Pambula Hospital doctors have slammed the decision to concentrate maternity services at Bega Hospital saying that the safety and quality of the service will be dramatically reduced.
It would lead to a downgrading of obstetrics services in the Bega Valley shire, reduce the number of doctors working at the Pambula Hospital and decrease the ability of the area to attract new doctors, they said.
“It is a ludicrous situation and a looming disaster,” Dr Robert Morton, chairman of the Pambula Hospital Medical Staff Council, said.
“There are major shortcomings with the report.
“It is unsustainable and there is going to be reduced safety. Mistakes will happen. The quality of the service will degrade.” (See letter Page 6)
The Greater Southern Area Health Service (GSAHS) announced last week that there would be only one obstetric service provided for the Bega Valley shire, which would be based at Bega Hospital.
Chief Executive Heather Gray said GSAHS had adopted the recommendations of the independent assessment of maternity services in the Bega Valley, conducted earlier this year to determine the best model of maternity care for the local community.
Ms Gray said the aim of the independent assessment was to improve the delivery of maternity services in the Bega Valley, ensuring the continuation of a safe, sustainable and high quality service.
“Our over-riding concern is the safety of expectant mothers and their babies in the Bega Valley,” Ms Gray said.
Ms Gray said ante-natal and post-natal care will continue to be available to mothers and babies in Pambula.
The independent assessment team was led by Dr Sue Morey, independent consultant and former Chief Health Officer for NSW, and also included a GP obstetrician, specialist obstetrician, a midwife and a consumer representative. (See report story Page 2)
Dr Janet Watterson of Pambula described the decision as “a sad day for us.”
Dr Michael Pentin of Eden said the closure of the Pambula maternity department was a big step in the downgrading and eventual closure of Pambula Hospital.
“Soon to follow will be the closure of the operating theatre... the next may be the closing of the casualty department,” he said (Letter Page 6)
GSAHS eastern sector general manager Ken Barnett said the key outcome from the review process was that there would be a safe and sustainable maternity service.
But he told ABC Radio on Monday that “without doubt, finding enough obstetricians to provide the service will be difficult.”
Mr Barnett also gave an assurance that Pambula Hospital would not be closed and said he would be meeting with doctors there today to discuss some of the issues further, including their desire to undertake more surgery there.
“We need to remind the community that Pambula Hospital’s continuity is certainly assured,” he said.
“We certainly need its emergency department, inpatient beds and the expertise they provide to service the whole shire.”
Mr Barnett also said that he was very keen to have the Pambula doctors engage in the new model of maternity services that would operate from Bega.
Bur Drs Morton, Watterson and Pentin were adamant that was not going to happen.
“We need a major shift in the commitment of GSAHS to the use of Pambula Hospital and its services, nursing staff and operating theatre usage,” Dr Morton said.
There was a need to increase usage, activity and staff numbers, retain and improve their skills and use midwives between both centres cooperatively.
“Then you can talk about having maternity services at both hospitals,” Dr Morton said.
The Member for Bega Andrew Constance called on NSW Health Minister John Della Bosca to appoint an independent board of administrators at Pambula Hospital and to develop and implement a new clinical services plan that sees community confidence restored in the facility’s future.
The recent exodus of doctors and the decision to close the maternity unit had come after years of neglect by the State Labor Government, Mr Constance said.
“It is a sad indictment of Labor’s mismanagement of health services,” he said.
“The major issues stem from a lack of staffing, particularly the on-call theatre staff and nurses since January 2007.
“That coupled with the alternate rosters leading to ‘stop, start’ units at both hospitals leaving women at risk has led to the health service deciding to close Pambula’s unit.”
Mr Constance said that “without doubt Labor will into the future badly manage the single unit at Bega Hospital.”
Dr Morton said that while he had to accept the report at this stage, he did not agree with it, and warned, “This debate on adequate obstetric services for the Far South Coast has only begun.”
He said, “The loss of five procedural GPs from the workforce by implementing this review is directly contravening the Federal and State governments’ plans to maintain and increase the number of procedural GPs.
“This attitude of disregarding and disposing of rural procedural GPs will lead to fewer and fewer GPs training to be procedural, as there will be no opportunities for them to practice their skills.”
Dr Watterson said the decision removed the right of expectant mothers to know who their doctor would be and added that there had already been problems with the two Bega doctors relying on “an unsatisfactory mix of locums.”
She said she understood the maternity unit at Bega Hospital was only told on the day of arrival who the locum would be and his mobile phone number.
On one day last week, the roster had TBA where the name of a locum should have been listed.
“What happens if the locum does not turn up or has an accident?” she asked.
“And they think this is safer. Relying on locums is a deterioration in services.”
The key fault all three GP obstetricians found with the report was that it specified an on-call minimum of six doctors to staff the service, whereas Bega had only two.
All three said that Bega would find it impossible to recruit four new GPs with obstetrics skills, partly because it did not have the population to support them, and partly because their numbers were dropping rapidly right across the state.
Dr Pentin said that the four local GP obstetricians who worked out of the Pambula Hospital, with around 100 years of accumulated experience, had effectively been put on the scrap heap by GSAHS.
“Their only option, should they wish to continue is to sell their practices if they can, and move elsewhere to where their skills are welcome,” he said.
The fourth member of the group, Dr Frank Simonson of Merimbula, who resigned from his position as Visiting Medical Officer (VMO) at Pambula Hospital in protest against GSAHS attempts to close down obstetrics services there is currently overseas on leave.
Dr Pentin said Bega Hospital would be left with only two GP obstetricians delivering all the babies, instead of six.
“This will result in Bega Hospital attempting to obtain fly-in locums, perhaps from overseas, which will be very impersonal for the mothers, and the risk of being able to keep finding adequately qualified locums is very real, which may result in intermittent closure of the service and women having to deliver at Canberra or Moruya.
“The midwifery staff will be apprehensive in dealing with locums whom they are not confident or familiar with. Continuity of care will be lost.”
Dr Pentin said, “The down grading or loss of Pambula Hospital is going to make the area less attractive for our practices to recruit young doctors and there is likely to be an exodus of some of the local doctors to other areas to continue practicing their skills.
“Additionally there will be a loss of much needed nursing and midwifery staff from the area as they are unable to practice their skills. I am already aware of two Pambula midwives who have arranged to work out of the area.
“The morale among the staff at Pambula Hospital is at an all time low, the main factor being the downgrading of the hospital, and their deskilling.
“GSAHS will have a massive problem in recruiting GP obstetricians as mentioned in the maternity report as there are very few remaining in NSW. Bega is less attractive to young doctors that a costal situation.”
Dr Morton said that while one really good maternity facility would be good, “this is not going to be one really good facility.
“We are going to have huge problems with maintenance of services, with maintenance of medical staff.”
He said it would be based on specialist obstetricians flying in and flying out to cover local shortages, a system which had already failed at Moruya and Albury.