Dr Kerryn Phelps, AMA President, with Howard Sattler, Radio 2SM

2 Aug 2002

SATTLER: Another day, another series of crises in the health system - and I've got a handful of them here, ranging from the mother who was forced to give birth in an ambulance parked at a service station, because they couldn't admit her to the hospital where she went.

In fact, they would admit her - this is the Taree hospital - but they didn't have a paediatrician; so back in the ambulance, and have the baby there.

We got another case of a young man, schizophrenic, goes to Hornsby hospital. They won't admit him for whatever reason up there, so he finishes walking in the traffic. Didn't die there; but when he was hit by a train that he walked in front of, he certainly did die. The mother was devastated.

And another story, telling us that big private hospitals, including some in Sydney - this is in the Herald story here today - are on the brink of shutting up obstetric wards because of crippling insurance costs.

Now, I thought that the Federal Government had sorted all this out, and there wouldn't be crises like this. On the line now is the President of the Australian Medical Association, Dr Kerryn Phelps. Hello, Kerryn.

PHELPS: Hello, Howard.

SATTLER: So clearly they haven't worked, they haven't sorted it out?

PHELPS: Still working on it, it's very much a work-in-progress, but there - as you've pointed out - is quite a sense of urgency about finding a solution before there is an escalation in the number of cases like this that we're hearing about.

SATTLER: All right, but the Government has said, "Oh, we'll give you comfort 'till the end of the year - you've got a six-month extension, don't worry about it - we'll sort it out between now and then."

But are you telling me that these hospitals particularly, already hit with hugely increased insurance premiums, are saying, "We just can't afford to go the rest?"

PHELPS: That's what the private hospitals are saying. So, even if the private obstetricians were available, they're finding decreasing number of places where they can actually have midwifery units and obstetric units that they can do the work that they need to do, to safely deliver babies into the world.

So it is a crisis, it's been looming for some time but it's certainly upon us.

SATTLER: Now, if these places, the private hospitals close their obstetric wards - where are the women who would normally be going in there, where will they turn to?

PHELPS: Well, if you ask the women who are looking for a private obstetrician of their choice to deliver their baby, how difficult it is for them to find somebody - you'll generally get a story where women are making six to eight, ten phone calls before they find an obstetrician who hasen't closed their books for that particular month.

And this is even if they ring up the minute that they find out they're pregnant. I mean, it's sort of getting to the point where you'd be on the phone to the hospital and the obstetrician the morning after the night before, just in case - because it really is getting very tight in some areas.

So we have a shortage of those people. Now, some of those people will be able to deliver in the public sector, but that's not why they got private insurance - they want their choice of doctor and hospital.

So some of them will be able to do that, but what I'm being told is that the public sector is now coming under quite significant strain as well.

SATTLER: Of course, so what are you saying? The Government's got to go better than just saying, "Oh we've extended it to December 31?"

PHELPS: I think it's becoming almost inevitable that the Government will have to extend its guarantee to the doctors beyond December 31st, so that the State Governments have time to get all of their reforms in place, and to have those reforms to have some bite.

But we're also going to need to, I think, take a special look at the higher risk specialties, like obstetrics and neurosurgery, and perhaps look for extra solutions around that to preserve those essential services.

SATTLER: Did you see the story about the woman driven from hospital to hospital, trying to find a paediatrician - up in the north of the state - and she finishes up having the baby in an ambulance parked at a petrol station? Goodness, what are we…

PHELPS: Well once again, a lucky situation because it was a safe delivery, but had it not been then we could have been looking at one of those disasters that we just desperately don't want to happen.

Although there was a maternal death over in Western Australia just recently, but not under similar circumstances - and that's tragic.

We also know that where you don't have adequate antenatal and post-natal services - and this is particularly in remote parts of Australia - that the infant and maternal death rates are higher than for areas where there is adequate obstetric services.

SATTLER: They're saying the obstetrics profession's "imploding" - is the word used by doctors - and places like Taree have been without a paediatrician for three months.

PHELPS: There's no obstetricians in private practice between Tamworth and Newcastle.

SATTLER: You're joking!

PHELPS: No, so the situation is dire, and the other problem is in the past, GPs in country areas used to take up where there weren't specialist obstetricians, and they're a disappearing breed now, too. It's very hard to find a GP in the country town who's still delivering babies.

SATTLER: Well, you wouldn't take the risk would you?

PHELPS: Well, it's the risk and the expense. The problem is that even if they're only delivering a dozen or so babies a year, and providing that safety and service for the community, they have to pay still, these enormous medical insurance premiums to cover themselves in case they're sued, in case something goes wrong, and they just don't want to have to take the risk.

And the other thing is, if they haven't got professional support around them - if they haven't got obstetricians and paediatricians and anaesthetists and midwives nearby - then it becomes a very lonely and isolated experience.

SATTLER: Yes, well, thanks for your time again.

PHELPS: Thanks, Howard.

SATTLER: Thank you for your time. That's Kerryn Phelps from the AMA. I mean that is… there's no obstetricians between Newcastle and… I missed the other one, anyway, but you heard it. Tamworth.

Tamworth! That's a real comfort to you if you're an expectant mother up there, isn't it? Terrific.


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