This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Quote Of The Year
Timeless Quotes - Sadly The Late Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"
or
H. L. Mencken - "For every complex problem there is an answer that is clear, simple, and wrong."
A
prolific circumcision doctor has lost his battle to perform operations while he
appeals a medical board decision, as new details emerge about one of his
newborn patients suffering an “amputation or partial amputation” of his penis
and another needing a blood transfusion.
Dr
Hershel Goldman, who estimates he has performed 20,000 circumcisions, has
sought to overturn an April ban imposed by the Medical
Board of Australia that prevents the Melbourne doctor from performing
circumcisions. His appeal remains ongoing, and Goldman applied to have the ban
lifted until the appeal concluded.
But the Victorian Civil and Administrative Tribunal rejected the 63-year-old’s request to delay the ban ahead of a full appeal hearing and decision this year.
In a May 30 decision published by the tribunal this week, it was alleged that Goldman performed a circumcision on a seven-day-old baby “where amputation or partial amputation of the penis occurred”.
The baby’s family claims that Goldman “pressed on with the ritual prayers for several minutes and delayed providing care to the infant” after their baby bled more than usual after the operation.
“Further, once confirming the amputation, concerns have been raised that Dr Goldman had no procedures in place to manage the complication, with management of the emergency being undertaken by guests at the party who were also medical practitioners,” the family told the Medical Board of Australia’s immediate action committee.
Goldman’s clinical records do not detail when he phoned an ambulance.
In another case considered by the board, another of Goldman’s seven-day old patients required sutures and a blood transfusion after a circumcision in a family home.
It is alleged that after the procedure, Goldman applied a bandage to the baby boy and instructed the parents to keep his nappy on for four hours.
Goldman
then advised the family he was travelling interstate and provided no on-call
coverage after he left their home, they told the committee.
When
the parents removed their son’s nappy four hours later, they said they
discovered “significant bleeding”. They said they contacted Goldman and he
advised them to travel to a hospital 40 minutes away for a review. The baby
required stitches and a blood transfusion at the hospital.
The
family in the second case also raised concerns about Goldman’s hygiene
practices and claimed he washed his hands in the kitchen sink and used a tea
towel to dry them before performing the procedure.
Goldman
told the committee that bleeding requiring sutures was not a sign of any error,
but that sutures were required in a small number of circumcision cases.
He
denied telling the infant’s parents that they should not remove his nappy for
four hours after the circumcision.
Goldman
said he told the parents to check the infant during routine nappy changes
within four hours of the procedure.
He
also denied he had poor hygiene and submitted that he used surgical antiseptic
after washing his hands with soap and water and dried them on a clean tea towel
supplied by the baby’s parents.
In
the first case, Goldman maintains that a partial amputation – not full –
occurred but acknowledged the seriousness of this complication. He also denied
the parents’ claims he performed the circumcision in poor lighting.
The
doctor submitted to the tribunal that he should be allowed to continue
performing circumcisions in clinical settings only, and not in people’s homes,
while the appeal process was ongoing.
Goldman
told VCAT he had performed circumcisions for 40 years, and that what he
referred to as the partial amputation was his first major complication in that
time.
He
argued he would suffer a “devastating financial impact” if he was banned from
performing circumcisions. It would also have a detrimental impact on the Jewish
and non-Jewish community, as half his clients were Muslim, he said.
But
VCAT deputy president Ian Proctor said the evidence did not give him confidence
that the serious risk posed by Goldman could be satisfactorily reduced by
banning only in-home religious procedures.
“The
paramount principle of the protection of the public and public confidence in
the safety of services provided by registered health practitioners outweighs Dr
Goldman’s personal interest in continuing his circumcision practice and
community interest in him being able to do so,” Proctor said.
The
substantive appeal will be heard at a later date.
Surely this is a procedure that
should only happen in ideal conditions (light, anti-sepsis etc.) in the hands
of someone who is fully trained in the procedure and how to manage any
complications.
The idea of this procedure happening
at a party suggests to me all those involved had / have essentially “taken
leave of their senses!” You can die of hemorrhage from this for heaven’s
sake!!!!
Worse still , it seems this bloke is
only in it for the money!
Heaven spare us from such nonsense, and practitioners of this ilk.
What a terrible story!
The first rule in the caring
professions is “first do no harm” and for this reason alone for-profit back
meddlers should stay away from all those who can’t provide informed consent for
their treatment on their own behalf!
A few days ago this appeared:
Chiropractors give themselves green light to crack
babies’ backs after four-year ban
Chiropractors
have given themselves the green light to resume manipulating the spines of
babies following a four-year interim ban supported by the country’s health
ministers.
In
a move that has been slammed by doctors as irresponsible, the Chiropractic
Board of Australia has quietly released new guidelines
permitting the controversial treatment for children under two.
The Royal Australian College of General Practitioners (RACGP) hit out at the decision, saying there was no evidence supporting the spinal manipulation of babies and children and that the practice should be outlawed. “There is no way in the world I would let anyone manipulate a child’s spine,” said Dr James Best, the College’s Specific Interests Child and Young Person’s Health chair.
“The fact that it hasn’t been ruled out by this organisation is very disappointing and concerning. It’s irresponsible.”
Spinal manipulation involves moving the joints of the spine beyond a child’s normal range of motion using a high-velocity, low-amplitude thrust.
In March 2019, the Chiropractic Board of Australia announced an interim ban on the spinal manipulation of children under two, following public outcry over a video of a Melbourne chiropractor holding a two-week-old baby upside down.
The chiropractor then used a spring-loaded device on the newborn’s spine and tapped him on the head. Then-Victorian health minister Jenny Mikakos described the footage as “deeply disturbing”.A Safer Care Victoria report at the time, which involved a systematic review by Cochrane Australia, found no strong evidence that spinal manipulation helped childhood conditions such as colic, back/neck pain, headache, asthma, ear infections or torticollis (twisted neck), despite it commonly being spruiked as a solution to these issues.
“The
major finding of this review is that the evidence base for spinal manipulation
in children is very poor,” it said.
A follow-up review last year by Cochrane Australia, commissioned by the
national healthcare watchdog AHPRA (the Australian Health Practitioner
Regulation Agency), reached the same conclusion.
The
initial review, provided to all Australian health ministers, recommended that
spinal manipulation should not be done on children under 12. It also
recommended urgent research to develop an evidence base for spinal manipulation
on children and advanced training for those providing paediatric care.
However,
in November the Chiropractic Board of Australia put out a statement to
“clarify” to members its expectations regarding paediatric care. It said a
range of care could be provided to children, including manual therapy, soft
tissue therapy and manipulation, if practitioners understand how children’s
needs differ from adults and modify their care appropriately.
Neurosurgical
Society of Australasia Board executive Dr Patrick Lo, who is also the Victorian
chair of the Royal Australian College of Surgeons, said children were
particularly vulnerable to injuries from spinal manipulation.
Melbourne
chiropractic Dr Ian Rossborough has been criticised for performing a
controversial technique on a four-day-old baby.
“Adults
have a balanced neck, head and shoulders – everything is supported – whereas
kids have a very big head-to-neck ratio,” the neurosurgeon said.
“If
you flick it around, the lollipop ball will fall off. That’s our major concern.
Those areas are so critical to the function and development of the child and we
are putting those at risk.”
Lo
said he had treated young adults who had suffered disc prolapses following
spinal manipulations performed by chiropractors. He said some of his colleagues
had treated patients who had experienced strokes following spinal manipulation.
Lo
will raise his concerns about the new guidelines for chiropractors at an
upcoming meeting with Safer Care Victoria.
Doctors
have been at war with chiropractors over the treatment of babies and children
for more than a decade.
In
2013, The Age reported on the disputed case of a Melbourne
paediatrician who claims he treated a four-month-old baby after one of her vertebrae was fractured
during a chiropractic treatment for torticollis, which causes the neck to twist
to one side.
And
in 2016, the RACGP urged its members to never refer patients to chiropractors
after a YouTube video emerged showing a
Melbourne chiropractor flexing a newborn baby’s back before pressing firmly on
her spine to produce a cracking sound. The movement, which was meant to treat
colic and reflux, caused the baby to cry.
A
spokesman for the Chiropractic Board of Australia said its updated policy would
ensure safe and appropriate care by chiropractors who treat children under 12.
He said this guidance was based on current evidence and information.
When
asked why Safer Care Victoria’s key recommendation – that spinal manipulation
not be performed on children under 12 – had not been incorporated into the new
policy, he said the board had considered the review’s common themes. He said
these included “best practice and evidence-based care, proper informed consent,
practice within the chiropractor’s skill”.
AHPRA
has received 335 notifications about chiropractors since 2021, with five of
these relating to child patients. A total of 96 notifications resulted in
regulatory action, such as cautioning a practitioner, imposing conditions on
their registration or accepting an undertaking from a practitioner.
A
Safer Care Victoria review identified very little evidence of patient harm
occurring in Australia, but noted “it was clear that spinal manipulation in
children is not wholly without risk”.
“We respect every parent’s right to choose appropriate healthcare options for
their child – when weighing up treatment options, you need to consider any risk
associated with that care against any potential benefits,” a Safer Care
Victoria spokeswoman said.
The
Australian Chiropractors Association said the review found that chiropractic
care for children was extremely safe. It said that in more than 29,000 online
submissions, there were no reports of harm to a child receiving chiropractic
care.
“Chiropractors
are registered professionals, completing a rigorous five-year university
degree-level course, equipping them with the expertise to appropriately tailor
their care to children of all ages,” a spokesman said.
The
association welcomed the board’s updated statement on paediatric care.
My view is that consenting adults
can do what they like with their bodies but they should not impose non evidence
based interventions on their progeny! It follows therefore that chiropractors should
stay away for all under 18 IMVHO!
This view is confirmed when we read
this saga:
Call for age limit after chiropractor breaks baby's neck
By Julia Medew and
Amy Corderoy
A
baby's neck has been broken by a chiropractor in an incident doctors say shows
the profession should stop treating children.
The injury was reported to the Chiropractic Board of Australia, which closed
the case without reporting it to the public and allowed the chiropractor to
keep practising as long as they undertook education with an ''expert in the
field of paediatric chiropractic".
The Sun-Herald has also seen evidence that chiropractors have been entering Sydney hospitals, including neo-natal intensive care wards and surgical wards, to treat patients without the required permission.
NSW Health has warned that any chiropractor working in a hospital without permission could put patients at risk, while the Australian Medical Association NSW says the behaviour is "outrageous".
Melbourne paediatrician Chris Pappas cared for a four-month-old baby last year after one of her vertebrae was fractured during a chiropractic treatment for torticollis - an abnormal neck position that is usually harmless. He said the infant was lucky to make a full recovery.
''Another few millimetres and there would have been a devastating spinal cord injury and the baby would have either died or had severe neurological impairment with quadriplegia,'' he said.
Dr Pappas complained to the Australian Health Practitioner Regulation Agency, which referred the case to the Chiropractic Board. Three weeks ago, he received a letter from AHPRA saying the case had been closed after the chiropractor committed to completing further education.
Dr Pappas said he was concerned the decision was an endorsement of chiropractic treatment for infants when there was no scientific evidence to support it.
''I think they have put the chiropractor's interests before the interests of the public,'' Dr Pappas said. ''[Treating infants] is inappropriate and it carries a very small but real risk of causing damage, and in some cases, devastating damage.''
A review published in the Pediatrics
journal in 2007 also found serious adverse events relating to spinal
manipulations in children, including a brain haemorrhage and paraplegia.
However, the president of the Chiropractors' Association of Australia,
Laurie Tassell, says chiropractic treatment is as safe for children as it is
for adults, and chiropractors should be able to treat patients in hospital, if
authorised.
"Chiropractic care can be remarkably gentle," he said. "Being
a five-year, university-trained spinal health expert, a chiropractor will
modify their adjustment techniques to suit the age and spine of each individual
child."
President of the Australian Medical Association Steve Hambleton said the
board needed to either produce evidence supporting chiropractic treatments for
children or rule out paediatric care. ''The AMA is not aware of any evidence
that chiropractic manipulative treatment of infants and children offers any
benefit at all,'' he said.
The Sun-Herald has seen Facebook
conversations in which chiropractors discuss methods of sneaking into
hospitals. Images, obtained by blogger Reasonable Hank, include one of a baby
being adjusted in a hospital.
AMA NSW head Brian Owler said it was "absolutely outrageous" for
chiropractors to treat patients in hospital without permission. "None of
us can go into an emergency department of a hospital and start treating
patients without proper credentials and medico-legal coverage," he said.
A spokeswoman for NSW Health said treating patients without notifying the
hospital may be improper conduct and it could be reported to the Health Care
Complaints Commission.
Chiropractors
have once again been banned from manipulating babies’ spines after a health
board reversed its controversial decision to allow the practice.
The about-face by the Chiropractic Board of Australia follows revelations in this masthead that
practitioners had quietly given themselves approval to resume spinal
manipulation of children younger than two from November after a four-year ban.
Does Australia Need To Develop Nuclear Power Capabilities And Nuclear
Reactors As The Coalition Is Claiming?
Yes16 (62 %)
No10 (38 %)
I Have No Idea0 (0%)
Total No. Of Votes: 26
A fairly clear cut vote but
seemingly of little interest considering the vote count! Seems a majority of people who read here are keen on nuclear reactor development. I am sure many would like a comment from the nuclear proponents explaining their thinking on this topic!
Any insights on the poll are
welcome, as a comment, as usual!
A poor voting turnout.
0 of 26 who answered the poll
admitted to not being sure about the answer to the question!
