This was published 2 years ago
Opinion
Where does the buck stop in WA’s health system? The coroner’s court is about to find out
Gareth Parker
ColumnistThe coronial inquest into the mistreatment of little Aishwarya Aswath is halfway through, but thus far, who could be truly surprised by any of the evidence that has been led?
From the beginning, the politicians with whom the buck allegedly stops have claimed the emergency department was adequately staffed on the night of her death; the clinicians on the frontline repeatedly tried to warn management that was not the case.
Aishwarya Aswath died after waiting for help at Perth Children’s Hospital.
The pleas for more resources were detailed by the nurses’ union in the days after Aishwarya’s death in April 2021, and they featured in the critical incident review that was released six weeks later.
“Uncovered sick leave of medical staff resulted in a reduction in available medical staff during the evening, delays in medical assessment, prolonged waiting times and impeded the capacity for medical staff to provide a more comprehensive response to parental escalation,” the review found.
“These factors may have contributed to a delay in recognition of the severity of the illness and initiation of treatment.”
Yet then-health minister Roger Cook and Premier Mark McGowan claimed black was white and night was day, saying the report did not identify any shortage of staff on the night, a position they still have not walked back.
Cultural issues at Perth Children’s Hospital have long been the subject of murmurings within the public health workforce, despite the glowing testimonial departing chief executive Aresh Anwar got from his bosses when he suddenly resigned two weeks before this coronial inquest began.
David Russell-Weisz praised Anwar for his “considerable expertise, strong work ethic, dedication and integrity”, and the resuscitated Rosanna Capolingua – installed as CAHS board chair after her predecessor Debbie Karasinski fell on her sword in the aftermath of Aishwarya’s death – thanked him for his service.
It was nonetheless revealing to hear Anwar finally acknowledge the obvious: that border closures had exposed the weakness of WA Health’s long-term strategy of importing health workers from overseas, which had contributed to the staffing pressures PCH had experienced.
Without itemising the testimony of each clinician who was in the ED that night, there is a common thread that runs through them.
They felt overstretched, overworked, harried, almost numb to the relentlessness of the workload that had accumulated in the months leading up to the tragedy.
It reflects the observation of the critical incident review that since October 2020 “senior clinicians have escalated substantial concerns around patient safety to senior management.
“The panel found that these risks had not been effectively managed until recently.
“A culture has developed which saw escalation as futile and ineffective, with staff therefore failing to call for assistance at times of increased acuity and activity (more obvious among nursing staff) even when there was availability of senior clinical nursing staff outside of the ED.”
This inquest is being watched, not just by political observers and interested members of the public, but a strung-out clinical workforce as well.
According to one emergency physician who has been following media reports, “none of what we are seeing and hearing surprises me”.
“We constantly run the system over capacity to the degree where systemically, these tragic situations are inevitable – then we blame,” they said.
“That poor family had this happen because no one seems to think that we should be running a decent acute care system in this society that is so wealthy and so well off.”
Another clinician, a nurse who is set to leave the public hospital and the state, said the coronial inquiry made her blood boil.
“(Hospital) management and the government knew for years that staffing levels were dangerous and it was only a matter of time before something would happen,” she said.
“As a nurse with friends working in nursing in all states and internationally, they are watching this inquiry closely. No one ever wants to be in front of the coroner, let alone thrown under the bus by the government they are employed by.”
And that is the broader point. It is about accountability.