House of Assembly Fifty-Second Parliament, Second Session (52-2) 52 2 Parliament of South Australia House of Assembly published Question Time Flinders Medical Centre FLINDERS MEDICAL CENTRE Mr HAMILTON-SMITH House of Assembly Waite FLINDERS MEDICAL CENTRE Mr HAMILTON-SMITH (Waite) (14:21): My question is to the Minister for Health. Did the health department's accident and emergency system fail stroke victim, Ms Stanislawa Gunther, on 3 January 2012? Ms Gunther was rushed to the Flinders Medical Centre Emergency Department in an ambulance, accompanied by her daughter, on the afternoon of 3 January after suffering a stroke. In a letter to the hospital, the patient's daughter says: My mother was left in a waiting cubicle from 5pm until midnight and was not checked by the doctors. She was left there without any food or drink until midnight. I gave my mum water and chocolates around 8pm because she was very hungry and said that her sugar level is very low because she is trembling and shaking. She had nothing to eat from 2pm and she vomited. The family has expressed the view that the emergency department was under-resourced at the time. The daughter said in her letter, 'The doctors were attending, I was told, to other patients.' Stroke doctors and nurses have confirmed to the opposition that stroke victims are normally triage category 1 or 2, to be seen within 10 minutes, and that if attended to by a stroke specialist within three to four hours, death or permanent disability can generally be averted. Having not been seen on time, Ms Günter is now permanently disabled, requiring full-time care from her daughter and family. The Speaker House of Assembly The SPEAKER: Member for Waite, I would ask you to keep your explanations a lot shorter in future. It is not a chance to do a grievance. Minister for Health. The Hon. J.D. HILL House of Assembly Kaurna Minister for Health and Ageing Minister for Mental Health and Substance Abuse Minister for the Arts The Hon. J.D. HILL (Kaurna—Minister for Health and Ageing, Minister for Mental Health and Substance Abuse, Minister for the Arts) (14:22): I thank the member for his question. It was carried in the media last night. My department and I have not received permission from the patient involved to discuss the particulars, but now that it has been in the public domain and the member has raised it in here, I assume that there is an implied arrangement where I can speak about her circumstances. I do it reluctantly because patient confidentiality is obviously an important part of the circumstances. First, I want to express to the lady and her family my sympathies for the circumstances that she is in. A stroke is an awful thing to occur to somebody, and to have an ongoing disability is obviously very stressful. I would also say that I have asked the department for an independent and full investigation of the facts, but I will tell you what I know at this stage. The alleged facts that were put by the member—which I am not saying he invented himself—are disputed facts. The health service informs me that the lady in question arrived at the hospital by ambulance at about 6.30pm and the process of helping her had begun when paramedics arrived at her home. Paramedics, nurses and doctors are all part of stroke management teams and they are all trained to identify and know what to do in the circumstances. So, the process of care in this particular case, I am told, began when paramedics came to her home. The advice I have—and this is something that needs to be confirmed—is that there is disputation, and sometimes patients are not really sure what is going on when things of this nature occur to them, so this is not a criticism. There is a view, I think, held within the health fraternity associated with this case that the lady in question did not get to the hospital for several hours—I think something like five or so hours—after the stroke had occurred. As a result of that— Mr Hamilton-Smith interjecting: The Hon. J.D. HILL House of Assembly The Hon. J.D. HILL: You might disagree, member for Waite, but I know from having looked at lots of cases over time, the perceptions by individuals about what is happening compared to what actually happens in a highly charged and emotional environment is often not accurate. This is not a reflection on her, this is about the facts. The advice I have is that the patient was outside the 4½ hour threshold when the intervention which may have assisted could have occurred. I will read to you what I am advised: in some cases, where clinically appropriate, intervention is available for patients who are experiencing a stroke to minimise the possibility of a permanent disability. Stroke intervention (thrombolysis) is only recommended for safe administration within 4½ hours of the onset of stroke symptoms. Any patients who are clearly experiencing stroke symptoms and arrive at Flinders Medical Centre within 4½ hours are considered for that particular treatment. The clinical director explained that this can be a complicated treatment, and that giving the drug after 4½ hours can in fact increase the risk of bleeding, so it is not something that you do safely. The clinical director further advised that this patient received the most effective treatment. Mr Hamilton-Smith interjecting: The Hon. J.D. HILL House of Assembly The Hon. J.D. HILL: This is what the doctor tells me, member for Waite; not what I am saying to you as a politician. This is what the doctors tell me. The clinical director further advised that this patient received the most effective treatment and that, on the basis of information medical staff had, the time it took to be assessed by a doctor would not have adversely affected the patient's outcome. The patient's family and the member for Waite have criticised the hospital staff for not triaging the patient at a higher level. I think, from memory, she was triaged at category 3. There were a lot of other patients who had higher triage categories who were treated by doctors. This patient, I am told, was seen on a regular basis by a nurse and looked after in the hospital. This is a sad set of circumstances; I am very sorry that the family felt that the hospital did not treat them in the way that they should. I will get a thorough investigation and confirm, to myself and to the house if it so desires, these circumstances, but that is what I am advised. I understand that, in emotionally-charged circumstances, people's views will differ about what actually happened.