source : the age
For most of us, the hospital is a place of last resort. It is also a place of vulnerability, where we depend on the care and attention of others. In such a setting, a sense of safety is vital.
It has long been the case that some of those who turn up to hospitals in need of treatment themselves pose a threat to others, whether that is due to mental illness, drug addiction or other circumstances. For the sake of staff and other patients, every hospital has to have protocols and the means to exclude such cases and protect its operations.
But The Age’s recent reporting on Victorian hospitals and their use of “not welcome lists” to ensure safety paints a troubling picture.
Paramedics have reported to the Victorian Ambulance Union (VAU), which represents them, that hospitals are triggering “code grey” or “code black” calls when they unload a listed patient from an ambulance, triggering internal procedures for security to attend and remove the person.
As paramedics and ambulance workers have made clear, the issue is not that such procedures exist; it is that the lists are currently not available to them. As VAU secretary Danny Hill put it: “If hospitals are unwilling to take them because they’re dangerous, why the hell shouldn’t paramedics at least have an awareness?”
At a time when paramedics in this state are already questioning their safety on the streets and whether existing laws offer them adequate protection, it cannot be acceptable that they are allowed to turn up to treat someone who it is known might carry the threat of violence without information to that effect. Hill says his union knows of cases in which ambulance workers have been assaulted that might otherwise have been prevented.
Part of the solution has to be in a uniform approach that recognises the rights of all the stakeholders. At present, each hospital is taking exclusion measures independently and confidentially. Requests from Ambulance Victoria for access to a list of banned patients for each hospital has been denied.
Beyond the question of appropriate access, it should be the case that these orders are recorded and held by the Health Department or an independent body. Major healthcare networks assure us not welcome notices are issued only “in serious cases”, but our reporters have heard of considerable variation in the frequency with which different hospitals issue them.
The only way to guarantee such a system is not abused or exploited to lighten a particular hospital’s load (by avoiding particularly difficult cases) is external scrutiny. A first step towards accountability would be for health services’ annual reports to include the number of such bans hospitals have made, just as they report WorkCover claims for injury due to occupational violence. There may well be sound reasons why one hospital excludes more people than another, but at present there is no way of testing that.
Such a record would also increase the protection such lists are intended to offer. As Pierce Tyson, of the Ambulance Managers and Professionals Association, notes: “Not welcome notices [in their present form] protect staff at one hospital, but then transfer the risk to paramedics and staff at other hospitals.”
The Allan government has acknowledged these problems and committed to address them through an anti-violence roundtable it set up last year. But some of those who attended the initial roundtable in November have told The Age of their concern that there has not been another convened since then. We inquired and were told by the government that a second roundtable would occur in June.
Health Minister Harriet Shing told a hearing into the state budget this week that her department does not possess secret lists of patients with challenging behaviour. However, The Age believes that either the department or a watchdog such as Safer Care Victoria should have access to the lists created by hospitals.
At present, the gaps in knowledge that exist are increasing the risk to healthcare workers. But they are also creating a class of people who cannot rely on receiving medical attention when they are in need.
In a case paramedics reported to their union, when one patient was refused entry to Northern Hospital in Epping, that person absconded into the streets without care while paramedics attempted to consult their duty manager.
The longer we wait to address this opaque and uncoordinated system of exclusions, the closer we come to a tragedy none of us wish to see. The only question is whether the victim will be someone in urgent need of medical attention, or someone doing their best to deliver it.
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