From a walk at Manly to amputation: hospitals putting 'lives at risk'

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From a walk at Manly to amputation: hospitals putting 'lives at risk'

By Carrie Fellner

It started with a harmless blister, the product of a stroll along Manly Corso on a warm November evening.

Three months later, John Stingemore was lying on a surgeon’s table in Dubbo, streaks of infection charging up his leg as doctors broke news two toes would have to be amputated.

Cobar resident John Stingemore is one of a number of residents who have had troubling encounters with hospitals in western NSW.

Cobar resident John Stingemore is one of a number of residents who have had troubling encounters with hospitals in western NSW. Credit:Janie Barrett

The grazier, 58, believes he is just one victim of a dysfunctional health system that is putting lives at risk across western NSW, including in his home town of Cobar, 700 kilometres north-west of Sydney.

An investigation by The Sydney Morning Herald has uncovered a string of troubling incidents within the past 12 months, including a death and a series of near-misses, at Cobar and Dubbo hospitals within the Western NSW Local Health District.

They include allegations a man lost most of his bowel after a hospital repeatedly refused to admit him; a patient being told his ward had “run out of Panadol”; and that in a facility that had undergone a multimillion-dollar upgrade, there was no-one who could insert an IV drip.

Cobar resident Bill‌ ‌Howlett,‌ ‌79,‌ said he was dismayed at ‌how‌ ‌the‌ ‌local‌ ‌health‌ ‌service ‌had‌ ‌deteriorated‌ ‌when‌ ‌his town ‌used‌ ‌to‌ ‌have‌ ‌“one‌ ‌of‌ ‌the‌ ‌best‌ ‌operating‌ ‌theatres‌ ‌in‌ ‌NSW”.‌ ‌ ‌

“Now,‌ ‌as‌ ‌soon‌ ‌as‌ ‌you‌ ‌go‌ ‌there‌ ‌with‌ ‌anything‌ ‌more‌ ‌than‌ ‌a‌ ‌toothache,‌ ‌they‌ ‌send‌ ‌you‌ ‌away,”‌ ‌he‌ ‌said.‌

Bill Howlett, Chris Boucher, and Pete Rogers on Cobar's main street. They are speaking out about the local hospital despite concerns about ruffling feathers in the tight-knit community.

Bill Howlett, Chris Boucher, and Pete Rogers on Cobar's main street. They are speaking out about the local hospital despite concerns about ruffling feathers in the tight-knit community. Credit:Janie Barrett

Many residents of the close-knit community of 4000 fear they are risking lifelong friendships by speaking out about their concerns.

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Local MP Roy Butler said the healthcare situation was so dire across his electorate of Barwon, which spans 44 per cent of western NSW, that many hospitals could no longer perform procedures as basic as changing a dressing or stitching up a wound.

He blamed the difficulties of attracting medical workers to the bush,‌ cost-cutting ‌and an increasingly ‌risk-averse culture in smaller facilities. ‌

Ballooning numbers

The problems are spilling over to larger feeder facilities such as Dubbo Base Hospital, which find themselves fielding ballooning numbers of patients from far-flung towns on top of their own populations.

In 2017/18, nearly $500,000 was spent flying 75 patients from Cobar to Dubbo. Last year, that number climbed to 99 patients.

Someone is being flown from Cobar hospital on average every 3.5 days.

When Mr Stingemore’s blister became badly infected in the weeks following his trip to Sydney, he attended Cobar District Hospital only to be turned away by a nurse.

“She said 'you need to be going to see a GP ... you shouldn’t be here, it’s not a life-threatening injury',” Mr Stingemore said.

The GP prescribed him antibiotics before the medical practice closed for a fortnight over Christmas.

Mr Stingemore asked the GP if he should be prescribed an extra course of antibiotics to cover the break.

“He said 'let’s play it by ear, if anything goes wrong go to the hospital'," Mr Stingemore said.

By New Year's Day, the festering wound had deteriorated to the point Mr Stingemore decided to return to Cobar Hospital and “not take no for an answer”.

'Serious alarm'

The doctor at the hospital “expressed serious alarm” and arranged for him to be taken 300 kilometres by road ambulance to Dubbo Base Hospital.

However, the driver was on holidays, leaving Mr Stingemore stranded in Cobar Hospital for three days without antibiotics. He became distressed as the redness travelled up his instep and into his ankle.

“The nurse in charge said we’ve got to get you out of here,” he said.

A plane was arranged to fly Mr Stingemore to Dubbo Base Hospital but another delay ensued because the pilot had exceeded his maximum hours working without a break.

When Mr Stingemore finally arrived in Dubbo, he was triaged and by midnight received his first dose of IV antibiotics.

“They said 'give us a call back here at 7am and we’ll send someone here to get you another bag of antibiotics',” he said.

Dubbo Base Hospital is the feeder hospital for much of western NSW.

Dubbo Base Hospital is the feeder hospital for much of western NSW. Credit:Janie Barrett

But the next morning, no one turned up. Mr Stingemore’s calls for help were futile, and by mid-afternoon his leg was throbbing.

“I pulled the trouser leg up and I nearly died when I saw the size of my calf and shin,” he said.

Eventually, Mr Stingemore attracted the attention of a nurse, who gave him his second dose of antibiotics.

“I said 'I can see what the problem is. There’s about 30 patients in here and there’s only two of you',” Mr Stingemore said.

When two doctors finally examined Mr Stingemore, they told him two of his toes would have to be amputated. He was resigned to his fate.

“I would have done it myself except I wouldn’t be able to sew the thing up properly,” he said.

Mr Stingemore convinced the doctors to amputate just one of the toes and treat the second with antibiotics so he wouldn’t lose his mobility.

$256 million upgrades

Health Minister Brad Hazzard unveiled a redevelopment of Cobar District Hospital worth more than $15 million in January and a $241 million redevelopment of Dubbo Base is due for completion next year.

A Western NSW Local Health District spokeswoman said the projects were part of a NSW-wide $304 million program of works to upgrade existing or build new multipurpose facilities in the bush.

“The Cobar health service provides excellent care,” she said. “ The new facility includes emergency, medical imaging, dialysis and more community health services under the one roof.”

She said staff could perform simple and complex dressing changes and the “vast majority” were also credentialled in first-line emergency care.

Services gutted

But Cobar residents said the services offered by their hospital had been gutted over the past two decades, including the maternity and surgical units.

The risks are borne by pregnant women such as Jordy‌ ‌Mackay‌, who ‌is‌ ‌preparing‌ ‌to‌ ‌move ‌to‌ ‌Dubbo‌ ‌for‌ ‌the‌ ‌fortnight‌ ‌leading‌ ‌up‌ ‌to‌ ‌her‌ ‌due‌ ‌date‌ ‌to‌ ‌avoid‌ ‌a‌ ‌300-kilometre‌ ‌dash‌ along the highway when she goes into labour.‌ ‌

Mr Stingemore said: “We’ve ended up with a 10-bed Band-Aid station. I think we've been led up the garden path out here."

Jordy Mackay and Michela Cartner have had to leave Cobar to give birth in Dubbo, 300 kilometres from home.

Jordy Mackay and Michela Cartner have had to leave Cobar to give birth in Dubbo, 300 kilometres from home. Credit:Janie Barrett

Cobar councillor Jarrod Marsden said the exorbitant cost of flying patients would be better spent on providing specialist services locally.

“Cobar is a town with five mines operating within 90 kilometres. We’re on the crossroads of two major highways, so the risk of a major emergency with multiple casualties I thought was pretty high,” he said.

A health district spokesman defended the practice, saying: “A key role of smaller facilities is to stabilise and support the transfer of patients to the right level of service in a timely and safe way.”

Dr Vahid Saberi, an adjunct professor at Southern Cross University who has held senior roles with NSW Health, wrote his thesis on small rural hospitals after being “struck by the lack of interest in developing a clear future strategy” for them.

Population shift

He said that as planners tried to shift populations into the regions, there were “important conversations that need to be had” about healthcare in the bush.

Dr Saberi said many small hospitals used to provide a degree of surgery and maternity services and would function effectively because a GP could provide a greater range of care.

A new era of specialisation in medicine had “slowly chipped away at the foundation of care a small hospital can provide”, Dr Saberi said. “A lot of them became really low-end rehab providers."

The health district spokeswoman said that in the most recent Bureau of Health Information survey, 97 per cent of Cobar health service and emergency department patients said their overall care was very good or good, higher than its peers and NSW as a whole.

"We regret any inconvenience or concern experienced by patients and always endeavour to provide the best possible care," she said. "Where people have concerns about their treatment, they are always encouraged to raise these issues with staff so they can be promptly resolved."

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