Cult leader James Gino Salerno in court

James Gino Salerno 

By ABC court reporter Rebecca Opie

The inner workings of a cult once based in a sprawling mansion in the Adelaide Hills region have been revealed during a District Court trial against its founder.

The cult lived in the historic Arbury Park mansion in Aldgate from 2001 until 2008.

James Gino Salerno, 71, is on trial in the Adelaide District Court before Judge Paul Slattery — without a jury — after pleading not guilty to nine counts of unlawful sexual intercourse.

The cult is based around Salerno's desire to create what he described as the "ideal human environment".

The court heard no decision was made without running it past Salerno and that on one occasion he had ordered all of the men to strip and wrestle naked in front of the group, before ordering all of the women to do the same.

In his opening address, prosecutor Patrick Hill told the court Salerno — also known as 'Taipan' — was always the leader of the group and the other 30 or so members were ranked by what the accused called the individual's "emotional quotient".

He said the group would hold daily meetings to discuss various ideas around the notion of the "ideal human environment" and that it was common for them to say "praise Taipan".

Women taught how to be a 'personal server' to Salerno

The court heard women in the group were responsible for looking after children, cooking and cleaning as well as tending to Salerno.

"This included caring for his hands and feet by these manicures and pedicures, running him a bath, towel drying him afterwards, brushing his hair, doing his laundry and also by giving him hand and leg massages," Mr Hill said.

The court heard girls as young as 13 were taught by older women in the group how to be a "personal server" to their leader, which included testing the temperature of his bath water with a thermometer to make sure it was to his liking.

The cult lived in the historic Arbury Park mansion in Aldgate from 2001 until 2008 when they relocated to Beaudesert in south-east Queensland.

The 17-room stone mansion was built by Sir Alexander Downer in August, 1935, and was the childhood home of former Foreign Affairs Minister Alexander Downer.

The South Australian Government bought the property in 1964 and it was used by the Education Department as a training centre for teachers prior to being sold to the Salerno family.

The court heard Salerno had a large bedroom suite to himself on the second floor of the mansion and other group members lived in dormitory style accommodation called the "Barracks."

Cult members had to obey 'higher-ranking children'

Members were required to do exercises every morning before breakfast at 7:00am and then all of the children had to line up in a row.

Mr Hill said each child had a ranking and had to obey the higher-ranking children.

"A higher-ranked child would complain of disobedience on the part of a lower-ranked child who did not follow one of his or her orders and the lower-ranked child would then be administered punishment," he said.

The court heard punishment included being struck on the head with a metre-long stick that had a large wooden knot on the end.

It heard there were also punishments enforced for stepping outside the hierarchy of rules, including being treated like a slave, being made to sleep outside or not being allowed to eat.

It was flagged that the trial would hear evidence from a former member of the group that women were submissive to men and subservient to the accused.

Mr Hill said the woman once stood up to Salerno and as a result she was told that if she wanted to act like a man, she would be treated like one, and was sent to work on 12-hour days clearing farmland with the men.

Members donated all of their income to the group which was then centrally controlled and redistributed on an as-need basis.

While the group moved from South Australia to Queensland in 2008, they are now based on a large property at Kununurra in the Kimberley, in north-east Western Australia.

The trial against Salerno continues.

What is 'mince'? Supermarkets and farmers clash over Funky Fields plant product

A plant-based product labelled as 'mince' hits Woolworths shelves, sparking anger.

ABC Rural

By Marty McCarthy, Anna Henderson

A decision by a major supermarket to sell 'mince' made from plants in the red meat aisle has angered farm lobby groups and infuriated a National Party senator.

Woolworths has placed a faux-mince product, made from plants and vegetables, in the meat section of its supermarkets under the brand name Funky Fields.

Competitor Coles will next week start trialling one of the world's best-known beef patty substitutes, Beyond Burger, in some of its Victorian stores.

In April, France banned the use of meat and dairy-related terms on vegan and vegetarian plant-based alternatives, while major farm groups in the United States are currently lobbying the nation's Department of Agriculture to do the same.

The National Farmers Federation has previously been hesitant to call for blanket bans on such terms, but president Fiona Simson has changed her mind.

"We need some decisions around what is meat and what is milk and how that should appear on a product label," she said.

"France is a country that really values where a product comes from and how it has been created, so it is interesting they took the lead on this, and we now need to follow this.

"We need to work out what we are taking to government and what government's role is in this to make sure we can pursue a labelling regime that is beneficial to consumers and producers."

Pull plant 'mince' from shelves: O'Sullivan

National Party senator Barry O'Sullivan has demanded Woolworths remove the product and re-label it, so the Federal Government does not have to step in.

"Woolworths need to pull it from the shelves today," Senator Sullivan told the ABC.

"Take it out the back and give it another name and call it whatever it is. But not 'mince', because that is crazy."

Senator O'Sullivan is expecting food labelling to become increasingly complex, and said the major supermarkets had a responsibility to shoppers.

"Have we gotten to a position in a nanny state where the government has to go from shelf to shelf, line by line, on every product and commodity and create legislation? No-one wants that," he said.

"I call on Woolworths and any other retailers to deal with this themselves, don't put us in a situation where government has to start to buy into more regulation or legislation."

Woolworths did not tell the ABC why it had decided to sell a plant product in the meat section, or respond to questions about claims it was misleading to consumers.

"We know some customers are looking to eat less traditional protein in their diets … in response we are pleased to range the [minced product] in our meat section to meet this demand," a Woolworths spokesperson said.

While farm lobby groups were hoping Woolworths was only trialling the move, the supermarket giant confirmed to the ABC that it is a permanent decision. Woolworths would not say whether other faux meat products would be relocated to the chilled meat section.

Earlier this week the UK's second-largest supermarket, Sainsbury's, announced that from the end of the month it will start selling a plant-based mince, made by Danish company Naturli Foods, in the chiller section of 400 stores.

"This is the first time consumers can buy a 100 per cent plant-based mince product that looks and tastes like minced beef, replace minced beef in all recipes, and be found in the cold counter next to the traditional beef," Henrik Lung from Naturli Foods said.

Naturli Foods is also the company behind the Funky Fields products.

Coles said it would place its new range of plant-based Beyond Burger patties, which have a similar taste and texture to traditional burgers, in its frozen section rather than the meat aisle, when it starts trialling them next week.

"Our chilled health range has seen double-digit growth with the most popular products including falafel balls, kale burgers and tofu," a Coles spokesperson said.

"We have seen demand significantly grow for vegetarian products in the past 12 months."

Farm lobby fury over 'meat' claims

The developments both in Australia and abroad have angered the Cattle Council of Australia (CCA), the nation's peak lobby group for producers of grass-fed beef.

"By placing the product within the defined meat protein cabinet the consumer is led to believe that the product is of equivalent source and this placement may mislead consumers," CCA chief executive Margo Andreas said.

"Quite simply, it's not meat!"

The labelling of plant-based meat substitutes has also upset the Australian Meat Industry Council's Patrick Hutchinson, who said the entire production supply chain needed to work together to address the issue.

"What we will be doing as an industry, farmers and processors, feedlots and retailers, is continuing our push to legislators to ensure product is accurately described," he said.

Mr Hutchinson said the livestock industry could not interfere in where a supermarket decided to place a product, but he said it could lobby for meat alternative products to be labelled differently, so consumers were not duped.

"It is a problem and that is why we want accurate descriptions, because these products are not meat, but we can't tell supermarkets where it can or can't sell product," he said.

"This is a case of [plant-based meat companies] utilising terminology to describe something aligned to meat because they can't sell it if they describe it accurately.

"That [faux-mince] product is a heap of different plants — wheat, mushroom and coconut, mixed together with binding agents, then beetroot juice to make it red — so it should be sold for what it is."

Senator O'Sullivan accused plant-based meat makers of leveraging off of the red meat sector's marketing edge.

"They are piggy-backing on the back of industries that have invested hundreds of millions, if not billions of dollars, to get their product identified for what it is," he said.

http://www.abc.net.au/news/rural/2018-06-16/meaning-of-mince-sparks-clash-between-supermarket-and-farmers/9875242

Dr Emil Shawky Gayed

Dr Emil Shawky Gayed allegedly operated on women without realising they were pregnant and removed one patient’s healthy ovary.

A New South Wales obstetrician and gynaecologist has been accused of performing an unnecessary hysterectomy and other irreversible surgeries on women without their consent, a tribunal has heard.

Dr Emil Shawky Gayed allegedly carried out multiple procedures that fell “significantly below” professional standards, including in cases where women could have been treated with painkillers and bed rest.

The case, which was heard before the NSW civil and administrative tribunal this week, was told that Gayed allegedly failed to detect a patient was pregnant before performing surgery on her that could have affected her foetus. When he discovered her pregnancy after the surgery, he paid for her to fly to Sydney to have an abortion.

https://www.theguardian.com/australia-news/2018/jun/08/surgeon-performed-unnecessary-hysterectomies-without-consent-tribunal-told

NSW abortion clinic 'safe access' Bill passes with overwhelming support

By state political reporters Sarah Gerathy, Brigid Glanville and Nour Haydar

A bill to ban protesters from outside abortion clinics passed the NSW Parliament with overwhelming support last night, despite the current and former Ministers for Women voting against it.

After hours of passionate debate, the private members bill passed the Lower House just before midnight at 61 votes to 18, with Premier Gladys Berejiklian and Deputy Premier John Barilaro among its supporters.

It means protesters who intimidate, harass or film people within 150 metres of clinics or hospitals that provide terminations will face punishments including jail time.

Upper House Labor MP Penny Sharpe, who was one of the driving forces behind the bill, described it as a "terrific day for women in New South Wales".

But she expressed dismay that The Minister for Women, Tanya Davies, and the former minister Pru Goward were among those who voted against it.

Ms Davies, who has previously described herself as "pro-life" defended the "sidewalk counsellors" who approach women seeking terminations.

"They don't force their views onto those women — they offer support and information that ... may not necessarily be provided within an abortion clinics," Ms Davies said.

"They don't force their views onto these women, they are offering simply another choice to these women — yet this Bill will criminalise that offer."

Ms Davies' position also raised the eyebrows of some of her Coalition colleagues, with some now questioning her fitness for the role.

One Government backbencher told the ABC, "I honestly cannot believe that the Minister for Women would vote against women's safety. Un-f**cking believable".

Another Coalition MP said, "This Bill is about respect, dignity and privacy of women — for the Minister for Women to not support this you have to seriously question if her position is tenable".

The current Family and Community Services Minister Pru Goward — who also served as Women's Minister in the past — also voted against the Bill, saying it was because she is a "strong and visceral believer" in the right to free speech.

"I would so much like to support this Bill, I know what it will mean to the women affected but I cannot," she told the chamber.

Ms Goward said she has always been a "strong supporter" of a woman's right to an abortion but said censorship "often begins gently and sensitively".

Earlier, Labor's Jenny Aitchison delivered an impassioned plea to her parliamentary colleagues urging them to protect women against "appalling" behaviour of protesters.

"We need to call it out for what it is," Ms Aitchison said.

"Violence, harassment and intimidation of women.

"I urge all members of the house when they are making their decision to consider this, we are not acting to curtail free speech or political communication.

"We are not stopping people from praying or holding their faith and we are not imposing overly harsh penalties on people who do not want to harm others."

Multicultural Affairs and Disability Services Minister, Ray Williams, said he could "never ever" support a Bill that could see someone imprisoned for "counselling, speaking or praying".

"I will always stand by the right of people to freely advocate, to speak out on behalf of issues that they feel very, very strongly," he said.

Liberal MP Alister Henskens said the Bill would achieve the opposite to its intended objectives and encourage more protests.

"Rather than reducing the amount of protests around abortion clinics and reducing the general anxiety around those premises, this Bill creates a new context for civil protest."

He raised concerns about the way the Bill was drafted, claiming it would "criminalise speech" and "erode freedom of expression".

"I'm am not motivated by any religious affiliations or obligations, I'm not a regular churchgoer," he said.

"A serious concern that I have with this Bill is that it imposes a new kind of restraint on the freedom of expression that has not occurred before."

Inside Labor’s Refugee Strategy

By Karen Middleton

Karen Middleton is The Saturday Paper’s chief political correspondent.

CFMEU Victorian secretary John Setka (left).

Refugee advocates handing out flyers in the foyer of last weekend’s Victorian Labor Party conference were surprised and thrilled when the Industrial Left’s hard man, John Setka, expressed his support.

Not realising who he was initially, one of the Refugee Action Collective’s volunteers engaged the state secretary of the militant Construction, Forestry Mining and Energy Union in conversation about asylum-seeker policy. His response was so pleasant and supportive that she offered him a sticker. It read: “Unions stand for refugees. Bring them here”.

Setka not only accepted it, he stuck it on his jacket and insisted she give one to each of the dozen or so of his members standing nearby, who all dutifully did the same.

She and others were shocked to hear later that Setka had backed a move to shut down the conference early and ensure an urgency motion to “bring them here” – along with several other motions, including one to recognise a Palestinian state – was not debated.

Afterwards, Setka tweeted his reasoning: “Why the hell are Labor people prepared to use a STATE Labor conference against the election of a FEDERAL Labor government? Our best chance for a more humane approach and community is a Labor government and that’s what we’re fighting for.”

When journalists tried to ask him about the shutdown, he simply grinned and said: “Democracy at work.”

Some senior Labor figures argue that shutting down debate and enraging Labor’s green-inclined left-wing supporters risked far greater political damage than letting the debate proceed and potentially giving ammunition to the Coalition.

But The Saturday Paper has been told the right-wing Australian Workers’ Union moved the sudden shutdown motion – which Setka’s left-wing CFMEU supported, along with other members of the breakaway group of Victorian unions now known as the Industrial Left – because it looked as though the pro-refugee motion might actually have enough support to be adopted if it was moved.

Delegates from other unions in the Industrial Left were among those prepared to support the refugee motion. Some say the sudden shutdown was sprung on them. And some say they believe, despite John Setka’s statements defending the move later, that it was sprung on the CFMEU, too.

The Industrial Left voted for it as instructed, but some are now calling that “a mix-up”.

Adopting a motion to bring refugees to settle in Australia would have put the Victorian ALP at odds with federal Labor’s policy platform – which is to resettle them but not to specifically “bring them here” – and emboldened those who want to change it when they get the chance at the party’s now-deferred national conference.

But at the same time, The Saturday Paper has been told there is not the appetite within the federal parliamentary Labor Party – including in the Left – for having the sort of big public fight on asylum seekers that they did three years ago.

Unlike in 2015, many in the parliamentary Left no longer want to oppose turning back asylum-seeker boats, provided it is safe.

They want something done about the situation in the offshore detention centres on Manus Island and Nauru and want people resettled, not held indefinitely. But many are not insisting resettlement be in Australia and are willing to wait until after Labor wins government to thrash out the details.

Asked for her view on Sky News, left-wing frontbencher Linda Burney supported some kind of time limit or time line on detaining people.

Few of her colleagues support an arbitrary time limit for fear would-be refugees could be encouraged to get on boats if they knew how long they were to be detained. Burney was later embarrassed when a staff member issued a transcript that omitted her comments.

The new draft platform opposes indefinite detention but does not advocate time limits. It does contain much more detail on Labor’s policy direction than previously.

The platform promises to work towards improving processing arrangements in transit countries and to reinstate the 90-day rule for processing applications. It says those found to be owed protection “will be given permanent protection under the Migration Act 1958” but does not say where, leaving that to be determined by the parliamentary party in government.

Speaking on ABC TV’s Q&A program this week, new Labor MP, Victorian left-wing former union leader Ged Kearney, reiterated her opposition to indefinite detention. But she would not commit Labor to bringing confirmed refugees from offshore detention centres to settle in Australia.

“Look, I think that we would hope that we could get them off those islands as quickly as possible – people off Manus, off Nauru and settled as quickly as possible. And I’m sure that that would be the intention of a Labor government.”

Pressed to clarify whether she was insisting on resettlement in Australia, Kearney said: “Well, not at this point.”

She said her first thought would be to get rid of the Coalition government. But she also revealed the pressure some Labor MPs are under from constituents who do not want refugees brought to Australia.

“There are people that have anxieties, they are angry for whatever reason, and they can’t see that bringing refugees here helps them,” Kearney said.

“You know … when I talk about refugees, they say: ‘Yes, but the schools are full. The hospitals are falling apart. There’s one road to town – it takes me four hours to get to work. Rents are high. My kid has never worked. I’m in insecure work.’ You know, these are real fears and real anxieties and they make people angry. Or they say to me: ‘I’ve been trying to get my brother here from India on a family reunion visa for five years. Why should I let someone come on a boat?’ They’re hard questions and they’re hard things to deal with and I think we have to acknowledge that those things are real and we have to deal with them.”

Within the parliamentary party, views have shifted on the asylum issue since the 2015 ALP national conference.

Then, the factional argument was over whether to insert a clause in the party’s platform to actively reject one of the Coalition’s anti-people-smuggling tools – turning back boats on the water.

The party’s Right faction won out – backed by the Victorian Socialist Left and the CFMEU. The platform did not specify a view on turnbacks, an effective authority to engage in the practice if necessary.

Three years on, while there may still be a push to change that from some sections of the wider party at the next conference, it’s not looking like winning much support.

Deferred from July 28 due to its clash with the newly announced date for five federal byelections, the conference has now been rescheduled for mid December.

There is still strong concern about detaining people offshore and particularly indefinitely, but the issue of turnbacks has lost its potency.

The looming federal election, due sometime between August and next May, has dampened the appetite inside Labor for another big public factional fight.

Nevertheless, there is some deep unhappiness, especially within the party’s Left faction, at the way things were handled last weekend.

Labor regularly boasts that the sometimes-difficult policy debates at its conferences are held in public, in contrast with the Greens, who do not allow media access to their equivalent conference debates.

After the weekend conference, the convener of Labor’s federal parliamentary Left faction, Victorian MP Andrew Giles, issued a statement on his Facebook page praising the state platform with one qualification.

“It is beyond disappointing that some delegates chose to shut down debate on important issues,” Giles wrote. “On Palestine, on women’s retirement incomes, on live exports, on the right to strike and on asylum policy. In Labor we pride ourselves on our culture of debate – of working through tough questions respectfully and openly, not hiding from these or from scrutiny of our positions. We can’t take this for granted. This goes to the heart of our challenge, which isn’t just to set out an alternative policy vision, but to reject cynicism towards politics by building a movement in which all of us can have a say in shaping our future.”

Rather than closing the detention centres, the AWU and CFMEU combined to close down the conference and decree that all remaining motions be debated instead by the party’s administrative committee, later and behind closed doors.

In his address to the Victorian conference, Shorten had vowed to take a tough approach to asylum seekers arriving by sea.

“A Labor government will stop the boats,” Shorten said. “The current government would like to say there’ll be another policy. There won’t be and I’m very committed to make sure the boats don’t start again. We also just happen to think we shouldn’t have kept people in semi-indefinite detention for five years in order to achieve this.”

Refugee advocates argue there is nothing “semi” about indefinite detention and that Labor should commit to something concrete to end it. Even some in the Industrial Left don’t trust the power dynamic at the top of the Labor Party to deliver change once in government if it hasn’t been locked in.

One told The Saturday Paper: “They feel if Labor doesn’t commit to something before they get into government, they’re not going to do anything after.”

But the appearance of division on the asylum issue – with the controversial John Setka involved – is fuelling Coalition attacks.

Home Affairs Minister Peter Dutton used parliament to attack Shorten not for opposing the government’s position on border protection but for supporting it – and having his union backers silence those on the Left who wanted to unwind its policies.

On Shorten’s support from the CFMEU, he said: “What did he have to do to get that deal? What did he have to promise the CFMEU? We will never know … unless he is elected as the next prime minister.”

The move by the AWU and CFMEU at the Victorian conference is casting a shadow over the party’s carefully negotiated draft national platform.

It was a very public reminder to the wider Labor Party – and a vivid illustration to those watching on, who may not have grasped it – that the two unions combined carry considerable sway and intend to use it.

The CFMEU’s backing of the shutdown is being seen within the wider party’s Left– and parts of the Right – as much more about power than policy and an alarming portent of how things might work in government.

The union is firmly backing in Bill Shorten as Labor leader. Along with the AWU, which Shorten formerly led, the CFMEU is acting as his Praetorian Guard against any threats to his leadership.

What it is being promised in return is not clear, although the abolition of the Australian Building and Construction Commission and greater work rights are high priorities.

In the run-up to an election, the Coalition seeks to weaken Shorten enough to make him wobble but not so much that he can be knocked over and replaced.

The Coalition does not want to face a newly elected Anthony Albanese, who, according to this week’s Newspoll, is more popular than either Shorten or Turnbull.

Although there is at least as much despair in some parts of the Labor Party about Shorten’s persistent unpopularity as there is about his union connections, there is no active move to replace him with Albanese or anyone else, and even if there were, very little time left to do it.

This article was first published in the print edition of The Saturday Paper on Jun 2, 2018 as "Inside Labor’s refugee strategy ". Subscribe here.

Australians must understand and question surgical fees for better health outcomes

Dr John Batten

By John Batten

Launceston General Hospital orthopaedic surgeon and University of Tasmania senior lecturer John Batten has been elected the president of the Royal Australasian College of Surgeons.

In 2017, Australia's hospitals admitted about 748,000 patients, an increase of almost three per cent in both emergency and elective admissions from the previous year.

Finding out that you, or a loved family member, needs surgery can be scary, overwhelming, and challenging physically, mentally and financially.

As the number of surgical procedures available grows, it's never been more important for patients to feel empowered and in control of the choices that will benefit their long-term health and wellbeing.

As president of the Australasian College of Surgeons (RACS), an organisation that advocates for the highest surgical standards, I want Australian patients to know that they can, and should, ask questions to give them peace of mind about both their care and the costs they can expect.

I also want Australians to know that high fees do not necessarily guarantee quality of treatment, care or outcomes.

While the vast majority of Australian surgeons aim to deliver affordable, lifesaving, quality patient care, there are a small number within the surgical industry who charge excessive, or sometimes even extortionate, rates.

These rogue operators charging excessive fees are in breach of the RACS Code of Conduct which seeks to ensure full disclosure and transparency in all aspects of surgical financial consent.

No one in a health system such as ours should have to contact a financial planner, re-mortgage their home, touch their superannuation or seek crowd funding to access surgical treatment. Urgent, acute or cancer related surgery can be timely and adequately dealt with in the public system and all surgeons have a duty to advise their patients of this.

What factors affect surgical fees?

Like all medical practitioners, surgeons do not have a standard set of fees, and RACS does not set fees. Fees related to an operative procedure account for many factors, including the difficulty and duration of the procedure and the cost of providing care before, during and after the operation, such as theatre costs, anaesthesia, pathology and dressings, bandages and other hospital costs. The surgical procedure itself is only one component of a number of different fees the patient receives.

There's also the evolution of technology in our sector and the impact it has on patient outcomes to consider.

Just like every sector around us, from manufacturing to financial services, the healthcare industry is benefitting from the development of innovative technology to enhance the lives of Australian people.

We've all seen, or at least heard of, surgical robots which are used most commonly to complement a surgeon's skills, increase accuracy and offer a minimally invasive procedure to patients.

Take an appendectomy (the removal of the appendix) for example. There are multiple ways that this operation can be undertaken; with or without technology, or a combination of both. If we put that into the context of fees, that's three different prices a surgeon might quote depending on how they complete the procedure, and which method best suits the needs of the patient.

Interestingly, when we look at all day and overnight hospital procedures (2014-15) about 95 per cent of patients face no gap payments, with the average gap payment for the remaining 5 per cent at $130. So the tail end of high fees comes from a very small percentage that needs to be looked at more closely.

At a systemic level, purchasing or contracting arrangements between private health insurers and hospitals can impact upon out of pocket costs and continue to remain opaque to patients and medical practitioners.

RACS encourages greater transparency of any conditions which may affect clinical decision-making.

To varying degrees, all these influences can impact the cost of a surgical procedure but should in no way influence the outcome of patient care.

Before agreeing to any procedure, patients should understand all available treatment options and associated fees and should seek a second opinion if they are concerned.

Be informed and educated

We want every Australian to feel confident, educated and to understand what to look out for when selecting a surgeon and agreeing to the fees for a procedure.

First, ensure that your surgeon is a FRACS. These are surgeons who are Fellows of the Royal Australasian College of Surgeons. They undergo rigorous training and commit to ongoing learning and maintenance of knowledge and skills demonstrated through various Continuing Professional Development (CPD) programs.

This ensures Fellows not only maintain competency but also continuously build on and improve their clinical knowledge and skills in order to provide high-quality contemporary healthcare to the public.

You should also take the time to contemplate the procedure and ask questions about care and fees, before agreeing to the surgery.

All patients should assess the financial implications of their surgery, which is a hugely important aspect of informed financial consent.

While the duty of patient care rests on the shoulders of surgeons and their dedicated teams, patients shouldn't be afraid to ask as many questions as possible to ensure total confidence in their choice.

There are several considerations that patients should think about when it comes to building a holistic view of their fees:

·         Ask for an estimated total cost of your procedure up front before you agree to the surgery

·         Where there is concern about fees, seek a second opinion or raise your concerns with your referring practitioner

·         If you have private health insurance, confirm what you are covered for with your insurance company and ask if there will be any out-of-pocket costs. In most cases even if you have private health insurance there will be some out of pocket costs

·         Before you go into hospital as a private patient ask your surgeon about the fees to be charged by all of the health professionals that might be involved in your care, including anaesthesia, pathology services, medical imaging, physiotherapists etc

·         If you continue to feel unsure of the proposed course of treatment or fees to be charged, ask your referring doctor to recommend another surgeon

Support for fair fees

As an advocate for sustainable and affordable fees, RACS strongly supports the full disclosure and transparency of fees as early as possible in the patient-doctor relationship and champions the need for patients to understand all treatment options available to them.

If you have any complaints or concerns about a surgeon you can raise these directly with the surgeon or the hospital or you can contact the relevant authority — the Australian Health Practitioner Regulation Authority.

We take a strong position on this issue, and also encourage all patients who consider their fees unreasonable to contact the RACS Professional Standards Department about any concerns on professional.standards@surgeons.org.

You can also read our frequently asked questions guide and other information that will help you make an informed decision about your medical care on the Royal Australasian College of Surgeons website.

John Batten is president of the Royal Australasian College of Surgeons.