Parliamentary Committees

Social Development Committee: Surgical Implantation of Medical Mesh

Ms LUETHEN (King) (11:01): I move:

That the 44^th report of the committee, entitled Inquiry into the Surgical Implantation of Medical Mesh in South Australia, be noted.

On behalf of the Social Development Committee, I have a number of people and organisations to thank. Firstly, it goes without saying: thank you to the individual witnesses and their families, who have given this committee their time and insights and provided accounts of their journeys with medical mesh, which have at times been understandably traumatic for them. We were told by South Australian women that this pelvic mesh has had a debilitating impact on their lives. For many women, they have been devastated also by the long wait times for help.

Through their written and oral submissions, the committee has been able to understand the deeply personal nature of the damage mesh can cause in the human body, how the experience of this for many sufferers needs to be given proper recognition and an appropriate response by the relevant authorities. The committee would also like to thank our state's pelvic mesh clinic and the staff who work at the clinic who provided oral evidence and written responses to many questions taken on notice.

The committee would like to thank the professional colleges, medical associations, non-government sector, universities and research institutes and their learned representatives, whose evidence was educative and much appreciated by the committee. Lastly, the committee thanks the advocacy groups who have assisted many of the mesh-affected women and men in this state and supported them through pain and in making their submissions to this inquiry.

I also thank the Presiding Member, the Hon. Dennis Hood, in the other house; the member for Newland, who chaired the committee for a period of this inquiry; and the committee members and secretariat for their work on this review. I would also like to mention and thank the member for Torrens, who moved this motion for this inquiry to be undertaken and has been a passionate advocate for mesh-injured South Australians.

I am pleased to be noting the report today on behalf of the committee. Briefly, the Social Development Committee started the inquiry into the surgical implantation of medical mesh by advertising across the state and calling for submissions in July 2019. The committee received 69 written submissions and held 15 hearings, with the report being tabled today the result of a very lengthy inquiry dating back to July 2019, so almost two years.

During this time, and largely as a consequence of the report of the Community Affairs References Committee in the Senate on the number of Australian women affected by transvaginal mesh, many changes have occurred in the regulations and the use of medical mesh. Some of that committee's recommendations are still to be fully implemented, but the majority have been, both federally and in South Australia.

After taking into consideration the evidence presented by the many stakeholders and examining some of the emerging national and international policies and regulations concerning the use of medical mesh in pelvic organ prolapse, stress urinary incontinence and hernia, the committee has made 17 recommendations to the Minister for Health and Wellbeing.

I will not go into any more detail this morning, but there is so much more I could say, and many of us were brought to tears listening to witnesses, except to say the report has now been publicly tabled. I do recommend the report to members of this chamber who have an interest in this important area and indeed to members of the public who may be interested. I think the report will provide a good basis for understanding the issues and for looking at what I believe will be a very overdue and worthwhile path ahead. The committee has made some strong recommendations. The inquiry was held in a multipartisan fashion, with much more focus on getting a result for people who have suffered.

I think the final point to make here is that there is no doubt at all that, whilst this particular form of surgery has been successful for some people, there are a significant number of people who have suffered intensely as a result of these implants or devices being inserted into them, and the response from the medical profession as a whole has been suboptimal, not just in South Australia but right across the world.

The committee attempted to take the best possible evidence it could in order to, firstly, perform an overview of the situation and outline some of the terrible suffering that has occurred as a result of these procedures but also to provide 17 recommendations on what should be done from here. I am pleased to inform the chamber that in many cases these recommendations have already been partially taken up or at least been seen as an obvious next step by those towards whom the recommendations are directed. The report is comprehensive and I commend it to the house. I look forward to contributions by other members.

Ms WORTLEY (Torrens) (11:07): In moving the private member's motion for an inquiry into issues related to the surgical implantation of medical mesh in South Australia, I said:

We know that the consequences for some women have been severe, and we also know that there are men now being impacted by the implantation of medical mesh…It is not everyone, just as it is with the medical mesh that women have had implanted…

The majority of these people will go on to have good results, but those adversely affected—and there are tens of thousands around the world—say the risk is too high.

Significantly, the Therapeutic Goods Administration has lifted the rating of mesh from medium to high risk. I said in that opening speech that we need to deliver not only for the women already affected but for those women—it may be your wife, it may be your daughter, it may be your mother—who could still be impacted by an adverse reaction resulting from this procedure.

Today, I want to acknowledge the courage and the selflessness of all the women and men affected by medical mesh implantation who have stood together in South Australia, Australia and around the world. I want to acknowledge also their families. I want to thank all the lived experience of the mesh injured who provided evidence to the inquiry, knowing how emotional and traumatic it was for them to relive their journey but who did so in the hope that it would make a difference. I hope today that you feel that it was worthwhile. I trust that the evidence from the inquiry and that recommendations contained in the report will go some way to delivering a positive outcome.

I want to thank committee members the Hon. Dennis Hood, the Hon. Emily Bourke, the Hon. Connie Bonaros, the member for King and the member for Newland. I would like to place on record a thankyou to the secretariat, Ms Robyn Schutte and Ms Mary-Ann Bloomfield. I would also like to thank the academics, the researchers and the members of the medical profession for their evidence and for their participation in the inquiry.

Importantly, today I want to acknowledge the women in South Australia and around the world whose voices went unheard for so long. In the chamber today, for the noting of this report delivered by the parliament's Social Development Committee inquiry, are some of the women and men whose lives have been impacted by the devastating adverse reactions to medical mesh: Kim, Tracey, Yvonne, Evelyn, Penny, Norma, Valerie and Dean and their families, each of them revealing deeply personal stories of their horror journey and the impact on them and their families.

Others affected and who played a significant role are Gwenda, Vicki, Kirsty, Eunice and Cynthia. I also want to place on record a special thanks to Rebecca DiGirolamo for her commitment to spreading awareness of this in the media, through the Sunday Mail and The Advertiser newspapers and also to the ABC for their reports. As a result of media coverage, contact was made with my office and with the committee secretariat by mesh-affected people not aware of the inquiry and by others who had suffered for years with symptoms, not knowing the cause.

I was contacted by these men and women who, after hearing about this inquiry and seeing it in the media or hearing by word of mouth, are finally able to understand what many doctors and specialists have been unable to identify: that their mesh may be the cause of their pain and suffering. The committee heard that some people did not even give fully informed consent prior to the implantation of medical mesh and many of the people who contacted me following the media reports supported this.

The first time I heard about mesh was from a constituent, Tracey, who is here today. Tracey left a message with my trainee. She wanted me to return her call. I had not had an opportunity to get back to her, but a couple of days later I was doorknocking and I doorknocked Tracey's door. She opened the door, grabbed my hand and said, 'You need to hear what I have to say.' Tracey told me, 'I'm not a number, I'm not a statistic, I am a woman who was just 29 years old when mesh ruined my life. After the birth of two children, I suffered stress urinary incontinence and 2006 saw the beginning of my harrowing journey.'

She told me that mesh stole her life. It stole her children's happiness and it almost stole her marriage. She said, 'It stole my mind and my body and my ability to trust another human being.' The damage physically, emotionally, financially and psychologically was far more damaging than the very reason why she had the surgery in the first place. Tracey recently travelled to Melbourne where, at a cost of thousands of dollars to herself, she had the mesh removed in the private health system. She told me that her pain has significantly reduced, but there still remains some damage that she hopes will be repaired in the future.

Kim is a mother of four, a career paramedic and a registered nurse. She shared her experience about the effects transvaginal mesh has had on her life, the life-altering impact on her and her family physically, emotionally and financially, impacting on both her personal and professional life. Kim had the mesh implanted in a hospital in South Australia, but she had to travel to the US, at her own expense, to have it removed. Kim said that mesh has impacted on every aspect of her life. Kim is an active advocate and has worked tirelessly to have the voice of mesh-injured women heard, and along with this she has the lived experience so that many of the mesh-injured will be in contact with her through their support organisations that they have set up. The same goes for Tracey.

Yvonne was not fully informed prior to mesh being implanted. The procedure has negatively impacted and altered every aspect of her life. She told me that going into surgery she was fit and active, a much-needed wife, mother and grandmother, and that she was full of hope. Due to adverse surgical injuries, she awoke bewildered and broken. A bladder perforation left her unable to void and catheter dependent. She developed a foreign body reaction to mesh, and she felt like she was dying a slow and agonising death, which at times, she says, would have been welcome. Mesh stole her dignity, her ability, self-esteem, confidence and independence. She is saddened when she reflects on life before mesh and life now.

We have women here in South Australia and around the world who have been telling these stories. In evidence, we heard similar stories, that after months and months of going to doctors and specialists with all sorts of symptoms and no record of the mesh implantation coming forward they were told it was in their head. Some were given medication because they were accused of being hypochondriacs and told they just needed to settle down. We heard evidence that it was not until the husband's penis was grated during intercourse, as if by a cheese grater, when there were physical signs, that the medical profession actually saw the impact that the mesh, which was coming through the woman's vagina wall, was having.

These recommendations that we have before us today need to be given the genuine and serious consideration that they deserve. We do not want this report to be one that is put on the shelf and ignored. We want this report to be one that will be taken into serious consideration and to have the recommendations by the committee implemented. There is already work being done, but there needs to be even more. The pace at which it is being done needs to be much quicker. We need to take it seriously and we need to deliver, not just for the women already affected but also for those who may be affected had this information not been made public. No evidence provided to this inquiry could reliably show how many people in South Australia have had an implanted mesh device or how many people have experienced adverse effects from an implanted mesh device.

There are 17 recommendations before us, and I would like to take time to go through them, but as I look at the clock I realise that we are not going to be able to do that, so I just want again to say thank you to everyone who submitted evidence. I want to say thank you to the women and the men who have stood up and delivered deeply personal stories. I hope that these 17 recommendations will be implemented and that they will impact significantly on your future and also the future of others who have been negatively impacted by medical mesh.

Mr PICTON (Kaurna) (11:17): I rise to support the noting of this very important report from the Social Development Committee in regard to the impact of medical mesh, pelvic mesh, that has been experienced by so many South Australians. I echo what the member for Torrens has said in thanking those survivors of mesh for the bravery they have shown in speaking up, not only on behalf of themselves but on behalf of other South Australians who have been impacted by what had previously been an unspoken issue that so many people had been faced with.

There are a significant number of South Australian women and some South Australian men who have been outrageously adversely affected by these implants. It has impacted their quality of life on a daily basis, and we have not given them the support and the help they need to deal with that issue. Thank you to all those people who have stood up and have forced this inquiry and this set of recommendations to happen today.

Secondly, we would particularly like to thank the member for Torrens, who has really taken up the fight on behalf of those people who have been impacted and who has been the leading advocate now in South Australia, in our parliament, on this issue and has pushed for this inquiry to happen. If it were not for the member for Torrens, this inquiry would not have happened. We would not have revealed the shocking state of affairs that so many people are facing and we would not have these recommendations that are now before the parliament. We will now see what the government's response to those is.

The member for Torrens has talked about the impacts and the process by which we got to this state where people have had these awful implants ruining their lives. I would like to take a bit of time to talk about the fact that we are now failing to help people who are in this difficult situation through the lack of support that they are receiving through our public health services at the moment. It is something that the committee examined in some detail and it also considered evidence from families and public health services. The report observes:

1. the Clinic [the SA Pelvic Mesh Clinic at the Royal Adelaide Hospital] still does not have a credentialed, properly trained and experienced Urogynaecologist employed at the Clinic. This means the Clinic is unable to meet one of the key parts of Recommendation 13 of the Senate Inquiry, which is to be able to give many of its patients what they most want and need—full surgical removal of their mesh devices. Further, the Clinic is 'dealing with a backlog, of five to 10 years of patients'

Five to 10 years of patient backlog is completely unacceptable. It goes on:

2. the women with the most serious complications will still be required to be assessed by a highly experienced surgeon inter-state as the proposed Urogynaecologist being recruited to SA will not be able to operate in the most complicated cases

Yet again, even when we do recruit this person, we are not going to be able to provide those services here in South Australia. The report continues:

3. it is not clear why the threshold for acceptance is so high and women are being turned away when they are in terrible pain. Because of the dedicated services offered by the SA Pelvic Mesh Clinic, the Committee considers this may be the best place for these women to receive their treatment, in South Australia where they also have family support

4. allied health service clinics for patients to receive treatment from physiotherapy, psychology, urology and pain management specialists are not full-time and a patient may not receive back-to-back appointments in a single month. This means patients may have to wait weeks, or months for their next appointment as they move through the Clinic's schedule of appointments

5. while efforts are now being made, appointment times for regional and rural patients are spaced out with difficult timeframes to be met, meaning patients have to travel long distances while nursing injuries, pain and discomfort, on numerous occasions. For most regional women, the time between appointments with allied professionals is too long.

Disappointing, or perhaps alarming, are the accounts from mesh injured women who have accessed services at the Clinic and have allegedly been treated with impatience, irritation, or disrespect by some of the staff at the Clinic.

The Committee has made a number [of] recommendations to the Minister for Health and Wellbeing to give consideration to addressing some of the problems identified about the Clinic's services in this report, urgently and into the near future.

So these poor people in this awful situation are not getting help. There is a backlog of five to 10 years. You cannot get the help in South Australia and, even when you try to get the help, you are treated with impatience, irritation or disrespect by some of the staff at the clinic. That is completely unacceptable, yet that has been well known now through the course of this inquiry over the past two years since it was instigated, and seemingly nothing has been done by the government to address these concerns that have been repeatedly raised by victims through this process.

We now have these recommendations on the table and the government needs to stop delay, stop inaction and actually address these recommendations. The recommendations state:

…the RAH [be] appropriately staffed to support South Australian women undergoing full and partial mesh removals, including post-operative staff…Investigate the potential for developing a 'hub and spoke' model of services, similar to the one being developed by the Queensland Pelvic Mesh Service…

Further:

(a) Urgently develop a policy to release existing funding (that has been previously identified for approved Mesh Clinic patients to travel to Victoria for assessment for full removal of their mesh implants under a Memorandum of Understanding (MOU) with the Royal Women's Hospital), so that these patients may seek care and surgery in Victoria without additional suffering.

It should not be acceptable that we have to send people interstate. The member for Torrens and I have spoken to many people who have had to travel overseas to get their treatment. At the moment, they are being denied any treatment in South Australia at all, so we need to help them in any way that we possibly can. The recommendations continue:

(b) Following the successful establishment of an MOU, those women who were, or are, on the SA Pelvic Mesh Clinic waiting list for full mesh removal surgery and have proceeded with surgery, be assessed for compensation so they are not financially disadvantaged.

(c) As soon as practicable commit additional funding to the SA Pelvic Mesh Clinic so that the Clinic can increase the services the clinic can provide to mesh affected women. This funding could provide for additional staff including: urogynaecologist surgeon(s); nurse consultant; physiotherapist(s); counsellor(s); lived experience advocates; social worker(s); pain management professionals to provide services to mesh injured women and assist with lodgement of adverse events reports to the Therapeutic Goods Administration.

15. Provide funding for the SA Pelvic Mesh Clinic to re-establish the Consumer Advisory Group of the Clinic to be led by appropriately remunerated lived experience staff—

re-established, because it was de-established. It continues:

16. Whilst a ‘hub and spoke’ model is being examined, urgently consider implementing a program of ‘mobile services’ to regional and rural mesh injured patients on a twice-yearly basis. Patients should have access to all services they would ordinarily have access to when they attend clinics in Adelaide—

Both the member for Torrens and I have spoken to many people who are in regional areas. Already, we know there are barriers to getting access at the Royal Adelaide Hospital Clinic and that is of course even worse if you live in regional South Australia. Finally:

17. To inform services provided by the SA Pelvic Mesh Clinic, initiate a review to be led by people with lived experience of mesh injuries and contributed to, by a Consumer Advisory Group, of the available services and continuity of care for mesh affected patients who have had a full mesh removal but still experience ongoing pain associated with mesh and mesh related injuries.

There are a whole series of very important and very precise recommendations that have come out of this very long inquiry, which has heard from the experts and has heard from the people affected. These should be put in place now. We should not have had to wait to get to this point to take action, but this is where we are now, years down the track.

We need an urgent response to the government in relation to these recommendations. Will they be implemented? Will we improve services for women who have been affected by these awful implants and suffer outrageous pain on a daily basis? We can help them, but we need to have the will and the leadership from the government to finally act on what is widely known now.

I would like to thank everybody who was involved in providing evidence to this committee. You have made a difference in raising our attention to this issue. I know that certainly the member for Torrens and I and others will keep campaigning on this issue because you have been very poorly served so far and we cannot let that continue into the future.

Dr HARVEY (Newland) (11:27): I would like to make a few brief remarks on this important report from the Social Development Committee. I would like to initially thank the other members of the committee for their work on this issue: the Hon. Dennis Hood, the Hon. Emily Bourke and the Hon. Connie Bonaros in the other place, the member for Torrens and, of course, the member for King. I would also like to acknowledge the work of the committee staff, Robyn Schutte and Mary-Ann Bloomfield.

Most importantly, I would very much like to thank those who contributed to the inquiry by providing evidence, particularly those mesh-affected women who shared their deeply personal stories and struggles. It was very quickly apparent in some cases how catastrophic the impact has been on their relationships, their mental health and so many aspects of their lives. This impact became quite clear when you saw how much of a ripple effect there was, with partners who were also deeply impacted coming along to the hearings and supporting their partners.

There was one particular hearing, I think when we were doing it online because it was in the midst of COVID, when a mesh-impacted woman was providing evidence on her story, her struggles and the difficulties she was facing. There was an impact on not only her partner but also her daughter, her daughter's partner and, in fact, the entire family, who were deeply impacted by this issue. It really shows how much it impacts the daily lives of these women.

It was clear from the evidence provided that women often were not completely aware of what the potential risks were going down this path and, in some cases, not even clear that mesh would necessarily be involved. If there were complications down the track, the symptoms were initially quite non-specific, such as abdominal pain or pain within the pelvic region that was not clearly understood, so it often took time to work out what the issue was.

There were numerous visits to doctors where they tried all sorts of different things, not thinking initially that it was mesh. To make it even worse, when those impacted women suggested that perhaps it was mesh, they were often fobbed off, ignored or their concerns were dismissed. Clearly, there was this real sense that they had not been listened to and that they had not been taken seriously, which I can only imagine would make dealing with the complications of mesh even worse than they already were.

Another complicating factor is that there were often not very good records about whether or not mesh was actually used, so it was very difficult to go back and work out who had mesh implanted as part of their surgery. In fact, in Queensland, when they reached out to women to alert them to services that were available to help them deal with mesh-related injuries, because they did not have records of who had had mesh and who had not they sent out thousands of letters to everyone who had had surgery within a particular region of their body.

Women would come in, and then they would have to work out from there whether they even had mesh. That really led to quite a long blowout in the time to deal with it because of the sheer number of people coming in and the lack of good records. The TGA changed their rating or level they apply to that as a medical device, which now has higher reporting requirements, but clearly those who had this implanted prior to that are still very much being impacted.

There are some very important recommendations as part of this report, and I would commend members to have a look at them. A number of other members have addressed many of these. I can say to those who have been impacted that, in conversations I have had with the Minister for Health and Wellbeing, the Hon. Stephen Wade, he absolutely takes these issues seriously.

There is a lot of work to do in this area; there is no question of that. Whether it is ensuring that we have appropriately qualified people here in South Australia to do the sorts of surgeries that need to be done, as well as setting up arrangements to have surgery done interstate, there is a lot of work to do, but I am confident that the issues are being taken seriously and that the government will work as quickly as possible to address them.

In conclusion, I would once again really like to acknowledge and thank those women for their bravery in their contributions to this inquiry. I can imagine that it would have been incredibly difficult to do. I genuinely hope that those who gave evidence felt that they were heard, that they were listened to, that they had been taken seriously and that real action will come about as a result of this work. I can certainly say that, for my part, I will continue to advocate to ensure that mesh-affected women have access to the supports and health services they need and deserve as soon as possible.

Ms LUETHEN (King) (11:34): To the mesh-injured women and South Australians, particularly those here today, some of whom are my family friends, I thank you for your evidence, courage, bravery and advocacy. You highlighted incredibly clearly to the committee the urgency and dire need for more support by the South Australian government and the need to provide funding so that those of you on waiting lists can have operations. We have heard you, we believe you, we feel deeply for you and we have made really strong recommendations. Thank you to the member for Torrens, the member for Newland and the member for Kaurna for your contributions this morning, and I commend the report to the house.

Motion carried.