ASMS Direct - Issue No 2010-17
28 October 2010
Dear Member
We welcome any feedback on the contents of the 17th issue for 2010 of ASMS Direct, our national electronic publication. This copy of ASMS Direct focuses on:
- 1. ASMS urges DHBs to support senior doctors in coping during MRT and laboratory workers strikes
- 2. Medical Council updating its statements
- 4. Reminder: Annual Conference Organisation, 18-19 November, Wellington (Te Papa)
- 5. Outcomes of World Medical Assocation General Assembly, 13-16 October, Vancouver
1. ASMS urges DHBs to support senior doctors in coping during MRT and laboratory workers strikes
The ASMS is aware of growing concern among many members about risks to patient safety arising out of the industrial dispute between the DHBs, on the one hand, and the APEX (mainly medical radiation technologists) and Medical Laboratory Workers Union, on the other hand. It is not appropriate for the ASMS to comment on the issues in these disputes (aside from the fact that we can’t understand them). Nor do we want to apportion responsibility for where both these disputes have ended up. Further, the ASMS does not support efforts to undermine the right to strike which is a right that sometimes is all that employees have available when dealing with difficult employees. Nevertheless the form of the current strikes is impacting in such a way as to compromise patient safety by creating potentially dangerous situations. Even requests for diagnostic tests and images which might reasonably be deferred are now risky for patients because of the difficulties of timely re-scheduling.
The ASMS has been raising our concerns and recommended a more suitable approach to the application of life preserving services agreements in our Joint Consultation Committees in individual DHBs. We have now also formally written, on 27 October, to the DHBs nationally outlining our position and advice. Our letter was addressed to Karen Roach, Chair of the DHBs Employment Relations Strategy Group, who is also the Northland DHB chief executive. She has subsequently forwarded it to all DHB chief executives. The letter is copied below and is hopefully self-explanatory:
Dear Karen
Support for SMOs during MRT and Laboratory Workers Strike
I am writing to you in your capacity as Chair of the 20 district health boards Employment Relations Strategy Group in order to draw to your attention and that of your fellow Chief Executives a matter that is causing numbers of our members increasing concern. It relates to their ability to deliver life preserving services during the long running medical radiation technologists’ strikes as well as, in a number of DHBs, the laboratory workers’ strikes.
It is not appropriate for the Association to comment on the collective bargaining dispute between the DHBs and the two affected unions. But it is appropriate to raise with you our concerns about the impact on our members who, as employees of the 20 DHBs, you have an important duty of ‘good faith’.
The problem facing our members is coping with the cumulative impact on the share volume of partial strikes (around 700 according to DHB comments) affecting diagnostic services. The impact is creating dangerous circumstances more so than if they had been full rather than partial strikes and did not involve diagnostic services. We have now reached a situation where even deferred non-acute treatment is dangerous because of the increasing difficulties in re-scheduling tests in a timely manner.
We are now hearing from our members that they are unable to practice safely because of challenges that have been made and are continuing to be made in instances when they have sought tests or imaging to provide life preserving services (including risks of permanent injury and disability) for their patients. These challenges are causing unreasonable and potentially life threatening delays (or risking permanent injury or disability) for their patients who are in need of life preserving services. This is consistent with the strong national statement on risks to patient safety from the chief medical officers/advisers which was announced at your media conference last week.
There is no doubt that most patients who find themselves in hospital are acutely unwell or have severe and sometimes life threatening chronic conditions. The fact of a strike affecting accessing diagnostic services does not lessen their condition and it must be left to our members to determine on a case-by-case basis whether the test or image they have sought is necessary for the delivery of life preserving services. If there is to be debate about that between the parties to the industrial dispute, that debate must be conducted later when the risk to the patient has gone or been reduced.
In the meantime the tests or request for imaging must proceed without delay. Without putting too fine a point on it, on the ground, on the day, at the time, the genuine decision of the relevant senior medical or dental officer in the matter of what is or is not a life preserving service is an ‘Ace of Trumps’ and is not to be questioned and must be carried out promptly. This is not supporting ‘strike-breaking’ and the Association would strongly resist the use of life preserving agreements for this purpose. Rather it is about respecting the tenor and intent of the ‘Health Sector Code of Good Faith’ in the context of patient safety.
That is the advice the Association is giving our members and we expect and request that all DHBs will support to the hilt any of our members who make such a decision during any future strikes including, I understand, a two-day national strike on 9-10 November. I will be advising our members of the contents of this letter through our electronic communication ASMS Direct.
I would be grateful for an early reply and acceptance of this request
Yours sincerely
Ian Powell
EXECUTIVE DIRECTOR
2. Medical Council updating its statements
The Medical Council is currently in the process of updating some of its older statements. These includes its statements on:
1. Responsibilities of Doctors in Management and Governance.
2. Complementary and Alternative Medicine.
3. Information and Consent.
4. Ending a Doctor-Patient Relationship.
Changes proposed by the Medical Council include:
· Improving the language used in the statements, with the intention of making advice as simple, clear and explicit as possible.
· Adding a foreword to make the purpose of each statement more explicit.
· Adding a review date which states that changes to legislation may make each statement obsolete.
· Indicating that the Council intends to review the statements within the next five years.
The Medical Council is seeking comment on the reviews to these statements and would welcome your views. The closing date for comment is 1 December 2010. Submissions can be sent to mthorn@mcnz.org.nz.
The four statements and proposed changes can be found at this link:
3. Use of CME expenses for laptops and electronic aids
Previously we reported the outcome of the national DHB MECA ‘variation’ which made it permissive for DHBs to agree to allow senior medical staff to use CME expenses to purchase laptops and electronic aids where the main reason is to support CME. The main effect was to make this explicit (it was already happening in most DHBs) and to remove the argument that a DHB could not do this because it was not explicitly mentioned in the MECA.
What has emerged from our subsequent investigations is that only three DHBs still refuse to allow CME expenses to be used in this more flexible manner. The three offenders are Auckland, Wairarapa and Canterbury. All three have agreed to reconsider their positions following the ASMS raising the issue at our Joint Consultation Committees and we hope that following reflection they will adopt a more flexible position.
With two qualifications all other DHBs accept that CME expenses can be used in this way. There are variations in the way in which this is done but the key point is that the principle is accepted and applied. They have not found the sometimes cited taxation bogey too difficult to sort out as is sometimes claimed in the other DHBs (essentially the SMO pays the FBT). The two qualifications are Whanganui and West Coast which we are unclear about.
4. Reminder: Annual Conference Organisation, 18-19 November, Wellington (Te Papa)
5. Outcomes of World Medical Assocation General Assembly, 13-16 October, Vancouver
The annual General Assembly of the World Medical Association (WMA) was attended by doctor representatives from 50 national medical associations. According to the WMA, among the issues discussed were:
Refugees—National medical associations were urged to support and promote the right of all people to receive medical care on the basis of clinical need alone and to speak out against legislation and practices that are in opposition to this fundamental right. In a statement revising its policy, the WMA said that refugees, including asylum seekers, refused asylum seekers and undocumented migrants, as well as internally displaced persons in all regions were among the most vulnerable in society and international codes of human rights and medical ethics declared that all people were entitled without discrimination to appropriate medical care. Doctors could not be compelled to participate in any punitive or judicial action or to administer any non-medically justified diagnostic treatment, such as sedatives to facilitate easy deportation from a country.
Chemical pollution—The meeting warned that chemical contamination of the environment continued to exert harmful effects on global public health. It agreed on a new statement urging national medical associations to press for legislation to reduce chemical pollution and human exposure to chemicals. Doctors should support the phasing out of mercury and other chemicals in health care devices and products and should support legislation to require an environmental and health impact assessment before the introduction of any new chemical or industrial facility. In addition, patients should be informed about the importance of safely disposing of medicines that are not consumed, and effective and safe systems should be developed to collect and dispose of these drugs.
Family violence—Revised policy on family violence was approved, setting out proposals for increasing awareness and involvement of the issue among doctors, including the need to oppose violent practices such as dowry killings, honour killings and the practice of child marriage.
Ethical organ procurement—A working group was set up to examine organ procurement, including the issues of transplantation from executed prisoners, the commercialisation of organ transplants, presumed and other systems of consent and related issues.
Juniors (residents) committee—The meeting agreed to help increase the involvement of junior doctors in the WMA. An associated members platform for junior doctors to get involved was agreed, so that issues relating to junior doctors, such as safe working hours, post graduate training and doctors' migration, could be more widely discussed within the Association.
Elections—Dr. Wonchat Subhachaturas, President elect of the Medical Association of Thailand, was elected President for 2010/11 and becomes the first doctor from Thailand to hold the post. He is a neurosurgeon who did his medical training in Bangkok. He was deputy secretary of the Bangkok Metropolitan Administration and currently works at the Thai Health Professional Alliance Against Tobacco. Dr. José Gomes do Amaral, President of the Brazilian Medical Association, was elected President-elect. He will become the third Brazilian to become President when he takes up the post at the WMA Annual Assembly in Uruguay next year. He is an anaesthetist.
Kind regards
Ian Powell
EXECUTIVE DIRECTOR
