There’s a hospital in Victoria where the chance of something going tragically wrong is significantly higher than in the hospital across town.
But you’re not allowed to know which one it is, because complication rates are hidden from the very people who need them most: patients and doctors.
Complications can involve shocking incidents, such as the cluster of potentially preventable baby deaths at Bacchus Marsh Hospital in 2013 and 2014, or less scandalous problems, like a basic infection contracted after an operation.
But while the data is collected by state and federal health departments, it is not produced in a way that allows hospitals to be identified and compared. Some suspect it’s out of fear they will be named and shamed.
Grattan Institute health director Stephen Duckett believes this should change, citing the US, where hospitals use such information to improve safety standards.
"It’s a major motivation to lift their game," Duckett says.
“Patients have a right to know the data on complication rates in different hospitals and for different procedures, so they – and their GPs – can make better-informed decisions."
Patients have a right to know the data ... so they – and their GPs – can make better-informed decisions.Grattan Institute health director Stephen Duckett
At a time when the community is seeking more information than ever before about the performance of their public services, an Age investigation has found that secrecy still underpins many parts of the health system.
In psychiatric wards, where sexual assault remains a problem, families are only told of allegations in one quarters of cases, while police are notified only 40 per cent of the time, according to recent research from the Mental Health Complaints Commissioner.
In the Department of Health and Human Services, bureaucrats dealt with 1540 Freedom of Information requests between 2016-17, but only 136 were released in full.
And in hospitals around the state, doctors are prevented from speaking out publicly because of gag orders in their employment contract.
Eastern Health, for example – which takes in Maroondah Hospital and Box Hill Hospital among others – obliges doctors to sign contracts saying confidentiality must apply to “all information regarding the current or future business interests, methodologies, proposals, policies, processes, and activities of Eastern Health.” It doesn’t leave very much to talk about.
A few dozen kilometres from Eastern Health, there’s a doctor working in Melbourne’s outer suburbs who suspects his local hospital may be inadvertently placing patients at risk.
The alarm bells began ringing a few months ago when the hospital stripped specialist doctors from overseeing surgical waiting lists. Instead, outpatient clinical nurses were put in charge of referrals. It also changed the way procedures were categorised, which he feared would result in some patients waiting longer than they should.
Privately, the doctor believed this decision was designed drive down the waiting list and make the hospital look as though it was performing well, even if it meant some operations might end up being refused or delayed.
Publicly, though, he can’t say a word without running the risk of being sacked.
Australian Medical Association state president Julian Rait says the secrecy invoked by gag orders undermine transparency and the needs of patients.
“I would argue that as a doctor you have an ethical obligation to speak out about matters of quality care,” he says. “But many can’t. They have to raise their concerns through us instead.”
Waiting lists manipulated?
The Andrews Government rightly argues that it provides more information about the state’s hospitals than its Liberal predecessors did, from quarterly performance data to regular updates about patient experience or specialist appointments.
“We’ve made a range of reforms designed at boosting transparency,” a spokesman for Health Minister Jill Hennessy told The Age.
It's also established two key agencies: the Victorian Agency for Health Information, to improve data entry, and Safer Care Victoria, to lift safety standards.
But whether it’s enough, or whether the published figures can be entirely trusted, is open to debate.
For instance, the government announced last month that the number of people waiting for elective surgery in Victoria dropped to 36,096 patients by the end of June, the lowest number on record.
In response, Opposition health spokeswoman Mary Wooldridge tweeted a graph based on the state's health performance data revealing that the number of patients on the list has a tendency to drop immediately around April to June: just before reporting time.
It begs the question: is the community getting a true picture of what’s happening in the system? Or is this type of transparency artificially contrived?
AMA president Julian Rait says that a “culture of KPIs” meant hospitals were on a mission to drive down waiting lists, which appeases the government, and in theory is a good thing, but could also have "undesired consequences".
He cites one recent case where a GP sought urgent treatment for a two-year-old girl with severe glue ear, a condition that was dulling her hearing and affecting her speech development. But despite the GP’s view that the girl required surgery sooner rather than later, Monash Hospital put her on a lower priority list with an expected wait time of at least 12 months.
I would argue that as a doctor you have an ethical obligation to speak out about matters of quality care, but many can’t.Australian Medical Association state president Julian Rait
The hospital says all cases are assessed individually and are escalated by clinical need.
Rait argues that the "deliberate strategy to stem the flow of patients at the door” doesn't always work out in the patients' best interest.
A veil of secrecy also exists in mental health hospitals, where assaults are an ongoing problem, prompting some doctors and advocates to call for the establishment of gender-segregated wards.
But when assaults happen, even Community Visitors from the Public Advocate’s office – the very people whose job it is to act as watchdogs for mental health patients – struggle to obtain the details.
After one particular sexual assault at Barwon Health in 2016, it took Community Visitors five months to get an incident report, despite a departmental code of practice saying they had the right to such information.
Public Advocate Colleen Pearce says this lack of transparency is unacceptable. After all, you can’t fix why you can’t see.
“It is important to know what’s happening in mental health facilities,” she told The Age.
“If Community Visitors are restricted in accessing incident reports, how do they know that the care and treatment expected by the community is being provided, and that people's human rights are being respected and safeguarded?”