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Health "transformation" set to cripple QEH cardiology

Opinion

The head of cardiology at the Queen Elizabeth Hospital, John Horowitz, asks why his world-renowned unit is set to be gutted, and raises a warning about the treatment of cardiology patients at the Royal Adelaide Hospital.

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A few Sundays ago, the Sunday Mail devoted considerable efforts to providing a fair and reasonable view of the Transforming Health exercise. However, it is certainly difficult to obtain “balanced” views on the subject from the health bureaucracy, their paid medical representatives or especially from the Minister.

In my role as Director of Cardiology at the Queen Elizabeth Hospital, I have observed, over the last two years in particular, attempts to remove our facilities for treating acutely ill cardiac patients from the western suburbs, the epicentre of heart disease in Adelaide.

It is currently proposed to reduce our bed numbers from about 28 to six, and to close our two cardiac catheterisation laboratories, which perform about 1500 procedures per annum, including management of heart attacks, insertion of pacemakers, and also diagnostic work in patients with angina, heart failure and cardiac rhythm disturbances. These services also provide the basis for QEH cardiac research, which has a strong reputation world-wide.

In summary, the Government’s plans would effectively cripple our whole functionality: we might as well be closed.

The real reason for this piece of bureaucratic nonsense is a fixed idea about the future role of QEH. It can have nothing to do with saving money: cardiac procedures at QEH are better planned than at the Royal Adelaide Hospital, primarily due to the utilization of a superb nuclear cardiology diagnostic service, which serves to avoid unnecessary procedures. On average, it costs at least $1000 less to investigate and treat a cardiac patient at QEH than at RAH.

It can also have nothing to do with prompt delivery of services: on the contrary, RAH persists in using a highly inefficient process to activate its emergency service for treating heart attacks, indeed the least efficient in the state. There is considerable concern at the reported very high mortality rate for people suffering heart attacks admitted to RAH.

Finally, it has nothing to gain at the level of ambulance transfer: incremental ambulance transport between QEH and RAH (in both directions under Transforming Health) will cost in one year more than the costs of replacing both QEH labs. Despite this, there are still cases of bypass of the QEH by ambulances with life-threatening cardiac emergencies on board. Recently a teenage boy was reported in The Advertiser to have collapsed in cardiac arrest during sport at Henley Beach High School, and was taken to RAH, not QEH. How this was allowed to happen, and why the Department of Health (who initiated the reporting of the case) regard it as a “triumph” of the health system is beyond my comprehension.

And yet, consider the “evidence” of consultation on the process of evolving cardiac care at QEH/RAH.

Transforming Health boss Vickie Kaminski stated to the press in June this year that QEH cardiology would be moved to the old RAH in July. Pressed to visit QEH Cardiology and learn something about the matter, she initially accepted, then reversed her decision after I gave her a list of questions to answer. She has never consulted with me in any way.

The chief executive of the Central Adelaide Local Health Network, Julia Squire, chaired more than 12 meetings with QEH/Hampstead staff, organising “presentations” of development plans without once asking any question. Eventually she was told that this “consultation process” was not productive. She visited QEH Cardiology once, and at least now knows a little about nuclear cardiology. She is yet to provide a rationale for the downgrading of QEH cardiology.

Transforming Health “ambassador” Dorothy Keefe is on record as saying that transfer of cardiac emergencies to RAH will improve outcomes, and that it is a “no-brainer” that it should occur.

Transfer of QEH cardiac emergencies to RAH will produce a reverse Muldoon effect: worsening outcomes at both places. Dorothy’s statements are made despite the fact that cardiology isn’t her area of expertise. Perhaps she should solve the problem of the distribution of PET scanners, which are used to plan management of cancers – her own specialty? Under Transforming Health, all four PET cameras will be located in the Adelaide CBD – hardly a triumph of distribution of resources.

Finally there’s Health Minister Jack Snelling.  Over his tenure in the post, he has spoken to QEH cardiology for about eight minutes, on a single occasion only. He asked no questions. However, he has said plenty in public.

He thinks that the main QEH catheterisation lab needs to go to the Lyell McEwen Hospital, so that LMH patients need not come to QEH. Actually, no LMH patients have needed to come anywhere outside LMH except if their cath lab is out of action  (an extreme rarity). Indeed, over the past five years QEH and LMH cardiologists have provided a very effective joint emergency service for heart attacks which is functional on a 24/7 basis. On average, less than 4% of QEH cardiac inpatients come from Northern Adelaide. Incidentally, the Minister has acknowledged in Parliament that he knows about the matter of the RAH heart attack mortality rates, but has apparently done nothing about this issue.  The Minister appears to be a very confused man.

The new RAH, an act of unwarranted hubris by the Rann government, is now an inevitable economic black hole, which will affect all of us profoundly over the next 30 years. Many other health “reforms” such as EPAS,  are also open to substantial criticisms. There has to be a statute of limitations on the ongoing process of making matters even worse than is the case at present. It’s time for the Government to consider its legacy: do they wish really to be immortalised along the lines of the old lady who swallowed a fly?

John D Horowitz is director of the Cardiology/Clinical Pharmacology Unit at the Queen Elizabeth Hospital and Professor of Cardiology at the University of Adelaide.

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