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Preference: Law

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National Framework for Maternity Services scrapped following AMA concerns

The AMA has welcomed the decision to scrap the National Framework for Maternity Services (NFMS) due to its flawed process.

The process involved inadequate stakeholder consultation and the spectacular failure to adequately engage expert obstetric, general practice, and other crucial medical specialists in its development.

AMA Vice President Dr Tony Bartone said obstetricians and GPs share the bulk of the care for women throughout their pregnancies and leaving them out of the NFMS process was a critical misjudgement.

“GPs are there with mothers at every stage of their pregnancy, including their postnatal care, and should never have been overlooked in the NFMS,” Dr Bartone said.

“The AMA has consistently warned that without genuine engagement with the medical profession, the review would be doomed to fail – which is exactly what has happened today.”

AMA Federal Councillor Dr Gino Pecoraro, an obstetrician and gynaecologist, attended a consultation forum on June 23 that led to the decision to scrap the NFMS.

“Today’s decision to scrap the flawed NFMS is a win for the women and children of Australia,” Dr Pecoraro said.

“What has happened has been a monumental missed opportunity to achieve the best possible maternity care for mothers and babies.”

Following an agreement at the April 2016 COAG Health Council meeting, the Queensland Government was tasked to lead the project to develop the NFMS, under the auspices of the Australian Health Ministers’ Advisory Council (AHMAC).

The AMA first became aware of the NFMS project in December 2016 – eight months after it commenced, and without any direct contact from AHMAC’s Maternity Care Policy Working Group (MCPWG) or its consultants – and has raised concerns about the project ever since.

The AMA’s concerns are shared by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) and the National Association of Specialist Obstetricians and Gynaecologists (NASOG).

Obstetrician-led care is an essential tenet of Australia’s maternity system.

There is clear and compelling evidence that shows that obstetrician involvement translates into lower mortality rates and fewer complications, not to mention lower costs.

“The AMA remains committed to work to see a strong NFMS,” said Dr Bartone.

Chris Johnson

[Correspondence] Exposure to lead in petrol and increased incidence of dementia – Authors’ reply

We appreciate the comments by Esme Fuller-Thomson and Sydney A Jopling, and Mark A S Laidlaw and colleagues on our cohort study,1 in which we investigated the association between living close to busy roadways and the incidence of dementia, Parkinson’s disease, and multiple sclerosis in Ontario, Canada. Both letters hypothesised that past exposure to leaded petrol might explain, at least partly, our observed association between living near roadways and higher incidence of dementia. Their proposition is an important reminder of the potentially long-lasting negative effects of many environmental factors on human health, even decades after exposures are dramatically reduced.

Air pollution linked with heart damage

A new report presented by the European Society of Cardiology says that there is strong evidence that particulate matter (PM) emitted mainly from diesel road vehicles is associated with increased risk of heart attack, heart failure, and death.

The lead author Dr Nay Aung, a cardiologist and Wellcome Trust research fellow at the William Harvey Research Institute, Queen Mary University of London, UK, said the cause for the heart damage “appears to be driven by an inflammatory response – inhalation of fine particulate matter (PM2.5) causes localised inflammation of the lungs followed by a more systemic inflammation affecting the whole body.”

Regarding how pollution might have these negative effects on the heart, Dr Aung said PM2.5 causes systemic inflammation, vasoconstriction and raised blood pressure. The combination of these factors can increase the pressure in the heart, which enlarges to cope with the overload. The heart chamber enlargement reduces the contractile efficiency leading to reduction in ejection fraction.

The researchers said they found evidence of harmful effects even when levels of pollution associated with diesel vehicles were less than half the safety limit set by the European Union.

Dr Aung said: “We found that the average exposure to PM2.5 in the UK is about 10 µg/m3 in our study. This is way below the European target of less than 25 µg/m3 and yet we are still seeing these harmful effects. This suggests that the current target level is not safe and should be lowered.”

In the UK, where the study was conducted, the Government recently produced its third attempt at a plan to bring air pollution to within levels considered safe under European Union legislation after judges ruled the previous versions were not effective enough to comply with the law.

Dr Penny Woods, chief executive of the British Lung Foundation, said: “Air pollution (in the UK) is a public health crisis hitting our most vulnerable the hardest – our children, people with a lung condition and the elderly.” 

Dr Woods added that, while progress was being made in high-income countries to reduce deaths from cardiovascular disease and cancer, those caused by lung disease had “remained tragically constant”. 

The World Health Organisation (WHO) estimates that some 3 million deaths a year are linked to exposure to outdoor air pollution. WHO also believes that indoor air pollution can be just as deadly. In 2012, an estimated 6.5 million deaths (11.6 per cent of all global deaths) were associated with indoor and outdoor air pollution together.

Only one in ten people breathe safe air according to WHO guidelines and over 80 per cent of the world’s cities have air pollution levels over what these guidelines deem safe.

The Australian Medical Association has developed a Position Statement on Climate Change and Human Health that acknowledges air pollution is the world’s single largest environmental health risk.

Meredith Horne

Germany set to introduce fines of up to €2,500 for failing to vaccinate

A new German law will be introduced obliging kindergartens to inform the authorities if parents fail to provide evidence that they have received advice from their doctor on vaccinating their children.

Parents refusing the advice risk fines of up to 2,500 euros under the law expected to come into force in June this year.

Health Minister Hermann Gröhe said it was necessary to tighten the law because of a measles epidemic.

Germany has reported 410 measles cases so far this year, more than in the whole of 2016. A 37-year-old woman died of the disease this May, in the western city of Essen.

The German government wants kindergartens to report any parents who cannot prove they have had a medical consultation.

However, Germany is not yet making it an offence to refuse vaccinations. The children of parents who fail to seek vaccination advice could be expelled from their daycare centre.

Vaccination rules are being tightened across Europe, where a decline in immunisation, has caused a spike in diseases such as measles, chicken pox and mumps, according to the European Centre for Disease Prevention and Control (ECDC).

Italy made vaccination compulsory in May this year, after health officials warned that a fall-off in vaccination rates had triggered a measles epidemic, with more than 2,000 cases there this year, almost ten times the number in 2015.

In 10 European countries, cases of measles, which can cause blindness and encephalitis, had doubled in number in the first two months of 2017 compared to the previous year, the ECDC said last month.

Measles is a highly infectious vaccine-preventable disease, and globally still one of the leading causes of childhood mortality.

The World Health Organisation reports that the European Region includes highly effective and safe measles and rubella vaccines in their vaccination programs; however, due to persistent gaps in immunisation coverage outbreaks of measles and rubella continue to occur. 

The Australian Medical Association endorses the overwhelming scientific evidence that vaccination saves lives. Important immunisation information is available in the Australian Academy of Science publication, The Science of Immunisation: Questions and Answers, which is available at www.science.org.au/immunisation.html .

Meredith Horne

Prosecco – Italian Champagne?

By Dr Michael Ryan

Italy has always been a wine producing monster. The French lay claim to the most prestigious wines and senses of tradition but Italy makes more wine, has been doing it longer and can make great peasant wine to stellar wines that make you weep.

Whilst Dom Perignon lays claim to inventing Champagne in 1693, Prosecco was made in 1893 by Carpene Malvoti and now outsells Champagne on a worldwide market. Prosecco is a sparkling wine that can vary in style from spumante (sparkling), Frizzante (semi sparkling) and tranquillo (still).

The grape variety is now formally known as Glera. Other white grapes used may include Verdiso, Bianchetta Trevigianna, Perera, Glera Lunga, Chardonnay, Pinot Blanco , Pinot Grigio and Pinot Nero.

Prosecco is now descriptive of the region where this wine is made. It has been promoted from a DOC area with DOCG status, implying more prestige. Prosecco is located in Trieste in Northern Italy, north of Venice.

The term Prosecco is protected under European law and is not supposed to be used elsewhere. In Australia we still use the term Prosecco. It seems the law is on our side. The name has been in commercial use so has prior recognition as it refers to the grape variety, not a region. Otto Del Zotto from the King Valley in Victoria pioneered this wine.

So prosecco is much cheaper than Champagne. Generally stainless steel fermentation, with tank secondary fermentation to make the bubbles keeps the price down. Some producers are experimenting with the” metodo classic” akin to  traditional methode as in Champagne.

The wine is served at 4-8 degrees. The usual aromas often include green apple, pear, honey dew, honeysuckle. Some more complex nutty creamy aromas develop with age. The bubbles are often softer as the pressure in the bottle is often only 2-4 atmospheres compared to 6-7 of Champagne. It is not known for its cellaring potential and usually drunk within 2-4 years of vintage.

It is mostly served as an aperitif. The Bellini cocktail is Prosecco and peach nectar mix. The most desirable cocktail that immediately transports you back to that Venetian bar is the Aperol Spritz. This is a mixture of Aperol, a light bitter liqueur from Campari, Soda water and Prosecco.

Wines tasted

Carpene Malvoti Superior Prosecco DOCG – $25 bargain – light yellow with delicate bubbles. The nose is classic green apples and tropical fruits. The mouth feel is smooth with balanced fruit and acidity. It sits well on the fore palate and I enjoyed with sashimi king fish with a dash of mirin and orange rind.

Mianetto Cartzzi DOCG Dry Prosecco- Not cheap at $50. Golden hues on the eye. The bouquet is an alluring cornucopia of green apples, citrus notes, pears and almonds. The bead is fine and combined with a restrained delicate palate, makes this a sultry moreish wine. Beautiful with poached quenelles of chicken mousse.

Dal Zotto  Pucino Prosecco 2016 – light yellow with nice bead. Aromas of citrus, lemons, apples. Nice dry style with good fruit and zingy acidity. The balance overall is of a nice soft wine equally good as an aperitif or poached scallops.

Santa & D’Sas King Valley Prosecco – Light green to yellow, good bead. Distinctive and fascinating aromas that show melon lemon notes.  The mouth feel is subtle, effective with the apple and nutty tones in the palate.

 

 

AMA a key player in federal politics

AMA President Dr Michael Gannon opened the 2017 National Conference letting delegates know that while the past 12 months had been eventful, much had been achieved in the realm of health policy.

He continued with that theme throughout the three-day event in Melbourne, which brought together not only the elite of the medical profession but also the highest level of Australian political leaders.

“The AMA is a key player in federal politics in Canberra. The range of issues we deal with every day is extensive,” Dr Gannon said.

“Our engagement with the Government, the bureaucracy, and with other health groups is constant and at the highest levels.

“Our policy work is across the health spectrum, and is highly regarded.

“The AMA’s political influence is significant.”

Describing the political environment over the past year as volatile – which included a federal election and two Health Ministers to deal with – Dr Gannon said the AMA had spent the year negotiating openly and positively with all sides of politics.

“Our standing is evidenced by the attendance at this conference of Prime Minister Malcolm Turnbull, Opposition Leader Bill Shorten, Greens Leader Senator Richard Di Natale, Health Minister Greg Hunt, Minister for Aged Care and Minister for Indigenous Health Ken Wyatt AM, and Shadow Health Minister Catherine King,” he said.

“Health policy has been a priority for all of them, as it has been for the AMA.”

While the Medicare rebate freeze was the issue to have dominated medical politics, there are still more policy areas to deal with in the coming year.

The freeze was bad policy that hurt doctors and patients.

“I was pleased just weeks ago on Budget night to welcome the Government’s decision to end the freeze,” Dr Gannon told the conference.

“The freeze will be wound back over three years. We would have preferred an immediate across the board lifting of the freeze, but at least now practices can plan ahead with confidence.

“Lifting the freeze has effectively allowed the Government to rid itself of the legacy of the disastrous 2014 Health Budget.

“We can now move on with our other priorities… We will maintain our role of speaking out on any matter that needs to be addressed in health.”

Dr Gannon said while the Medicare freeze hit general practice hard, it was not the only factor making things tough for hardworking GPs.

General practice is under constant pressure, he said, yet it continues to deliver great outcomes for patients.

GPs are delivering high quality care and are the most cost effective part of the health system.

“One of the most divisive issues that the AMA has had to resolve in the past 12 months is the Government’s ill-considered election deal with Pathology Australia to try and cap rents paid for co-located pathology collection centres,” Dr Gannon said.

“We all know that our pathologist members play a critical role in helping us to make the right decisions about our patients’ care. They are essential to what we do every day.

“It was disappointing to see the Government’s deal pit pathologists against GPs.

“The recent Budget saw the rents deal dumped in favour of a more robust compliance framework, based on existing laws. This is a more balanced approach.”

Other issues the President highlighted as areas the AMA is having significant influence included: Health Care Home Trial; the Practice Incentive Program; My Health Record; Indigenous Health; After-Hours GP Services; the MBS Review; public hospitals; private insurance; and the medical workforce.

Chris Johnson

[Perspectives] Galileo—speaking truth to power

Galileo Galilei was a great catch. When, in 1612, he joined the Accademia dei Lincei in Rome, Italy, it was but 9 years old. The academy had been started by four young men excited by the idea that science was the way to understand the world. Galileo founded modern science in Italy and was famous for it. He looked at the stars and made observations, he did experiments, he reasoned, he argued. And, importantly, he questioned received wisdom. He fought it, shredded it, mercilessly showed its flaws.

Doctors caring for doctors

BY AMA PRESIDENT DR MICHAEL GANNON

The health of doctors, especially our mental health, has been very topical in recent weeks.

It was a major focus at the AMA National Conference in late May, and it went viral on social media through the Crazy Socks for Docs awareness campaign, which was pioneered by Melbourne cardiologist, Dr Geoffrey Toogood.

Following National Conference, Minister Hunt announced a $47 million suicide prevention initiative, with $1 million set aside specifically to support mental health and reduce suicide in the health workforce. This was most welcome.

I have since written to the Minister about programs for mental health suicide prevention in the medical workforce.

I stressed to the Minister the importance of having the mandatory reporting requirements under the National Law amended, so as to not dissuade medical practitioners from seeking necessary medical treatment or assistance.

It is well known that doctors are at greater risk of suicidal ideation and death by suicide.

So far this year, we have lost several colleagues to suicide–and these are not isolated incidents.

While there is a wide range of factors involved in suicide, we know that early intervention could be critical to avoiding many of these tragic losses.

Unfortunately, the reality is that there are significant barriers, real and perceived, that prevent some doctors from seeking access to formal health care.

The AMA is working to change this situation, and is currently working with the Medical Board of Australia to establish accessible and robust doctors’ health services across the country.

One of the key barriers that the AMA has identified to accessing care is mandatory reporting.

Mandatory reporting for doctors was introduced in NSW in 2008, and then into the National Law for all practitioners in 2010.

The intention of the legislation was to ensure the protection of the public by requiring doctors and other health practitioners to report colleagues under defined circumstances.

The legislation intentionally created a very significant bar for reporting by stating that only matters of grave significance should be reported to the regulator.

One of the requirements for mandatory reporting is to report on health and impairment. This obligation applies to both colleagues and treating doctors.

The AMA, medical colleges, and the medical defence organisations have been concerned for some time that this provision creates a barrier to health professionals in accessing health care, particularly in relation to mental illness.

The lived experience of doctors’ health advisory services across the country confirms these fears.

An extensive study of over 12,000 doctors undertaken by beyondblue in 2013 revealed that one of the most common barriers to seeking treatment for a mental health condition were concerns about the impact of this on medical registration.

The Western Australian Government recognised this concern and after dogged, persistent, and forceful representation from AMA WA over many months, created a provision in their legislation to exempt treating practitioners from the requirements of the Act in WA.

While it has been difficult to collect clear evidence of the impact of the mandatory reporting provisions on doctors seeking treatment, the AMA, doctors’ health services, medical colleges, and the medical defence organisations receive feedback from doctors regarding their fears about seeking medical treatment.

We know anecdotally of cases of doctors travelling to WA for treatment.

Of great concern, it is very clear that some doctors are actively avoiding medical care, where possible, out of fear of the mandatory reporting obligations.

The Western Australian exemption has not made a material difference to the rate of mandatory notifications in that jurisdiction.

The Independent Review of the National Registration and Accreditation Scheme for health professions commissioned by the COAG Health Council in 2014 listened to the concerns of the medical profession and other groups, recommending that the National Law to be amended to reflect the same mandatory notification exemptions for treating practitioners established in the Western Australian law.

As health practitioners, we know the dangers of delaying access to medical treatment or of only providing limited information.

This risk is particularly pronounced with mental illness, where delaying treatment can result in a person ending up with a far greater level of impairment.

As such, we believe the current legislative arrangements are not protecting health practitioners and, equally importantly, they are failing to protect the public.

In my letter to him, I told Minister Hunt it is time for Health Ministers in the seven jurisdictions (excepting WA) to act on the recommendation of the 2014 review report. I am hoping for his support on this most important matter.

 

[Editorial] Progress in environmental litigation

Ahead of June 5, which marks World Environment Day, the UN Environment and Colombia Law School’s Sabin Center issued a 40-page report, The Status of Climate Change Litigation—a Global Review, released on May 23, which brings together environmental cases of litigation to date. Effective solutions to combat the effects of climate change have been slow to arise. One of the main barriers to implementation is that holding one government or organisation accountable for a global issue is misaligned with the scale of the problem.