The residents of Mintabie are becoming increasingly concerned about the lack of health care available to them. Early in the year Clinic services in the town were withdrawn with no community consultation.  The RFDS who had flown into town once a month, ceased this operation.

While services are available at Marla, this is a 30-45 minute journey, along a very poor road and many residents do not have a vehicle able to undertake this trip. Too, there was no community consultation over the withdrawal of services and to date residents have received no clear indication as to what issues have been identified which would necessitate the removal of services. If we were informed of the issue then matters could be addressed, but this opportunity has not been provided.

Residents are even more concerned after an incident which occurred in July involving a long term member of the community, whom I will call Bob.

I am writing this article because I have received no answer from Frontier Services as  yet and one email from Community Health SA acknowledging my letter and assuring me they were looking into the matter. The RFDS has replied stating that they are satisfied with the doctor’s handling of the case, but none of my questions were answered and I believe the issue needs to be publicised in order to put our concerns into the public arena. Townspeople are surely entitled to answers to these questions I put to both organisations in order to alleviate fears for their own health.

The following is a copy of a letter I sent to both the RFDS & Frontier Services, with a copy to Country Health SA on 8th August, expressing our justifiable concerns.

I am writing to express concerns over the recent treatment of a resident of the small community in which I live, treatment which may have an impact on other residents in the future.

Six weeks ago Bob from Mintabie, in the far north-west of South Australia was driven into the Clinic at Marla, as we no longer receive services from the clinic in the town. He was very ill and realised he would need to be transferred to a hospital down south, so brought a bag of essential supplies with him, fully expecting to be flown back on the RFDS plane, as had occurred in the past.

He was seen by the regular attending doctor, who was familiar with the patient’s history of alcohol mis-use, compounded by diabetes. However, after speaking to the patient, the doctor told him that there was no point in transferring him south, no treatment was available for his condition, his liver had failed and he was to return to Mintabie, a place with no medical facilities, and there were no options! This ‘advice’ was witnessed by another resident of Mintabie who had transported Bob to Marla anticipating his transfer to Adelaide.

Bob was returned to his place of residence at the time – a small single room at the rear of the Mintabie Hotel, with no facilities. He was very ill, limited mobility, unable to eat without vomiting and with a much distended stomach causing him considerable pain and discomfit. Several community members took it upon themselves to assist him by helping him to shower and try to encourage him to drink fluids. After considerable concerns were expressed Clinic staff arrived in town to address a meeting of those wishing to know Bob’s prognosis. At the meeting the nurses unequivocally stated that Bob was dying! 

There was no treatment available to Bob, according to both nurses, his liver had ‘packed it in’ and his kidneys were failing. It was only a matter of time before he died and the meeting had been called in order to assess whether the community was prepared to provide palliative care for him or whether palliative care needed to be assessed elsewhere. No other options were considered.

Bob is a Vietnam Veteran who is a full TPI with a Gold card, so treatment options because of economic concerns was not an issue.

To cut a long story short, Bob was eventually, after intervention from family and friends, sent to the Royal Adelaide Hospital where he has been treated for the past 2 weeks. He has been subjected to a variety of tests – none of which had been organised or provided for by the RFDS treating doctor in order to arrive at a definitive diagnosis. The outcome is that he has had an excess of fluid drained which has made him much more comfortable and is now able to take nourishment.

I have spoken to his medical team, at his request, who assure me that while he does have cirrhosis of the liver and some respiratory concerns he is not in need of palliative care or in danger of dying in the immediate future. He is to be transferred to a rehabilitation facility and then has been assessed as being fine to return to the community, albeit with a recommendation he resides in an area with some medical facilities.

My concerns are over the cavalier treatment of Bob. He and his family have gone through a great deal  of anguish over being informed he was dying and had a very limited time to live, which has turned out to be untrue. No treatment options appear to have been offered, either to redress his medical condition or to alleviate existing problems, both of which have since been provided at the RAH.

Questions I and many in the community wish answered are:
 Why were the community and Bob all informed he was dying and that palliative care was the only option when this has been proven to be false?
 Why did the RFDS Treating doctor not transfer him to hospital when it was patently obvious Bob was very ill and had come prepared to be flown out?
 How could such a diagnosis be made with no tests being performed?
 What assurance does our community have that future patients will not be treated in a similar fashion?

I believe there needs to be some accountability provided for this patently obvious mismanagement. We live in a remote, isolated area and while residents moving to the town accept that medical facilities in such an area may be limited, most residents have settled with the understanding that a Clinic was accessible most times and in serious cases the Flying Doctor was able to land in the town in order to transport those in need to facilities able to meet their needs. Recently, this has proven not to be the case, with the loss of both the clinic and RFDS services to the township.  Now, this has been compounded by the treatment of Bob, which causes a considerable amount of worry for many of our older residents who wonder if they too will be sent away to die in pain and isolation when there are actually other viable options.

I would appreciate answers to the above questions which I could share with the community. It appears to me that a serious breach of Duty of Care has occurred and while I do not wish to create dissention I believe our community deserves an explanation. I realise that by writing this letter I may be leaving myself open to animosity from those of whom I am raising concerns but I have chosen not to send this anonymously as these concerns are grave enough to be taken seriously.

In the weeks since I wrote this letter Bob has continued to receive treatment at the RAH, who are now working with Veteran’s Affairs to sort out a small unit in Adelaide for him to live in, where he can access medical care if required.

“Bob’s sister, who is the main contact for the family is distraught over the handling of the entire affair. When she spoke to her brother, after he had been ‘treated’ at the Marla clinic, she was given the news of her brother’s impending death. His ex-wife and daughters were also apprised of this state of affairs and were extremely upset. However, once bob was admitted to the RAH and examined and treated by a team there and it became evident that there were options and treatment available, anger has now set in, together with the initial feelings of relief and thankfulness that the original diagnosis was incorrect. Bob’s sister believes that an apology must be made to the gentleman and his family and that there needs to be some level of accountability.’

A positive outcome from this whole affair is that several Mintabie residents have decided it is time to take matters into their own hands. It appears unlikely that health services are going to improve in the near future. As the nearest service of any kind is at the very least 30 minutes away there is a need for a First Aid post in the town, to be able to cater for minor injuries/illnesses, at least until patients can be stabilised enough to travel along a dirt road which is in very poor condition at the moment.

Stations are able to purchase special medical kits with essential supplies to be used in conjunction with advice from the RFDS. We have requested the same sort of service, particularly given the fact that the rainy season will soon be upon us which can often see our one access road closed for several days. We have a Registered Nurse residing in town and several residents with a Senior First Aid Certificate who are prepared to volunteer their services on a roster system.

It appears from these experiences that Mintabie residents have come full circle, with a return to the days when the town had to be entirely self-sufficient. The entire scenario is unfortunate, as until this year, Clinic facilities and treatment have been second to none, but if we now have to be pro-active and take charge of our own health care then we will do the best we can!

Veronica Hartnett
Mintabie Resident