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.

Letter sent home with students from Adelaide Catholic schools by the recently convicted Archbishop

Archbishop of Adelaide Philip Wilson found guilty of covering up child sexual abuse

By Nancy Notzon, ABC News

 Archbishop Philip Wilson's legal team tried four times to have the case thrown out of court.

The most senior Catholic to be charged with concealing child sexual abuse — Adelaide's Archbishop Philip Wilson — has been found guilty by a New South Wales court, in a landmark ruling.

The 67-year-old was accused of covering up abuse by priest Jim Fletcher in the NSW Hunter region in the 1970s.

As part of his defence, Wilson's legal team tried to argue that as child sexual abuse was not considered a serious crime in the 1970s, it was not worthy of being reported to authorities.

However, Magistrate Robert Stone cast that claim aside in a ruling that could have ramifications in courts around the country.

Speaking outside court, abuse survivor Peter Gogarty said the verdict was "one of the most significant days in criminal law in Australian history".

Abuse survivor Peter Gogarty thanked police and the prosecution for their work on the case.

"I think this will now open the doors for other jurisdictions to start looking at trying to prosecute people who deliberately looked after their institution and, literally, threw children to the wolves," Mr Gogarty said.

"On behalf of all of the victims — who have been abused in this country and elsewhere — I just want to say what an enormous relief it is that the people who let this happen are finally being brought to account."

There were gasps from those in the packed courtroom when Magistrate Stone handed down the verdict.

People were crying and shaking hands after the hearing.

The prosecution has requested a custodial sentence for Wilson, for reasons of "deterrence" and "denunciation".

Wilson remains on bail on the condition that he attends his sentencing hearing, which will be held on June 19.

The harshest sentence Magistrate Stone is able to give is two years in prison, and he has the option of suspending the sentence.

"Archbishop Wilson knew what James Patrick Fletcher was up to in 1976," Mr Gogarty said.

"Fletcher was already abusing me by then, but Wilson could've stopped it, he could've got me help.

"I am very pleased that the prosecution is going to push for a custodial sentence.

"We're talking about children being sexually abused and the Archbishop knew — that to me demands a custodial sentence."

In a statement, Archbishop Wilson said he was "obviously disappointed at the decision published today".

"I will now have to consider the reasons and consult closely with my lawyers to determine the next steps," Wilson said.

Wilson's legal team made four attempts to have the case thrown out, arguing it was not in the public interest and that his diagnosis of Alzheimer's should preclude him from trial — although it did not preclude him from retaining his position in the church.

Peter Creigh (centre)

His lawyers maintained throughout the trial in Newcastle Local Court that while one victim, Peter Creigh, was abused by Fletcher as a child, Wilson, who was an assistant parish priest in East Maitland at the time, did not know about it.

Mr Creigh previously asked for a non-publication order on his name to be lifted.

He clutched his partner's hand as Magistrate Stone read out the verdict.  The magistrate said he found Mr Creigh to be a truthful and reliable witness.

"I am satisfied and find that Mr Creigh described to the accused he performed fellatio of Fletcher and masturbated Mr Fletcher," Magistrate Stone said.

Magistrate Stone said he did not accept Wilson could not remember a 1976 conversation, in which Mr Creigh, who would have been aged 15 at that time, described his abuse at the hands of Fletcher.

The magistrate said Mr Creigh "had no motive or interest to deceive or make up the conversation".

Magistrate Stone said Wilson knew "what he was hearing was a credible allegation and the accused wanted to protect the church and its reputation".

The magistrate said if Wilson had reported what he knew to police, it would have helped in prosecuting Fletcher.

He said Wilson knew the Creigh family.

"He knew what the young man was telling him was believable," Magistrate Stone said.

Magistrate Stone said he accepted Wilson had no role in the assaults and that Fletcher had never made admissions to him.

1967 Referendum on Aboriginal Rights

In 1967, 90.77 per cent of Australians voted yes for a change that they believed would improve the lives of Indigenous peoples.

They thought the referendum gave Aboriginal people citizenship rights and the right to vote.

In fact, it did neither of these two things.

The two changes that did occur were, firstly, that Aboriginal and Torres Strait Islander people were to be included in the census, and secondly that the Federal Government was given the power to make laws for Indigenous people.

Up until that point, Indigenous people were the responsibility of the states.

At the time of the referendum, Aboriginal and Torres Strait Islander people could vote in every part of Australia, with the Queensland laws being the last to change in 1965.

Disgraced ex-MP Barry Urban's story riddled with plot holes, committee finds

By Jacob Kagi 

According to Barry Urban, the horrors he witnessed while investigating war crimes in the Balkans as part of a 1990s United Nations mission still have a chilling effect on him two decades later.

"When you go into a town and you see bore water on the side of a wall of limestone, it is not bore water; it is actually blood," the now former WA MP told the state's most powerful parliamentary committee.

"I can tell you more gory stories of fields where DNA [was] 100 metres apart, body parts, where it was just artillery fire."

Mr Urban, elected to State Parliament in an upset result in the seat of Darling Range as part of WA Labor's 2017 landslide, had long maintained he was seconded from England's West Midlands Police to investigate atrocities linked to the conflict in the Balkans.

But the Procedure and Privileges Committee, tasked with investigating his qualifications and claims, found serious holes in that story.

Barry Urban's unproven claims:

·         He had a degree from the University of Leeds;

·         He had a Certificate of Higher Education in Policing from the University of Portsmouth;

·         He had completed nine out of 10 modules of a Diploma of Local Government;

·         He was seconded from West Midlands Police in 1998 and served with the United Nations mission in the Balkans, where he provided security for a team investigating war crimes;

·         He was posted a service medal by UK authorities;

·         He subsequently lost such medal;

·         He was entitled to wear such a medal; and

·         He was under a genuine but mistaken belief that he was entitled to wear a replica police overseas service medal.

He said he served in a team of six British police officers, but could not name one of them or even say where they came from.

He was asked if he could name a commanding officer of the task force. The best he could offer was there was a "General Molineux" there.

Perhaps coincidentally, Molineux is the name of one of the biggest football stadiums in the British police district in which Mr Urban actually did work.

A list of West Midlands officers who went to Bosnia did not include Mr Urban's name.

The only bit of evidence he could provide to the committee was a 1998 policing career review, which noted a posting to Bosnia was an aim he had.

Mr Urban said the person who wrote that, plus other senior West Midlands officers from the time, would verify his claims.

They did not.

The now-retired officer who wrote that 1998 review told the committee:

"You could not always trust everything he said. I have a feeling it's all baloney,"

"I'm absolutely convinced he never went to Bosnia," another former superior said.

The committee, who recommended Mr Urban's expulsion from Parliament, agreed.

And they found the alleged Balkans mission was not the only matter about which Mr Urban lied.

'Sounds like a load of nonsense'

The committee found claims he had completed a diploma through the WA Local Government Association were incorrect, and he was also found to have lied extensively about the "fake medal" that kicked off the whole scandal late last year.

He had initially claimed to have completed postgraduate studies at Portsmouth University, but later admitted not having ever stepped foot on the campus.

Mr Urban claimed all it took for that "qualification" was for him to submit his police probation file.

But the university has no record of him, or of anything like that course existing, and former police force colleagues outwardly mocked the suggestion when queried.

So too was his claim to have earlier secured a degree from Leeds University.

That institution had no record of him, a close work colleague from the time said it would have been "impossible" for Mr Urban to do that, and a newspaper listing of graduates at the time did not list his name.

Mr Urban provided a document he claimed was his degree. The committee saw it differently.

"Given that the committee has established beyond reasonable doubt that the member has not been awarded a Bachelor of Arts degree with honours, [the document] can only and must necessarily be described as a forgery," committee chair and house Speaker Peter Watson told Parliament.

That forged document was also provided to other organisations in an illegal act, Mr Watson stated.

With five key claims made by Mr Urban both in Parliament and before the election all found to have been thoroughly debunked, the committee found the situation was beyond repair.

"The committee is of the view that the Member for Darling Range has demonstrated a pattern of serial dishonesty and deception for at least two decades," Mr Watson said.

"The committee does not consider that [Mr Urban] is the person he represented himself to be."

First person convicted of refusing to stand for a judge in court in NSW

By Brooke Wylie, ABC News

The wife of a convicted Islamic State recruiter has become the first person in NSW to be found guilty of refusing to stand for a judge in court.

Moutiaa El-Zahed, 50, was charged with nine counts of engaging in disrespectful behaviour in court, an offence that was introduced in NSW in 2016.

She sat defiantly with her arms folded as she was found guilty of the charges.

A Sydney Magistrate said Ms El-Zahed "communicated a lack of respect for the court and the judge" by not rising to her feet when District Court Judge Audrey Balla came in and out of court during a civil hearing in 2016.

"There is no evidence before this court that she genuinely held any religious beliefs [and] there is no evidence that the teachings of Islam compelled this conduct," Magistrate Carolyn Huntsman said.

Ms El-Zahed is the wife of convicted Islamic State recruiter Hamdi Alqudsi, who is serving a six-year jail sentence for helping young Australians travel to Syria to fight.

In 2014, during a counter-terror raid on her home, Ms El-Zahed along with her two sons and her husband alleged they were assaulted by police and falsely imprisoned.

They took the matter to court and the case was dismissed, but during the hearings the court found she knowingly refused to stand when the judge entered the room.

At the time, when the matter was raised, her lawyer advised the court he was "not happy" about his client's decision not to stand.

"My instructions is that she won't stand for anyone but Allah your honour," he said.

Judge Balla warned she could be subject to legal action.

"It may well be that each occasion she does it, may be considered a separate offence," she said.

Dressed in a black niqab, she stood as Magistrate Huntsman entered Sydney's Downing Centre courtroom today.

But upon the magistrate leaving, Ms El-Zahed remained seated and crossed her arms.

Magistrate rejects claim NSW laws were unconstitutional

Magistrate Huntsman determined 2016 legislation making it an offence to be disrespectful in court was constitutionally valid.

In 2016, NSW Parliament passed the Courts Legislation Amendment (Disrespectful Behaviour) Bill which attracts a maximum penalty of 14 days in jail or a $1,100 fine.

The law was the first of its kind in Australia and it applies to all courts in NSW except the Children's Court.

Magistrate Huntsman, in delivering her judgement, rejected defence claims that the legislation introduced under then-NSW attorney-general Gabrielle Upton was unconstitutional

"I reject the defendants contention that section 200(a) is rendered invalid," she said.

The matter will return to court on June 15. 

Letter from Megan Markle's half brother to Prince Harry

Dear Prince Harry,

It’s not too late, Meghan Markle is obviously not the right woman for you.

As more time passes to your royal wedding, it became very clear that this is the biggest mistake in royal wedding history.

I'm confused why you don't see the real Meghan that the whole world now sees.

Meghan's attempt to act the part of a princess like a below C average Hollywood actress is getting old.

What kind of person starts out by using her own father until he's bankrupt, then forgets about him in Mexico leaving him broke, over mostly all her debts.

And when it's time to pay him back she forgets her own father like she never knew him.

My father will never recover financially from paying Meghan’s way, nor emotionally from disowning him. Meg is showing her true colours.

It's very apparent that her tiny bit of Hollywood fame has gone to her head, changing her into a jaded, shallow, conceited woman, that will make a fool of you and the royal family heritage.

Not to mention, to top it all off, she doesn't invite her own family and instead invites complete strangers to the wedding. Who does that? You and the royal family should put an end to this fake fairytale wedding before it's too late.

Her own father didn’t get an invite, whom should be walking her down the aisle.

She forgets if it wasn’t for my father she would be busing tables and babysitting to pay her old debt off.

The whole world is watching Meg make bad decisions and choices, it’s not too late Harry.

Meghan is still my sister. She is family. So whatever happens is up to her, whether she wants to forget knowing me or the rest of her family, family comes first.

Also, you would think that a royal wedding would bring a torn family closer together, but I guess we're all distant family to Meg.

Sincerely Tom Markle Jr