Australian Doctor Australian Doctor 7th September 2018 | Page 3

NEWS 3
australiandoctor.com.au 7 SEPTEMBER 2018
Paul Smith
HAVING participated in a politi-
cal blood bath that made a rup-
tured spleen look like a paper
cut, Greg Hunt returned to his
other job as Minister for Health
last week.
The MP for Flinders had quit
the health portfolio to join the
cabinet tag team that failed to
make Peter Dutton Australia’s
30th prime minister. But he sur-
vived the aftermath.
Last week he was sworn
in as health minister and took to
Twitter saying he was “humbled
and honoured”.
With a federal election
expected next year, there will
probably be no major change
in policy under new Prime Min-
ister Scott Morrison. After the
coup, he promised to make tack-
ling chronic disease a key area of
focus for the new-look govern-
ment, along with maintaining
access to affordable medicines,
aged care and Medicare.
However, the position of rural
health minister disappeared in
his cabinet shake-up, with the
portfolio becoming part of a new
super-portfolio of Regional Ser-
vices, Decentralisation and Local
Government run by Senator
Bridget McKenzie.
No pay for
vexatious
complaints
Antony Scholefield
THE Federal Government has
rejected the idea of paying
financial compensation to doc-
tors who are subjected to vexa-
tious complaints.
Amid growing alarm about
the emotional damage endured
by health professionals caught
up in the complaints system, a
Senate report last year flagged
the idea of a compensation
scheme to cover doctors’ time,
efforts and legal costs. But the
government has rejected the
proposal, saying it would deter
people from “raising their con-
cerns with AHPRA”.
“Evidence suggests ... greater
risk is posed to the public from
people not reporting their con-
cerns,” the government said in its
written response last month.
The government also said it
was unclear from the Senate
report exactly who would pay
the compensation to doctors —
the government, the watchdog
itself or the complainants.
Each year, AHPRA receives
about 5000 complaints against
doctors, though it says fewer
than 1% of these are vexatious.
Hospital fracture
care often broken
Clare Pain
FEWER than a quarter of elderly Australian
patients discharged from hospital after hip
fracture leave on osteoporosis therapy, reg-
istry data shows.
Most patients did not even receive indi-
vidualised written information on how to
prevent future falls, according to the 2018
annual report of the Australian and New Zea-
land Hip Fracture Registry.
The report shows that only 24% of
patients left hospital on a bisphosphonate,
denosumab or teriparatide. Some 9% were
on osteoporosis treatment at admission
and 36% were on calcium or vitamin D on
admission.
The co-chair of the registry, geriatri-
cian Professor Jacqui Close, said the results
compared poorly with UK hospitals, where
70-80% of hip fracture patients were dis-
charged on osteoporosis therapy.
Part, but not all, of the problem was due
to the “perverse incentive” of state funding,
which meant that hospitals were reluctant
for their pharmacies to bear the cost of initi-
ating treatment, she said.
But GPs also had a role to play and there
were opportunities to intervene when
patients sustained less serious fragility frac-
tures, Professor Close said.
“You need to be targeting the patient in
their 70s who breaks their wrist,” she added.
And bone densitometry was not essential.
“If a patient has a fall from standing height
and breaks their hip … you know they have
osteoporosis,” she said.
Dr Evan Ackermann, chair of the RACGP’s
expert committee on quality care, said over
the past 20-30 years there had been a shift in
fracture presentations, with patients going
to ED rather than a GP.
GPs also had a role
to play ... when
patients sustained
less serious fragility
fractures.
Discharge summaries should invite GPs
to consider osteoporosis management in
appropriate cases, he added.
The data from 41 hospitals and more than
7000 patients admitted for hip fracture last
year showed the average patient was aged
84, with one-quarter of admissions being for
people aged over 90.
Seventy per cent of patients were women,
29% were in residential aged care and 39%
had known cognitive impairment prior to
admission. Patients in aged-care residences
and those with cognitive impairment were
particularly at risk of fractures and should be
on vitamin D, said Professor Close.
The report ranked the hospitals for their
hip fracture care, however, seven refused to
be identified.
Registry co-chair, orthopaedic surgeon
Professor Ian Harris, lauded the hospitals
that agreed to be named.
“This is very powerful data. No hospital
wants to see themselves as underperform-
ing,” he said.
Read the annual report here: bit.ly/2NEnQiE
Variation in treatment of hip fractures in 2017 (41 hospitals)
Key performance indicator Lowest performers Average length of stay in emergency department Wollongong, NSW
Unidentified hospital 13 hours Townsville, Qld 3 hours
Documented pain assessment within 30 mins of arrival at ED Westmead, NSW 0% Unidentified hospital 99%
Average time to surgery (excluding transferred patients) Wollongong, NSW 59 hours Unidentified hospital 23 hours
Patients mobilised by first day after surgery Wollongong, NSW 63% Westmead, NSW
Mater South Brisbane, Qld 100%
Patient assessed by a geriatrician Mater South Brisbane, Qld 0% The Northern, Vic
Sunshine Coast University, Qld
Lyall McEwin, SA 100%
Plan in place to manage future falls and fracture risk Mater South Brisbane, Qld
Prince Charles, Qld 0% Westmead, NSW
Sunshine Coast University, Qld
Lyall McEwin, SA 100%
Discharged on bisphosphonates, strontium, denosumab or
teriparitide Westmead, NSW 0% Princess Alexandra, Qld 73%
Highest performers
Note: Hospitals that dealt with fewer than 50 hip fractures per year were excluded
GP fights insulin murder conviction
Antony Scholefield
A FORMER GP jailed for murdering
his wife by administering a lethal
dose of fast-acting insulin is appeal-
ing his conviction, claiming the cause
of his wife’s death was never proven.
Brian Crickitt, from Sydney, was
sentenced to at least 20 years behind
bars last year after he allegedly killed
Christine Crickitt with an injection
of NovoRapid to the buttock on or
around New Year’s Day 2010.
The forensic pathologist never
ascertained a cause of death and did
not find traces of insulin in the body.
Justice Clifton Hoeben convicted
Crickitt based on circumstantial evi-
dence, including that he obtained
insulin by using a script he had writ-
ten for one of his patients and had,
in the days leading up to his wife’s
death, performed a Google search for
the terms “insulin” and “fatal”.
Last week, Crickitt appeared at the
NSW Court of Appeal by video-link
from the maximum-security Hunter
Correction Centre.
His lawyers argued the judge had
made an error of law by convicting
Crickitt without a means of murder.
“Assume his honour was cor-
rect that [Crickitt] fabricated scripts,
looked things up on the internet and
injected the deceased,” barrister
Hunt back
after his
role in coup
Gabriel Wendler said. “If insulin didn’t
kill her, he’s not guilty of murder.”
If Crickitt did administer the injec-
tion it might be “something else, but
not murder”, Mr Wendler added.
He argued it was different to other
murder cases with no proven cause of
death, such as cases with no body.
“In those circumstances, the case
Brian Crickitt’s
lawyers argue the
judge made an error in
convicting him without
a means of murder.
ran on the basis of ‘we don’t know’.”
“This is an unusual case where
a positive case is presented, and at
the end of the day, it can’t be deter-
mined,” he said.
In response, prosecutors argued
that the original case acknowledged
that the cause of death could not be
proven and “was run purely as a cir-
cumstantial case”.
The weight of circumstantial evi-
dence, considered in total, entitled
Justice Hoeben to convict Crick-
itt even without a medically proven
cause of death, they said.
In the original case, Crickitt’s law-
yers argued that Mrs Crickitt could
have died from suicide or positional
asphyxia after a fall.
One of the three appeal judges said
it was an “extraordinary coincidence”
if Mrs Crickitt died from suicide on the
same night when her husband had the
means to commit murder.
They reserved their decision.