Staff failed to properly check on new mum before death
Sarah Skillington was last seen alive by her husband at 10.27pm as he left her room at the perinatal unit in the Ramsay Health Care-owned Mitcham Private Hospital, in Melbourne's east, on November 18, 2023.
The 33-year-old was discovered unresponsive more than 10 hours later and declared dead.
Coroner David Ryan found the overnight nurse did not conduct hourly observations as required and it appeared a "culture" had developed among some night-shift staff that meant checks were not done appropriately.
A suicide note was found at her home in the days after her death and the coroner said the message was likely written before she was admitted to hospital.
"I am unable to conclude that Sarah's death could have been prevented had she been appropriately observed overnight and in the morning on 19 November 2023," he said in his findings on Wednesday.
"Even if hourly observations had been performed, Sarah would still have had an opportunity to take her life in the intervening periods."
He noted Ms Skillington would not have been able to take her own life if the design of her room was different, an issue the hospital had since addressed.
A nurse who worked on the morning the 33-year-old was found dead concluded crumpled bed clothes might have been mistaken for Ms Skillington's sleeping body.
The new mother had a difficult birth, experienced anxiety in the days after the delivery and suffered sleeplessness, the court heard.
She previously had disordered eating, health anxiety and reported "fleeting suicidal ideation".
Ms Skillington said she was exhausted when admitted to hospital and the coroner noted the overnight nurse wanted to prioritise the mother's sleep, which was in line with her treatment plan.
Her doctor did not determine she was suffering from postpartum psychosis when she was admitted, but Mr Ryan agreed with medical evidence she likely experienced the condition at her death.
The coroner described Ms Skillington, a well-regarded architect, as a remarkable woman and her death as a "tragedy which has devastated her family and friends".
"Although the risk of self-harm cannot be completely eliminated for voluntary patients in mental health facilities, patients and families should be able to be confident that they will be appropriately supervised and cared for in a safe environment," Mr Ryan said.
Recommendations to the hospital's operator Ramsay Health included tests on its rooms, specific postpartum psychosis training for nursing staff and changes to admission forms.
In a statement, Ramsay Health Care offered condolences to Ms Skillington's family and said the findings would be reviewed.
"We have offered to meet with her family, if and when they feel ready, should they wish to discuss any aspects of the findings and recommendations," a spokesperson said.
Steps have been taken to implement all recommendations from a previous review to ensure safe and effective treatment was provided, they said.
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As Healthscope's fate looms, Lake Macquarie Private Hospital is expanding
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"They say to us, this is what you'll get for this and that service." The federal health department states that "doctors set their own fees for private medical services". "Many doctors and insurers use gap arrangements to remove or reduce your gap payment. "Fees for the same type and quality of care might vary, depending on who you see and where they are located." Ms Rewitt said the healthcare sector must "find new ways of doing things". "People are getting older and living much longer. They live with lots of comorbidities." She said there was a lot of change and opportunity ahead. "We do a lot more work now with robotics. Patients spend a lot less time in hospital. They recover better. "The question then is, what resources are available after they've left the hospital." Consumer law won't allow Ramsay Health Care to buy the up-for-sale Newcastle Private Hospital. So said Lake Macquarie Private Hospital CEO Sharon Rewitt when asked about the prospect. "The ACCC wouldn't easily give us another hospital in the Hunter. It doesn't like anyone to dominate completely," Ms Rewitt said. "We already have a big footprint here." Ramsay owns Lake Macquarie and Warners Bay private hospitals, and officially opened a $20 million surgical centre in Charlestown earlier this month. A $45 million, six-storey expansion of Lake Macquarie Private at Gateshead gained state planning approval in May. An earlier plan for a $120 million, 10-storey tower was also approved. Given the volatility of the market, Ramsay is considering when and how to proceed. However, a concussion clinic and stroke unit have been established and the oncology unit has expanded at the Gateshead site. Newcastle Private is among the 37 hospitals owned by Healthscope, which is in receivership and expected to be broken up. It was reported this week that Ramsay was among nine parties to express interest in Healthscope hospitals. "Ramsay has publicly said we would be interested in some of the hospitals in areas where we are not," Ms Rewitt said. She said the private health sector in Newcastle was "a very competitive environment". "People are a lot more discerning now. They have information. "They can say, 'I don't want to go to that hospital because I don't think they're good. I want to go to this hospital'." The cost of surgery and seeing specialists in the private sector has come under scrutiny. Federal Health Minister Mark Butler said in March that the Albanese government would upgrade the Medical Costs Finder website. The website will display the average fee charged by specialists, including surgery prices, alongside the national average. Mr Butler said the cost of medical and hospital services was "a key driver of health inflation for consumers". He said this fed into "higher out-of-pocket costs and higher private health insurance premiums". Ms Rewitt said labour and supply costs had "gone up significantly and remain challenging". "Post-COVID, nothing really returned to normal. Over the last few years, there's definitely been an erosion of margins," she said. Private hospitals have been locked in a battle with health insurers for higher payments to cover the rising costs of treating patients. In March, Mr Butler threatened health insurers with "regulatory action" if they did not take "immediate steps" to boost funding to private hospitals. Asked if her hospital had experienced a boost, Ms Rewitt said "we have". "We're still in negotiations with a few of the insurers." She said the price of surgeries was "dictated by what we get from the health funds". "They say to us, this is what you'll get for this and that service." The federal health department states that "doctors set their own fees for private medical services". "Many doctors and insurers use gap arrangements to remove or reduce your gap payment. "Fees for the same type and quality of care might vary, depending on who you see and where they are located." Ms Rewitt said the healthcare sector must "find new ways of doing things". "People are getting older and living much longer. They live with lots of comorbidities." She said there was a lot of change and opportunity ahead. "We do a lot more work now with robotics. Patients spend a lot less time in hospital. They recover better. "The question then is, what resources are available after they've left the hospital." Consumer law won't allow Ramsay Health Care to buy the up-for-sale Newcastle Private Hospital. So said Lake Macquarie Private Hospital CEO Sharon Rewitt when asked about the prospect. "The ACCC wouldn't easily give us another hospital in the Hunter. It doesn't like anyone to dominate completely," Ms Rewitt said. "We already have a big footprint here." Ramsay owns Lake Macquarie and Warners Bay private hospitals, and officially opened a $20 million surgical centre in Charlestown earlier this month. A $45 million, six-storey expansion of Lake Macquarie Private at Gateshead gained state planning approval in May. An earlier plan for a $120 million, 10-storey tower was also approved. Given the volatility of the market, Ramsay is considering when and how to proceed. However, a concussion clinic and stroke unit have been established and the oncology unit has expanded at the Gateshead site. Newcastle Private is among the 37 hospitals owned by Healthscope, which is in receivership and expected to be broken up. It was reported this week that Ramsay was among nine parties to express interest in Healthscope hospitals. "Ramsay has publicly said we would be interested in some of the hospitals in areas where we are not," Ms Rewitt said. She said the private health sector in Newcastle was "a very competitive environment". "People are a lot more discerning now. They have information. "They can say, 'I don't want to go to that hospital because I don't think they're good. I want to go to this hospital'." The cost of surgery and seeing specialists in the private sector has come under scrutiny. Federal Health Minister Mark Butler said in March that the Albanese government would upgrade the Medical Costs Finder website. The website will display the average fee charged by specialists, including surgery prices, alongside the national average. Mr Butler said the cost of medical and hospital services was "a key driver of health inflation for consumers". He said this fed into "higher out-of-pocket costs and higher private health insurance premiums". Ms Rewitt said labour and supply costs had "gone up significantly and remain challenging". "Post-COVID, nothing really returned to normal. Over the last few years, there's definitely been an erosion of margins," she said. Private hospitals have been locked in a battle with health insurers for higher payments to cover the rising costs of treating patients. In March, Mr Butler threatened health insurers with "regulatory action" if they did not take "immediate steps" to boost funding to private hospitals. Asked if her hospital had experienced a boost, Ms Rewitt said "we have". "We're still in negotiations with a few of the insurers." She said the price of surgeries was "dictated by what we get from the health funds". "They say to us, this is what you'll get for this and that service." The federal health department states that "doctors set their own fees for private medical services". "Many doctors and insurers use gap arrangements to remove or reduce your gap payment. "Fees for the same type and quality of care might vary, depending on who you see and where they are located." Ms Rewitt said the healthcare sector must "find new ways of doing things". "People are getting older and living much longer. They live with lots of comorbidities." She said there was a lot of change and opportunity ahead. "We do a lot more work now with robotics. Patients spend a lot less time in hospital. They recover better. "The question then is, what resources are available after they've left the hospital." Consumer law won't allow Ramsay Health Care to buy the up-for-sale Newcastle Private Hospital. So said Lake Macquarie Private Hospital CEO Sharon Rewitt when asked about the prospect. "The ACCC wouldn't easily give us another hospital in the Hunter. It doesn't like anyone to dominate completely," Ms Rewitt said. "We already have a big footprint here." Ramsay owns Lake Macquarie and Warners Bay private hospitals, and officially opened a $20 million surgical centre in Charlestown earlier this month. A $45 million, six-storey expansion of Lake Macquarie Private at Gateshead gained state planning approval in May. An earlier plan for a $120 million, 10-storey tower was also approved. Given the volatility of the market, Ramsay is considering when and how to proceed. However, a concussion clinic and stroke unit have been established and the oncology unit has expanded at the Gateshead site. Newcastle Private is among the 37 hospitals owned by Healthscope, which is in receivership and expected to be broken up. It was reported this week that Ramsay was among nine parties to express interest in Healthscope hospitals. "Ramsay has publicly said we would be interested in some of the hospitals in areas where we are not," Ms Rewitt said. She said the private health sector in Newcastle was "a very competitive environment". "People are a lot more discerning now. They have information. "They can say, 'I don't want to go to that hospital because I don't think they're good. I want to go to this hospital'." The cost of surgery and seeing specialists in the private sector has come under scrutiny. Federal Health Minister Mark Butler said in March that the Albanese government would upgrade the Medical Costs Finder website. The website will display the average fee charged by specialists, including surgery prices, alongside the national average. Mr Butler said the cost of medical and hospital services was "a key driver of health inflation for consumers". He said this fed into "higher out-of-pocket costs and higher private health insurance premiums". Ms Rewitt said labour and supply costs had "gone up significantly and remain challenging". "Post-COVID, nothing really returned to normal. Over the last few years, there's definitely been an erosion of margins," she said. Private hospitals have been locked in a battle with health insurers for higher payments to cover the rising costs of treating patients. In March, Mr Butler threatened health insurers with "regulatory action" if they did not take "immediate steps" to boost funding to private hospitals. Asked if her hospital had experienced a boost, Ms Rewitt said "we have". "We're still in negotiations with a few of the insurers." She said the price of surgeries was "dictated by what we get from the health funds". "They say to us, this is what you'll get for this and that service." The federal health department states that "doctors set their own fees for private medical services". "Many doctors and insurers use gap arrangements to remove or reduce your gap payment. "Fees for the same type and quality of care might vary, depending on who you see and where they are located." Ms Rewitt said the healthcare sector must "find new ways of doing things". "People are getting older and living much longer. They live with lots of comorbidities." She said there was a lot of change and opportunity ahead. "We do a lot more work now with robotics. Patients spend a lot less time in hospital. They recover better. "The question then is, what resources are available after they've left the hospital."
ABC News
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Former patients of neurosurgeon Greg Malham describe 'arrogant' and 'dehumanising' behaviour
The controversial Melbourne neurosurgeon at the centre of a Four Corners investigation will be referred to the medical regulator by his former hospital over complaints by a patient about his care. The patient said surgeon Greg Malham's behaviour went beyond "simply poor bedside manner". "It is a sustained display of arrogance [and] neglect," she wrote to the hospital. She is one of many former patients and colleagues of Mr Malham who have contacted Four Corners, following the program God Complex, to describe their own dealings with the neurosurgeon and what they say was inappropriate care and follow-up. Melbourne's Warringal Private Hospital, owned by Australia's largest private hospital provider Ramsay Health Care, terminated Greg Malham's temporary credentialing to operate at the facility after the program went to air. Warringal CEO Maree Mendola told staff in an email that the allegations raised in the Four Corners story about Mr Malham's workplace conduct "are serious and do not align with Ramsay's values". This was the second hospital to part company with Greg Malham. Mr Malham resigned from Melbourne's Epworth Private Hospital in May after a video emerged of him tearing down an election corflute for independent MP Monique Ryan and referring to "burying the body under concrete". The video was described by Epworth CEO Andrew Stripp in a statement as "abhorrent". Greg Malham was recommended to Emma Pursey as a "spinal wizard", but she said his treatment of her extreme pain after an operation in 2013 was "not only dismissive but dehumanising". Ms Pursey wrote to Epworth Hospital's CEO, Andrew Stripp, when the corflute story broke, telling him "women deserve better". "I sincerely hope Epworth's leadership will commit to real cultural and systemic change," she wrote. Ms Pursey, an actor, producer and writer from Melbourne, underwent major fusion surgery to address the ongoing effects of childhood scoliosis. But she said that after the operation, she was beside herself with pain and unable to sleep the entire duration of her rehabilitation stay. "Despite repeatedly reporting my symptoms and spiralling into sleep-deprived distress, I was discharged without appropriate pain management," Ms Pursey wrote to the Epworth CEO. "For weeks I pleaded for help. It wasn't until I broke down on the phone in tears that Malham finally took my call and prescribed Lyrica, which brought immediate relief. "The delay was entirely avoidable." Four Corners is not suggesting that the operation itself was negligent. Ms Pursey's complaint is about Mr Malham's response to her pain. Ms Pursey wrote to the CEO that at a six-week follow-up appointment, she was dismayed when she asked Mr Malham if she could resume activities such as dancing. She said he responded by saying: "You already know the answer to this question, so I'm not going to sit here and answer stupid questions." "When I sought further clarity, he instead went to show me YouTube videos of his own dancing (which I declined to watch) and spoke at length about his black belt in karate," Ms Pursey wrote. "My questions were disregarded, and I was made to feel humiliated and irrelevant in the conversation about my own body. "His behaviour toward me — an experienced, informed patient with complex chronic health issues — was not only dismissive but dehumanising. "The power imbalance was palpable, and I have carried the trauma of that post-operative period for years." Ms Pursey said in her letter that she was writing to Professor Stripp because it was clear from the corflute video that "I will not be alone". "What has come to light is clearly not an isolated incident — it is part of a deeply troubling pattern of behaviour that deserves thorough scrutiny," she wrote. Ms Pursey did not hear back from Professor Stripp until he was contacted by Four Corners. In his reply to her on Tuesday — which she provided to Four Corners — he apologised and said that he would, with her consent, refer her complaint to the medical regulator, the Australian Health Practitioner Regulation Agency (AHPRA). "The way you described your experience with clarity and courage was powerful," Professor Stripp wrote to Ms Pursey. "Your disappointment, frustration and the impact it had on you came through clearly, and I am sorry that your experience of care was not what we aspire to provide." Ms Pursey's letter was passed on to an external investigator employed by the hospital when the corflute video went public. Greg Malham resigned from Epworth before the external investigation commissioned by Epworth had completed. "I'm also grateful for your willingness to assist us in the work we're doing to improve how we respond to concerns raised by patients," Professor Stripp wrote to Ms Pursey. Professor Stripp said in a statement that he could not discuss individual cases, but Epworth recognised "the serious concerns raised with ABC Four Corners" and understood "how distressing such experiences can be". "When things don't go as they should, we want to listen, learn and act," Professor Stripp said. He encouraged any patients who wanted to raise similar matters to contact the hospital through its patient feedback service. Orthopaedic foot surgeon Andrew Kingsford was troubled by Greg Malham's lack of explanation when he emerged from an operation with the neurosurgeon with a paralysed arm. He had been admitted to Epworth in 2019 with a strained back from years of bending over in an operating theatre. Mr Malham told him that he needed to have his neck fused because his arthritis was placing pressure on his spinal cord. Mr Kingsford woke from the operation unable to move one of his arms. "I said, 'why can't I move my left arm?' And [Greg Malham] said 'it should be temporary ― have some physio and you'll be fine.'" But after many months of therapy, it did not improve significantly — Mr Kingsford was not able to perform his own surgery, nor to fly his plane to Albury on the NSW border, where he did monthly operations. Eventually, Greg Malham offered to operate again and did multiple procedures to open up and relieve pressure on the nerves, but Mr Kingsford said that paralysis worsened. Mr Kingsford said Mr Malham never told him why the surgery left him the way it did, and when he pushed him for a reason, he did not give one. "At my last review consultation with Greg Malham, he said there was nothing more he could do and he asked me to leave," Mr Kingsford said. Mr Kingsford acknowledged that all surgeons have complications in their surgery, and Four Corners does not suggest that Mr Malham was negligent. "Compassion and empathy expressed to the patients and their families [is vital] when these events occur. "I was very emotional when I watched your story as it rekindled my emotional distress that I had been experiencing and coming to terms with over several years," he said. He was forced to retire early, had to sell his farm and abandoned his post-retirement plan to pilot Angel Flights, flying sick country children and their families to city hospitals. "I was only 62 when he operated," he said. "My retirement looks very different than it would have otherwise been." Alexandra Clemens, who had back surgery with Greg Malham in 2006, also found the surgeon's behaviour after her operations extremely troubling. Ms Clemens kept contemporaneous notes (which she has provided to Four Corners) and subsequently wrote a letter of complaint. In them, she detailed how Mr Malham called her "sweets", minimised the pain she was experiencing after surgery, and blamed her for being unfit and slow to heal. Kristy, a nurse working in recovery at the time of Ms Clemens's operation, told Four Corners she was always on high alert when she heard Mr Malham speaking to patients because "he had very little sympathy for anyone". She said "arrogant surgeons" often did not want to know about the pain patients were in after operations because "they think they've done such a great job". Ms Clemens's notes describe the surgeon as "very offhand, aggressive, rude, patronising, dismissive and generally unprofessional". "On one of his ward visits following the first surgery, he did kiss me on the forehead, which I thought was a tad odd," Ms Clemens said. And in her letter dated June 4, 2006 and addressed to Mr Malham, she told the surgeon: "Greg, in 2006 fifty-one-year-old women are not little girls who should be patronised and growled at because they are asking their surgeon questions. "I am your patient and my concerns deserve to be acknowledged. "Also and perhaps more importantly, I am a human being and I have a right to be treated with dignity and respect." Ms Clemens said she did not receive a reply from Greg Malham. All three of these patients said they were speaking out in the hopes of broader institutional change in the surgical culture. "I hope that the Epworth begins, through this case, a change of culture that will then extend across the nation," Ms Pursey told Four Corners. "It will take a long time, but bringing light to such darkness is where we can hopefully begin to change the world of medical misogyny." Greg Malham has not responded to any of the many questions Four Corners has sent him, including those about these three patients.
ABC News
3 days ago
- ABC News
Clients 'disgusted and appalled' by Ramsay Health Care psychology clinic shutdowns
Defence veteran Kate* has battled mental illness for more than a decade, at one point even attempting to take her own life. "I sort of hit rock bottom two and a half years ago again. I asked for help this time, which was good, and I've been getting help ever since with Ramsay," she said. "My psychologist gets me like no one else does." Kate was making significant progress before she received news from her therapist that her local Ramsay Psychology clinic would close at the end of August. Kate's psychologist told her Ramsay Health wanted to transition patients to telehealth appointments. "It feels like [Ramsay Health] didn't want [our psychologists] to tell us so that when we did find out, we would have no choice but to stay with them doing telehealth … instead of allowing our psychologist to work with us to sort something else out beforehand," she said. Last week, the ABC revealed Ramsay Health Care would close 17 of its 20 psychology clinics within weeks, citing concerns like rising costs and uneven demand. A briefing note sent to staff said Ramsay Health Care was "exploring the merits" of expanding its existing psychology telehealth services. The ABC has spoken to multiple psychologists employed at Ramsay Psychology clinics who did not want to be identified because they are not authorised to speak publicly. They said staff were "left completely in the dark" about the decision to close the clinics, describing the company's communication to staff as "appalling" and "shambolic". They also claim there were "zero warning signs" the clinics they worked at were about to close and that they were initially instructed not to communicate the planned closures to some of their patients and were given little time to plan. "It's heartbreaking to see our clients left out there in the community with no support," one psychologist told the ABC. "We have clients who have been attending our clinics for years and a lot of them have come out of sessions crying, because the psychologist told them that they will no longer be seen by them. "We will have to find a space to see these vulnerable clients and sometimes they are just not easy to find." Psychologists said they were told their contracts would be ending, but they might be able to pick up telehealth sessions, however it was unclear what that model would look like. Ramsay Health Care is Australia's largest private hospital operator, and its psychology clinics treat a range of high-risk patients with various mental health conditions, including young children, for conditions like depression or PTSD. The provider also runs a separate network of mental health clinics, however they will not be affected by the change. The President of the Australian Psychological Society, Dr Sara Quinn, said the closure of Ramsay Health's psychology clinics across multiple states would have a big impact on its patients. "When a local psychological service closes, it doesn't just remove that place for these people to go, it removes that trusted pathway into care for those who are most vulnerable," she said. "A closure forces people to start again with a new clinician if they're able to find one. And that can, for some people, involve retelling incredibly traumatic and difficult histories, navigating systems that they've never navigated before. "It can then lead to people falling through the cracks." Dr Quinn said clients with the most acute needs would be disproportionately affected. "The clinics that have been closed are closely connected to hospital mental health systems," she said. "People on psychiatry wait lists or those recently discharged from hospital are going to then lose critical follow-up care at the very moment they're potentially most at risk. "So instead of stabilising there, they're left in limbo and we know that many will deteriorate or even end up back in emergency or relapse to the point of needing another hospital admission," she said. Dr Quinn said the clinic closures have also sent shock waves through the profession. "Without urgent reform, closures like this are going to become more common and even more Australians will miss out on the mental health care they need and deserve." One week after Kate learned her local clinic was closing, she received an email from Ramsay Psychology confirming it would shut its doors at the end of August and offer clients telehealth sessions instead. Kate will be able to continue seeing her psychologist in person at another clinic but she said if that was not the case, she would have been "scrambling to find another one" because "there's no way I would have continued with Ramsay." In a statement, Ramsay Health Care said it, "has been working closely with psychologists and other stakeholders to ensure a safe and considered transition for clients impacted". The provider also said it had asked "psychologists to communicate directly with their clients and support them to continue care — either through our expanded telehealth services or with another trusted provider" and that "clients are being informed as part of this process". *Name has been changed to protect identity.
