WA regional hospitals hit record high for ambulance ramping hours
The June figures from St John represent a new high for regional ramping, surpassing the previous record of 222.2 hours last September.
Ramping happens any time an ambulance spends more than 30 minutes waiting outside a hospital for their patient to be received.
While every regional hospital except Northam experienced a month-on-month increase in June, Bunbury hospital bore the brunt of the problem, accounting for about 85 per cent of non-metropolitan ramping hours.
Meanwhile, metropolitan hospitals collectively observed a small decrease.
WA deputy opposition leader and shadow health minister Libby Mettam said the situation was putting regional West Australians' lives at risk.
She said spikes in ramping could also hamper the capacity of paramedics to respond to emergencies.
Health Minister Meredith Hammat said ramping was a nationwide issue with a range of complex contributing factors.
"Our government is throwing everything we can at it," she said.
"Bunbury Regional Hospital is currently undergoing a $471.5 million redevelopment to boost patient capacity, and we've significantly increased staff numbers statewide by more than 30 per cent since 2021.
"WA Country Health Service has several initiatives to attract and retain junior doctors in the regions, and I'm pleased to report a record 33 interns joined the health service this year."
The state government began a significant redevelopment of Bunbury hospital in January to expand its capacity.
But the Australian Medical Association (AMA) said while the project would add more beds, it would not address staffing shortages, which it believed was behind the ramping increase.
AMA WA president Kyle Hoath said it was a chronic and growing problem.
"The workforce in our regional areas is stretched really thin … particularly when we look at Bunbury," he said.
Dr Hoath said it was not just hospital staffing shortages having an impact on ramping.
He said general practitioners were under pressure in regional and rural areas too, partly due to a lack of specialist services, meaning some patients were forced to lean on emergency services instead.
Dr Hoath has urged the state government to invest more in attracting medical staff to the regions and incentivising them to stay.
The National Rural Health Alliance echoed that call.
"We need to make sure that we pay people well, not less, that we make sure their practices can function without feeling that they're stretched," chief executive Susanne Tegen said.
"It's about time people that live in rural Australia receive the same access to healthcare and the same amount of dollars [as is] spent on urban people."
Dental surgeon David McInerney is well acquainted with the difficulties of attracting staff to the region.
But the Margaret River-based practitioner said it was not always for lack of desire.
"There is simply nowhere for them to live," Dr McInerney said.
Recently he had to put three of his dental staff up in vacant dwellings on his own property in order to keep them.
"Other health practices who don't have that additional help would be struggling to attract staff because if they don't have anywhere to live, they're not going to come," he said.
Dr Mclnerney said the area's growing population was also putting a strain on other essential infrastructure, including Margaret River Hospital itself.
He said this added pressure to Bunbury's system as locals were often forced to turn there instead.
"People are seriously ill but they're being shipped away from their families and their support networks simply because they don't have the beds available," he said.
The ABC has contacted the WA Country Health Service (WACHS) for comment.
St John WA declined to comment.
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ABC News
31 minutes ago
- ABC News
Tasmanian mum finds breastmilk donors on social media to help feed triplets
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News.com.au
31 minutes ago
- News.com.au
Dr Boreham's Crucible: It's a long way to the top if you want to roll prostate cancer, but Clarity is a clear contender
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Fresh from a $203 million capital raising, Clarity is undertaking two phase III diagnostic trials and an adjunct study of its diagnostic agent, 64-Cu-SAR-bis-PSMA. The prostate specific membrane antigen (PSMA) is present in most prostate cancers. The therapeutic variant, 67Cu-SAR-bis-PSMA is subject to a phase II trial (see below). About Clarity Clarity was formed in 2010 by TM Ventures and listed on August 24, 2021, having raised $92 million at $1.40 apiece. The company is based on the work of the late Dr Alan Sargeson at the Australian National University; and Prof Paul Donnelly at the University of Melbourne's Bio21 Institute of Molecular Science and Technology. Clarity is based in Sydney's now-gentrified inner-city Redfern. Taylor trained at the Garvan Institute in Sydney before spending 15 years in investment banking (including at boutique firm Inteq Ltd). He was keen on commercialising Australian life sciences and decided sitting in an investment bank 'ivory tower' wasn't going to cut it. He joined Clarity as executive chair in late 2013. Clarity's current chief scientific officer, Dr Matt Harris was part of TM Ventures and was Clarity CEO between 2010 and 2018. Dr Colin Biggin then took over and was replaced by current CEO Michelle Parker last October. Dr Biggin remains as chief operating officer and an executive director. In April this year, Clarity dropped a neuro-blastoma program (Sartate) and a prostate cancer program (Bombesin), to focus on three key efforts. They are programs for prostate cancer, neuro-endocrine tumours (Sartate) and breast cancer (Bombesin). Let's get (a bit) sciencey Clarity's SAR-bis-PSMA reflects a 'novel approach of connecting two PSMA-targeting agents to Clarity's proprietary sarcophagine (SAR) technology'. SAR securely holds copper isotopes inside a cage-like structure, called a chelator. This prevents copper leakage into the body. It also is able to bind a targeting agent – anything from a small molecule to a large antibody. The imaging agent is for improved positron emission tomography (PET) scanning. Taylor says Clarity's molecule developed for PSMA targeted imaging was similar to other products such as Pylarify and the unpatented gallium-68 PSMA-11 (the basis of Illuccix). But the first product was just as bad as the others. 'So, we went back to the benchtop and re-built that molecule into a bispecific, with two targeting agents instead of one,' he says. 'That increased the uptake to the lesion by two to three times, one hour after administration … and allowed for significantly better imaging at 24 hours.' Get a (half) life Clarity claims a half-life of 12.7 hours for copper-64, compared with less than two hours for the standard of care gallium-68 or fluorine-8. Patients can be administered and imaged the same day, next day or even the day after. 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Participants in the first three cohorts in the dose escalation stanza have been treated with three strengths, with no 'dose limiting toxicities'. Even at the low dose, pre-chemo patients saw a PSMA reduction of 50%. At double the dose all patients had an 80 %-plus PSMA reduction; two of them 90 % plus. One patient with 'no hope' had a complete response, that is, the tumour disappeared. The company is likely to begin a phase III trial if the positive trends continue. NET agent is a Disco hit In mid-June, Clarity revealed top-line data from the jazzily titled Disco, a phase II effort for patients with known or suspected neuro-endocrine tumours (NETs). 'Patients with NETs are often misdiagnosed and experience delays in receiving the correct diagnosis,' the company says. Comparing Clarity's 64-Cu-Sartate with the gallium-based, standard of care 68-Ga-Dotatate, the results showed Clarity's agent to be more effective, either four or 20 hours post-administration. Across the 45 study participants, 64-Cu-Sartate detected 393 to 488 lesions, compared with 186 to 265 for 68-Ga-Dotatate. More than 90% of the 'discordant' lesions were Sartate positive and all of the biopsied legions were verified as cancer. 'In the Disco trial, we continue to observe the substantial limitations of the current generation of short half-life isotope products,' Taylor says. Clarity is planning a phase III study and has a therapeutic trial in mind as well. Sartate targets the somatostatin receptor SSTR2, present in other cancers such as certain breast and lung tumours. Finances and performance Last month's $203 million raising was through a placement at $4.20 a share, a hefty 18% premium to the 15-day weighted average price. 'I have never done a deal that fast,' says Taylor, who dubs the raising as 'fast, well executed and sizeable'. The raising was one of the biggest in ASX biotech history. In a similar supersized vein, in April last year the company raised $121 million in a rights issue and placement (at $2.55 a share). Last December, Clarity shares were promoted to the ASX200 index. Over the last year its shares have ranged from a record high of $8.79 on September 23 last year to a low of $1.46 on April 9 this year (amid the Trump tariff turmoil). The stock hit an all-time low of 40 cents in May 2022. Clarity shares have been affected by the build-up of short-sellers who account for about 10% of the register. Over the last week the stock has lost close to 20%. Short sellers borrow shares and sell them, in the hope of buying them back at a lower price and restoring them to the lender. Size of the prize With prostate cancer, Canaccord estimates Clarity's total addressable market at US$5 billion in the next three to five years, with sales of US$730 million. The firm estimates the current (poorly served) biochemical recurrence (BCR) market at between 110,000 and 200,000 patients, who on average have 1.7 to 2.2 scans per year, equating to a potential scan volume of 187,000 to 440,000 per year. A further 500,000 BCR patients may benefit in future. The firm reckons that in the first year of launch, 64-Cu-SAR-bis-PSMA could generate US$17 million of revenue, rising to US$580 million by year three. Canaccord says while there's pent-up demand in the BCR population, the overall market for prostate imaging and therapies is crowded. 'Clarity will be required to show data in line – or improved on – those available therapies, especially as a later entrant.' Meanwhile, Clarity estimates the US neuro-endocrine tumour diagnostic at around 100,000 scans per year, increasing to about 120,000 scans a year by 2029. Dr Boreham's diagnosis Taylor says that taking expanded indications into account, the neuro-endocrine tumour opportunity is 'as large, if not larger' than the prostate cancer imaging potential. He initially viewed the prostate cancer diagnosis market as low risk and low reward. Given the unserved needs, especially from the BCR cohort, he now concurs it's a 'blockbuster market'. Two years ago, your columnist compared Clarity to the fifth Wiggle, in that the company's profile was overshadowed by that of the commercialised Telix. 'We are now more like AC/DC than the Wiggles, looking to make it big in the US with Australian tech,' he says. As AC/DC would attest, it's a Long Way To The Top in terms of cracking the US market. But it's a lovely view when you get there. We're confident Clarity can reach the summit – at least with a diagnostic approval. On the therapy side, hopefully TLX-591 and Clarity's candidate can get to market. For the benefit of Sydney CBD passers-by, we also hope Taylor keeps his gear on. At a glance ASX code: CU6 Share price: $3.62 Shares on issue: 371,893,943 Market cap: $1.35 billion Financials (June quarter 2025): receipts nil, cash outflows $9.1 million, cash balance $84.1 million (ahead of $203 million placement) Chief executive officer: Michelle Parker
The Australian
2 hours ago
- The Australian
The mentally ill and cognitively disabled in prisons often are detained indefinitely
The next day, as we entered the prison, I saw a concrete yard that adjoined the isolation block. Four small cells fronted on to this yard and one of them contained a prisoner by the name of Adrian Faulton, a 25-year-old severely cognitively disabled man from the remote Arnhem Land community of Wadeye. For five months, Faulton had been locked for 22 hours a day in a small cell in Berrimah's isolation block. He was unfit to plead and under the care of the public guardian. This is what I wrote on the front page of The Australian on December 8, 2008: 'When getting out?' Mr Faulton asks of anyone who will talk to him. He spends his hours pacing back and forth in his cell, periodically asphyxiating himself as a distraction from the blank horror of his days, squeezing his throat with his thumb and shutting off the airway. Most nights, his wailing resounds in the isolation wing. When his mother visited him in prison, it was a heartbreaking scene as she wept and attempted to hold her son. When she departed, Adrian fell down on his hands and knees. sobbing and calling out for half an hour: 'go home, please, please'. I believe this newspaper report to be the first – and still to date the only – contemporaneous, first-hand account in the media of the experience inside prison of a person unfit to plead subject to indefinite detention in this country. I later found out that Faulton had chewed one of his fingers off in prison. The Northern Territory, which has one of the highest imprisonment rates in the world, is of course an outlier in its almost total lack of forensic healthcare facilities for prisoners such as Faulton, with an unknown number of cognitively disabled and severely mentally ill individuals housed in prison. It was estimated in 2022 that the number of people with severe mental illness or cognitive disability, or both, who were detained indefinitely in the nation's prisons was about 1200 people nationwide, with documented examples of forensic patients being detained for up to 42 years and 30 years respectively in Queensland and the Northern Territory. Extraordinarily, a federal parliamentary committee that investigated the issue couldn't gain clear statistics on this patient cohort – not even its real size, let alone any evidence beyond anecdote as to patients' experiences in detention, length of detention or rehabilitation outcomes. This underscores the fact our enormously expensive forensic justice systems are subject to little granular data collection, let alone scrutiny, in Australia. I would go so far as to say that, apart from some basic publicly accessible data, prisons are subject to the least transparency and scrutiny as to what really goes on in them of any major institution in this country. To an observer like me, especially after having read this month the extraordinary personal reflection of forensic psychiatrist Trevor Ma in the journal Australasian Psychiatry, an absence of transparency generally in prisons leaves those valiantly attempting to provide care amid severe moral injury, fighting in the shadows. Ma painted a devastating picture of how Australia's carceral systems were making mentally ill people on the inside infinitely worse. Restrictive practices are the norm, including segregation of at times up to 24 hours a day, sometimes on and off for years. Effective treatments for those with psychotic disorders in the general prison system are simply widely unavailable. Ma's stark observation that 'Australian prisons are places of punishment and fundamentally incompatible with good mental health' throws up a dilemma that seems to me to challenge directly the way our criminal justice system deals not only with the huge proportions of those with mental illness in prisons who receive little psychiatric care, but also the much smaller population that is unfit to plead. When these individuals are placed on forensic orders, it's for a dual purpose: rehabilitation, but also the protection of the public. Politicians are justifiably concerned to protect public safety and most of those on forensic orders have been charged with extremely serious crimes. But I suspect if the public understood the circumstances of deprivation and disadvantage that affect many people with disability, who often end up in prison because of a failure of community healthcare, our discourse on these complex matters would be greatly enhanced. Judges who issue forensic orders assume healthcare will be provided for these patients, ideally in a forensic hospital. But this doesn't always happen. In NSW, the number of forensic patients in maximum security prison has been growing year on year as forensic hospitals overflow. The waiting list to get a bed in Sydney's main forensic hospital at Malabar frequently stretches to two years. Rehabilitation of mentally and cognitively impaired forensic patients in prison has been described by judges as an impossibility, and in fact the reverse occurs. It's interesting to ponder how societies dealt with mentally ill and mentally disabled patients before the birth of psychiatry and the development of the common law that ushered in fitness to plead procedures. In pre-Norman England, before the development of the system of trial by jury after the Norman Conquest and the subsequent establishment of the King's Courts, those deemed insane were considered unable to form the necessary intention required for guilt, known as mens rea, and routinely were sent home to the care of their families rather than punished. Ancient Roman law also followed the principle of satis furore ipso puniter – living with madness is punishment enough for criminal behaviour. As psychiatry advanced and understanding of mental illness became much more sophisticated, being deemed an idiot or madman was not sufficient to be excused from being held to possess the faculties necessary for a trial to proceed as long as a defendant could understand the trial process. It was the case of James Hadfield in Victorian England, a member of a millennialist cult who attempted to bring about his own judicial execution via the botched shooting of King George III in 1800 at the Theatre Royal in Drury Lane, to bring about the Second Coming of Christ, that led to the enactment of the Criminal Lunatics Act in Britain. The Criminal Lunatics Act mandated that those unfit to plead or not guilty by reason of insanity be sentenced to detention, predominantly in prisons or asylums. Treatment consisted of restraint and sedation akin to punishment. The finding of insanity required a diagnosis of a medical disorder. But what was delivered in asylums could hardly be said to be treatment. I would contend that it is arguably this lack of nexus between a medical diagnosis and a genuine medical treatment that still reverberates through justice health systems today when it comes to those unfit to plead. Incarceration of those unfit to plead still does not come with any specific mandate under modern laws to provide treatment. This is especially so for the growing number of cognitively disabled people on forensic orders and in prisons generally. Cognitive disorders can be managed but cannot be rehabilitated. So how can our forensic systems be said to be at all fit for purpose? When it comes to attempting to obtain liberty, the challenges for patients can be enormous. Even for those in forensic hospitals, it seems to me that the challenge for a patient of demonstrating at tribunal review hearings or in court that they no longer pose a risk to the public amounts to a Kafkaesque task – largely because remedial programs are so thin on the ground. Without access to such programs and demonstrated remediation, providing sufficient evidence to a risk-averse tribunal or judge in seeking a non-custodial order or release can be extremely difficult. Barrister and academic Ian Freckelton has undertaken groundbreaking analysis of the reasoning of Supreme Court judges in Victoria who are tasked with hearing applications for release by forensic patients. In Victoria, the legislative threshold that must be satisfied of non-endangerment to the public has been held by judges to hinge on the achievement of stable mental health: in particular compliance with treatment and the substantial diminishment of symptoms or effective recovery. All of these factors are heavily influenced by the availability and effectiveness of mental health services within forensic detention systems. If these services are stretched so thin as we all know they are, here again is the catch-22 for patients. Not only that, judges also have tended to take into account the provision of services that would support a released patient in the community. Threadbare services here again come back to bite the patient: the state's neglect of community mental health could well mean the difference between incarceration and liberty. In NSW, applications for release are decided by the Mental Health Review Tribunal. Unlike most mental health tribunals around Australia, hearings of the MHRT are open to the public in NSW. Yet, short of individuals attending to observe hearings, which is incredibly rare, we know virtually nothing from the public record about how the tribunal balances risk and liberty when hearing applications for release. Judgments are rarely published by the tribunal, ostensibly on the basis of identity protection. Apart from a few key academic studies, we know little about how long patients spend in forensic detention – for instance, do they routinely spend longer in forensic detention than they would have if they had pleaded guilty to the crime of which they were charged? So what is the risk of further crime on release? The literature in NSW shows that when forensic patients are able to access rehabilitation services, they pose a relatively low risk of recidivism when granted conditional and unconditional release. A 21-year retrospective outcome study by Sydney psychiatrist Olav Nielssen and his colleagues at the University of NSW found that reoffending by forensic patients released into the community in NSW was low and that none of the patients who were granted unconditional release in the 20 years up to 2010 went on to commit a further serious offence. Thomas Embling Hospital in Victoria has similar low recidivism rates for serious crime among those who have forensic orders revoked – in fact in 2021 that rate was zero. When I've spoken to Nielssen about these findings, he has described them as one of the few bright spots on the mental illness policy horizon, in that it shows the forensic healthcare system is working and people are being rehabilitated. But could it be that if these patients had been provided with appropriate secure healthcare and social support outside of the justice system, the same low rates of recidivism would have been seen? Is this practical or affordable? I am not sure. Certainly recidivism rates among those released from forensic orders are significantly lower than the general prison population. I do wonder, if we accept that those who have committed serious offences but are unfit to plead were very unwell or mentally impaired at the time of the offence, are we over-estimating the ongoing risk they pose if properly treated? Such treatment and the critical provision of secure housing are orders of magnitude cheaper to the state than forensic detention. It is a sad reality even today that forensic patients are treated, in some instances, more harshly under the law than convicted prisoners. This has been starkly demonstrated in NSW by Kerri Eagle, a lawyer turned forensic psychiatrist, in her academic work analysing how the courts have dealt with forensic patients subject to limiting terms who face applications by the state for extensions to their forensic status. NSW imposes limiting terms – that is, a time-limited forensic order – for those who are unfit to plead who are found at a special hearing on the limited evidence available to have committed the crime for which they were charged. It's a qualified verdict of guilt but does not amount to a conviction. Amendments to the Mental Health (Forensic Provisions) Act in NSW legislate a test in similar terms to that applied to high-risk offenders subject to preventative detention orders – except that the legal threshold the state must meet to keep forensic patients in detention or subject to a custodial order, as opposed to, say, a recidivist pedophile, is far lower. Eagle has described this as 'unequal treatment under the law'. I think I'd describe it as flabbergasting. Eagle's analysis found that almost all of the forensic patients whose cases she studied, most of them cognitively disabled but without mental illness, had remained in jail throughout their limiting terms and had not been transferred to a forensic hospital. This meant they effectively had received no rehabilitation or therapeutic care in the least restrictive environment possible. The trend was so stark that Eagle concluded these forensic patients were subject to ongoing loss of liberty by reason of a lack of access to appropriate care and treatment in prison. It hardly needs to be said that a prison environment for a cognitively disabled person is wholly inappropriate and amounts to punishing such individuals for something over which they have no control: their disability. So what do we know about how forensic patients respond to their predicament and its profound uncertainty? In contrast to many aspects of healthcare and social service where experience rules the day, the experience of forensic patients is barely documented at all. Most of the academic studies of experience that have interviewed those in forensic detention internationally describe universal themes: patients experience a pervasive sense of resignation, fear, dread and anxiety daily. Patients are subject to conditions that in some instances are more restrictive than prison. They speak of living in fear of punishment, being subject to threats, violence, exertion of authority and living with a profound sense of disempowerment. Patients experience their situation in custody as being fixed and predetermined, and feel a sense of being 'stuck', with no power to influence their circumstances. In conclusion, I want to return to the Northern Territory. After my visit to Berrimah prison in 2008, I was contacted by the guardian of a young Arrernte man, who told me that this young man was being held in maximum security prison in Alice Springs in horrendously harsh conditions and had been there for several years despite being unconvicted and cognitively disabled. Aged in his early 20s, the young man routinely would bang his head against the bars of his cell until he bled. He was shackled every time he stepped out of his cell, routinely forcibly sedated, and on several occasions placed in a spit hood and strapped to a restraint chair. Tragically, this young disabled man had fatally stabbed his uncle, whom he dearly loved, as a teenager after being left alone and unsupervised all day in a remote community. I followed this man's story for more than 15 years and late last year was able to report on his eventual freedom after 17 years in the forensic system. The NT government had fought tooth and nail for the continuation of forensic orders, but the NT Supreme Court was swayed by the fact, with the right care, with National Disability Insurance Scheme and family support, this young man displayed an enormous reduction in behaviours of concern and was a largely peaceful citizen. Sadly, I cannot name this man now because in May he died at the age of just 34, after less than a year of freedom. He spent almost as many years of his life locked in prison as he did free. But his fight for freedom set an important precedent. The headline of our story of this man's eventual, cruelly short freedom, was: Imprisoned by Disability. His case was extreme, but that headline would seem to me to apply to many forensic patients, even those in forensic hospitals. The key question for me in these matters is: amid an appalling lack of mental healthcare and in the enormous challenges of caring for those charged with awful crimes but not criminally culpable, are we really mitigating risk or are we amplifying it? And at what cost? This is an edited text of Natasha Robinson's speech to the Royal Australian and New Zealand College of Psychiatrists Forensic Faculty Conference in Melbourne. Robinson, The Australian's health editor, is an admitted lawyer and a doctoral candidate at QUT's Australian Centre for Health Law, researching forensic mental health law.
