Children suffering from tuberculosis (TB) have died in the Torres Strait border region after being taken away from Queensland clinics under inconsistent health department policies, an audit found.
Key Point:
- Dr. Emma McBride says Torres Strait doctors face ethical conundrum
- Audits need more training on ethical and medical law issues
- Significant delays in transferring TB patients to PNG facilities
The audit was triggered by the death of a Papua New Guinea (PNG) girl who had sought treatment at a Queensland health clinic from tuberculosis, a doctor involved in the project confirmed.
A research paper obtained by ABC details the findings of an audit examining the outcomes of PNG patients with suspected tuberculosis who crossed borders and sought treatment at Queensland health facilities between 2016 and 2019. Did.
At least six patients, including children, were found dead after being returned to PNG from Queensland clinics for treatment in hard-to-access and poorly equipped medical facilities, the paper said. did.
Two of the six people who died after being sent back to PNG should have been automatically entitled to seek refuge in a Queensland hospital for treatment, an audit found. .
This paper was lead-authored by leading tuberculosis experts, including senior health nurses from Queensland.
It noted that there was “inconsistent application of the aeromedical recall policy in which patients were not transferred for treatment despite meeting criteria for medical severity and urgency.” suggested.
“Various adverse outcomes have been reported in this cohort, including high mortality and loss of follow-up. Policies aimed at avoiding such outcomes, particularly criteria for aeromedical recall to tertiary facilities was not consistently applied,” the paper states.
“This study fully identifies the criteria by which clinical decisions are made to return PNG patients who have visited public health clinics in Australia to the PNG healthcare system or to medically transfer them to Australian hospitals. I couldn’t.”
It said medical services were expected to provide emergency medical care “in line with human rights.”
Local clinicians had to work “in a complex health environment limited by the scope of practice, clinical tools available, verbal and implicit policies and funding constraints,” the paper found.
“The pressure on clinicians to make sound clinical judgments – often life-or-death decisions – while avoiding costly treatment from patients outside Queensland’s health responsibilities is a quiet threat.” This can lead to significant suffering and risk-taking for frontline clinicians, including training and experience.”
Queensland Health defended its handling of Torres Strait health care, saying PNG citizens in clinics were “treated according to their clinical needs like everyone else, and this situation has not changed.” I’m here.
Queensland government policy is that PNG citizens with life-threatening health emergencies can come to a Queensland clinic for treatment.
In some cases, Queensland clinics are closer to their home villages than any hospital in PNG, offering better services and resources.
During the survey each year, dozens of PNG citizens visited the clinic with symptoms of tuberculosis as they were battling a tuberculosis epidemic in their home village in PNG’s Western Province.
The paper said it investigated the outcomes of 213 PNG patients with signs and symptoms of tuberculosis who crossed the border to seek treatment at a clinic in Queensland.
Clinicians used observational charts to score each patient after assessing respiration, heart rate, oxygen saturation, blood pressure, body temperature, level of consciousness, pain, and distress.
The scores were then used in patient management and taken into account in deciding whether to evacuate a patient to a Queensland hospital.
Queensland Health Guidelines state that if a score is 5 or above, Queensland’s Torres and Cape Hospital and Health Service has an obligation to “ensure that patients receive care in Australian hospitals by air medical evacuation.” It says that it means that there is
The study found that of 48 patients with a score of 5 or higher, 22 were not evacuated and 2 later died.
We also found that 5 patients under the age of 18 did not evacuate despite having a score of 5 or higher.
Of the other 165 patients classified as having a health score of 4 or less, another four were later found dead.
The paper highlights a number of issues, including:
- Under the current system, there is no means of recalling patients requiring further evaluation or follow-up according to local policy
- In 2017-2018, the average delay in transferring patients to Daru General Hospital, the closest major healthcare facility to PNG, was 120 days.
- Delays in patient transport increase the risk of TB infection and death, and increase Queensland health care costs for patients to be treated in Queensland clinics
- Early warning tools used to identify serious health problems were not developed to detect serious chronic diseases such as malnutrition and tuberculosis.
- Medical decisions may be influenced by non-clinical factors such as high cost.
Also noted was the fact that clinicians were using the ‘upper limit of care’ procedure to consider whether to limit care. It is typically used in the context of terminally ill patients.
The paper provides six recommendations, including increased staff training related to ethical and medical-legal issues, and review and improvement of the patient health scoring system.
We also called for a pathway of care that included documentation of a battery of vital signs immediately prior to hospital discharge, medical review of patient health scores, and ongoing monitoring and evaluation to ensure transparency and justice.
Costs for providing outpatient care, aeromedical transport, and hospital management of critically ill PNG TB patients from the Torres Strait to Australian hospitals were reported at $124,280.
One of the study’s authors, Dr Emma McBride, who runs a clinic in the Torres Strait and is also employed by the Queensland Department of Health, said the audit reflected significant asymmetries in cross-border healthcare. said there is.
She said it highlighted the plight of frontline doctors and their ethical conundrums.
“On the border front, there are concerns that there is pressure of all kinds to secure funds to treat Torres Strait Islanders, but there is an ethical obligation to do what is best, and doctors and nurses Teachers are left to follow this ethical path, said Dr. McBride.
“We are trying to show evidence that this is not being applied consistently.
“The bottom line is not to blame nurses and doctors for coal face. The idea is not to criticize people making difficult decisions in the heat of the moment. Emphasize the fact that you can do better in good health.” It is a system approach to do.
Dr McBride said the audit was the result of anecdotal evidence of people making decisions under severe pressure that could have resulted in death.
“A girl died and an audit was requested and approved by medical authorities,” she said.
Dr McBride said Australia is seeing the “tip of the iceberg” in terms of tuberculosis cases, given that the nearest major PNG settlement on Dal Island handles hundreds of cases a year.
She said about a third of those cases involved drug-resistant tuberculosis.
On Friday, Queensland Health issued a statement saying it has delivered a world-class aeromedical recovery program.
“Patients referred to Retrieval Services Queensland will be managed according to their clinical needs,” said Queensland Health.
“The provision of health services to PNG citizens residing in PNG is the responsibility of the PNG government, not the Queensland health system.
“However, all Queensland Health facilities, including the Torres Strait facility, are providing emergency care in accordance with relevant humanitarian principles, laws, regulations and agreements, regardless of nationality or personal circumstances. ”
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