SELECT COMMITTEE
INTO PUBLIC OBSTETRIC SERVICES
TRANSCRIPT OF EVIDENCE TAKEN
AT PERTH
ON MONDAY, 30 OCTOBER 2006
SESSION ONE
Members
Hon Helen Morton (Chairman)
Hon Anthony Fels
Hon Louise Pratt
Hon Sally Talbot
______
Public Obstetric Services Monday, 30 October 2006 - Session One Page 14
Hearing commenced at 11.45 am
LEVITT, DR LEON
General Practitioner Obstetrician,
Grantham House Family Medical Practice, examined:
KAILIS, DR MARIA
Grantham House Family Medical Practice, examined:
The CHAIRMAN: On behalf of the committee I welcome you to the meeting. You have signed a document entitled “Information for Witnesses”. Have you read and understood the document?
The Witnesses: Yes.
The CHAIRMAN: These proceedings are being recorded by Hansard. A transcript of your evidence will be provided to you. To assist the committee and Hansard, please quote the full title of any document that you refer to during the course of this hearing for the record. Please be aware that the microphones are for recording purposes, not necessarily to enable us to hear you better. Ensure that you do not cover them with papers or make too much noise near them, and please try to speak in turn. I remind you that the transcript will become a matter for the public record. If for some reason you wish to make a confidential statement during today’s proceedings, you should request that the evidence be taken in closed session. If the committee grants your request, any public and media in attendance will be excluded form the hearing. Please note that until such time as the transcript of your public evidence is finalised, it should not be made public. I advise you that premature publication or disclosure of your evidence may constitute a contempt of Parliament and may mean that the material published or disclosed is not subject to parliamentary privilege. Would you like to make an opening statement to the committee?
Dr Levitt: Only to say that the letter, which we co-wrote and signed on 11 August, accurately reflects our views about obstetric services at Osborne Park Hospital. We are happy to answer any questions following on from those comments that we have made.
The CHAIRMAN: Do you wish to make any opening statement?
Dr Kailis: Mine is fairly much the same. We both enjoy working at Osborne Park Hospital and feel it provides a very good service to the women and their children of that area. We understand that the closure of the hospital is something that has been suggested. We would hope that the hospital will not close but will continue to provide maternity and obstetrics services.
The CHAIRMAN: When you are talking about the closure of the hospital, you are referring to the closure of the obstetrics services unit?
Dr Kailis: Yes.
The CHAIRMAN: I will focus my questions on the document that you have provided. At the top of page 2 you refer to services being community focused. We have probably all got different understandings of what that means. Will you tell us what you mean by “community focused” and what it is that makes the services like that?
Dr Kailis: It is partly the size of the unit, so people feel more personalised in that service; they do not feel they are going to some amorphous, big place. The care the midwives give in the clinics is more community focused. I know that the social workers work very hard with the various ethnic groups that are there at the moment. There is the visiting midwives service. It seems more of a grassroots sort of service. They do not feel that they have been put into a multistorey tertiary centre, which might seem not so easy to access and as friendly as the service provided at Osborne Park. They do not feel that they are put into some great big building where people are just numbers. I think that people feel much more personalised with the service they are given. A lot of that is because of the size of the unit and also the service that the midwives provide.
Dr Levitt: And to some extent even the position and appearance of the hospital.
Dr Kailis: Definitely.
Dr Levitt: It is tucked away from the busy grind of the city and freeways etc in a nice, quiet, calm environment with lots of trees around it. It is single storey. I think that patients feel that it is a calmer, quieter, more comfortable place to go to.
The CHAIRMAN: I have been there within the past 12 months and have had a look. I think that quite a lot of work has been done on the interior to make it different.
Dr Kailis: I was amazed at how they had such good funding to maintain the interior. It is really nice. Being on the ground floor, it feels more normal; the birthing process is more of a normal process. People do not go into somewhere where they can disappear. They can still see the sunlight and trees, and people are on the same floor.
Dr Levitt: The other aspect is that the labour ward is relatively luxurious in terms of its capacity to handle family and friends and provide a nice service. There is a large, comfortable room for the family to sit, mull over events, watch television or whatever, and a connected clinical room, which most of the other hospitals do not have, so the patients feel that they have got a special service there.
The CHAIRMAN: In the next paragraph you refer to the hospital as having a natural birth focus. I think you have touched on that a little bit, but would you like just to expand on what you mean by a natural birth focus?
Dr Levitt: It is not a tertiary referral centre, so the complex obstetrics can be weeded out and sent to King Edward Memorial Hospital, where inevitably more difficult patients will be seen and there will be more poorer outcomes. Therefore, more patients as a percentage come to Osborne Park who will have a normal vaginal delivery or a simple caesarean section or simple outcomes without the major complications. I am sure that both of us have had patients at Osborne Park who have ultimately gone in an emergency setting over to King Edward, because the nature of obstetrics is that sudden, bad things happen, but, generally, a lot of those are weeded out prior to delivery, so there are a higher percentage of normal deliveries there.
Dr Kailis: I think that once again the midwives mostly have the focus on and aim of a normal delivery, as everybody does, but there is more of a focus on having a normal delivery; the use of the spa for pain relief; and the Snoezelen room, which they use sometimes for early labour. They try to be perhaps more focused on what the women do tend to want and they are very supportive in that. On the other hand, though, I do not think that they are averse or slow to recognise complications and the need to bring in assessment if intervention is necessary, but the focus is still on the natural birthing process, helping women to do what they want to do and for it to be as close to whatever the women would like to do. If that is a natural sort of process, they really try to facilitate that in women without rushing in to do things too quickly. It is just the atmosphere of the place and the people who work there and the support they give the women in those sorts of processes.
The CHAIRMAN: Do you know off the top of your head what the caesarean rate is at the hospital?
Dr Kailis: I should.
Dr Levitt: It has actually just changed, because they had a change of a head of department, who was an Englishman who had a focus on avoiding caesarean sections. The caesarean section rate went down to about 15 per cent, but the difficult vaginal delivery rate went right up. He has now left, and it will probably go back to what is a more reasonable rate, which previously was about 33 per cent.
Hon SALLY TALBOT: When you say “reasonable”, do you mean in line with the state average?
Dr Levitt: I mean in terms of achieving good outcomes for babies. The guy who came in as head of department was out of step with all other medical practitioners in Western Australia. He produced a lot off difficult forceps deliveries with - we will not know yet - potential problems for the babies. That really brings us to one of the other issues that I have, which is that because of the doubt over the future of the unit, it is very difficult to attract senior obstetricians to the hospital to lead the department. They jumped at the possibility of this Englishman coming, and he turned out to be unsatisfactory.
[12 noon]
That expectation of trying to attract the right type of people is a real problem for morale.
The CHAIRMAN: Is already having an effect on attracting specialist obstetricians?
Dr Levitt: Yes.
The CHAIRMAN: And anaesthetists?
Dr Levitt: I do not know. I only know of the difficulty with the head of department.
The CHAIRMAN: I am talking about the doubt over whether the -
Dr Levitt: I am sure it has an effect on the other services also. However, the paediatricians who currently service the unit are very loyal. They have been there for a long time and are very capable. I do not think they would walk away from the unit because they have a great sense of responsibility to it. There is already an operating unit, and an anaesthetist is servicing the rest of the hospital. Those two services are probably okay, but I am not directly aware of it. It is particularly the senior obstetricians whom we have a problem attracting.
Dr Kailis: It is not always easy to get anaesthetists or neonatal paediatricians services full stop because there is a shortage of their services. The availability of anaesthetists is okay at the moment.
The CHAIRMAN: This is a bit of a leading question and you may choose to not answer it: is that one way of creating a self-fulfilling prophecy? Is it the case that if some doubt is created, it is difficult to attract people and less is done to attract them?
Dr Kailis: Who has created that doubt? It was not created within the hospital.
Hon ANTHONY FELS: It was created by the government’s decision.
Dr Kailis: It has been created from outside the hospital. I do not believe it is a self-fulfilling prophecy that was created by the hospital because the staff at the hospital did not create it. The staff were absolutely devastated when the news came out. For a long time there have been rumours that the hospital would possibly close, but when it looked like this was definitely going to be it and that nothing could sway that decision, the staff were devastated, especially the midwives. The slightly older midwives in particular said that they would not work anywhere else. They think that it is the best environment for a midwife to work in. They are not interested in working at any of the other hospitals. It can become a self-fulfilling prophecy, but it did not originate at the hospital. The staff are trying hard to keep on going as though it will not close. They are hoping that something will intervene in the next four years.
The CHAIRMAN: What are the birth numbers like?
Dr Kailis: They have increased in the past few months.
The CHAIRMAN: That is usually a good sign.
Dr Kailis: They have definitely increased in the past few months. There was a slight decrease, but the numbers have now increased quite considerably.
Dr Levitt: The number of births is around 1800. I have not found an obstetrician who knows where those 1800 births could be accommodated if the unit is closed. People who work at King Edward Memorial Hospital tell me that there is no desire for that many patients to give birth there, and nor at Joondalup. I am baffled by where the women will go and by how government believes it will be able to accommodate those 1800 births.
Hon SALLY TALBOT: Is that because they are the low and medium-risk cases?
Dr Levitt: No, it is because of the numbers.
Hon SALLY TALBOT: What proportion of patients who start their obstetric care at Osborne Park are then transferred to a tertiary hospital if they run into difficulties and their risk factors change?
Dr Kailis: It is a very small percentage. It would be less than five per cent. The figure of 1800 is the number of babies who are delivered there; it is not the number of patients who start their procedures there.
Dr Levitt: In our practice, we would see a woman in our rooms, and she was a high-risk patient, we would not start the process of booking her there; we would refer her to King Edward.
Hon SALLY TALBOT: Or to a specialist obstetrician.
Dr Levitt: Yes.
Hon SALLY TALBOT: This might be the appropriate moment to ask about your own specific qualifications and the GP obstetric model of care that you are part of. What does it mean to be a GP obstetrician?
Dr Kailis: There are different models. The model we both maintain is that we see women privately and publicly. We also go to St John of God. We send the public patients to Osborne Park Hospital. They visit us initially and they visit Osborne Park Hospital once early in their pregnancy, mostly to ascertain their risk factors and to ensure that they are suitable to go to that hospital. We then provide their antenatal care. The women have one visit at 36 weeks of gestation and then the ladies go back to the hospital and the hospital checks that everything is okay and there are no problems. We continue to see them and manage them for their deliveries. We do normal vaginal deliveries ourselves, as well as the low-risk, forceps and vacuum deliveries. If a caesarean section is required to be performed, or if any other complications arise at any stage, we call in the hospital doctors to help us manage those patients. Usually we will remain and assist in a caesarean section if that is required.