MEDICUS MARCH 2016

LIA

WESTERN AUSTRALIA

Journal of the Australian Medical Association WA | March 2016 Volume 56 / Issue 2 | amawa.com.au

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Council President Dr Michael Gannon Immediate Past President Dr Richard Choong

MARCH 2016

Vice Presidents Dr Andrew Miller Dr Omar Khorshid Honorary Secretary Dr Janice Bell Assistant Honorary Secretary Dr Marcus Tan Honorary Treasurer Professor Bernard Pearn-Rowe Councillors Division of General Practice (WA) Dr Steve Wilson A/Prof Rosanna Capolingua Division of Specialty Practice Dr Tony Ryan Dr Martin Chapman Division of Salaried and State

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A Valuable Ally New interns welcomed

Government Service Dr Mark Duncan-Smith Dr Dror Maor Ordinary Members Dr Daniel Heredia Dr Stuart Salfinger Dr David McCoubrie Prof Geoff Dobb Co-opted Members Dr Steve Wilson Dr Tim Koh A/Prof Peter Maguire

The Broken State Will new reforms save WA’s mental health system? • Adj/Prof John Mendoza

Dr Michael Page Dr Chris Wilson Dr Ian Jenkins

Prof John Newnham Prof Shirley Bowen Mr Daniel Dorevitch Mr Sid Narula AMA (WA) Office Executive Director Mr Paul Boyatzis Director: Industrial & Legal Ms Marcia Kuhne Executive Officers Mr Michael Prendergast Ms Josphine Auerbach

• Mr Timothy Marney • Dr Tim Koh • A/Prof David Mountain

• Dr Richard Choong • Dr Martin Chapman

6 32 REGULARS 02 President’s Desk 03 From the Editor 04 Industrial 08 Event: FEATURES

Expert Witness All you need to know about providing medical reports for guardianship and administration hearings

Mr Simon Bibby Ms Leah Pantelis

14 Stirling Highway Nedlands WA 6009 (08) 9273 3000 mail@amawa.com.au www.amawa.com.au Medicus Editor and Director of Communications

More than just back-up Leading medical indemnity insurers on the issues that matter

Mr Robert Reid Deputy Editor Ms Janine Martin Advertising Inquiries Phone Mr Des Michael (08) 9273 3000 Copy Submissions Phone Ms Janine Martin (08) 9273 3009 or janine.martin@amawa.com.au Services Business Services Manager Ms Noelle Jones Financial Services Manager Mr John Gerrard Medical Products Manager Mr Anthony Boyatzis Health Training Australia Manager Mr Geoff Jones The publication of an advertisement, article or inclusion of an insert does not imply endorsement by the AMA (WA) of the views, service or product in question, and neither the AMA (WA) nor its agents will have any liability for any information contained therein.

61 Drive 62 Travel 64 Wine 65 Book Shelf 66 Framed 67 Food 68 Member Benefits & On the Town 71 Classifieds : Professional Appointments, Positions Vacant, Rooms for Sale/ Lease

44 Opinion:

Dr Chris Wilson

45 Opinion:

Dr Sophie Doherty

46 Profile:

Intern meet-and-greet

Dr Elizabeth Gray

10 News 18 Cover Story:

48 Opinion:

Daniel Dorevitch

The Broken State

51 Opinion:

30 Opinion:

Sid Narula

COGP – Dr Edwin Kruyz

53 Dr YES 54 AMA in the Media

33 Feature: Medical

Indemnity Insurance 39 Clinical Edge 42 Q&A: Prof Ian Rogers

56 Family Law 58 Technology

75 Greensheet

M A R C H 2 0 1 6 M E D I C U S 1

P R E S I D E N T ’ S D E S K

Careful compassion needed for dealing with asylum seeker issue

Dr Michael Gannon AMA (WA) President I t would be extremely hard for any Australian to not be aware of the contentious issues around asylum seekers. For more than a decade, it has, at times, dominated the political debate and probably played a major role in the outcome of at least one federal election. More recently, the Federal AMA made its voice heard on the issue, convening a symposium in Sydney. The Federal President Professor Brian Owler has been widely commended on his speech at the event. However, many of our members here in Western Australia were unhappy with the Federal AMA event, as well as our position on the subject, which culminated in a number of resignations. Human compassion is not something that belongs to one side of politics or another. There might be disagreement amongst members of the profession as to the degree of failure of the Rudd/ Gillard Government’s policy of a more relaxed attitude to maritime arrivals. The proposal to send asylum seekers to Malaysia and the

Solution’ of sending desperate human beings to Manus Island in Papua New Guinea and Nauru are all well known. The Commonwealth Government is spending millions of dollars dealing with this problem. The decision by our colleagues at Lady Cilento Children’s Hospital in Brisbane to not discharge baby Asha back to Nauru was controversial. I understand and applaud the compassion of my medical colleagues. Equally they might be seen to be ‘setting the bar’ extremely high when they refuse to discharge patients into ‘unsafe’ environments. It is a sad but unfortunate reality that every day of the week vulnerable Australians are discharged into less than ideal settings in the community, in step-down facilities and residential aged care facilities. It can be dangerous to assert that a new mother might struggle to care for her babe in arms, sometimes less than 30 hours after delivery. The intergenerational failure of our ability to look after patients with mental illness is further testament to this. These issues are not simple. The misery of the Syrian refugee crisis and the hundreds of thousands of people now living in often appalling conditions in continental Europe must trouble even the hardest heart. The fact that only 26 of the 12,000 refugees who Australia promised to accept from Syria have arrived, is testament to the huge complexity of organising security checks, quarantine, housing, social services and schooling. The AMA’s policy in this area is very carefully crafted and worded. We have been criticised for straying outside

the health issues. Professor Owler’s comments talk clearly about the issues of returning children to detention, the inherent health risks of this, and the ethical duty not to discharge children into unsafe settings. The secrecy provisions in the Border Force Act place doctors in unenviable positions. It is however, very hard to separate our policy and the content of the Symposium from being seen to be critical of the government’s immigration policy. Surely we cannot support measures, which might in any way incentivise desperate human beings to put themselves and their children on leaky boats. There were 1,700 children in detention on mainland Australia and Christmas Island when the Coalition took office. It peaked at well over 2,000. Now there are 67. Further, when organisations such as the AMA speak out against government policy, they need to recognise the risk to other aspects of their agenda. We need to consider the deleterious effect it may have on our relationship with government. If we criticise government policy, we are also obliged to provide workable alternative solutions. According to UNHCR, there are 50 million refugees, asylum seekers and internally displaced people worldwide. It is not remotely feasible to assist even 1 per cent of these people. It is our job to participate in international agencies to, wherever possible, minimise the impacts of drought, pestilence, disease and war. Recently I welcomed representatives of Ishar, the multicultural women’s health

decision to house them in old Air Force bases in remote areas of the country’s north, in locked-down detention facilities in our capital cities, or the ‘Pacific

Continued on page 3

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F R O M T H E E D I T O R

A victory for common sense

centre in Mirrabooka, to the AMA. I have been very grateful for their work over the years with a high proportion of the patients in my antenatal clinic at Osborne Park Hospital being refugee women living in suburbs such as Girrawheen and Balga. Their ability to provide culturally-sensitive health services, translation, basic primary care, advocacy and refuge services for an often very desperate group of women is admirable. It is unfortunate that their perinatal mental health program was recently subject to a withdrawal of funding. Here is a great example of an A n Italian diplomat, Count Galezzo Ciano – also known as Mussolini’s son-in-law – was almost certainly quoting a local proverb in 1942 when he said: “La victoria trova cento padri, a nessuno vuole riconoscere l'insuccesso.” Roughly translated, this equates to: “Victory has 100 fathers. No one wants to recognise failure.” Count Ciano’s much quoted statement came to mind when considering the recent decision by Health Minister Dr Kim Hames to keep the Bentley Hospital maternity unit open for at least another two years. This followed the Review of Maternity Services in metropolitan non-tertiary public hospitals, written by esteemed Obstetrician Professor Con Michael, and delivered in November last year which found that the maternity unit was “an unsatisfactory facility that is badly in need of refurbishing”. “It is not conducive to establishing a

efficient, independently run, caring and compassionate NGO filling a niche that the public health system does not. I am proud to be advocating on their behalf in discussions to reverse the cuts with the Health Department and the Mental Health Commission. Sometimes difficult decisions need to be made as a sign of compassion and love. Opening borders without care and consideration potentially exposes the citizens of a nation to security risks. Asylum seekers themselves can too easily fall into the clutches of those who would profit from their misery, different and safe contemporary model of care,” the report said. Dr Hames’ decision not to accept Professor Michael’s recommendation to close the maternity unit was immediately welcomed by a range of groups and organisations. As Count Ciano would have said, the decision had many fathers. Perhaps it was a combined victory, but certainly the clinically and carefully detailed approach by the AMA (WA) and in particular, President Dr Michael Gannon, played a major part in the Minister rejecting the report’s recommendation. The role of the media was also important, with a series of articles about Bentley. But let us remember that as early as June 2015, Dr Gannon wrote to the Health Minister expressing concern about the possibility of closure – followed up with additional pressure through a series of meetings and representations.

like people smugglers, pimps and unscrupulous employers. I support a compassionate humanitarian migration program. I hope that we all do, but we may need to support our elected politicians when they make decisions that benefit the overwhelming majority of Australians. If we can maintain community support for a generous, organised compassionate migration program, and invest in the development of migrant communities in Australia through organisations like Ishar, we are further enriched as a nation. ■ Dr Gannon immediately called the Minister’s reversal “a victory for common sense”. “There was a lot of misinformation floating around about consolidation of obstetric units in the Perth metropolitan area, and the review into maternity services. However, to close the unit at Bentley was way too soon, and way too fast.” Dr Gannon said. “What this decision does reflect is the difficulty attracting and retaining a high standard midwifery workforce. Midwifery Group Practice is an inefficient way of deploying a limited cohort of trained health professionals. Women and babies enjoy the highest standards of care when midwives, Obstetricians, Paediatricians and Anaesthetists work in teams. “I would like to thank the Minister for his decision. However, we now need assurances that any urgent repairs and upgrading of equipment necessary at the Bentley Hospital obstetric unit are made as quickly as possible.” Dr Gannon said. ■

Careful compassion needed for dealing with asylum seeker issue Dr Michael Gannon Continued from page 2

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I N D U S T R I A L INDUSTRIAL SNAPSHOTS

2016 PUBLIC SECTOR SALARIES CLAIMS

THE AMA (WA)’s claims for replacement industrial agreements will be served on the Minister for Health by early March 2016. The claims will replace: • Department of Health Medical Practitioners (Metropolitan Health Services) AMA Industrial Agreement 2013 • Department of Health Medical Practitioners (WA Country Health Services) AMA Industrial Agreement 2013 • Department of Health Medical Practitioners (Director General) AMA Industrial Agreement 2013

Alcohol Office) AMA Industrial Agreement 2013 • Department of Health Medical Practitioners (Clinical Academics) AMA Industrial Agreement 2013. The claims are informed by the surveys sent to members in 2015 and feedback from the Inter Hospital Liaison and the Doctors in Training Committees. Negotiations are due to commence by 1 April 2016. The industrial team will post industrial updates on the AMA (WA) website to keep members informed of progress throughout the negotiation process. Members who would like to discuss any issues they have in relation to the coming round of bargaining should contact the AMA (WA) industrial team on (08) 9273 3000. ■ LATE IN 2015 the AMA (WA) wrote to all metropolitan hospitals seeking information about proposed changes and inviting discussions. In their responses, Bentley, Rockingham and Osborne Park hospitals advised no specific changes were proposed at the time. Meetings have been held with Fiona Stanley, Royal Perth, Fremantle, Sir Charles Gairdner, Rockingham and Princess Margaret hospitals. At the meetings, the AMA has been assured that where changes are being proposed, they are being undertaken at Department level with the involvement of the practitioners (RPH and PMH) or changes are yet to be agreed upon and the AMA will be invited to participate in the consultation process (FSH, FH and SCGH). Meetings are ongoing with King Edward Memorial Hospital. AMA advocacy at RPH assisted several departments, resulting in no changes being introduced after correct processes were eventually followed. Our advocacy also resulted in the Director General holding meetings with heads of departments at FSH and RPH. The AMA urges members to contact the industrial team (08 9273 3000) with their concerns about threats to jobs or changes being made without consultation ■ JOB CUTS

• Department of Health Medical Practitioners (Drug and

2016 PRIVATE SECTOR SALARIES CLAIMS

THE AMA (WA) is working with members in salaried employment in the private sector to develop claims for replacement enterprise agreements. The relevant agreements are: • Royal Flying Doctor Service of Australia (Western Operations) Medical Practitioners Industrial Agreement 2013 • St John of God Murdoch Hospital AMA Medical Practitioners Industrial Agreement 2013 • Australian Red Cross Blood Service Medical Officers Enterprise Agreement WA 2013 . • And a new agreement to apply at St John of God Midland Public Hospital. ■

ACCESS TO LEAVE - DiTs

THE AMA (WA) continues to receive complaints from Doctors in Training about their lack of access to professional, annual and parental leave. Any member who would like to discuss their individual concerns should contact Leah Pantelis at the AMA on (08) 9273 3000. ■

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I N D U S T R I A L

AMA (WA) 2016 Elections – get involved!

Included in this edition of Medicus is a nomination form for the following positions: Council: • President • Vice Presidents • Honorary Secretary • Assistant Honorary Secretary • Honorary Treasurer • Six Division Delegates • Three ordinary members elected by members of the Association. Nominations must reach the AMA (WA) Returning Officer no later than 5pm on Monday 11 April, 2016 . This is an opportunity to increase your involvement in the AMA (WA) and to assist in serving your fellow members. ■

WESTERN AUSTRALIA General Practice patient rebates frozen until 2018. The new Federal Minister for Health has stated she wants to HEALTHCARE IS YET again under the budgetary microscope. Primary healthcare is under pressure with

WESTERN AUSTRALIA

consult with the profession. To date, there is no evidence that the government has done so. Your AMA representatives have been lobbying hard with the government to reconsider its plans to cut patient rebates and make Myhealthrecord fit for purpose amongst other matters of major concern. The Australian Medical Association (WA) members are therefore urged to take a strong interest in the coming AMA (WA) elections, not only by voting, but by getting involved and nominating for Council Office Bearers.

OUTER METRO AND RURAL EMERGENCY PHYSICIANS INCENTIVES PACKAGE

THE AMA (WA) is interested in member feedback about the public sector recruitment freeze announced in December 2015. A member survey will be sent out in the coming weeks to seek information about the impact of the freeze on the provision of services, jobs and the cost of running services. ■ PUBLIC SECTOR RECRUITMENT FREEZE

THE AMA (WA) has been advised by the Department of Health that there will be no reversal of the sudden and unilateral change by DOH to withdraw longstanding arrangements to pay incentive packages to attract and retain emergency physicians to rural and outer metro areas. The DOH has made this decision despite evidence of a shortage of ED physicians particularly in rural areas but also in outer metropolitan areas and despite lack of evidence of the promised review. The AMA continues its advocacy. ■

HEALTH SERVICE BILL 2016

• bestow responsibility upon the DG for the overall management of the WA health system; • require service agreements to be entered into between health services and the DG; and • establish the Minister for Health as a body corporate known as the Ministerial Body. Health Service Providers will be responsible and accountable to the DG. The DG will be the employing authority of all chief executives of health services. The DG will have the power to appoint, performance review and remove chief executives. The key areas of AMA advocacy are the lack of dedicated representation on the Boards by practising medical practitioners and the role of the DG who will have responsibility for health services, which are required to report to the DG. ■

THE WA GOVERNMENT proposes new governance arrangements for the management of hospitals and health services planned for formal implementation from 1 July 2016. The appointment of interim Chairs for the respective Boards were announced in December 2015 and the creation of the Eastern Metropolitan Health Service was announced more recently. The Director General met with the AMA (WA) on 17 February 2016 to provide a briefing about the proposed Health Services Bill 2016. The Bill will: • establish a separation of functions, roles, responsibilities and accountabilities; • establish new statutory entities known as health service providers; • bestow responsibility upon the DG for strategic policy and planning in the role of system manager;

M A R C H 2 0 1 6 M E D I C U S 5

I N D U S T R I A L

Expert Witness Doctors play an integral role in guardianship and administration hearings at the State Administrative Tribunal of WA

T he State Administrative Tribunal of Western Australia (Tribunal) was established in 2005 as one of the first ‘super tribunals’ in Australia, replacing a number of specialist tribunals and boards. A large part of the jurisdiction of the Tribunal from its inception is guardianship and administration proceedings. To give an idea of volume, the Tribunal received approximately 8,000 applications in the last 12 months, of which approximately 5,500 were guardianship and administration- related applications. It is therefore a very high volume jurisdiction, which is steadily increasing every year. The large percentage of guardianship and administration matters requires the Tribunal to make a decision as to whether someone can make reasonable Q. In what capacity is a medical practitioner requested to complete a medical report making an assessment of a person’s decision- making capacity? CW: When a medical practitioner completes a medical report in relation to a guardianship or administration application, they do so as a witness providing evidence to the Tribunal to assist it in reaching a decision in the person’s best interests. Q. What is involved in completing a medical report? CW: In many instances, a medical practitioner completes the medical

decisions in their own best interests, or whether they require the appointment of a guardian (to make personal decisions in relation to matters such as medical treatment, accommodation and provision of services) and/or an administrator (to make financial decisions and decisions in relation to property). The starting position in guardianship and administration hearings is a presumption that the person is capable of making their own decisions. The Tribunal is cautious in removing this important right from individuals and will only do so as a last resort. Fundamental to guardianship and administration hearings, is the question as to whether the person currently has cognitive capacity to make decisions and if not, whether report from their recollection of the person and their particular diagnosis assisted by a review of their file notes and any relevant assessments. On occasion, the medical practitioner may complete the report following a consultation or formal assessment of the person. Q. What is the capacity of a medical practitioner to refuse to complete a medical report if not having assessed the person? CW: If the medical practitioner has not assessed the person and is not suitably familiar with the person to provide a reliable opinion on their

there are any less restrictive options available rather than appointing a

substitute decision-maker. The Tribunal must make an

assessment of a person’s decision- making capabilities and therefore relies heavily on medical evidence. Therefore when the Tribunal receives an application, it must be accompanied with a medical report (also known as a 'doctor's guide) or the Tribunal will require, by way of an order, a treating medical practitioner to provide a WALLACE, Member of the State Administrative Tribunal about the requirements a doctor must fulfil when providing such medical evidence and the relevant implications. decision-making capability, then they ought to refuse to provide the report on that basis. However, if they are the person’s current or regular treating medical practitioner, it may be appropriate for them to arrange a consultation or assessment to enable them to provide the report. Q. What is the capacity of the medical practitioner to discuss any concerns they may have concerning the person, the subject of a guardianship application, with the SAT without incurring a penalty? CW: Medical practitioners complete the report and/or provide written report prior to the hearing. Medicus asked CHARLOTTE

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I N D U S T R I A L

or oral evidence to the Tribunal as a witness who is required to do so by the Tribunal. Therefore, on the basis that they are providing their honestly held opinions, there should be no penalty for providing information requested by the Tribunal. Q. What is the SAT process involved in a guardian being appointed to make decisions for a person? Does SAT have options available to avoid making the ultimate decision depriving a person of their decision-making rights? CW: There is a legal presumption that people have the capability of making their own decisions. Before appointing a guardian or administrator, the Tribunal must be able to rebut the presumption of capability on the basis of clear medical evidence. If the medical evidence is insufficient to rebut the presumption, or supports that the person has capacity, then the Tribunal will dismiss the application. In addition, to appoint an administrator, the Tribunal must find that the lack of capability to make reasonable judgments is due to a mental disability. Even if the Tribunal finds that the presumption of capability can be rebutted, it must still find a need for the appointment of a guardian or administrator. To consider the question of need, the Tribunal must explore whether less restrictive options are available to support the person. Less restrictive options include the ability to execute an Enduring Power of Attorney or

Enduring Power of Guardianship, the ability of a family member to make treatment decisions as next-of-kin, joint signatories to banks and Centrelink and so forth. Q. Can a medical practitioner apply to SAT either on behalf of a patient arguing against an application for guardianship or seeking more information on behalf of a patient about a guardianship application? CW: The most effective way to oppose an application seeking the appointment of a guardian or administrator is for a medical practitioner to provide the Tribunal with a medical report stating that in their view, the person has the capability of making their own decisions. If the medical practitioner wishes to assist the person to access information from the Tribunal, there is an application which can be completed seeking access to the application and other documents held on the Tribunal file. The doctor can also telephone Tribunal staff to discuss general questions in relation to the application and proceedings. The practitioner is also welcome to accompany the person to the hearing or attend by telephone with the person. Q. Do medical practitioners have access to information provided to SAT in relation to a patient who is the subject of a guardianship application? CW: If a medical practitioner is a party to the guardianship/administration proceedings or has been asked to provide a medical report to the Tribunal, they

can seek access to other reports and documents filed with the Tribunal. Q. Is a medical practitioner remunerated for the time spent completing a medical report? CW: Unfortunately the Tribunal is unable to remunerate medical practitioners for time spent completing medical reports for the purposes of a hearing at the Tribunal. The medical report has been drafted by the Tribunal with consideration of the practitioner’s time taken to complete it and with the expectation that completing the report will prevent the need for the practitioner to attend the hearing, which would otherwise be required. Q. What happens to a medical practitioner who does not return a completed form? Are there penalties applied? CW: If a medical practitioner does not complete the medical report, having been ordered to do so by the Tribunal, and without providing the Tribunal with a reasonable explanation, then the medical practitioner is likely to be summonsed to give oral evidence at the hearing. Q. If a medical practitioner is required to give evidence in a case concerning a patient, can the practitioner give such evidence remotely? CW: It is rare that a medical practitioner would be required to personally attend a guardianship or administration hearing at the Tribunal. Attendance is usually by telephone and occasionally by way of video conferencing. ■ ■

Charlotte Wallace LLB LLM practised as a litigation lawyer from 1998 until 2011 and is also an accredited and experienced mediator. She was appointed as a full-time legal member of the State Administrative Tribunal in June 2011. Charlotte manages the guardianship and administration jurisdiction of the Tribunal and is also actively involved in the civil and commercial and vocational regulation areas of the Tribunal’s jurisdiction. Charlotte also established the Tribunal’s inaugural Pro Bono Scheme and is the Scheme Coordinator.

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E V E N T

A valuable ally The annual intern meet -and-greet was a good time to remind WA’s newest

M edical graduates had entered a noble and wonderful profession but faced challenges like never before, Australian Medical Association (WA) President Dr Michael Gannon told the 2016 Intern Cocktail Party held last month. With almost 100 interns at the Nedlands Yacht Club on the shimmering banks of the magnificent Swan River, guests caught up over canapes and fine wines as they were welcomed to the profession by both Dr Gannon and the Director General of the Health Department, Dr David Russell-Weisz. Dr Gannon spoke about his experience in the Doctors in Training Committee and his 21 years of involvement with the AMA. “Tonight is a time for you to catch up with old friends and exchange those great stories that I have no doubt you now all have,” he said. “Life as an intern is an exciting time for you. You will see people at their best and you will see people at your worst. You get to see people at their most joyous and doctors of the challenging times ahead and how the AMA can help

Catching up: Drs Monica Leung, Nick Laidler, James Waldron and Gabby Touyz.

That’s not a given for those in the room tonight. “But I have a clear message for everyone here. “You will need the AMA at various times during your career. You will need our advice and guidance, you will need our support,” Dr Gannon said. “I can think, on a personal level, of a couple of dark times in my career when the AMA was there for me,” he said. Dr Gannon also thanked the Co-Chairs of the DiT Committee, Drs Chris Wilson and Michael Page for their great contribution to policy debates. “The Committee has gone from strength to strength over the last few years with a number of major achievements such as the Training Portal.” The Director General of the WA Health Department, Dr David Russell-Weisz also addressed the guests, and told them that it was during his time as an intern in

a “dingy south London hospital” that he met someone who told him he should spend some time in Australia. Russ took the advice and came to New South Wales for a year – many years ago. A member of the AMA (WA) himself, Russ took the opportunity of detailing some of the changes in WA Health that had occurred over the last few years and “I agree with Michael. There are times when you will need your colleagues and you will need your Association, he said. Co-Chair of the AMA (WA) DiT Committee, Dr Chris Wilson also took the opportunity to remind the interns present to always look out for one another, talk about any problems with their peers or even the DiT Committee, and to always maintain relationships outside of the medical community. ■ some planned for the future. He also supported Dr Gannon’s comments.

their most personal moments. “But never underestimate how challenging your life will be. “It gives me no pleasure to say that I sense great apprehension and uncertainty in interns and medical students today – something my generation of doctors didn’t face. “In my day you knew that if you worked hard enough, you would be able to craft out a career in an area that you wanted.

Words of advice: WA’s Chief Medical Officer Professor Gary Geelhoed, Shadow Health Minister Roger Cook, WA Health’s Director General Dr David Russell-Weisz and AMA (WA) President Dr Michael Gannon.

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E V E N T

Dr Ben Roestenburg flanked by AMA (WA) DiTs Co-Chairs Dr Chris Wilson (left) and Dr Michael Page.

Professor Geoff Dobb with Dr Amanda Ling.

Dr Ashleigh Norris with Dr Nicholas Ward.

Dr Tinashe Chinzou with Dr Uri Harrington.

Drs Stephanie Sim, Jess Ling, Kerewyn Hay and Tamara Ponos.

Dr Ki-Yung Luo with Dr Ian Loke.

Drs Stephen Paul, Stephen Pannell, Christopher Kovacs and Malcolm Teo.

Drs Nathan Luies, Andrew Robinson, Shashi Pantula and Luke Librizzi.

Drs Madeleine Venables, Tom Bartlett, Jemma Ford and Andrés Noé.

Drs Kiran Narula, Binu Jayawardena, Mohamed Mustapha, Oliver Rouhiainen and Ben Verstandig.

The ice-cream truck proved a big success.

Dr Elizabeth Armari with partner Dr Joseph Faraj. Drs Jacinta Montgomery, Shiran Xiao, Grace Morley, Kimberley Minas and Jemma Hogan.

M A R C H 2 0 1 6 M E D I C U S 9

N E W S

$2.5 million to build suicide prevention skills

THE STATE GOVERNMENT has announced $200,000 in grants for suicide prevention training programs, including education for high-risk groups. Mental Health Minister Helen Morton said the grants were the first round of $2.5 million allocated to build community suicide prevention skills over the next four years. “This expenditure backs the State Government’s commitment to halve the number of suicides by the end of 2025, as part of the $25.9 million Suicide Prevention 2020: Together we can save lives strategy,” Mrs Morton said. “Grants of up to $20,000 are available for local government and not-for-profit organisations to undertake evidence-based training focused on mental wellbeing and suicide prevention. “A further $2.3 million will be available over the next three years for education and prevention programs that build

understanding and capacity to respond to suicide risk factors." The Minister said educating service providers and the public about suicide risk factors and how to recognise and support someone who was suicidal was integral to preventing suicide. Applications for small grants close on March 31, 2016.

For further information, visit http://www.mhc. wa.gov.au For more on Mental Health in WA, see page 18 for our cover story. ■

WA Mental Health Minister Helen Morton.

2016 MEMBERSHIP RENEWAL

Your continued support allows us to achieve significant outcomes for doctors. Help us do it again this year.

Please note, this is the final edition of Medicus for members who are yet to renew their membership for 2016.

Support your Association and renew your membership for 2016. Go to amawa.com.au to renew online or call 9273 3055.

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PROFESSOR ROSSA CHIU , a Fellow of the Royal College of Pathologists of Australasia (RCPA), has said that her team’s latest developments in human plasma cancer DNA analysis are pushing new boundaries by identifying the organs where cancer is located via a blood test. This approach, termed plasma DNA tissue mapping, is akin to performing a CT scan using blood samples. Professor Chiu and her colleagues at the Chinese University of Hong Kong (CUHK) have developed new methods to diagnose cancer, conduct prenatal diagnosis, and assess patients who suffer from an auto-immune condition called Systemic Lupus Erythematosus. Professor Chiu predicts that it could be just a few years away from this latest technology being implemented in regular medical practice. “We have developed a brand new technology, which takes plasma cancer DNA analysis, also known as liquid biopsy, to the next level. “Now, the technology is not only able to detect abnormal DNA caused by cancer, it also allows us to scan a blood sample in order to locate where (which organ) the abnormal DNA is coming from. For instance, we might be able to identify that 10 per cent of the DNA is from the liver, or in expectant mothers, 20 per cent is coming from the placenta. “In the past, we have tried to find a marker for liver cancer, however every cancer is very different and no single marker is particularly useful for a specific type of cancer. “With our latest technology, we have improved the blood-based test so much that we can now look at the profiles in the blood sample and then map out which tissues are making regular and abnormal amounts of contribution. Generally it takes approximately one week to analyse.” ■ BLOOD TEST THAT DETECTS CANCER’S LOCATION BEING DEVELOPED FOR CLINICAL USE

GROUND-BREAKING DISCOVERY IN VERTEBRATE DEVELOPMENT PROCESS

RESEARCHERS FROM THE Harry Perkins Institute of Medical Research have uncovered molecular instructions that provide important information required for the

formation of embryonic body structures, such as limbs or the nervous system, by comparing these processes in fish, frogs and mice.

Prof Ryan Lister and Dr Ozren Bogdanovic.

Professor Ryan Lister and Dr Ozren Bogdanovic from the Perkins Epigenetics and Genomics Laboratory led the study, which has been published in in the prestigious journal Nature Genetics . Their work is focused on the epigenome, an extra layer of information present in cells that is made up of millions of miniscule chemical tags attached to the DNA, that can switch genes on or off and instruct a cell on how to develop into different tissue, such as skin or heart. Laboratory Head Professor Lister said there was a phase during embryonic development when very different animal groups look remarkably similar. During this phase, these pre-programmed epigenetic signposts switch genes on or off to trigger the correct development of early embryonic structures. The researchers use powerful genome analysis technologies to precisely map the location of these chemical signposts, in order to better understand the epigenetic process of development, which could be used in the future to show how these processes may go awry and cause disease or disability. Dr Bogdanovic, the first author of the study, said the researchers were comparing the way these epigenetic signposts changed throughout embryo development in different species in order to form a blueprint for normal development. “By looking at early stage embryos of different species, we were able to find the existence of multiple epigenetic switches that appear to be critical for limb formation or brain development,” Dr Bogdanovic said. “The switches change similarly in all these different organisms, even though they’re separated by hundreds of millions of years of evolution.” ■

Pushing boundaries: Plasma DNA tissue mapping is like performing a CT scan using blood samples.

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including lawyers, medical advisors, claims managers and local state experts, it’s hard to make a case against the expertise of Avant. A claim against you can happen at any time. Don’t wait until it’s too late, call us today.

This year, many doctors like you will face a medico-legal claim. Without a strong team to defend you, any action could have a massive impact on your career. As Australia’s leading MDO, Avant has the depth, strength of resources and experience to advise and protect you. With 70 in-house medico-legal specialists,

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*IMPORTANT: Professional indemnity insurance products are issued by Avant Insurance Limited, ABN 82 003 707 471, AFSL 238 765. The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at www.avant.org.au or by contacting us on 1800 128 268.

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N E W S

More specialists choosing Albany THE GREAT SOUTHERN region now has more than 24 medical specialists living in the area with the appointment of the first resident Geriatrician at Albany Health Campus (AHC). specialists work across areas

such as general medicine, critical care, mental health, medical imaging, public health, palliative care and obstetrics.

Health Minister Kim Hames said the facilities at the recently constructed AHC provided an excellent opportunity for doctors wanting to work in a cutting-edge facility in a regional location. “The increasing number of highly regarded specialists choosing to live and work in Albany has resulted in improved medical services, increased capacity to treat more patients locally and has provided a more sustainable workforce in the region over the past three years," Dr Hames said. “The resident specialists include an Oncologist and General Physician who together have been providing a highly valued service to the Great Southern community for 30 years. “That’s in addition to a well-known and respected Western Australian respiratory physician who moved to Albany in 2015 and an Orthopaedic Surgeon who has performed almost 1,000 elective and emergency procedures in the past two years.” The Minister said the health campus now had three resident General Surgeons who, with their visiting colleagues, performed the second highest number of elective surgery cases each year in the WA Country Health Service. Other

On the up: Albany Health Campus has earned a reputation for its high-tech education and simulation training facilities.

The increase in local specialists and regular visiting specialists has been credited with a reduction in the number of patients accessing Patient Assisted Travel payments to travel to Perth to attend specialist appointments. There had also been an increase in the number of junior doctors at Albany Health Campus with eight resident medical officers, six interns and nine registrars, and the facility is expanding its telehealth service to reduce the number of patients needing to travel out of the region. Dr Hames said Albany Health Campus had earned a reputation for its high-tech education and simulation training facilities, plus its adoption of cutting-edge technology such as electronic discharge summaries to improve communication between hospitals, specialists and GPs. ■

For a great cause

THIS YEAR THE Western

Australian Medical Student’s Society (WAMSS) sports representatives are swimming to Rottnest Island

on 19 March in the Port to Pub 20km Swim. Swimming to raise funds for Motor Neurone Disease Western Australia (MNDWA), they have chosen this locally-based charity as instead of a strong research focus, it specialises in providing professional information and support services to people living with MND, their families and carers. The goal is to raise $5,000 for the charity and WAMSS would greatly appreciate your support. Please visit the facebook page WAMSS Swims to Rotto to find out more, as donations of any size would be greatly appreciated and can be made at https://give.everydayhero. com/au/WAMSSrottoswim ■

M A R C H 2 0 1 6 M E D I C U S 15

A M A ( WA ) AWA R D S It’s Awards season! Nominations for the 2016 AMA (WA) Awards are now open B elow are details for two awards that will be presented for 2016. All awards will be judged by independent expert panels and winners announced at the AMA (WA) Gala bust of Hippocrates. For further detail contact Paul Boyatzis either by email paul.boyatzis@amawa. com.au or phone 9273 3007.

Junior Doctor of the Year 2016: Nominations for this prestigious annual award open on 21 March 2016. The AMA (WA) Junior Doctor of the Year (Dr Camille Michener Legacy Award) recognises the significant and outstanding contributions of our Doctors in Training to the medical profession and the community in areas such as teaching and education; leadership and advocacy; and doctor’s wellbeing and community service. The Award establishes a fitting legacy to the memory of Dr Camille Michener who is remembered as a staunch advocate and benevolent friend, well-liked and respected by all who knew her.

Dinner and Awards Night on Saturday 25 June at the Perth Convention and Exhibition Centre. AMA (WA) AWARD: Nominations for the AMA (WA) Award are invited from all sectors of the medical profession, before Friday 29 April 2016 . It is expected that nominees will have demonstrated a tireless dedication to either the service of others, their chosen field, or be pioneers who have worked without seeking recognition for their efforts. Nominations should be accompanied by adequate evidence and include the names of supporting referees. The winner is presented with a fine bronze

Nominations will close at 4.30pm on Friday 29 April 2016 . So start thinking about who you will nominate for this Award to ensure that we continue to recognise and celebrate the outstanding contributions of our Doctors in Training to the medical profession and the community. Achievement: Professor Kingsley Faulkner and Dr Jackie Scurlock were recognised with the coveted AMA (WA) Hippocrates Award last year while Professor Bryant Stokes was presented the AMA (WA) President’s Award.

For further information please contact Leah Pantelis leah.pantelis@amawa.com.au . ■

M E D I C A L C A R E E R S EXPO Tuesday 12 April, 6 - 9pm Burswood on Swan For junior doctors and graduating medical

students. Discover and discuss career options. Register your attendance and keep informed: www.facebook.com/PMCWA

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Charity AMA (WA ) 2016

Gala Dinner

& Awards Night

Please join us for a magical night of celebration, entertainment and prizes Saturday June 25 Perth Convention and Exhibition Centre BelleVue Ballroom at 6.30pm The AMA (WA) will host the 2016 Charity Gala Dinner and Awards Night in recognition and support of DR YES youth program. This unforgettable evening will also honour the achievements of outstanding Western Australians who have made significant contributions to medicine in WA. Book now for this exclusive event by contacting Skye Connor on 9273 3028 or email skye.connor@amawa.com.au For more information, visit www.amawa.com.au AMA Members $270 per head / Corporate Tables (10) $2,950 Dress Black Tie (optional)

C O V E R S T O R Y

The Commonwealth Mental Health Reform package will soon be rolled out across WA, but will it significantly shake up the system? H ow do we take an 18-year-old into hospital through triage and admit her as having suicidal ideation, have her attempt to take her own life on the ward as an inpatient, and then discharge her?”

failed them and their families. While the Alma Street Inquest cited poor communication and procedures at the clinic, the findings represent on a broader scale the intrinsic failures in mental health – at the primary, community and tertiary care levels. Since the deaths, a new Mental Health Act has been introduced, which the Health Department says addresses many of the issues of communication that had been contributing factors. In addition, the State Government maintains that 61 per cent of the coroner’s recommendations had been implemented, and the rest would be too. Mental health has been a National Health Priority for the past two decades. Yet there has remained widespread public concern about the nature and apathetic pace of mental health reform. Challenges in delivering better mental health and suicide prevention services have persisted, prompting the introduction of several recent initiatives at both Commonwealth and state levels, focused on improving sector and service coordination and mental health

These words reflect the horror and heartbreak of Geoff Diver and the complete mistrust he has in our State’s mental health system. Mr Diver’s 18-year-old daughter, Ruby Nicholls-Diver, completed suicide in 2011, just hours after being discharged from the Alma Street psychiatric unit in Fremantle. Ruby’s death and those of four other West Australians who were treated at the clinic before taking their own lives were the subject of a Coronial Inquest last year. In an article published in August 2015 on ABC Online, Mr Diver said the evidence highlighted a system in disarray. “You’ve got these people who are already grappling with the notion of failure, and the system essentially invites them to fail every step, and make you feel like a failure every step,” he said. Like Mr Diver, there are countless West Australians who are living with the tragic consequences of a system that has

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