‘Cut costs’: Northern Beaches Hospital staff take aim at management after toddler’s horrific death

Staff at Northern Beaches Hospital say concerns were raised about cost-cutting for years before the horrific death of toddler Joe Massa.

Staff at Sydney’s troubled Northern Beaches Hospital say they tried to raise concerns about dangerous cost-cutting for years before the horrific death of toddler Joe Massa, accusing private operator Healthscope of now having “blood on [its] hands”.

The NSW government is awaiting the outcome later this year of an Auditor General investigation into the Frenchs Forest hospital — widely considered a basket case by Northern Beaches residents — but Health Minister Ryan Park says “no one has to argue … this is not the best model of healthcare”.

Healthscope, Australia’s second largest private hospital operator, bid $2 billion in 2014 to build and operate Northern Beaches Hospital under a public-private partnership (PPP) until 2038. Northern Beaches Hospital opened in October 2018 and just months later, in May 2019, Healthscope was acquired by Canadian private equity giant Brookfield for $4.1 billion.

In September, 22-month-old Joe Massa died after what should have been a routine emergency department visit resulted in what his parents say was a preventable tragedy. Elouise and Danny Massa on Thursday called out systemic failures at the hospital, demanding urgent reform and accountability.

“Joe had no chance of life once we walked through the doors of the ED,” Mrs Massa told news.com.au.

Nurses protest outside Northern Beaches Hospital. Picture: Brendan Read/Daily Telegraph

One staff member, who spoke on the condition of anonymity, said Healthscope had “cut costs like you would not believe” since Covid despite concerns raised internally of the “danger to patients and staff” that “weren’t being listened to”.

They claimed cost cuts had resulted in fewer nursing and doctor hours in emergency and mental health, and a reduction in security guards.

“[Healthscope] now has blood on [its] hands,” the staffer said.

“It is all about the bottom line, profit before patients. [Healthscope wants] NBH managed like a private hospital and does not care that patients arriving at ED are very unwell, often without a diagnosis. These patients are very different to elective surgery patients arriving at … other private hospitals. We can see more terrible incidents unless something is done.”

The staffer added “hiring practices are a problem”.

“It is hard to recruit experienced staff into NBH as they don’t want to leave the public system,” they said.

“Why give up all your sick leave and long service leave that you’ve accrued after many years of service, only to lose it all when you move onto a private EBA? Out of necessity the managers need to recruit lots of new graduate nurses, who have no experience and need lots of supervision. Many overseas nurses are recruited. Healthscope ... has placed a ban on the use of agency nurses. This is a shame as they are often Australian trained and have relevant experience. But they cost too much.”

Healthscope has been contacted for comment.

Joe Massa died in September after a series of failures by the hospital. Picture: Supplied

Joe was taken to the emergency department on the morning of September 14, after experiencing vomiting the previous night.

By the time they arrived at the hospital at 7.06am, Joe had a dangerously elevated heart rate and was pale, floppy and growing unresponsive.

The boy was suffering significant hypovolemia, a condition that occurs when the body loses too much fluid — and that would typically be treated by IV fluid resuscitation — but was misdiagnosed as a case of gastro.

Crucially, the ED triage nurse documented that Joe was in triage category three, which indicates a patient requiring treatment within 30 minutes, rather than the “red zone” category two, defined as requiring treatment within 10 minutes due to an imminently life-threatening condition.

Outdated IT systems meant alarming vital readings entered into Joe’s patient record were not immediately flagged and escalated.

Mrs Massa said over the next three hours staff at the hospital failed to listen to her concerns, denied repeated requests for an IV drip, and ignored critical warning signs including Joe’s skyrocketing heart rate, limpness, rash and loss of consciousness.

At 10.47am, Joe suffered a catastrophic cardiac arrest.

A Serious Adverse Event Review (SAER) later identified a number of serious failures in Joe’s case including “failure to recognise and respond to a heart rate in the red zone particularly in the absence of fever”, “failure to respond to parental concern” and “failure to respond to clinician concern as per internal escalation processes”.

“During the SAER investigation, it was identified that two clinicians’ professional practice was not to the expected standard and have referred this to the hospital’s executive unit for further management,” the report said.

Elouise Massa said Joe was ‘failed at every possible level’. Picture: Supplied

“The SAER team acknowledge they cannot say definitively that the child’s death was preventable, however, they do acknowledge that there was a delay/failure to recognise deterioration. The SAER team accept that an earlier recognition of the deteriorating child may have provided an opportunity for early escalation and resuscitation with potential prevention of the cardiac arrest event.”

In a statement on Thursday, Healthscope said Northern Beaches Hospital “offers its deepest condolences to the Massa family for the loss of their son, Joe”.

“We recognise Joe’s death has caused unimaginable heartache and grief for the family,” a spokesman said.

“We have met with the family to apologise and hear directly about their tragic experience and to discuss the findings of the Serious Adverse Event Review. We will continue to support the family in any way that we can as we implement the improvements identified in the review, including improvements around triaging processes and internal escalation processes.”

Speaking to 2GB’s Ben Fordham on Friday, the Health Minister said the health system “let Joe’s family down, and the system has errored in a way that has had catastrophic outcomes”. “That will never be lost on me, I hope it is never lost on the team at Healthscope, and it certainly won’t be lost on [NSW Health Secretary] Susan Pearce and our staff,” Mr Park said.

“This is a massive tragedy that shouldn’t have happened, a tragedy that at multiple steps along the way could have been intersected and changed. And the biggest one, having read through the report now four or five times, the biggest one that comes out is a failure to listen to mum, and that is a catastrophic outcome as a result of that ignorance.”

Healthscope has been accused of putting ‘profits before people’. Picture: Brendan Read

But Mr Park stopped short of saying Northern Beaches Hospital was “a problem”.

“This is a hospital that it’s not a model of health care that I would have preferred to have seen happen in New South Wales when it was first introduced many years ago,” he said.

“I don’t believe this is the very best model of healthcare that we can do in New South Wales, the privatisation of it, I opposed at the time.”

Northern Beaches Hospital’s controversial privatised model was announced by the former Liberal government in 2015.

It’s the only one of its kind in the state after strong public opposition led the former government to scrap plans to expand the model to Maitland, Wyong, Goulburn, Shellharbour and Bowral.

Mr Park said parents in the Northern Beaches “don’t want to hear that now”.

“They want to hear what we’re going to try and do to fix it,” he said.

“This is not about passing the buck. The previous government went down this path. They were elected to do that. That’s what happened. I’ve got to now try and make sure that this hospital is as strong and as robust and as reliable, and, most importantly, as safe as possible.”

Joe suffered a catastrophic cardiac arrest. Picture: Supplied

He accepted Fordham’s suggestion, based on feedback from Northern Beaches residents and hospital staff, that Healthscope “want to make money, and they do that by cutting costs and profits come before people”.

“Yeah, this is not the best model of healthcare, no one has to argue that,” Mr Park said.

“I argued at the time that I didn’t think this was right. There [were] going to be multiple other hospitals going to be privatised. That was changed, thank goodness. What we need to do at the moment, while Healthscope are still operating this facility, is making sure that they are doing so in a safe, effective way that meets the needs of the community.”

On Thursday, Shadow NSW Health Minister Kellie Sloane said it “might be a stretch too far” to blame outsourcing of the hospital to Healthscope.

“While the hospital is operated by Healthscope, it is still subject to oversight by NSW Health,” she told 2GB.

“Now, if Healthscope has failed to meet its standards, then it will face penalties and consequences, and that should absolutely be looked at. The Auditor General is looking at Healthscope at the moment in relation to Northern Beaches Hospital, and so we should review their report when it emerges critically.”

Ms Sloane said she was “not going to defend” Northern Beaches Hospital, and suggested reports that rationing amid global IV fluid shortages should be investigated.

NSW Health Minister Ryan Park. Picture: John Appleyard/NCA NewsWire

“We should absolutely be asking that question,” she said.

“I’m not suggesting that was the case. I think there were multiple other reasons that this poor little boy wasn’t attended to on top of the IV fluids question, there needs to be a review of emergency department protocols. I do not understand why they didn’t listen to Eloise, a mum who was advocating so loudly and determined for her child.”

Mr Park, however, said he did not believe IV fluid shortages were a factor.

“At the time, I was getting twice daily updates around our supplies within our hospitals,” he said.

“Around about that time, we had around two to two-and-a-half weeks’ worth of supply at each hospital. So from my perspective, that is not an excuse, that is not a reason, that cannot be laid down as a reason why we let Joe down.”

On Friday, a planned 26-hour strike by hundreds of Healthscope nurses and midwives, including at Northern Beaches Hospital, was called off following an urgent hearing in the Fair Work Commission overnight.

Healthscope lodged an urgent application to suspend the protected industrial action by NSW Nurses and Midwives’ Association (NSWNMA) on Thursday afternoon.

NSWNMA acting general secretary Michael Whaites said the union disappointed in the ruling.

“Our members are in pursuit of pay equity with their Queensland counterparts and minimum safe staffing levels in all Healthscope hospitals,” Mr Whaites said in a statement.