerting pressure on the Government through the hospital system is the intent of all your bans isn't it, or many of your bans directed at the hospitals?---All the actions we are taking are about putting some pressure on the Government so that they will address our claim.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1289
Now, you - I think at stage 3 was - - -
PN1290
THE SENIOR DEPUTY PRESIDENT: Are you tendering that News.com article, Mr Parry?
PN1291
PN1292
MR PARRY: Now we then note that your Union went to stage 3 bans. Correct?---Yes, that is correct.
PN1293
And presumably again that was to increase pressure on the Government?---That is correct.
PN1294
And again I think you have a copy of those stage - new bans?---Yes, I do.
PN1295
Now I think that is in tab 6, your Honour.
PN1296
THE SENIOR DEPUTY PRESIDENT: Yes.
PN1297
MR PARRY: The first ban - the new one, is:
PN1298
All cases of events received on the 000 line, code 1, code 2 or code 3 will receive an emergency ambulance response.
PN1299
Is an emergency ambulance response - lights and sirens?---No, it is not.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1300
It is not?---No. It is a response from an emergency ambulance and in fact all calls that come in on that code - on 000 that is the response they are supposed to receive.
PN1301
Right. So a Code 3 person may well not require an ambulance but an ambulance will still attend?---That is correct.
PN1302
And if that person gets into the ambulance that person will then be taken to an emergency department, is that your understanding?---Well, it is a bit - it is a little bit different from that. That is a possibility but it needs to be understood that the ambulance service is not there for Code 3 work. There is a whole private sector that does the Code 3 and the routine transports. But what has happened is the emergency ambulance sector are undertaking the transports that the private cannot or will not do and that just ties up emergency ambulances and makes them unavailable to respond and save a life. What we have done here is just officially say, "Look, we are not playing ducks or drakes with these. If these patients present we will quickly get them to hospital and clear them". Because you can spend an hour trying to make other arrangements.
PN1303
Yes, but I just want to work my way through the consequence of applying the ban. That is, Code 3 a call will be made; the ambulance officer will attend - - - ?---Yes.
PN1304
In normal circumstances that patient may well not require an ambulance or can be dealt with in some other way than being transported in an ambulance, correct?---If you have got the luxury of time.
PN1305
Well, we are dealing with Code 3?---That is what this is about. Look, it is quite true. If you get a Code 3 transport and you get a Code 3 case and you go to a psychiatric patient that needs to be assessed you can then spend an hour at the patient's home with the patient, making other arrangements, or, you can transport them rapidly to hospital and someone who has got the resources can then make those arrangements.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1306
You have a boy who hurts his finger - sore finger - rings an ambulance, ambulance will attend - - - ?---Yes.
PN1307
The response will be, "Well, we will take you to the emergency department, get in", and then that child, for example, will be simply taken to the emergency department at the nearest hospital?---Yes.
PN1308
That is the way - - - ?---Yes.
PN1309
- - - the ban is meant to operate, isn't it?---Yes, it is.
PN1310
Yes?---Yes.
[11.57am]
PN1311
It is meant to operate by increasing the number of people simply presenting at emergency departments in hospitals isn't it?---Well, it needs to be understood that it has got to be tempered within reason. No paramedic is going to transport a child with a sore finger unless they have got a reason to suspect it is fractured. They will put a bandaid on it, kiss the child and that is the end of the matter. There will be no transport.
PN1312
In some cases. In other cases there might be if people are applying the bans strictly mightn't they?---Well, it will depend on the circumstance and it depends on the paramedic and the patient that they have got and the circumstances of the patient.
PN1313
Right. And that ambulance officer will make this assessment and he will not know whether the nearest hospital is on bypass or on queues?---That is correct.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1314
And he will present that child to the nearest emergency department - - - ?---Yes.
PN1315
- - - not knowing the status of that emergency department?---That is true. But if it was a child with a sore finger and he did that then that patient would be triaged within the first minute or two, on the evidence we heard yesterday, and then they would go and sit in the waiting room for the rest of the day. That is net effect of that. There is no impact whatsoever on the hospital system.
PN1316
It is your understanding that there is no impact. It is your statement there is no impact on the hospital?---That is correct. There is absolutely no negative effect on the hospital system.
PN1317
I see. Now the second ban is:
PN1318
All persons responded to by paramedics will be transported to the closest available hospital unless they refuse transport and no persons will be triaged as services not required, no ambulance care required for any such categorisation.
PN1319
See that?---I do.
PN1320
Right. Now these are bans that are again meant to be applied strictly?---Yes, they are.
PN1321
THE SENIOR DEPUTY PRESIDENT: Well, if that is right the member attending the child with the cut finger applying the bans strictly would take that child to the hospital wouldn't he?---Your Honour, paramedics are sensible people.
PN1322
But if the ban is applied strictly that is what would happen Mr Morris?---The reality, Commissioner, the reality is that it is not the paramedics' decision to take
**** RODNEY WILLIAM MORRIS XXN MR PARRY
a person. A person also has to want to go. And no paramedic takes any person who does not want to go to hospital. Yet the child - if the child has got a cut finger and the parents have called for an ambulance to respond to that cut finger and they are concerned and they want their child to go to hospital the paramedic has to take the child. Now it is true that paramedics are very skilful people and can talk parents and children out of going to hospital they are just not exercising that option any more. They are just doing the basics of their job and complying with the caller's request. And that is the essence of it. It is not about taking people to hospital who do not want to go there. These people do want to go to hospital that is why they called an ambulance.
PN1323
Yes. Thank you.
PN1324
MR PARRY: The intent of this increased level of industrial action was, as I suggest, to increase again the numbers of people attending at hospital emergency departments?---No, that is not correct. It was to highlight to the government the value the paramedics bring to the community and to the government by going through the triage function. Now the government does not count that as work. And have not resourced the ambulance service to do that work. And if the government wants paramedics to do that very valuable function out in the community, I believe it is a very valuable function, then they have got to provide the resources to do it because while paramedics are doing that work there are other people who can die for the want of a timely ambulance.
PN1325
Now you, I think, went in your media role - you spoke to the ABC, Mr Faine last Friday did you?---That could be correct.
PN1326
On 23 July?---I have spoken to Mr Faine but I do not remember the date.
PN1327
Well, I have a transcript here of an interview you gave with Mr Faine following a call from a Senior Registrar at St Vincent's public hospital. Do you recall that interview?---Yes, I do. I do not recall the whole interview. I recall talking to Mr Faine.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1328
All right. Well, perhaps if I could hand you a copy of the REHAME transcript?---Thank you.
PN1329
Now do you recall speaking to Mr Faine last Friday morning?---Yes, I do.
PN1330
And this was before the most recent bans came into force?---Yes, I believe so. Yes.
PN1331
And - - -
PN1332
THE SENIOR DEPUTY PRESIDENT: But after the notice had been given.
PN1333
MR PARRY: The notice - yes. After the notice. This was part of your media round after upping the, after upping the level of the industrial action?---No, that is just not correct.
PN1334
And you spoke to Mr Faine and he commenced, I think, referring to a call he had had, on the first page, from a Senior Registrar at St Vincent's public hospital telling us - and I am reading from the first bit of what Mr Faine said - right?---Yes.
PN1335
Mr Faine: Telling us that his hospital was, well, chock a block with patients between 1.45 and 3.30 this morning. He thought it was unsafe if they couldn't go on bypass or pre-bypass because of industrial action that is currently under way by the ambulance employees union.
PN1336
Now that was the lead in?---Yes.
PN1337
And that is what you were told?---Yes.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1338
You then gave your version of the industrial action and you were taking it, I think you said for certain reasons and then Mr Faine brought in the enterprise bargaining that was taking place. I am on page 5. And on page 5 in the bottom right hand corner is a number and - do you have that page?---Yes, I do. Page 5. Yes.
PN1339
And at the bottom there is Mr Faine saying, and I quote:
PN1340
We hear from a doctor here that he had genuine concerns about the safety of people in his department earlier this morning so have you gone too far.
PN1341
And you said:
PN1342
No, we haven't gone too far. In fact the doctor is probably right.
PN1343
Do you see that?---Yes.
PN1344
You - - - ?---He is right that they were understaffed on the day for the workload they were experiencing.
PN1345
And the doctor had genuine concerns about the safety of people?---Yes.
PN1346
And you had no reason to doubt either his concerns or what was going on in St Vincent's that day did you?---Yes, I did. And I thought I explained that but I did not explain it very well obviously.
PN1347
I see. And your position was:
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1348
That is not a threat to public safety caused by our actions.
PN1349
?---Exactly. Nothing to do with ambulance or paramedics.
PN1350
You accept that there is a threat to public safety but it is not caused by you?---Absolutely.
PN1351
Yes?---But nothing to do with these actions.
PN1352
PN1353
MR PARRY: Now if Commission would excuse me briefly.
PN1354
And, Mr Morris, the 22 July bans, the ones that you notified then, they came into force, I think on Monday morning at 7 am?---That is correct.
PN1355
And they included the new bans 1 and 2 and they also include the pager communication bans and all those bans set out under Group B?---Yes, that is correct.
PN1356
And you expect your members to adhere to those bans?---Yes, we do.
PN1357
Yes?---Except unless it is a threat to public safety or a patient's safety in which case they modify them as they see fit.
**** RODNEY WILLIAM MORRIS XXN MR PARRY
PN1358
As they see fit?---Well, there was a very clear disclaimer given at the beginning that if the patient is in a time critical situation or if the patient has needs then the patient's needs overtake any industrial action and the paramedics are instructed to care for the patient and do the right thing by the patient in each and every case, and we have been doing that for a long, long time now.
PN1359
I have nothing further, your Honour.
PN1360
THE SENIOR DEPUTY PRESIDENT: Yes. Thank you, Mr Parry. Mr Friend, any re-examination.
PN1361
PN1362
MR FRIEND: Mr Morris, you said earlier that the way the bans operate, and what the paramedics do, are protecting their patients, what did you mean by that?---The patient care is paramount in ambulance and ambulance paramedics are trained to care for patients and to make right decisions on behalf of patients. That is their job. They respond to patients; they triage them; they treat them and they transport them to the hospital which is the appropriate care facility. They generally do not take them anywhere else. Now the focus has to be on the patient, on the life that can be saved, and the next focus then has to be making yourself available as quickly as possible to save another life because there is a shortage of ambulance vehicles and there is a shortage of ambulance paramedics in the State of Victoria. Unlike fire fighters, for example, where there are always more fire fighters and fire vehicles than there are ever fires, and there is always another vehicle that can be sent, in ambulance there is inevitably people who are in the community suffering pain, or in a situation where they might die, and there is not necessarily a local available ambulance to respond to them.
**** RODNEY WILLIAM MORRIS RXN MR FRIEND
PN1363
Now, you also said when it was put to you that ambulance were carrying persons to full emergency departments on bypass and you responded that that was correct to an extent. What did you mean by that?---Probably to the extent that the paramedics make the right decisions on behalf of their patients. If paramedics had a time critical patient and they were on their way to St Vincents and the Royal Melbourne was an appropriate they could otherwise go to then that is what they do. They do the right thing by their patient. If the patient was truly time critical then the appropriate place to go is the closest hospital and the closest hospital, notwithstanding how busy they are, is the best place for that patient to be.
PN1364
Thank you, Mr Morris. Your Honour.
PN1365
PN1366
MR FRIEND: Your Honour, I handed up a document while I was opening, which I did not tender, which I ought to have had marked.
PN1367
THE SENIOR DEPUTY PRESIDENT: that is the Rules of Engagement - - -
PN1368
MR FRIEND: Yes.
PN1369
THE SENIOR DEPUTY PRESIDENT: At the Cabrini. Yes, that will be exhibit - I do not think you have tendered any to date have you, Mr Friend?
PN1370
MR FRIEND: I do not think so, your Honour.
PN1371
PN1372
PN1373
THE SENIOR DEPUTY PRESIDENT: Take a seat please?---Could I have a drink please.
PN1374
Yes. If somebody could help there. Thank you.
PN1375
MR FRIEND: Could you state your name and address please?---Gary Becker, (Address Supplied).
PN1376
And your occupation?---Clinical support officer, MICA Paramedic.
PN1377
And for how long have you been in that occupation?---I have been with the Metropolitan Ambulance Service for 25 years and I have been a Clinical Support Officer for 10 years.
PN1378
And what is a Clinical Support Officer?---A Clinical Support Officer is a qualified MICA Paramedic, who is involved - we respond on ambulances; we do a lot of teaching and training and we also spend probably about 25 per cent of our time in the MAS Communications Room as the senior over-riding clinician.
PN1379
And what do you do as a clinician in the Communications Room?---I guess broadly speaking we triage jobs as they come in - all types of jobs and decide whether - we just keep an eye on what is flowing through and whether it needs upgrading, downgrading or going to various either non-emergency or emergency stretchers.
PN1380
THE SENIOR DEPUTY PRESIDENT: So you triage those jobs remotely as it were, do you?---I beg your pardon?
PN1381
You triage those jobs remotely do you, you do not actually see the patient when you are in the Control Room?---No, no, we triage them remotely by a computer screen.
**** GARY ANDREW BECKER XN MR FRIEND
PN1382
Yes, yes. Thank you.
[12.13pm]
PN1383
And is that for the purpose of designating what type of response there is?---Yes. Basically there is - there is two facets to it, one is to - well, there are several facets but two main ones. One is to triage all the non-emergency work that comes in and see whether it is true non-emergency work and it can go to the contractors, or whether it goes to Metropolitan Ambulance Service. And the other factor is to keep an overall view of all the jobs coming through to see whether or not they are being dispatched appropriately, often liaising with doctors and nurses.
PN1384
And you said you were also a MICA paramedic. Can you just explain very briefly what that means?---MICA, Mobile Intensive Care Ambulance paramedic is - goes through all the usual training of the full ambulance paramedics, and we do a further one year training to do - basically enhance the treatment we can give to patients with further drugs and medical procedures.
PN1385
Thank you. Now, when you - - -
PN1386
THE SENIOR DEPUTY PRESIDENT: Is that full time training, one year full time training?---Yes.
PN1387
MR FRIEND: When you are working in the communications room you would become aware of when hospitals go on bypass?---Yes, we do.
PN1388
And can you give an indication - I am sorry, hospitals are in particular clusters; we have heard evidence to that effect. Do you agree with that?---That is correct.
PN1389
Yes. Now, are you aware of circumstances where all of the hospitals in a particular cluster are on bypass?---Yes. There are - there are clusters as you stated, and there are occasions, reasonably frequently, that all those hospitals go on or wish to go on bypass.
**** GARY ANDREW BECKER XN MR FRIEND
PN1390
And when you say there are occasions, how often does that happen?---I guess it is an irregular thing, but sometimes it may be several days in a row. Other times it might be a couple of days without it, but on the whole I would say it probably happens - over a period of time it probably happens a few times a week.
PN1391
Yes, all right. Now, when you are not in the communications room you work out on the road as a MICA paramedic?---Yes.
PN1392
Do you take patients to emergency departments?---Yes, I frequently take patients to the emergency departments.
PN1393
And what areas do you work in?---Broadly speaking I work from around the Box Hill area right across to the northern suburbs, so around sort of Box Hill Hospital covering across to the Austin and Northern Hospitals and into the city.
PN1394
Yes. Now, prior to the bans being put in place earlier this month or in June, were you ever aware of patients being left in corridors on trolleys?---Yes, I was, frequently.
PN1395
How often would that happen?---Every day. I mean, that is - has been for some time a frequent occurrence. Some hospitals are worse than others but, yes, Box Hill Hospital, Austin Hospital, Northern Hospital; virtually every day there are patients on trolleys in the corridors.
PN1396
Now, are you - what about ambulances arriving at hospitals and being ramped up?---Once again, it is a frequent occurrence and the duty team managers, in particular, as the resource managers often have to contact the hospital or the ambulance officers, paramedics, to ask them why have you been so long at a hospital, and it is because they are queued up.
PN1397
And have you ever in an emergency department seen patients put into the waiting room or on chairs?---Oh, yes. Yes, I have.
**** GARY ANDREW BECKER XN MR FRIEND
PN1398
Was that before the bans?---Yes. Mostly before the bans. I have got numerous examples of that occurring.
PN1399
Is that something that would happen occasionally or frequently or - - -?---Every day.
PN1400
Every day. Has there been any change in the frequency of that that you have noticed since the bans were put in place?---No. I would have to say no, albeit the bans have only been in for a short time and what I have noticed, no.
PN1401
What about an increase in ramping up since the bans were put in place?---Probably - from what I have observed mostly has been remotely from the communications centre.
PN1402
Yes?---And from what I have observed there, I would say it is no different. It happens, it is still happening.
PN1403
Yes?---But it is no different.
PN1404
And what about patients on trolleys?---Once again, I would say it is unchanged.
PN1405
Do you recall an incident at the Austin Hospital about a year ago?---Yes, I do.
PN1406
What happened then?---I transported a patient with a dislocated - fractured dislocated shoulder, from memory, had a - well, he was in severe pain and he was in a pretty bad way. We took him to the Austin Hospital who weren't on bypass, and we got met by the senior doctor who came out and just basically said, you will have to just put in him the waiting room. I stated, well, that is not appropriate because this patient had a lot of morphine, he was in severe pain, my opinion was he needed to be seen.
**** GARY ANDREW BECKER XN MR FRIEND
PN1407
Yes?---And he agreed with that but he said, "You will have to put him in the waiting room."
PN1408
What did you do?---We reloaded the patient - I made a phone call to Box Hill Hospital to see if they were able to accept him as the next nearest, and we took the patient to Box Hill Hospital and he was seen straightaway.
PN1409
Can I ask you with the current bans on what action would you take in those circumstances?---I would do the same thing.
PN1410
Thank you. Wait there, please.
PN1411
PN1412
MR PARRY: If your Honour pleases. Mr Becker, you are not a doctor or a nurse?---Correct.
PN1413
You have been involved in the negotiations for the EBA?---Yes, I have.
PN1414
You have attended the negotiations as a representative of the union?---Yes, I have.
PN1415
And one of the claims being pursued I think is for increased rates of clinical support officers?---Yes.
PN1416
And that is a particular interest of yours, isn't it?---Yes.
**** GARY ANDREW BECKER XXN MR PARRY
PN1417
And that is one of the matters you have been pushing in negotiations, isn't it, that clinical support officers should get better and more conditions?---Yes.
PN1418
Right. I am sorry, how long have you been involved in the negotiations; from the start?---No, approximately - approximately, I would say, two months but not from - if you say they started back in February, I wasn't involved right back then.
PN1419
I see. Have you been involved in formulating the bans?---No.
PN1420
You have left that to others, have you?---Well, yes, basically. I haven't been really involved in any of that.
PN1421
When you say not really involved, have you been involved at all in formulating bans?---No.
PN1422
Now, when a - you are a clinical support officer. That means, I take it, that you work in Tally Ho?---Yes.
PN1423
That is where the emergency communication centre is, isn't it?---Yes.
PN1424
And what, do you work there all the time?---No, I work approximately 25 per cent of it. It is a varying roster but it is approximately 25 per cent of our roster.
PN1425
Now, when a hospital advises bypass status, there is a call made to the emergency control room?---Yes.
PN1426
And you understand that there has been a measured assessment made by emergency doctors and nurses at a particular hospital if they want to go to bypass status?---Yes.
**** GARY ANDREW BECKER XXN MR PARRY
PN1427
And you respect presumably such senior people coming to that assessment?---Yes.
PN1428
You don't argue with the hospital and say you shouldn't be on bypass, do you?---No.
PN1429
And it is a fairly significant thing, a hospital going on bypass, isn't it?---Well, yes, I guess it is for them and it is for us.
PN1430
Well, it is for the emergency department because they are really saying to the ambulance service, we are full, we can't take any more people, aren't they?---No, they are saying that - they are indicating to us that they are busy and they don't really want to see any more patients.
PN1431
Well, that is the agreed protocol, isn't it, that HEWS is a status where they really don't want patients but, if they have to turn up, they will turn up?---No, they will take - that is - no, that is not right. With HEWS they will take their own patients; patients that have a history at their hospital.
PN1432
They will take their own patients. They will take emergency patients. Or they will take, what, patients that walk in off the street or - there is three categories, isn't there?---Yes, and - - -
PN1433
Yes?---Yes.
PN1434
Right. But when bypass is reached, it is really them saying, we are not going to take anyone unless they are life critical?---Well, they will still take patients that walk in off the street, so we are not in control of that. And they can't knock patients back off the street, and they don't. And, yes, they will generally only want to take time critical patients.
**** GARY ANDREW BECKER XXN MR PARRY
PN1435
And there is great uncertainty as to whether patients will walk in off the street, isn't there; no one can predict that?---Well, they - there is busier times and quieter times but, yes, it is generally not quite predictable.
PN1436
Right. Now, you have delivered patients to emergency departments, what, in the last month I suppose?---Yes.
PN1437
Have you continued to deliver to hospitals on bypass?---Not that I am aware. When I say this, to clarify that, in the last month I have been on - I was on leave so actually over the last month I haven't worked a lot on the road.
PN1438
Well, you haven't worked at all. You had four weeks leave, didn't you?---I just said I had leave.
PN1439
Well, when did you come back, ten days ago?---Yes.
PN1440
Where have you been working since you have come back?---As a clinical support officer.
PN1441
At Tally Ho?---I worked on - I had two days sick leave, my first two days.
PN1442
Right, that is - - -?---Yes. Then I worked in Tally Ho on the Sunday, from recollection.
PN1443
Right?---And then I have done some shifts on the road.
PN1444
How many?---I haven't got the roster. You obviously have got it there.
**** GARY ANDREW BECKER XXN MR PARRY
PN1445
No?---Three, four.
PN1446
Three, four. And in that time you have not, to your knowledge, delivered to a hospital on bypass?---Correct.
PN1447
Right. Leave aside the bans, if you were a - leave aside the industrial action, you as an ambulance officer becoming aware that a hospital was on bypass, unless the patient was critical, you would not take the patient there; correct?---Aside of the bans, yes.
PN1448
Yes. Now, as far as you are concerned now, in the three shifts you have had back you have delivered patients to emergency departments?---Yes, I have done a couple.
PN1449
And you have no idea whether they were on bypass or not, do you?---No.
PN1450
No, and you have put the patients there; they have been triaged and you have driven off?---Yes.
PN1451
Right, and you don't know how long they sit there. You don't know where they sit, do you?---No.
PN1452
And you have mentioned about patients being left on trolleys in corridors or in chairs. That is not a desirable thing to happen, is it?---Well, it depends what is wrong with the patient. I mean, no, but generally speaking to be left in a chair when you have got - when you should be lying down, no, that is not desirable.
PN1453
No, it is to be avoided, isn't it?---Yes.
**** GARY ANDREW BECKER XXN MR PARRY
PN1454
And it would be presumably distressing for the patient to be treated like that, wouldn't it?---Well, that is why we took them to another hospital in the case that I gave.
PN1455
Yes, I see. Yes, I have nothing further. If your Honour pleases.
PN1456
THE SENIOR DEPUTY PRESIDENT: Yes, thank you. Mr Friend, anything in re-examination?
PN1457
MR FRIEND: No re-examination, your Honour.
PN1458
PN1459
THE SENIOR DEPUTY PRESIDENT: Yes, Mr Friend.
PN1460
MR FRIEND: I call John Taplin, your Honour.
PN1461
PN1462
MR FRIEND: State your name and address, please?---Yes, John Gregory Taplin (Address supplied)
PN1463
Yes, and your occupation?---MICA paramedic.
PN1464
How long have you been a MICA paramedic?---I have been in the ambulance service for over 20 years.
PN1465
Yes?---And a MICA paramedic for the last four years.
PN1466
Yes, and have you had some role in the union in the past?---Yes, I was the General Secretary of the union from 1990 to '94.
PN1467
Yes, and do you have a position in the union now?---I am a state councillor for the union, on the executive.
PN1468
Now, as a MICA paramedic where do you work?---I work at MICA 6 which is the MICA unit next to the Frankston Hospital.
PN1469
And the Frankston Hospital services what area?---Frankston Hospital covers all the Mornington Peninsula. It has - there is Rosebud Hospital at Rosebud which is part of Frankston's responsibilities, and also would probably cover up to about Aspendale, out towards Carrum Downs, Skye, Pearcedale, right down to Tooradin, that way. It is a fairly large area.
PN1470
Now, if Frankston Hospital is on bypass where are patients taken?---If Frankston Hospital is on bypass, the most likely places are Dandenong if they are not on bypass, Monash Medical Centre. If either one of those aren't available or it is appropriate, then they have to go up to The Alfred, depending where you are coming from. Lower grade patients who wouldn't be requiring any time critical care may be taken to Rosebud Hospital if they are not on bypass.
**** JOHN GREGORY TAPLIN XN MR FRIEND
PN1471
Now, have you ever picked up a patient while Frankston Hospital has been on bypass, had to go past it?---Yes, on a number of occasions.
PN1472
Do patients have any response when they realise they are not going to the closest hospital?---I think it is an unfortunate situation that we go to many patients and they will actually ask us through our assessment of them, is Frankston Hospital on bypass. Because it has such a reputation that it is on bypass quite a lot, and a lot of patients who do have a history and go there, often that is one of the first questions they ask us when we come.
PN1473
Yes, and what is the relevance of that question; what do they do with your answer to that question?---I think there is - over time there has been a little bit of acceptance of that. Some people don't want to go to another hospital. If we believe that they need to go to hospital for assessment and treatment, then we will encourage them to go to the other hospital. On some occasions with patients you might even try and still get them in to Frankston Hospital; sometimes with success, sometimes not.
PN1474
If you think they need to go to hospital but they won't go to anywhere - they won't go with you because Frankston is on bypass, can you make them go?---You can't make them go, no.
PN1475
All right. Now, if Frankston is on bypass and you have to go up to the Alfred, what is the situation with supply of ambulances on the Mornington Peninsula?---It can be and has been very limiting. We have got another MICA unit which is stationed down at Dromana now. That has been in place for the last few years. But there is a number of occasions that we may well be loaded with a patient that we have to go past Frankston and we are aware that the other MICA unit is also dispatched out on a job and it may be unavailable, that you realise there is no MICA resource on the whole Mornington Peninsula.
PN1476
Yes. Are you contacted about that before Frankston goes on bypass?---When?
**** JOHN GREGORY TAPLIN XN MR FRIEND
PN1477
Are you asked what the position is with ambulances before Frankston goes on bypass, before you go up the highway to Melbourne?---Yes. We will - this is - we will routinely check in to see what are the hospitals - a common thing that you will hear asked across the air: Which hospitals are open?
PN1478
All right, thank you.
PN1479
PN1480
MR PARRY: Yes. If your Honour pleases.
PN1481
How long have you been at State Council for, Mr Taplin?---State Council, just over the last year.
PN1482
And you had four years as General Secretary, '90 to '94?---That is correct.
PN1483
Held other positions or offices in the union?---No, they are the only ones.
PN1484
Now, I will follow up a couple of things. You said - as I understand your evidence you said you routinely check in as to which hospitals are open. Do you remember saying that - - -?---Yes, that is correct.
PN1485
- - - just at the very end?---Yes.
PN1486
That is absent the bans, isn't it?---That is - yes, before the bans, yes.
**** JOHN GREGORY TAPLIN XXN MR PARRY
PN1487
So when you were giving that evidence you were giving evidence of what would occur, that is, ambulance officers would exchange information about which hospitals were open?---That is correct.
PN1488
And open - as far as you are concerned "open" is not on bypass?---Not on bypass or HEWS, whichever.
PN1489
And you would also - ambulance officers would also get that information through the dispatches?---Correct.
PN1490
Or through the team managers?---Not sure about the team managers, no.
PN1491
Not sure. I see. And that is before the bans. Can I take it the position is you respect the bans?---I respect the bans and - I think the point is sometimes where, as paramedics - difficult members for a union at times to represent because of - that we will override if patients' health and safety is, we believe, going to be affected. We have to go, sometimes, against our directions and that is why I think it has been developed that we have riders over that, that if the patient is - it's their health and safety and even at times, you know, we are really concerned about their welfare as well, too, that we will override those for the best care.
PN1492
Well, which rider are you referring to here, Mr Taplin, which rider? Is the rider you are referring to the one that - you were in court and you heard Mr Friend, I am sorry, take Mr Morris to the rider which was:
PN1493
Where the patient is time-critical and the patient is in a life-threatening emergency situation and every second counts, then members are expected to vary or ignore the following actions.
PN1494
Is that the rider?---Yes.
**** JOHN GREGORY TAPLIN XXN MR PARRY
PN1495
So if it doesn't fall within that rider the bulletins from Mr Morris make it clear that all actions should be applied strictly as written, don't they?---They do.
PN1496
So if it doesn't fall within that rider you are going to follow the actions strictly as they are written?---On the judgment of that particular patient in those circumstances that you are faced with you would give - I guess it is a holistic look at each individual case.
PN1497
Well, it is not only a holistic look but I am assuming it varies from ambulance officer to ambulance officer?---It may well do.
PN1498
And some ambulance officers may apply the bans absolutely strictly and only subject to that rider and others may be a little more flexible?---Look, I - I spoke to a few paramedics last night about that and there is a hundred per cent consensus that if someone is in a life-threatening situation they will do it in the best interests of the patient.
PN1499
Well, I am sure we are all happy to hear that. Well, let us deal with your evidence about - in Frankston area where patients ask if the hospital is on bypass. That is, I take it, where there is a call made, it could be code 1, code 2 or code 3?---Mm, mm.
PN1500
And you might attend at a residence in the Frankston area and a patient says, I don't want to go to Frankston, it might be on bypass. What do you say to them now?---I haven't had that situation come up.
PN1501
Oh, I see. So for the last six weeks that situation - I am sorry, the last month - - -?---Four weeks.
PN1502
Four weeks - - -?---..... less than four weeks.
**** JOHN GREGORY TAPLIN XXN MR PARRY
PN1503
That situation hasn't arisen with you?---In the last four weeks, no.
PN1504
Well, the position would be that there is - you might not know whether Frankston is on bypass?---Not directly. At times, because we are in and out of there a lot, we will have an understanding of their - how busy and that they are not, but I may not have a knowledge of it.
PN1505
You may well not - have not known for the last month when you dropped patients off whether the ambulance - whether the hospital was on bypass or not?---At some times that might be the case.
PN1506
Have you dropped people off when bypass has been in existence and you knew about it?---Yes.
PN1507
And so you knew the situation was that the hospital was not open, as it were, and you have continued there and you have pulled up and you have put the patient out, the patient has been triaged and you have driven off?---No. The process in that case is I have either rung through and spoken directly to the medical staff. Gone through the clinician and he has advised them of the patient's care - of the patient's condition. And in those occasions - I can just think of two off the top of my head who were patients who were having heart attacks at the time and we have relayed those details through and the respect that we are treated with at Frankston Hospital, they respect our judgment and they don't hesitate to take those patients. We give them as much notice as we can so that they can move people around and we generally arrive and are ushered straight into the resuscitation cubicle and the - it is a sort of a team effort that we have, it is a continuity of care with those.
PN1508
THE SENIOR DEPUTY PRESIDENT: Just so that I understand the evidence?---Yes, your Honour.
PN1509
Isn't it the position in normal circumstances, bans aside, that when a hospital is on bypass, if there is a time-critical patient regardless of the bypass status the hospital will accept such a patient and the ambulance service will take the patient to the nearest hospital - - -?---That is correct, your Honour.
**** JOHN GREGORY TAPLIN XXN MR PARRY
PN1510
Is that the normal situation? Yes. Yes, I just wanted to make sure I understood. Thank you?---Yes.
PN1511
MR PARRY: And the two examples you gave, I think, of patients having heart attacks, they were time-critical?---They were, yes.
PN1512
I see. And let us - there was a hypothetical position of a - not a time-critical patient - in the Frankston area asking if Frankston was on bypass. Presumably, at the moment would tell them, we don't recognise the bypass status of hospitals, I'm still taking you to Frankston?---The - who was that - was that patient in question? Could you just - - -
PN1513
I am sorry. You were dealing with a position in the Frankston area where you said, "Patients ask us if Frankston is on bypass or not". Now, I am assuming that, as you understand it now, if a patient asked you that you would say, we don't recognise the bypass status and I will still take you to Frankston?---It is only hypothetical. I haven't had that situation but - - -
PN1514
I see. Yes, I have nothing further, if your Honour pleases.
PN1515
THE SENIOR DEPUTY PRESIDENT: Yes, thank you. Do you have any re-examination of Mr Taplin?
PN1516
MR FRIEND: No re-examination, your Honour.
PN1517
PN1518
MR FRIEND: Call Robert Ferguson.
PN1519
THE SENIOR DEPUTY PRESIDENT: Robert Ferguson.
PN1520
PN1521
MR FRIEND: Mr Ferguson, could you please, for the record, state your full name and address?---Robert John Ferguson. (Address Supplied)
PN1522
And your occupation?---Clinical Support Officer with the Metropolitan Ambulance Service.
PN1523
And you are also a MICA Paramedic?---I am.
PN1524
How long have you been a MICA Paramedic?---I have been a MICA Paramedic for 19 years.
PN1525
How long have you been a Clinical Support Officer?---Ten and a half years.
PN1526
And how long have you been with the Metropolitan Ambulance Service?---25 years.
PN1527
Now, as a Clinical Support Officer are you aware of when hospitals go on bypass?---When we are in the clinician role, yes.
PN1528
And you are aware that hospitals are in clusters?---Yes.
PN1529
Does it happen that all of the hospitals in a cluster go on bypass?---It does.
PN1530
How often does that happen?---I don't have exact figures. My impression, though, would be that it would certainly happen at least a couple of times a week.
PN1531
And when that happens, what results are there in terms of people being taken to those hospitals?---If all the hospitals are in the cluster are on bypass together, then bypass is ignored and we inform the hospitals that that is the case. We won't recognise the bypass.
**** ROBERT JOHN FERGUSON XN MR PARRY
PN1532
Now, you don't spend all of your time working in the communications room?---No, we work there about 25 to 30 per cent of our time.
PN1533
And have you been working since the bans were on?---I have.
PN1534
And you have been working in the field, so to speak?---I have.
PN1535
Now, prior to the bans going on, did you ever see patients on trolleys in corridors in emergency departments?---Yes, I did.
PN1536
Was that something you saw frequently or infrequently?---It happens frequently and in fact I can recall that happening 25 years ago when I joined the ambulance service.
PN1537
Has it changed in those 25 years?---My impression would be that, no, it hasn't changed very much.
PN1538
Have you seen more of it since the bans came on?---No, I have not.
PN1539
Have you seen patients in chairs - - -?---Yes.
PN1540
- - - at emergency departments. Is that something that happened before the bans were on?---Yes.
PN1541
Has it happened - have you seen it since the bans?---I haven't personally seen that since the bans, no.
PN1542
Was it something that you saw frequently or only infrequently?---It is a frequent occurrence for patients at triage if they have a minor or low acuity type problem they will be put in the waiting room.
**** ROBERT JOHN FERGUSON XN MR PARRY
PN1543
Now, are you aware of the private ambulance providers?---Yes.
PN1544
What areas do you work in when you are - - -?---I work mainly on the southern peninsula area, from Frankston to Portsea, and across to the Western Port side.
PN1545
And with the patient transport vehicles from the private providers, where do they - what parts of the hospital do they use for access?---They - it would depend. Some of it is just a practicality of where the parking bays are. If they are going to some departments in the hospital they would park in the emergency department but they also do deliver patients to the emergency departments.
PN1546
And are you aware if they are notified of hospitals that are on bypass?---I understand they are from time to time by the dispatcher.
PN1547
Now, have you ever had the experience of having a patient in your ambulance and not being able to go to the closest hospital because it is on bypass?---Yes.
PN1548
How does the patient feel .....?---Generally, it is very distressing for the patient and also for their relatives.
PN1549
Yes. Nothing further, your Honour.
PN1550
PN1551
MR PARRY: If your Honour pleases.
PN1552
Mr Ferguson, you have been involved in the EBA negotiations, haven't you?---Yes, I have.
**** ROBERT JOHN FERGUSON XXN MR PARRY
PN1553
And how long have you been - and when you have been involved you have been involved on behalf of the union?---I have been advising the union, yes.
PN1554
Yes. You have attended the negotiations?---I have attended two meetings.
PN1555
And is your particular interest a claim in respect of Clinical Support Officers?---I have two interests. One is on behalf of the Clinical Support Officers and the other is on behalf of Ambulance Officers in general.
PN1556
Do you hold any union positions?---Not elected position, no.
PN1557
Not an elected position?---No.
[12.45pm]
PN1558
Now, in the last few weeks, the period when the bans have been in existence, I think you were asked by my learned friend: are you aware of when a hospital goes on bypass, and you said, "Yes, when you are in your clinician's role"?---Yes.
PN1559
And how do you become aware, and in the last month have you become aware in your clinician's role of when hospitals go on bypass?---Not that I can recall.
PN1560
Right. So in the last month I think you said you performed at least 25 to 30 per cent of the time?---Yes.
PN1561
So in the last month you, in your clinician's role, have not been aware of when a hospital has gone on bypass?---Before the bans I would have been. If I - I can't recall what shifts I worked as the clinician, but before the bans we would have been aware.
**** ROBERT JOHN FERGUSON XXN MR PARRY
PN1562
Well, before the bans were put into place there is a whiteboard, there is a computer system, isn't there?---Yes, but it doesn't flag on my computer system.
PN1563
Right. You become aware in the control room through any number of means - via discussions, the whiteboard, the computer - that a hospital is on bypass?---Yes.
PN1564
Right, and that happens regularly?---Yes.
PN1565
Right, and so in the last month while the second levels bans have been in existence you have not been aware at any time of the hospital going on bypass?---No.
PN1566
No, and presumably the only possible explanation for that is that the calls that are coming through aren't being placed in the computer system or put up on the whiteboard?---I am not sure about what calls come through. They don't come to me, but I am aware that nothing has been put on the whiteboard.
PN1567
Right. Now, when you are out in the field, and you have been out in the field in the last month?---Yes.
PN1568
Does it remain the position that in that period you don't know when a hospital goes on bypass?---Generally unless you make a specific request, you wouldn't be informed until you call the dispatcher to tell them that you are loaded for a particular hospital.
PN1569
Yes, but as I understand the bans, the status of being on bypass is to be ignored by ambulance officers, isn't it?---Yes, it is.
PN1570
Right?---Dependent on the patient's condition.
**** ROBERT JOHN FERGUSON XXN MR PARRY
PN1571
Well, if it is life threatening time critical, you would treat the patient in one way, wouldn't you?---Yes.
PN1572
Other categories you would treat in accordance with the ban?---Yes.
PN1573
Right, and so in the last month when you have been out in the field, have you delivered patients to hospitals you knew were on bypass?---No.
PN1574
So you have delivered patients but you don't know whether those hospitals are on bypass or not?---That is correct.
PN1575
Right, and in doing that, you have been following the union ban?---Yes.
PN1576
Right. Yes, I have nothing further, if your Honour pleases.
PN1577
THE SENIOR DEPUTY PRESIDENT: Yes, thank you. Mr Friend, re-examination?
PN1578
MR FRIEND: No, your Honour, there is no re-examination.
PN1579
PN1580
THE SENIOR DEPUTY PRESIDENT: Is this a convenient time? You have two more witnesses, Mr Friend, is that correct?
PN1581
MR FRIEND: I do, your Honour; possibly three. And it would assist us if we could have some time for discussion over lunch because there may be some issues in relation to the third. If we can - if this is a convenient time for your Honour, it is a convenient time for us.
PN1582
THE SENIOR DEPUTY PRESIDENT: Yes. Well, we will adjourn until a quarter to two.
PN1583
MR PARRY: Well, your Honour, we were advised in opening - - -
PN1584
THE SENIOR DEPUTY PRESIDENT: Yes, Mr Parry.
PN1585
MR PARRY: Sorry, your Honour has adjourned but - - -
PN1586
THE SENIOR DEPUTY PRESIDENT: Well, I haven't; I am indicating that we will.
PN1587
MR PARRY: Yes. I just go back to the opening of my learned friend when he advised of particular witnesses: Mr Becker, Mr Ferguson, Mr Taplin, and there were a Mr Norbury and Mr Stephenson.
PN1588
THE SENIOR DEPUTY PRESIDENT: Yes.
PN1589
MR PARRY: I am not aware of any other third witness. We would simply want to be advised of who that is.
PN1590
MR FRIEND: We will certainly do that, your Honour.
PN1591
THE SENIOR DEPUTY PRESIDENT: Yes.
PN1592
MR FRIEND: It is availability questions and various other things but we will do - - -
PN1593
MR PARRY: If your Honour pleases.
PN1594
THE SENIOR DEPUTY PRESIDENT: Yes. Well, we will adjourn until a quarter to two.
LUNCHEON ADJOURNMENT [12.50pm]
RESUMED [1.50pm]
PN1595
THE SENIOR DEPUTY PRESIDENT: I can indicate that I will hear the Rural Ambulance matter on Friday and Monday.
PN1596
MR FRIEND: Thank you, your Honour. I indicated before lunch that there were steps in the process of trying to obtain information about another witness. We have done that. The witness that we wish to call is Dr Mark Fitzgerald, who is the Director of Accident and Emergency Services at the Alfred Hospital. Your Honour, he has been very difficult for us to contact. He is on duty today, and not available to give evidence. We would seek to call him, if it is convenient to the Commission, tomorrow or Friday when he could come.
PN1597
I have prepared a subpoena, or had a summons to witness prepared for your Honour to consider, if it would be of assistance. If that could be issued. But his evidence, your Honour, will be of some significance. You have heard from four other directors of accident and emergency services. The Alfred is the largest such hospital in the state. And as I understand Professor Fitzgerald's evidence, it will go to questions of the effect of bypass, and the necessity to go on to bypass. These are obviously crucial questions in relation to the matter before your Honour.
PN1598
So what I would need to seek from your Honour in relation to that is, first, the issue of the summons, and, second, adjournment of the matter until such time as convenient to your Honour, either tomorrow or Friday.
PN1599
THE SENIOR DEPUTY PRESIDENT: Well, I would be inclined to adjourn this matter until tomorrow, so we can try to complete this matter before we start on the Rural Ambulance matter on Friday.
PN1600
MR FRIEND: Yes.
PN1601
THE SENIOR DEPUTY PRESIDENT: Mr Parry, what do you have to say about this?
PN1602
MR PARRY: Well, we have just heard about this a few minutes ago. Our position has been of course throughout that we want the matter progressed as a matter of urgency, and we are concerned about matters that will delay the prosecution of the hearing. We are unsure as to why the evidence about the effect of bypass at the Alfred Hospital and the necessity to go to bypass is of such contest that it requires the adjournment of the matter.
PN1603
We have explained the bypass system, and the way it operates differently at hospitals with different numbers. We just don't see the importance of the evidence in the context of the matter.
PN1604
THE SENIOR DEPUTY PRESIDENT: Yes. Well, in the absence of pleadings, Mr Parry, it is a bit difficult, isn't it, to precisely identify the nature of the case and the relevance of the evidence. Is there any possibility of you making Dr Fitzgerald available even today? I take it you are concerned about the delay, if he is to be called tomorrow?
PN1605
MR PARRY: We have a concern about the delay, yes.
PN1606
THE SENIOR DEPUTY PRESIDENT: Yes. Well, is that a viable alternative, to try to get him here today?
PN1607
MR PARRY: If your Honour would excuse me briefly. We will make a call, and attempt to do what we can in that direction, your Honour.
PN1608
THE SENIOR DEPUTY PRESIDENT: Yes. Well, in the meantime we will proceed with the remaining two witnesses, and see where we have got to at the conclusion of their evidence.
PN1609
MR PARRY: As your Honour pleases.
PN1610
MR FRIEND: Thank you, your Honour. I will hold on to the summons for the moment, because it may not be necessary.
PN1611
THE SENIOR DEPUTY PRESIDENT: Yes, it may not be necessary.
PN1612
PN1613
MR FRIEND: Could you state your full name, please?---My full name is Peter Anthony Norbury.
PN1614
And your address?---(Address supplied).
PN1615
Your occupation?---I am a MICA paramedic.
PN1616
How long have you been a MICA Paramedic?---12 years - sorry, I have been a MICA Paramedic for 6 years, I have been an Ambulance Paramedic for 12 years.
PN1617
And what area do you work in?---I am currently acting in the position of Manager of a single response MICA unit and a road unit based at the Epworth Hospital.
PN1618
THE SENIOR DEPUTY PRESIDENT: A Manager of what response? I missed that word?---Single response.
PN1619
MR FRIEND: Now, are you aware of circumstances where hospitals go on bypass?---I am.
PN1620
Does that happen on occasions more than one hospital in a cluster?---Yes.
PN1621
How often would you say that happens?---I would be aware of it happening on a weekly basis.
PN1622
And if all of the hospitals of a cluster go on bypass, what happens?---We take the person to the nearest appropriate hospital.
PN1623
Have you been working since the introduction - - -
**** PETER ANTHONY NORBURY XN MR FRIEND
PN1624
THE SENIOR DEPUTY PRESIDENT: Well, what does that mean, Mr Norbury, the nearest appropriate hospital?---Your Honour, it means that if someone has a life - there are situations set up under something called the State Trauma Guidelines, where if someone suffers severe multiple trauma, and that we are in a certain time frame of the two major trauma hospitals in Melbourne, that is, the Royal Melbourne or the Alfred, then we take people to those hospitals. Bypass in that case, I am led to believe, does not apply to those hospitals in cases of multiple trauma. They are designated trauma centres.
PN1625
Yes, but I thought the question was, if all the hospitals in the cluster go on bypass, and you said you take the person to the nearest appropriate hospital. I am just wondering what you meant by appropriate hospital?---Under those trauma guidelines - - -
PN1626
No, not the trauma guidelines. If all hospitals in a cluster are on bypass?---Well, in that case we will take them to the nearest hospital.
PN1627
The nearest hospital?---Yes, subject to the trauma guidelines.
PN1628
Yes, I see now. Thank you.
PN1629
MR FRIEND: Is the trauma guidelines something that might make one hospital more appropriate than another?---Yes.
PN1630
Now, have you been working since the bans were instituted?---I have.
PN1631
Prior to the bans being instituted, did you see patients on stretches in corridors at emergency departments?---Yes.
PN1632
How often would you see that?---On a weekly, if not daily basis.
**** PETER ANTHONY NORBURY XN MR FRIEND
PN1633
What about patients in chairs in waiting rooms?---I have.
PN1634
And how often would you see that?---On a weekly to fortnightly basis.
PN1635
Since the bans have been in place, have you seen those things?---Yes, I have.
PN1636
And how often?---To the same degree.
PN1637
Have you seen ambulances ramped up prior to the bans being put in place?---Yes, I have.
PN1638
And what about after the bans?---Within the last - since the time the bans have been introduced, on two occasions, yes, I have.
PN1639
Have you ever had occasion to take a patient to a hospital which wasn't on bypass, and be sent away?---Yes, I have.
PN1640
How do those circumstances arise?---I have presented at the hospital. The triage nurse has explained to me that it will be some time before the person is being seen. I asked why they weren't on bypass, and they said they hadn't gone on bypass because they didn't want to incur a financial penalty. That it would still be some time before that person was seen, so I reloaded the person, and moved them to another hospital.
PN1641
Has that happened on more than one occasion?---Yes.
PN1642
What effect does it have in patients to be moved from hospital to hospital like that?---Well, they are obviously distressed that they are still with us and not in the hospital. If we explain to them that they will probably be - they will be seen at another hospital and we will take them there, then they usually are, well, not happy about it, but they are agreeable to it.
**** PETER ANTHONY NORBURY XN MR FRIEND
PN1643
PN1644
MR PARRY: You are on the State Council of the union?---I am.
PN1645
How long have you been on the State Council for?---I believe two years.
PN1646
And have you been involved in the negotiations?---No.
PN1647
Have you been involved in putting the industrial action together?---No.
PN1648
In the period that you have been - that the bans have been in existence, isn't it the position that when delivering a patient to a hospital, you are not aware of whether that hospital is on bypass or not?---I am not aware of whether the hospital is on bypass or not. Over the last two weeks, or the last four weeks since I have returned to work from leave - five weeks since I have returned from leave, I have received a number of pagers from MAS letting me know that there has been a shortage of beds at a hospital, and that there may be delays there. I believe MAS has instituted a program where they have the hospitals informing the group managers, who then send us pagers to do that.
PN1649
So you have been finding out from the pager system whether a hospital is on bypass or not?---Yes - no, not on bypass. There has not been any bypasses instituted. That there is a shortage of beds, and that there will be - may be some delays there.
PN1650
As I understand the nature of the bans, though, that message doesn't get taken much notice of, as far as you are concerned. You still take the patient to the nearest hospital?---In the context of the bans.
**** PETER ANTHONY NORBURY XXN MR PARRY
PN1651
Yes, that is unless - only if they are suffering a life threatening, or in a life threatening position, would you deviate from the bans?---My understanding of the bans was that if it will be a detriment to the patient, that I wouldn't take them there.
PN1652
Sorry, where do you get that understanding from?---From my reading of the - it is my interpretation of how things are read.
PN1653
Which particular reading - which document are you looking at? Where do you get this concept of detriment to the patient, do you recall?---I don't recall. There is a number of bulletins out at the moment, but I can't recall the specific one, no.
PN1654
THE SENIOR DEPUTY PRESIDENT: Have you acted in accordance with your understanding during the period of the bans, Mr Norbury?---Yes.
PN1655
What have you done?---In what situation, sorry, your Honour?
PN1656
Well, that is what I am asking you. In what situation have you acted on that understanding of the bans?---Well, in the context of patients presenting at hospitals, there are five categories under the hospital system. If they are category 1 or 2 patient, I would present to the hospital nearest to me: that is, if they need to be seen immediately, or with in 10 minutes, then I will present to the nearest possible hospital, because even within the inner urban area it is probably going to be more than 10 minutes before being assessed by a doctor.
PN1657
This is while the bans are in place?---Yes. And I will regard that, if that was going to affect them, as being life threatening. And if they needed that assessment, then that is the place to gain that assessment, at the nearest public hospital. In the situation of category 3 patients where they need to be assessed within 30 minutes, then I would - if I was aware that there would be untimely delays about getting that person assessed, then I would move to the nearest hospital where I thought they could get that. If I arrived at the hospital in the inner urban area, then I would move down the road if I found that they didn't. If they are category 4 or 5 patients, then I would present them to that hospital, unless they refuse to go.
**** PETER ANTHONY NORBURY XXN MR PARRY
PN1658
MR PARRY: Just so I can be clear on this. The untimely delays about getting assessed, which category of patient was that?---Category 3.
PN1659
Category 3. And that is not life threatening?---It is a person who needs to be assessed within 30 minutes to determine properly the level of their care.
PN1660
So that is the way you interpret the bans?---Yes.
PN1661
That for those people, category 3, if there is going to be an untimely delay, you will take them to another hospital?---If I believe that untimely delay would be of detriment to them, and may be life threatening.
PN1662
Have you actually done that in the last three or four weeks?---Yes.
PN1663
On how many occasions?---One that I am aware of. One that I can remember in the number of cases that I have done.
PN1664
Was the hospital on bypass?---There weren't on bypass, though I had received a page that there would untimely delay.
PN1665
So the untimely delay was a hospital that should have been on bypass, but had not called bypass?---I don't know if they had been on bypass. I received a number of pages, both pre and post the bans, about hospitals having untimely delays, in whatever form.
PN1666
Untimely delays - - -?---That is the wording of the page, not my wording.
PN1667
Yes, but I think you also used the term, untimely delays?---I am sorry, I was paraphrasing the page as it went out there.
**** PETER ANTHONY NORBURY XXN MR PARRY
PN1668
So if you are aware of a category 3 patient - leave aside the bans - being delayed at a hospital, you would consider taking them elsewhere?---Dependent upon their condition.
[2.07pm]
PN1669
And as I understand it, the concern is you gave an example earlier of taking to a hospital on bypass - or actually it wasn't on bypass and the triage nurse said it would be some time before the patient was seen?---Yes.
PN1670
Right, and that is not a very desirable position for some time - for the triage nurse to make such an assessment, is it?---In what respect, sorry, sir?
PN1671
The patient's respect?---No, but that is the state of the public hospital system.
PN1672
It is not a desirable position that people not be assessed as soon as possible in an emergency department?---It is not desirable that people get assessed in an inappropriate time.
PN1673
Right, and it is distressing for the patients?---I don't think anyone is pleased about waiting in hospital times.
PN1674
Yes, thank you. Nothing further.
PN1675
THE SENIOR DEPUTY PRESIDENT: Yes, thank you. Yes, Mr Friend.
PN1676
**** PETER ANTHONY NORBURY RXN MR FRIEND
PN1677
MR FRIEND: Mr Norbury, that last instance just referred to, the triage nurse saying it would be some time before the patient could be assessed; assessed for what?---In one case they had suffered a fractured neck - femur.
PN1678
YYes, and was that a triage assessment or an assessment following triage?---It was a triage assessment.
PN1679
So that would have been able to be handled if there was more than one triage nurse on at the hospital?---I am sorry, Mr Friend, it is - - -
PN1680
Sorry, was it the case that there was only one triage nurse at the hospital?---Yes.
PN1681
Do you know which hospital that was?---The Austin.
PN1682
The Austin. Nothing further, thank you.
PN1683
PN1684
PN1685
MR FRIEND: Would you state your name and address, please, Mr Stephenson?---Michael Stephenson. (Address supplied)
PN1686
THE SENIOR DEPUTY PRESIDENT: Is that with a "v" or a "ph"?---With a "ph", your Honour.
PN1687
Thank you.
PN1688
MR FRIEND: And your occupation?---MICA paramedic.
PN1689
How long have you been a MICA paramedic?---Four years.
PN1690
And were you an ambulance paramedic before that?---For three years prior to that.
PN1691
Yes, and what position do you currently - where do you currently work?---I am currently the Acting Manager of the MICA unit at the Alfred Hospital in Prahran.
PN1692
Now, have you been working since the bans were put in place in early June?---I have had a month of leave, and I have been back at work for a week and a half.
PN1693
Yes. During that week and a half have you seen the operation of thee bans?---Yes, I have.
PN1694
Prior to the commencement of the bans, did you see patients on stretchers in corridors?---Yes, I have.
PN1695
And how often would you see that?---That would be a daily occurrence.
**** MICHAEL WILLIAM STEPHENSON XN MR FRIEND
PN1696
What about after the implementation of the bans?---I would say it is unchanged from that time.
PN1697
Prior to the implementation of the bans, did you see patients in chairs in waiting rooms in emergencies?---Yes, I have.
PN1698
And how often would you have seen that?---That would be a daily or almost daily occurrence.
PN1699
And what about after the implementation of the bans?---I would say that that is unchanged.
PN1700
Have you seen ambulances prior to the implementation of the bans ramped up waiting to get into an accident emergency centre?---Yes, I have and that is the norm of the places I work at.
PN1701
What places do you work apart from The Alfred?---Predominantly currently The Alfred, but previously at Monash Medical Centre in Clayton that would be a daily norm.
PN1702
Does that happen when hospitals are on bypass?---It doesn't - it tends not to be such a prominent problem on bypass but it is a persistent problem when they are not on bypass when they have activated the HEWS or the pre-bypass system.
PN1703
Yes. Do you recall the time in November 2002 when you saw some ambulances ramped up at Monash?---Yes, I do. And if - at that time there was a number of ambulances backed up and - - -
PN1704
How many would you say?---Probably six or seven.
**** MICHAEL WILLIAM STEPHENSON XN MR FRIEND
PN1705
Yes?---And I triaged the patients myself, the patients in the line; went to speak to the director of the unit and the admitting officer of the unit, and asked them why the case was such and - - -
PN1706
Why what case was such?---Why there was so many ambulances banked up and they weren't on bypass.
PN1707
Yes, and what were you told?---And the response was that they were not to be on bypass as a direction from the Health Minister prior to the upcoming state election.
PN1708
Yes. Is it common to see six or seven ambulances ramped up?---Well, it is not uncommon. Four or five would be the norm.
PN1709
Yes. Now, since the implementation of the bans, have you seen ambulances ramped up?---No, I haven't.
PN1710
Yes. Thank you, Mr Stephenson.
PN1711
PN1712
MR PARRY: If your Honour pleases. You are a state councillor in the union, aren't you, Mr Stephenson?---I am.
PN1713
How long have you been a state councillor for?---About one year.
**** MICHAEL WILLIAM STEPHENSON XXN MR PARRY
PN1714
Have you been involved in putting together the industrial action that is being taken?---No, I have not. I have been involved in - after the taking of industrial action in issues where I believe there might be concerns of public safety, and I have had those issues addressed by the state executive to my satisfaction that did not involve the bypass bans.
PN1715
Right. You have been away on holidays, have you?---That is correct.
PN1716
I am sorry, over what period; I didn't quite catch that?---One month.
PN1717
One month. And when did you come back?---A week and a half ago.
PN1718
Right. That is, what, last Monday; around last Monday?---That is correct.
PN1719
And so you haven't been around at all while the first stage of industrial action was on; right?---Yes, I was around when the first stage of industrial action was on.
PN1720
Right. And you have come back and you are at stage 2 bans now?---Well, this is stage 3 bans.
PN1721
Today; as of today it is stage 2 - - -?---Stage 3.
PN1722
Stage 3, but when you came back last Monday it was stage 2, wasn't it?---That is correct.
PN1723
Right. You were in the court and you heard Mr Norbury give evidence about the use of the pager system to advise of the status of hospitals?---That is correct.
**** MICHAEL WILLIAM STEPHENSON XXN MR PARRY
PN1724
Are you familiar with that yourself?---Absolutely.
PN1725
Were you using it last week?---Yes.
PN1726
And that is following the pager to find out the status of hospitals?---Yes, that is correct.
PN1727
How did it affect what you did, finding out the status of hospitals?---It didn't affect me in any way.
PN1728
Because you were following the bans; that is, it didn't matter whether they were on bypass or not?---No, I have not been put in the situation where I have had to go against the advice of that page because I have not had a hospital that I have been going to who would have issued one of those pagers that would have affected a patient that I had.
PN1729
So you haven't had to go to a bypass hospital yet?---No.
PN1730
Are you aware that the - you are aware of stage 3 bans?---That is correct.
PN1731
Are you aware that they ban the use of pagers?---Yes.
PN1732
Are you going to comply with that ban?---I would have to consider it.
PN1733
You would have to consider it. You are aware that the union puts out bulletins attached to the industrial action?---In fact, when I say I would consider it, I think I would adhere to it.
**** MICHAEL WILLIAM STEPHENSON XXN MR PARRY
PN1734
Right. You would adhere to it?---Yes.
PN1735
So as of today at least, you are not going to take any notice of your pager?---No.
PN1736
Right. So as of today, you won't know the status of the hospital?---No.
PN1737
No?---And under normal circumstances I wouldn't anyway.
PN1738
Right. You wouldn't know the status of the hospital?---No, because the hospital can issue a pre=bypass or a HEWS warning to me but that may, in fact, mean that they are on bypass. They might say that they are on HEWS but, in fact, they might have five or six ambulances banked up. They are already in a situation which is well beyond a bypass situation, but they use the pre-bypass system to avoid financial disadvantage. So I am normally not informed. I would be - I can't imagine I would be any further disadvantaged than I am currently.
PN1739
You are not - so leave aside the bans, you are not told whether a hospital is on bypass or not; is that your evidence?---Oh, no, we are told they are on bypass, but we are frequently told they are on pre-bypass when, in fact, they are in situations that is well beyond bypass. So they use pre-bypass as a pseudonym for bypass.
PN1740
Right. So you are aware before the bans came into place that a hospital was on pre-bypass?---Yes.
PN1741
As of now when we don't look - you are not going to look at the pager, you won't know whether a hospital is on pre-bypass or not, will you?---No.
PN1742
No. I see. So you will simply go to the nearest hospital not knowing what the status of that hospital is?---That is correct. And in the large majority of patients that I would take to hospital in the back of my ambulance, that would be the norm anyway because they are requiring the attention of that hospital.
**** MICHAEL WILLIAM STEPHENSON XXN MR PARRY
PN1743
Right, yes. I have nothing further, if your Honour pleases.
PN1744
THE SENIOR DEPUTY PRESIDENT: Yes, thank you. Mr Friend.
PN1745
MR FRIEND: There is no re-examination, if your Honour pleases.
PN1746
PN1747
MR FRIEND: Aside from the question of Dr Fitzgerald, your Honour, those are the witnesses for the union.
PN1748
THE SENIOR DEPUTY PRESIDENT: Yes. Mr Parry, are you in a position as to advise as to Dr Fitzgerald's availability.
PN1749
MR PARRY: No, I am not, your Honour. Might it be stood down for a short time while I make those inquiries?
PN1750
THE SENIOR DEPUTY PRESIDENT: Yes. How long do you need?
PN1751
MR PARRY: Hopefully five minutes, your Honour. Perhaps I could advise your associate - - -
PN1752
THE SENIOR DEPUTY PRESIDENT: Yes, very well.
PN1753
MR PARRY: - - - once I have made contact with the people I need to.
PN1754
THE SENIOR DEPUTY PRESIDENT: Yes. Well, we will stand down for a short time.
SHORT ADJOURNMENT [2.18pm]
RESUMED [2.43pm]
PN1755
THE SENIOR DEPUTY PRESIDENT: Yes, Mr Parry, what is the position?
PN1756
MR PARRY: Your Honour, I have contacted the CEO of the hospital, and he has asked Dr Fitzgerald to attend. We understand that Dr Fitzgerald is available and could attend; however, the doctor, as we have been advised, is not prepared to attend today or come voluntarily. The doctor apparently has some belief that he might be available on Friday. Our position is that we are here and available. If there is to be a subpoena issued, we are prepared to come back later in the day and go on with the matter. We would prefer to continue, clearly. Ultimately it is a matter for your Honour if we do come back tomorrow morning.
PN1757
THE SENIOR DEPUTY PRESIDENT: Yes. Well, practically how will we serve a subpoena on the doctor and get him here this afternoon? I am prepared to issue a summons, I can indicate that.
PN1758
MR PARRY: Well, we are not seeking a summons, your Honour.
PN1759
THE SENIOR DEPUTY PRESIDENT: No, I know that. But as a matter of practicality, I will issue the summons. It will be served hopefully today, and get him in tomorrow. I don't know how we would get him here today under a summons in any event, Mr Parry.
PN1760
MR PARRY: No bench warrants, your Honour.
PN1761
THE SENIOR DEPUTY PRESIDENT: Not that I am aware of, unless you can point to a regulation.
PN1762
MR PARRY: I don't think I can do some research on that. Well, that is our position. We are prepared - - -
PN1763
THE SENIOR DEPUTY PRESIDENT: Yes. Yes, well, thank you for - - -
PN1764
MR PARRY: We would like to continue today.
PN1765
THE SENIOR DEPUTY PRESIDENT: Yes, and so would I.
PN1766
MR PARRY: We understand the position.
PN1767
THE SENIOR DEPUTY PRESIDENT: Mr Friend.
PN1768
MR FRIEND: Yes, your Honour, we have spoken to the doctor today, and not to the CEO, and our understanding was that he was heading a rapid response team at the hospital today which is why he was unavailable today. We understood from him that he was available tomorrow. We haven't spoken to him since we heard what Mr Parry has just said to me. But we did believe that a summons would be appropriate. We would seek your Honour to issue the summons. We would undertake to have it served this afternoon and would ask that the matter resume tomorrow morning. There will be a delay of a few hours, I appreciate that, your Honour, but - - -
PN1769
THE SENIOR DEPUTY PRESIDENT: I doubt that that will delay a decision. Yes, do you have a summons for me to sign?
PN1770
MR FRIEND: Yes, your Honour.
PN1771
THE SENIOR DEPUTY PRESIDENT: I will attend to that now and it can be - when is that returnable, Mr Friend?
PN1772
MR FRIEND: It says the 29th, which I think is tomorrow. The days are going so quickly at the moment, your Honour, I don't know .....
[2.45pm]
PN1773
THE SENIOR DEPUTY PRESIDENT: Yes. Well, I will amend it in handwriting to indicate that the doctor is summoned to attend before me rather than before a member of the Commission, otherwise he may well turn up and not know where to go.
PN1774
MR FRIEND: Yes, your Honour. Yes, I will have that issued now and provided to your - - -
PN1775
MR FRIEND: Those instructing - - -
PN1776
THE SENIOR DEPUTY PRESIDENT: - - - instructors and that can be dealt with.
PN1777
MR FRIEND: If your Honour pleases.
PN1778
THE SENIOR DEPUTY PRESIDENT: Yes. But in the meantime I propose that we continue to the conclusion of both of your respective submissions and we will call the doctor tomorrow and you can make additional submissions in respect of his evidence as you both desire.
PN1779
MR FRIEND: If your Honour pleases.
PN1780
MR PARRY: Would your Honour just excuse me for a second?
PN1781
THE SENIOR DEPUTY PRESIDENT: Yes.
PN1782
MR PARRY: Your Honour, I have half prepared a written document which has just been corrected. If I had 10 minutes that might shorten what I have to say to you.
PN1783
THE SENIOR DEPUTY PRESIDENT: Yes. Well, I think if - - -
PN1784
MR PARRY: So if I could have it stood down for 15 minutes I will - - -
PN1785
THE SENIOR DEPUTY PRESIDENT: If it is going to shorten the proceedings by more than 15 minutes I will stand it down for 15 minutes.
PN1786
MR PARRY: I half promise. If your Honour pleases.
PN1787
THE SENIOR DEPUTY PRESIDENT: We will adjourn until five past three.
SHORT ADJOURNMENT [2.49pm]
RESUMED [3.08pm]
PN1788
THE SENIOR DEPUTY PRESIDENT: Yes, Mr Parry.
PN1789
MR PARRY: If your Honour pleases. Your Honour has before you the applications by the - - -
PN1790
THE SENIOR DEPUTY PRESIDENT: I take it we are only dealing with the Metropolitan Ambulance Service which is BP2004/4285?
PN1791
MR PARRY: That is so, your Honour. Your Honour is dealing with an application to terminate or suspend the bargaining period. Your Honour, in opening this matter, I made a number of submissions about the industrial instruments and various tests and considerations of the terms "welfare" and "threat to endanger" and so forth. They have been reproduced in a document and if I could hand a copy of that document up to your Honour.
PN1792
THE SENIOR DEPUTY PRESIDENT: Yes.
PN1793
MR PARRY: Now, your Honour, under the heading, Negotiations, your Honour has heard evidence from Mr Morris today that there have been negotiations commencing on the 25th - or in January - February - and since that time there have been negotiations continuing on. There has been an exchange of documents. There has been an extensive number of claims made by the union. The meetings have continued up until last week. Indeed, I think Mr Morris gave evidence that there was an MAS - a specific meeting last Monday. And indeed on Friday there were letters sent by - a letter sent by Mr Lee, the Director of Industrial Relations, about further meetings but they did not take place.
PN1794
There isn't any, on the evidence, immediate prospect of resolution. The position of Mr Morris is that there are a large number of claims and they all remain outstanding. Now, in this context of negotiation for a new enterprise agreement your Honour has heard and seen documents that indicate that there is an industrial campaign in place. And that industrial campaign has involved the union issuing, in accordance with the Act, 170MO notices in three stages.
PN1795
Now, your Honour, as is manifest, we contend those actions are designed to put pressure on the government to concede claims. There was the first stage of bans and they are set out in, I think your Honour gave it the exhibit number A1. There was the first set of bans on 7 June and those bans covered a range of matters clearly designed to restrict the availability of ambulances and place other restrictions on the way the service operated.
PN1796
Now, ultimately, the existence of those bans didn't lead to the progressing of negotiations to the satisfaction of the unions - the union - notwithstanding that, of course, the parties continued to meet and ultimately the union made a decision in late June to increase the pressure on the government further and - - -
PN1797
THE SENIOR DEPUTY PRESIDENT: I take it, it is implicit in what you say that MAS can't concede the claims or come to an agreement without the government approving it. That is implicit in what you say, but I seek confirmation of that.
PN1798
MR PARRY: That is implicit and I - that is implicit and I can make it explicit, I suppose - - -
PN1799
THE SENIOR DEPUTY PRESIDENT: Yes.
PN1800
MR PARRY: If that is what your Honour is asking. And I think it is fairly clear that that is the way the union understood it.
PN1801
THE SENIOR DEPUTY PRESIDENT: Yes. Well, it is certainly the way I understand it but I just want to make sure my understanding is correct.
PN1802
MR PARRY: Yes. Well, we, as your Honour is aware, I have intervened for DHS in this matter and we are a party and we have been involved, being DHS, in the negotiations throughout. And we contend that these actions have been designed to put pressure on the government to concede claims in respect of the ambulance services.
PN1803
Now, the second category of bans were designed - I am sorry, were sent by letter dated 29 June 2004. And this was a significant escalation in the campaign as the new bans, being bans 5 and 6, were bans that went beyond pressures being placed on the administration and the immediate operation of the ambulance service but they dragged in the public hospital system. And they dragged in the public hospital system by targeting two mechanisms that were used to enable the proper and timely and appropriate treatment of emergency patients. And those two systems were the Hospital Early Warning System and the bypass system.
PN1804
Now, the Hospital Early Warning System has been around for, I think Dr Kennedy said a couple of years. The bypass system has a much longer history. And bypass is a system whereby hospitals, in effect, say that their emergency departments are unable to cope with further influx, and I will turn to the evidence of that shortly. But these bans, particularly bans 5 and 6, were designed so that the ambulance service couldn't provide that level of co-operation that both the HEWS system and the bypass system require.
PN1805
And that was designed, we contend, to create a situation where emergency departments of hospitals had extra people attending that either didn't need to attend a hospital or attended notwithstanding the existence of bypass status. And this was designed to put pressure on the emergency departments of the hospitals and consequently, presumably, put pressure, both in a political and public sense, and indeed in the delivery of a proper health system, pressure on the government.
PN1806
Now, that was what we contend was the intent of this escalation of the bans. It was intended that it would create a system where, notwithstanding that the status of HEWS or bypass was notified, that ambulance officers in the field were to ignore that status and attend at the hospital. Now, we recognise that there was a position where time-critical patients and those in dire threat of their lives may well have been treated as a different category, and the ambulance officers may well have treated them appropriately. However, there is a very large number of other persons attending emergency departments that perhaps don't fall into that category, are in category 2 or 3, that do require assessment and do require treatment.
PN1807
Now, we also, in this, recognise that the workers in emergency departments, the doctors and nurses perform a difficult and a complex role. They have to treat and stabilise patients before moving them either to wards or into intensive care. And it is a system, up to date absence the bans, that depends on co-operation. If the bypass system is reached - there has been a number of terms your Honour has heard it described as - the emergency departments aren't open, they are to capacity. I think there is some transcript - I am not sure if your Honour has transcript yet?
PN1808
THE SENIOR DEPUTY PRESIDENT: I have some.
PN1809
MR PARRY: We have been provided with a set at lunch time.
PN1810
THE SENIOR DEPUTY PRESIDENT: You may well be ahead of me.
PN1811
MR PARRY: Well, your Honour has heard evidence from four - - -
PN1812
THE SENIOR DEPUTY PRESIDENT: Yes, go on, Mr Parry.
PN1813
MR PARRY: Your Honour has heard evidence from four senior and very experienced medical practitioners that have knowledge of the operations of emergency departments. And they have given evidence of their concerns and their experiences and they are not to be discounted lightly. They are obviously independent of both the - they are independent of the services. Their primary concern is the treatment of patients and that, no doubt, motivates them to come to this Commission and give the evidence they have given.
PN1814
However, each of them gave evidence about the HEWS and bypass systems. And, for example, I think Dr Kennedy, who was the first witness, gave evidence about the buffer of the bypass system and he gave that at paragraph 199, and he described the bypass system as a:
PN1815
A decision-making mechanism is in place for bypass in our organisation...
PN1816
and I am quoting:
PN1817
...where the lead clinician is on the floor, medical and nursing, the bed management staff and the executive on call are involved in a decision for bypass and I am involved in that decision on each occasion.
PN1818
Also:
PN1819
The basic principle around bypass is that it is a mechanism that the emergency department would utilise in partnership with MAS to decrease the risk that may exist in an emergency department. So it would be employed when, in the judgment of the clinical staff involved, there were significant risks to patients if the department continued to become more congested or high acuity patients attended the department within the next period of time.
PN1820
That is a senior doctor describing the circumstances when a bypass situation exists and has, he describes, when senior clinicians, doctor and nursing, make a judgment that there are significant risks to patients if the department continues to become more congested - or higher acuity patients attend. Also, your Honour has heard from Dr Bradford who was from the peninsula region and at paragraph 424 he described bypass - this is within paragraph 424:
[3.21pm]
PN1821
The bypass is a risk management tool. It is a way of reducing and balancing the risks within an emergency department during a peak period.
PN1822
And your Honour has also heard from Dr Kelly from the Western Hospital who at paragraph 18 - 718, gave her evidence about bypass and she indicated at paragraph 717 that HEWS and bypass were called as rarely as they can manage to do so at the Western General. As she said:
PN1823
A bypass is a workload management issue across the health system, and we are aware that by going on bypass ...(reads)... more patients being brought into the department.
PN1824
So we contend that the calling of a bypass situation is a measured and serious step by the hospital emergency department, and it is taken in circumstances where those practitioners form a view that there is a risk to patients by bringing more patients into the department. This is not - and I am sorry, finally Mr Kennedy I think also at paragraph 200 described it as:
PN1825
A buffer to allow the system to settle and for us to implement strategies to make it safe.
PN1826
And there he was referring to the emergency department and its operations.
PN1827
Now, this is not, we contend, an administrative step. It is not a step that on the evidence before the Commission these doctors are taking for financial reasons. They are not taking it for some administrative reasons. They are taking it to address a position of patient welfare and patient care. Now, we recognise, of course, that those attending emergency departments - often people who are stressed and distressed and, indeed, that could often, as the Commission may accept, be part of a patient attending an emergency department. However, when further - when the system of bypass is ignored, that means that further patients will turn up. And we contend that that creates a situation where that increases the stress and distress, and increases the risks that exist for those patients, both there and who are turning up.
PN1828
Now, we contend that the intent of the bans on second stage was to create a situation of increased stress, tension, difficulty and pressure in emergency departments. That was the intent of the union and the bans had that effect fairly quickly. Your Honour has seen exhibit A5 which was the bulletin sent out by Mr Morris on 7 July, some two or three days after these bans had come into existence. And at that time even after that short period, Mr Morris himself recognised that crews and patients have faced confrontation and conflict at the hospital. And we contend that that confrontation and conflict was intended to occur, and did occur.
PN1829
Now, of course, exhibit A5 demonstrated that the concern of the union was that the MAS, the service, was trying to get around these bans and was trying to create a position where the hospital knew the position, and the ambulance officers knew the position. And what had happened manifestly from the letter was that there had been use of the paging system to ambulance officers to tell them about hospitals being on bypass, and the group manager ringing the hospital and saying: look, ambulances are going to turn up notwithstanding the fact that you have said you are on bypass.
PN1830
Now, Mr Morris and the union became very unhappy about this, and the reason for their unhappiness is fairly clear from exhibit A7; that is, as Mr Morris said in exhibit A7 where he described the MAS managers as "scabbing", he said:
PN1831
These were actions taken to undermine the hospital bypass protected industrial action.
PN1832
Now, of course, it was trying to undermine it. It was trying to ameliorate the effect of that action by making people aware that when they attended at the hospital, that the hospital knew what was going on and the ambulance officers knew what was going on.
[3.30pm]
PN1833
Now, the position was, of course, that what this led to - and I again jump ahead a little - was that in the most recent bans this loophole apparently that MAS have been using by utilising the paging system has been banned again and any other form of communication has been banned. And the intent - again I will go back shortly - but the intent of the stage 3 bans we have reached is that the ambulance officers are to be kept in the dark out there. They are not to be told whether the hospital is on bypass or not. They are not to read their pagers. They are not to be told by the dispatchers. They are not to be told. So they are not told. The patient presumably has no idea. And then the ambulance officer attends at the nearest hospital in ignorance of what the status is in that emergency ward, and the hospitals have no input to the status of the patients coming in, their condition, of course; does know.
PN1834
Now, the bans at second stage, to go back to the second stage bans, continued on for a couple of weeks. And in that couple of weeks period there were ongoing discussions and attempts to resolve the matter, clearly unsuccessful. But it wasn't as though there was nothing not happening out there in the public hospital system. The affects of these bans were manifesting themselves, and they don't manifest themselves in some way that is predictable or that the hospitals can predict or, indeed, the ambulance service itself can predict. They manifest themselves when a number of emergency events accidents, occur, and the hospital emergency department comes under pressure.
PN1835
And your Honour has heard the evidence of, firstly, I think Ms Kelly who gave evidence about what happened at 8 July at the Western Hospital. And her evidence I think starts at paragraph 732 and on that day a Dr Wallby contacted MAS to tell them that the Western Hospital had requested HEWS, and then a couple of hours later requested bypass. And as she said, when that request for bypass is made"
PN1836
We only -
PN1837
and this is at paragraph 735:
PN1838
We only expect to receive a life threatening emergency if there is not another viable option ...(reads)... and then only after consultation.
PN1839
She went on and gave evidence about six ambulances then turning up, and she described at paragraph 740 those patients, their condition, and, of course, the uncertainty of other patients coming into the emergency ward not through the ambulance system. And she said, and it is at paragraph 741, they were treated, the treatment was not as optimal, there were delays, people were taken off monitors, they were taken off vital sign monitors. And she described it as "a patch and move" job. So you have a situation where a stretched emergency department is stretched further by events beyond its control. Patients there go through delays. They go through other - removing from other medical equipment, and they are treated as she described.
PN1840
Now, not surprisingly, she gave evidence of how that affected - or the reaction to her. And as she said, she had to deal with some very angry patients and some very angry relatives. And I think that was at paragraph 745, 744:
PN1841
Angry patients and very angry relatives having a go at her personally ...(reads)... why can't I come and see them?
PN1842
Now, she described this, and we recognise that some times people will be placed in corridors and there will be waiting. However, this experienced doctor said this was - when asked, was this an unusual circumstance in your experience, she said:
PN1843
Absolutely. We have not mounted that type of response in the time that I have been the director.
PN1844
So we are not dealing here with a normal situation. We are dealing here with an extreme situation which not only places pressure and stress and strain on the patients and their relatives but also, as your Honour has heard, on the staff in the emergency departments.
PN1845
Now, your Honour has also heard that on 13 July there was - your Honour has also heard of some - the situation that occurred at the Western Hospital some five or six days later. I think the date was 14 July, where a situation occurred which was a code yellow situation; obviously a situation beyond the - a very unusual circumstance as she described it:
PN1846
A fume leak in a sterilising department.
PN1847
And she described this at paragraph 750, and they were very concerned that they were unable to treat patients with acute heart attacks or needing urgent surgery and:
PN1848
We requested bypass status in the circumstance.
PN1849
Now, clearly that is a fairly serious situation and, as she said, an unusual circumstance. But during that period four ambulances arrived, and she gave that evidence at paragraph 751.
PN1850
THE SENIOR DEPUTY PRESIDENT: It was also put to her that that hospital was exempted, but I don't recall any evidence from the union in a positive sense about that.
PN1851
MR PARRY: Mr Morris - - -
PN1852
THE SENIOR DEPUTY PRESIDENT: And draw me to it if there was.
PN1853
MR PARRY: Mr Morris said, as best I recall - - -
PN1854
THE SENIOR DEPUTY PRESIDENT: Mr Friend will take me to it I am sure, Mr Parry.
PN1855
MR PARRY: Well, no, it was an important matter for our purpose, that is it is all - he said, yes, he was aware of it, he was - it was a Sunday he said. And I am not sure 13 July was a Sunday, but he was rung at home by a senior manager; he said the industrial actions not apply. Now, well, he gave that evidence; fine. Mr Morris sitting at home, wherever his home is, sitting there at home getting a call saying industrial actions don't apply. We have the evidence, and on the ground, they did. Whatever he said, the ambulances still turned up. So it is all very well for him to be sitting at home saying, well, the industrial actions don't apply. On the ground in the emergency department at the Western Hospital the ambulances continued to turn up. So that is really where the evidence sits with regard to that.
PN1856
Now, your Honour, so that was the position at the Western Hospital. And now there was also, your Honour might recall, Dr Bradford giving evidence about the position at the Frankston Hospital, the code yellow situation there. This was I think on 13 July. They requested a - and I think he gave particular times at paragraph 392, at 5.40 pm on that day he was informed there was a crisis situation. And ultimately there was a request for bypass made. And this is as he said, I think this is at paragraph 393:
PN1857
They called three bypasses on that day. It was a busy day, and ambulances continued to arrive during those bypasses ...(reads)... and during that hour they reached 57 in the department.
PN1858
Now, this was a department that had 34 beds. So at one stage there were 57 patients and 34 beds. Now, he gave evidence to the Commission that he was informed that there was a crisis situation, that there were significant risks for patient care:
PN1859
Patients arrived -
PN1860
and I am quoting from paragraph 394 -
PN1861
Patients arriving in ambulances were not able to be triaged by the triage nurse ...(reads)... to mitigate what we saw as a significant risk situation.
PN1862
So on that day the continual arrival of the ambulances during the bypass created a situation which was described by Dr Bradford as a "significant risk situation" and it was treated as an internal emergency. Now, he said that this created the risk situation. The risk situation he later described at paragraph 408 as:
PN1863
Risks for patients, particularly patients who were waiting to be triaged ...(reads)... bring doctors from the wards to the department.
PN1864
Now, it is, as he said in his evidence at 416, in excess of 50 patients was very abnormal. And the reasons, he also gave reasons why yellow responses are called and they are, as he described at paragraph 418:
PN1865
Major telecommunications failure, a major equipment failure, electricity failure, gas leaks were those sort of informal emergencies.
PN1866
Now, at Royal Melbourne Hospital on 17 July a situation developed where there was I think seven ambulances arrived during a bypass. He said, Dr Kennedy at page 254:
PN1867
Seven is extraordinary.
PN1868
And he, indeed, went on and said it was "quite extraordinary" and then dealt with the options in that extraordinary situation. Obviously it involved trolleys to chairs, people being unloaded on to chairs, people in corridors being treated. And as he described it, none of these were particularly satisfactory. Now, we, of course, say here that the welfare threat is not simply to the patients who are both coming into the emergency department, who are in the emergency department or who are in other parts of the hospital and affected by the knock-on effect. But we also say that these are emergency staff are the doctors and the nurses and the other staff who, no doubt, are used to coping with emergency situations by the nature of their job. But for senior doctors to be here saying it is stressful for these staff this situation, we shouldn't be ignoring the position of those staff.
PN1869
And I think we should note that it is not only the people in the knock-ons and the delays and the unhappy relatives, but the risks manifest themselves in a number of ways. I think Dr Kennedy at paragraph 257 spoke to treating patients in public spaces is not good and that is distressing, but he also spoke about the risks about congested emergency departments in international experience, as he described it:
PN1870
A decreased ability to deliver basic care like management of heart attacks within desired timeframes ...(reads)... to infectious diseases.
PN1871
and as he said:
PN1872
There are a huge range of examples I suppose,
PN1873
And he also went on and spoke of the stresses on staff, at paragraph 259. Now, your Honour has also had evidence from Dr Dent, another senior emergency doctor, about the position at St Vincent's. The stresses and strains, and how he has attempted to get around that. And he is essentially supportive of the evidence of the other doctors. And I think his evidence went to how disconcerting this all is for patients losing contact with their primary nurse. He described it as sub-optimal.
PN1874
[3.47pm]
PN1875
He spoke of the elderly getting confused and disoriented, and people being treated in non-private areas with poor spaces for treating clients. Now, the bans that were in existence in this two week period commencing on 4 July, this 2 1/2 week period, led to what we contend were - as the doctors described themselves, abnormal and extraordinary circumstances. It put the emergency system at the four hospitals under great pressure, and it had the consequences that each of the doctors spoke of.
PN1876
Now, of course we had the evidence of Mr Morris today. Mr Morris was continuing to make his press statements throughout this period. He was continuing to make it clear in a very public way both what the union intended by their campaign, and what they thought they were achieving by their campaign. He was shown some of his press comments in exhibit A8, and as he said there and accepted in exhibit A8, it was crunch time:
PN1877
Unless we get significant movement, we will strongly increase our industrial campaign.
PN1878
He spoke of the bans that were now in place. He said:
PN1879
Hospitals will start to bank up as a result. There will be bed blockages and a blow-out in elective surgery waiting lists, Mr Morris said. We intend to exert a fair amount of pressure on the Government through the hospital system, but we won't ban a patient being taken to a hospital with a higher level of care.
PN1880
Now, we of course agree in large part that what he intended, he was achieving. He was achieving disruption to the hospital system. There was pressures on the hospital system, and that was his intent. His intent was to put pressure on the hospital system, and consequent pressure on the Government.
PN1881
Your Honour has seen through the exhibits A5, A6 and A7 how MAS were trying to overcome the bans by direct contact with ambulance officers, by use of the pager system, and contact with hospitals. However, the position then went to stage 3 bans, and these stage 3 bans here as described in - I think it is in tab 6.
PN1882
THE SENIOR DEPUTY PRESIDENT: And they came into effect this morning, did they?
PN1883
MR PARRY: Yesterday morning - I am sorry, no. Monday morning.
PN1884
THE SENIOR DEPUTY PRESIDENT: They were notified on the 22nd, and came into force on the 26th. Yes.
PN1885
MR PARRY: Yes, they were notified on 22 July, and he sent - the union, Mr Daley, the Branch Secretary, sent an authorisation to engage in industrial action dated 22 July. That maintained the existing bans, but also introduced new ones. Now, these new bans were as set out - I think the first one was that all cases events received on the triple O line, whether they be code 1, code 2 or 3, were to receive an emergency ambulance response.
PN1886
Now, your Honour has heard through either some of the ambulance officers, and indeed Mr Morris, that this meant that there wasn't to be triaging or assessing. That if you called an ambulance, and you got in the ambulance, you were going to be taken to an emergency department. And, secondly, the second ban was that all persons responded to by paramedics will be transported to the closest available hospital unless they refuse transport, and no persons will be triaged as services not required, no ambulance care required, or any such categorisation.
PN1887
Now, those are the first two new actions notified, and they are actions manifestly designed to exacerbate the position in the emergency departments of public hospitals. They are designed to create more people being placed in emergency departments, to increase the pressure on emergency departments, and to presumably increase the pressure somehow on the Government through that process.
PN1888
There is also another ban, or other bans on pager communication and E-mail communication. Clearly, what was intended here was to make effective the earlier bans that had been placed at the beginning of July. Mr Morris has been fairly blunt about telling us what is intended. Ambulance officers are to be kept in the dark. They are not to know whether the hospital is on bypass or on HEWS. It is intended that they simply pick up any patient they are called to, and take them to the nearest hospital, leaving aside the life threatening circumstance.
PN1889
Now, we contend that this was a system that was designed to exacerbate the situation. I think Mr Morris gave a radio interview, exhibit A9, where he was asked about St Vincent's Hospital, he was asked on 23 July, and he was asked about the genuine concerns of a doctor in the emergency department. The doctor had genuine concerns about the safety of people in his department earlier this morning - and this is at page 5. Mr Morris accepted the doctor is probably right, but that is not a threat to public safety caused by our actions. So the position of Mr Morris appears to be, well, yes, there is a threat to public safety, but we didn't cause it.
PN1890
Now, our submission is this. The bans are designed, and have created a system where there are more people coming into emergency departments than would normally be there. Some of them should not be going to emergency departments. That increases the pressure on emergency departments. It will be the position that increased pressure on emergency departments often leads to bypass situations. If hospitals do seek to go to bypass, the ambulance officers will not take the phone calls, will not make an announcement that that is the position, will not tell the officers, and do not want communication with the hospitals about the position of the officers.
PN1891
[3.55pm]
PN1892
It is designed to create a position where ambulances continue to attend during bypass, continue to offload patients. Our submission is that will inevitably lead to repeats of what occurred at the Western Hospital, at the Royal Melbourne Hospital, at the Frankston Hospital, and at St Vincent's Hospital. There will be positions where inevitably, we contend, that there will be bypass situations called. They will not be recognised by ambulance officers. Ambulances officers will continue to attend and leave patients there.
PN1893
There will be, we contend, inevitably confrontation and conflict. There is a greater likelihood of persons and patients being placed on trolleys, on chairs, there being delays in their triaging, assessment and treatment. This will, we contend, inevitably lead to circumstances where there is increased stress for patients, their relatives, and also stress for the staff.
PN1894
We do say, of course, that there are knock-on effects when these circumstances occur, as Dr Kelly has given evidence of, surgery delays, code yellows may have to be called, which take people out of other areas, people off monitors, and so forth. As Dr Kennedy said, the examples of these risks are numerous. It is hard to go through a list and categorise each and every possible one, but certainly they each exist.
PN1895
We submit that there is a threat. As it exists at present, to endanger certainly the welfare of patients that are in emergency departments, and of course those that will become patients in emergency departments inevitably in the following weeks. We also contend on the evidence of the doctors and their evidence about the risks to health and safety, that there is a threat to endanger the health and safety of patients.
PN1896
So we contend that the jurisdictional requirement of section 170MW(3)(a) is met. The issue then comes down, as your Honour recognised yesterday, to the exercise of a discretion under 170MW(1). We submit that the discretion should be exercised. The threat is one that affects either vulnerable people, being those in emergency departments, and also as one affecting workers in emergency departments carrying out work themselves under stress and pressure.
PN1897
Further, with regard to the discretion, there is no immediate prospect of the matter being resolved. Indeed, we understand that that is not an immediate prospect, and it should bear on the exercise of the discretion. Further, might we say in the - - -
PN1898
THE SENIOR DEPUTY PRESIDENT: Does that bear upon, Mr Parry, the exercise of a discretion as between suspending or terminating?
PN1899
MR PARRY: Yes, it would.
PN1900
THE SENIOR DEPUTY PRESIDENT: I would appreciate it if you at some stage address me on when one should suspend, or when one should terminate, and what criteria should influence that exercise of discretion.
PN1901
MR PARRY: Yes, your Honour.
PN1902
THE SENIOR DEPUTY PRESIDENT: That is, of course, assuming I decide to do either.
PN1903
MR PARRY: Yes. I am contending - I have made a submission that we met the first hurdle. I am now dealing with the second one.
PN1904
THE SENIOR DEPUTY PRESIDENT: Yes. And as I understood your opening, your primary position is that the bargaining period should be terminated, and alternatively suspended.
PN1905
MR PARRY: My primary position is termination, and that is the application we make. Your Honour will recall that our application also seeks suspension. We recognise that there is a discretion in your Honour, once you have reached the jurisdictional stage, and that discretion will involve balancing up the negotiations, and the likelihood of reaching agreement, the role that the Commission may have in that process, and the immediate effect of the industrial action.
PN1906
Now, our primary concern here is removing the industrial action. We note that can be achieved either by termination or suspension. Now, our primary position is termination. Our secondary position is that your Honour could decide that it might increase the prospects of agreement if your Honour were to suspend for a period of six weeks, engage in a conciliation process to hopefully bring about resolution, and adjourn the application to the end of that period. And if agreement was not reached, we would contend at that time that the resumption of the action in the terms proposed would lead to the same threats and risks arising.
PN1907
So they are the two, and I suppose it is a discretionary judgment for your Honour to balance up those considerations.
PN1908
Those are our submissions, your Honour.
PN1909
THE SENIOR DEPUTY PRESIDENT: Yes, thank you, Mr Parry. Yes, Mr Friend.
PN1910
MR FRIEND: Your Honour, in my opening earlier this morning I made some point of emphasising the use of the word "endanger" in the provision. The position the union takes is that looked at as a whole, the industrial action that is being taken endangers neither the health or safety, nor the welfare of the population, or a part of it.
PN1911
My learned friend, Mr Parry, in his submissions has not really sought, except in a most general way, to focus on the words of the statute, and to bring his case within the words of the statute. He only in a most passing way at the end of his submission made, as he put it, as I understood it, a subsidiary submission that you might be entitled to find on some of the evidence that there was an endangerment of health and safety.
PN1912
He did not call for that finding. He did not submit your Honour should make that finding. He said, his primary position was you should find there is an endangerment to the welfare of two groups of people, perhaps three: existing patients in emergency departments, people that are to come to emergency departments, and staff in emergency departments.
PN1913
THE SENIOR DEPUTY PRESIDENT: I understood him, and I may have misunderstood him, to also refer to existing patients in the hospital who might be affected if services or monitors, and so on, are taken away from them to deal with people in emergency departments. That is as I understood his submission.
PN1914
MR FRIEND: Well, he may have gone to that, your Honour, and I may have missed that aspect of it. Your Honour, I want to go back to the section, and the proper construction of it. I take your Honour first to the decision that my learned friend handed up yesterday, The State of Victoria, Department of Health and Community Services v Health Services Union of Australia. I am not sure if this is one of those cases that your Honour appeared in.
PN1915
THE SENIOR DEPUTY PRESIDENT: I was wondering that.
PN1916
MR FRIEND: I think it was. It went up to the High Court, and then back to the Industrial Court, which your Honour didn't do. Does your Honour have that? It is at Print L9810.
PN1917
THE SENIOR DEPUTY PRESIDENT: Yes, I do.
PN1918
MR FRIEND: Mr Parry took you to it. I want to just take you again to page 15. The meaning of endanger the life, personal safety or health or the welfare of the population or part of it. And your Honour, I agree that the use of those words in 170PO(1)(b)(i) is the use of the same words with the same meaning as we have to deal with here in MW(3)(a).
PN1919
Now, there is a submission by the ANF that the word "welfare" had to be read ..... generis with life, personal safety and health, and that was rejected. And the Full Bench said:
PN1920
We see no reason why the word "welfare" should have other than its ordinary meaning, being a state of faring well, or wellbeing.
PN1921
The whole of the passage:
PN1922
The life, the personal safety, or the health or the welfare of the population or part of it comprises common words, and we do not think it helpful to attempt to define them ...(reads)... or the health and welfare of the population or part of it.
PN1923
Now, as your Honour may recall, the outcome of that case had been a termination of the bargaining period under the then existing provisions, which under those provisions led to the making of a paid rates award, which had been done.
PN1924
There was then a challenge brought in the High Court in respect of that decision. One of the bases of the challenge was that the provisions themselves, in particular, 170PO(1)(b), were unconstitutional. In other words, there was no power to make such a law. That matter was heard by a Full Court of the Industrial Relations Court of Australia, comprised of Wilcox CJ, Lee and Moore JJ.
PN1925
Their Honours, in considering the validity of section 170PP under that legislation had to come to consider how it was that those provisions reflected Australia's international obligations, because the validity of these provisions and the one we deal with now are based upon the External Affairs power. These provisions, your Honour will be aware, apply equally to Division 3 and Division 2 agreements. It is not a case where one can look to the Corporations power for assistance.
[4.10pm]
PN1926
At page - the case that I have referred to is reported (1996) 68 IR 442. At page 448 the court comes to consider the question of whether 170PP is a valid law. They note at the bottom of that page that parliament has there provided that the object of the decision was to give effect to certain of Australia's international obligations and provide for a right to strike. There is no comparable provision in the present Act of course, your Honour, but as I said just a moment ago the only source of power for this provision has to be External Affairs.
PN1927
Turning over the page at 449, the second last paragraph, their Honours noted that the International Covenant on Economic, Social and Cultural Rights supported the provision, but then went on to consider material which had been relied on by the second respondent:
PN1928
The International Labour Organisation's freedom from association and protection of the right to organise conventions ...(reads)... does not in terms recognise the right to strike though as a body of opinion that considers it does so impliedly...
PN1929
THE SENIOR DEPUTY PRESIDENT: Sorry, where are you, Mr Friend?
PN1930
MR FRIEND: I am reading from the bottom of page 449, your Honour.
PN1931
THE SENIOR DEPUTY PRESIDENT: Yes, thank you.
PN1932
MR FRIEND: I am sorry, your Honour:
PN1933
...a body of opinion that considers it does so impliedly, the accepted approach to the construction ...(reads)... found in the Vienna Convention and the Law of Treaties and if necessary recourse to the .....
PN1934
They then make reference on the next page to the Committee of Freedom of Association and its decisions, and there is a quotation from article 3 - I am sorry, at the end of the second paragraph, I will read it, your Honour:
PN1935
The reports of the committee have proceeded on the basis that the right to strike is comprehended by the right of workers to associate conferred by the convention.
PN1936
Article provides:
PN1937
The workers of employers organisations shall have the right to draw up the constitutions and rules to elect their representatives in full freedom, to organise their administration activities and to formulate their programs. The public authorities shall refrain from any interference which would restrict this right or impede the lawful exercise thereof.
PN1938
The report goes on:
PN1939
However, the digested decisions of the committee make plain that the right to strike is not an unqualified one. In relation to strikes by employees in the civil service or essential services...
PN1940
this is the important part, your Honour:
PN1941
...the digest states, Essential services, the civil service and certain other undertakings, the committee has acknowledge that the right to strike can be restricted or even prohibited in the civil service or in essential services insofar as a strike there could cause serious hardship to the national community and provided that the limitations are accompanied by certain compensatory guarantees.
PN1942
Now, your Honour, in the system we have the compensatory guarantees are the MX arbitration. But it is the focus on serious hardship which I want to direct your Honour's attention to because in looking at the provision in our Act which implements into Australian law this convention along with the International Covenant on Social, Economic and Political Rights, there is a focus on the limitation on the right to strike or to take industrial action, we would say, being available only in cases of serious hardship. And it is in that context, in my submission - - -
PN1943
THE SENIOR DEPUTY PRESIDENT: But this limitation is a limitation generally, is it not, Mr Friend, it is not a limitation restricted to essential services, or civil services?
PN1944
MR FRIEND: No, your Honour.
PN1945
THE SENIOR DEPUTY PRESIDENT: Does that put that quote in a different context?
PN1946
MR FRIEND: Well, no, your Honour, because it is the basis on which you - your Honour, it is a - the question of what is an essential service is probably tied up with the question of what causes serious harm to the economy, or endangers the health, safety and welfare of the population or a part of it. If one reads that as being equivalent to essential services - if one doesn't, then there becomes an issue about the limitation on the power and whether that is validly enacted.
PN1947
And the point I seek to make out of this, your Honour, is that one has to, when approaching 170MW(3), be aware that the restriction arises in cases where there is something very serious likely to result. Now, by way of illustration, a great deal of what my learned friend Mr Parry has submitted is that there has been distress, or extra waiting, or discomfort. And, your Honour, we say that those things will come about with many, many strikes and that is not what the provision is directed at. There needs to be something more than that, there needs to be endangerment and that is a serious word, it means something much more than being affected, it means something much more than being adversely affected.
PN1948
THE SENIOR DEPUTY PRESIDENT: Yes. Is endangerment to the welfare of the population, in your submission, something that I should equate with the causing of serious hardship as envisaged in that quote to which you took me?
PN1949
MR FRIEND: I wouldn't say - I wouldn't submit that it needs to be equated with serious hardship, your Honour, but it has to be a serious consequence for the population.
PN1950
THE SENIOR DEPUTY PRESIDENT: Yes, thank you.
PN1951
MR FRIEND: It is not something that is trivial or just an effect, nor yet an adverse effect, your Honour. The submission is that it has to be a serious consequence for the population or a part of it. Now, your Honour, in my submission, it doesn't seem that one can identify as the population or a part of it employees in particular hospitals, but one can identify in the context of this case, I would accept, the population of the Metropolitan Ambulance Service area. That is a part of the population: people who are serviced by MAS. The threatened action for tomorrow doesn't endanger people who are in emergency services now.
PN1952
THE SENIOR DEPUTY PRESIDENT: No, but if Mr Parry is right, it endangers people who might be in emergency services tomorrow.
PN1953
MR FRIEND: Correct, your Honour. So if he is right the real question is: Can one say that the welfare or life, personal safety or health of the people who live or work in the area serviced by MAS is endangered?
PN1954
THE SENIOR DEPUTY PRESIDENT: Or some of them?
PN1955
MR FRIEND: No, it is the population or a part of the population. One can't talk of the people who suffer the effects and say that that is the part - - -
PN1956
THE SENIOR DEPUTY PRESIDENT: No, it is not - could the part be, in your submission, those who may require emergency services during the period of the bans?
PN1957
MR FRIEND: Well, my submission is that that wouldn't be the correct way to construe the statute. But, your Honour, I don't know that anything turns on that because everyone within that population is in a position of perhaps needing - - -
PN1958
THE SENIOR DEPUTY PRESIDENT: Yes, I see.
PN1959
MR FRIEND: - - - an ambulance. And if that came to eventuate and there were the consequences that Mr Parry has addressed your Honour on, then I would accept that population is endangered.
PN1960
THE SENIOR DEPUTY PRESIDENT: Yes, I understand.
PN1961
MR FRIEND: But I really want to try and get it on a logical framework in terms of the statute itself, your Honour, because I think it is important to do that approaching a matter of this significance.
PN1962
THE SENIOR DEPUTY PRESIDENT: Indeed.
PN1963
MR FRIEND: One, then, has to direct attention, your Honour, to the question of whether that has in fact occurred. Now, I opened up, your Honour, by saying that there wasn't really a submission before you that there was endangerment of the life, personal safety or health of anyone. There was at best, and maybe Mr Parry in reply will want to make a direct submission on behalf of MAS and Department of Human Services, that there is danger to the life, personal safety or health. We don't understand to have done that, your Honour - that he doesn't do that. We would submit your Honour couldn't find that on the evidence. An ..... invitation to your Honour that it might be open on some of the evidence. It is not a submission to that effect. You know, either MAS and the Human Services say that is the case or they don't. They bring this case here, or MAS does, and they ought to say that if that is what they say is - - -
PN1964
THE SENIOR DEPUTY PRESIDENT: Well, they bring it on the basis of an alleged threat to endanger the welfare of the population or part of it - - -
PN1965
MR FRIEND: Correct, your Honour, and - - -
PN1966
THE SENIOR DEPUTY PRESIDENT: - - - which they say is a lower threshold than the others.
PN1967
MR FRIEND: Yes. Well, I don't know - may or may not be a - - -
PN1968
THE SENIOR DEPUTY PRESIDENT: That is what they say. I don't know what your submission is.
PN1969
MR FRIEND: Yes. It may or may not be a lower threshold, your Honour, but if it is just welfare well, then, we look at that, your Honour, and we have to ask, what constitutes endangerment of welfare? And what sort of consequences to welfare of the population one needs to find to take as serious a step of terminating a bargaining period and thereby stopping protected action. Now, one should also bear in mind that in a context of the Act there is a focus on the bargaining parties reaching agreement and a focus on the Commission not intervening except in very restricted circumstances. And I don't need to take your Honour to the objects in section 3 in regard to that.
PN1970
The evidence, I submit, your Honour, is that there is some effect. Now, your Honour, I don't have the benefit of the transcript, we weren't aware that it was being prepared - well, maybe it often comes this quickly but not in my experience and we didn't - - -
PN1971
THE SENIOR DEPUTY PRESIDENT: The court reporting service has been exemplary in this case and it is almost a running transcript. I think we have just received part of the transcript of today's proceedings as well.
PN1972
MR FRIEND: Yes. Well, we haven't got - - -
PN1973
THE SENIOR DEPUTY PRESIDENT: And copies are available for the parties.
PN1974
MR FRIEND: Thank you, your Honour. Obviously, I haven't had the benefit of looking at it and I will have to do my best on the basis of what I can recollect from yesterday.
[4.23pm]
PN1975
It is clear from the evidence of all four of the doctors who gave evidence yesterday, your Honour, that none of them was taking every step that they could take to ameliorate the effects of this industrial action. And in those circumstances it can be said that whatever is happening is not due in a sufficiently causal way to the industrial action undertaken by any of these paramedics. That is the first point.
PN1976
THE SENIOR DEPUTY PRESIDENT: Is that right?
PN1977
MR FRIEND: Well - - -
PN1978
THE SENIOR DEPUTY PRESIDENT: Let me just put this to you, and then you can provide a response. As I understand the thrust of that submission, assume for a moment that the industrial action would have the effect of threatening to endanger the welfare of part of the population but for - but that could be ameliorated by the hospitals doing something to avoid that. Is there an obligation on the hospitals to do that, and if they don't take those steps does that detract from the proposition, assuming that it is otherwise factually correct, that the industrial action has that effect?
PN1979
MR FRIEND: Yes. Assuming that the industrial action has that effect - - -
PN1980
THE SENIOR DEPUTY PRESIDENT: Yes.
PN1981
MR FRIEND: - - - my submission, your Honour, is that it is not - it doesn't lie in the mouth of the other party in reality, which is Human Services, the Government, to put itself in the position where people are put in danger and then come to the Commission and say, terminate the bargaining period. There are two ways in which that is put. The first way is the way I just put it; I say that breaks the casual nexus. And the second way I say it is a powerful consideration in respect to the exercise of discretion, and I will come back to that in due course, your Honour.
PN1982
Secondly, your Honour, as I submitted in opening, it is not possible to look at the industrial action in isolation from the system at which it is taken. And your Honour has had a good deal of evidence. We had quite a concentration yesterday on patients in corridors and how bad that was, your Honour. And it happens all the time. There are unsatisfactory things which happen all the time. There are circumstances that give rise to what Dr Dent called - Mr Dent I think it was, sub-optimal care which happened all the time.
PN1983
One of those things which happens all the time is, of course, ambulances being kept off the road. And your Honour in looking at the whole matter in context has to take into account that one of the effects of the action is that ambulances are on the road, able to do what they are supposed to be doing, much more effectively because the evidence clearly establishes that the bypass system is really a means of shifting over-burden on hospitals on to the ambulance service and putting an over-burden on the ambulance service.
PN1984
Now, one thing, your Honour, that you haven't had the benefit of in all of this case is one word of evidence from the employer. It is a telling consideration, your Honour, in relation to all of this. One would have thought that the Metropolitan Ambulance Service would be in a very good position to give your Honour some assistance about the case that is being put. There was a suggestion that someone would give evidence but, instead of that, my learned friend chose to make a number of assertions from the bar table and to seek to draw out from my witnesses what he could to support his case.
PN1985
Your Honour has to draw a Jones v Dunkel inference in relation to that which is that we can't, of course, speculate as to what the evidence of MAS might have been. But your Honour is entitled to it, in my respectful submission, or to draw an inference that nothing MAS said could have assisted it. And that, therefore, all of the things put in evidence by witnesses for the union about the way MAS operates and the effect of these bans in respect of MASs operation is unchallenged. It would have been a simple thing for someone from MAS to come and say, well, it is causing us all these problems. There is another aspect of this, your Honour, too.
PN1986
THE SENIOR DEPUTY PRESIDENT: But isn't the case for the applicant that it is causing not MAS all these problems, it is causing the hospitals all these problems and they brought evidence from the hospital?
PN1987
MR FRIEND: Yes, they have, your Honour, but they have also said that MAS can't notify ambulance crews. They are having difficulty managing the resources, and there is difficulty in communication between the hospitals and MAS. Now, those are the sorts of pieces of evidence that have arisen. We also know, your Honour, two things about the bypass issue. Firstly, that the action was introduced on 4 July and yet we wait 2-1/2 weeks and wait, in fact, for the third tranche of industrial action before MAS makes any application.
PN1988
It is clear that bypass is the significant - bypass and HEWS, both of which are in the second tranche, are the significant things. None of the witnesses for the hospitals made a serious suggestion, in my submission, that the changes brought about by the - well, none of them had any real knowledge of the first ban in the third tranche. Changes brought about by the second ban in the third notice were likely to cause significant problems. Yes, they might cause some discomfort; they might cause some distress. But that doesn't get to the point, the hurdle that they need to pass which is endangerment to the welfare of the population.
PN1989
The second thing, your Honour, is that the bypass changes have been going on for 2-1/2 weeks, yet it fell from one of the witnesses for the hospitals, Mr Dent, that MAS requested not to be called. They had set up a different system for dealing with hospitals requesting bypass but they didn't want to be bothered overnight. Well, your Honour, if the consequences of this are so serious, why did they wait and why is it only a problem in daylight hours?
PN1990
Your Honour, in my submission, it is very clear that the union - it is clear that ambulance paramedics are dedicated people who do a very difficult job. It is clear that they are in the business of saving lives and not hurting people. The evidence from the union and what one can see from the documents is that a very serious attempt has been made to ensure that the industrial action will not put anyone in jeopardy; that it will not endanger welfare. The industrial action about which most complaint is laid and about which most of the evidence is concerned has been allowed to go for 2-1/2 weeks and then, all of a sudden, it needs to be dealt with in two days.
PN1991
Your Honour, I will obviously have some more submissions to make in this regard tomorrow after we hear the evidence of Professor Fitzgerald, and I think that I will be better able to address your Honour on the question of bypass and the significance of it at that time. So I might, if I may, leave that at the moment and leave your Honour with the submission that endangerment of welfare requires much much more than transient pressure, stress and strain which is what my learned friend - the words that my learned friend repeatedly used. And it is transient, your Honour, and one wonders as a matter of English whether some transient harm of that sort of nature, one doesn't - as a matter of English, some transient harm of that sort of nature can't constitute endangerment of welfare. One wonder whether transient harm can in any way constitute endangerment of welfare.
PN1992
Your Honour, in terms of discretion, it is clear that the parties are a long way apart. We acknowledge that, your Honour. We don't anticipate that a suspension of the bargaining period will assist and to reach agreement at all. The whole purpose of industrial action is to place pressure on the negotiating parties, or allow them to place pressure on each other lawfully in an attempt to reach agreement. That having not worked over this period of time, there seems to be no - nothing to be gained by a suspension.
PN1993
We would also submit, your Honour, that in these circumstances termination would not be appropriate and that is because, in my submission, your Honour needs to take into account all of the relevant factors including the state of the hospital system, the very minor changes which really do amount to resources being moved from one area to another as a result of these bans, and the fact that no one has in any concrete way suggested that any person has been put in danger; that their welfare has been harmed or put into danger. I might conclude there, your Honour, subject to Professor Fitzgerald's evidence tomorrow.
PN1994
[4.37pm]
PN1995
THE SENIOR DEPUTY PRESIDENT: Yes, thank you, Mr Friend. Mr Parry, do you want to reply now, or do you want to - would it be more efficient if you wait until after Dr Fitzgerald's evidence?"
PN1996
MR PARRY: I think it will be more efficient. I don't anticipate it will be a long reply, but I think it will be more efficient to do it tomorrow morning, after the evidence. If that is convenient to your Honour.
PN1997
THE SENIOR DEPUTY PRESIDENT: Yes. Well, perhaps the best way to proceed will be to have Dr Fitzgerald called tomorrow morning. You will cross-examine. Mr Friend can then conclude his submissions based on that evidence, and you can reply.
PN1998
MR PARRY: If your Honour pleases.
PN1999
MR FRIEND: Well, I might, just reserve the right to perhaps say something, if there is anything about what Mr Parry says about Professor Fitzgerald.
PN2000
THE SENIOR DEPUTY PRESIDENT: Yes.
PN2001
MR FRIEND: And is depending on what it is.
PN2002
THE SENIOR DEPUTY PRESIDENT: Yes, indeed. Well, in that case we will adjourn until 10 am. I have a video hearing between here and Sydney at 9.30, so I may be a little late. We will adjourn this matter until 10 am.
ADJOURNED UNTIL THURSDAY, 29 JULY 2004 [4.39pm]
INDEX
LIST OF WITNESSES, EXHIBITS AND MFIs |
RODNEY WILLIAM MORRIS, SWORN PN917
EXAMINATION-IN-CHIEF BY MR FRIEND PN917
CROSS-EXAMINATION BY MR PARRY PN975
EXHIBIT #A5 AA BULLETIN OF 7 JULY PN1209
EXHIBIT #A6 E-MAIL TRANSMISSION OF 8 JULY TO MR MORRIS FROM MR COYA PN1216
EXHIBIT #A7 BULLETIN DATED 09/07/2004 PN1254
EXHIBIT #A8 NEWS.COM ARTICLE OF 18/7/2004 PN1292
EXHIBIT #A9 TRANSCRIPT OF INTERVIEW OF 23 JULY WITH MR MORRIS PN1353
RE-EXAMINATION BY MR FRIEND PN1362
WITNESS WITHDREW PN1366
EXHIBIT #U1 RULES OF ENGAGEMENT DOCUMENT RE CABRINI HOSPITAL PN1372
GARY ANDREW BECKER, SWORN PN1373
EXAMINATION-IN-CHIEF BY MR FRIEND PN1373
CROSS-EXAMINATION BY MR PARRY PN1412
WITNESS WITHDREW PN1459
JOHN GREGORY TAPLIN, SWORN PN1462
EXAMINATION-IN-CHIEF BY MR FRIEND PN1462
CROSS-EXAMINATION BY MR PARRY PN1480
WITNESS WITHDREW PN1518
ROBERT JOHN FERGUSON, SWORN PN1521
EXAMINATION-IN-CHIEF BY MR PARRY PN1521
CROSS-EXAMINATION BY MR PARRY PN1551
WITNESS WITHDREW PN1580
PETER ANTHONY NORBURY, AFFIRMED PN1613
EXAMINATION-IN-CHIEF BY MR FRIEND PN1613
CROSS-EXAMINATION BY MR PARRY PN1644
RE-EXAMINATION BY MR FRIEND PN1677
WITNESS WITHDREW PN1684
MICHAEL WILLIAM STEPHENSON, SWORN PN1685
EXAMINATION-IN-CHIEF BY MR FRIEND PN1685
CROSS-EXAMINATION BY MR PARRY PN1712
WITNESS WITHDREW PN1747
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