17 October 1998
Certification and Approval Services
Aged and Community Care Division
Commonwealth Department of Health and Family Services
P O Box 9848
Dear Mr xxxxxxx,
Licences for pathology laboratories and aged care facilities.
Sun Healthcare controlled facilities.
I write to you again because I have now made contact with people who know a great deal about Sun Healthcare's operations in the USA and because the information is so disturbing. I find your failure to acknowledge documents which reveal a potential threat to citizens both rude and disturbing. It indicates an unwillingness to confront important issues. At issue is the suitability of a nursing home company which is for practical purposes controlled by a group which on the available evidence must be assumed to have neglected, misused and abused its charges for profit.. It has indicated its intention to supply nursing home care in Australia.
Nursing Homes:- It seems that there is a US wide outcry about appalling standards of care in for profit nursing homes -- neglect, abuse, starvation, malnutrition, infections, bed sores, filth, unwashed faecal soiling and needless deaths. Sun Healthcare is central to the concerns which started in California when community groups learned what was happening. Such things can all be laid at the door of under and unskilled staffing. One cannot but be reminded of Turner's statement in 1996 that there was so much "fat in the system". His intention to cut staff and costs in order to generate profits was clear. This is the consequence.
Betrayal:- The exposures in California led to a hearing before the congressional committee into aged care and a damning report titled "Betrayal: the Quality of Care in California Nursing Homes". The press reports of abuse, neglect and misuse which I have enclosed confirm the hearings belief that the problems are US wide and that Sun is a key player.
Hospitals closed - court actions:- I have enclosed with this letter only those press clippings addressing Sun Healthcare. Sun's hospitals have been closed by regulators for failing to maintain safe standards. There are now Qui Tam court proceedings against Sun by citizens groups in California. These allege widespread neglect and needless deaths in nursing homes. To support their case vast numbers of death certificates were studied with disturbing findings indicating that many died needlessly from neglect.
Qui Tam:- In the USA citizens may prosecute on behalf of the state if the issues are systemic and many have suffered. These are called Qui Tam actions. This is one of the ways in which citizens can act to protect others. If a conviction is obtained then they are rewarded. This encourages whistle blowing and social responsibility.
I hope to obtain much more information shortly. From what I have heard I believe that it would be unthinkable to allow these people to care for aged Australians.
Note that nurses have once again come out on strike in Massachusetts because of Sun's unwillingness to resolve issues of staffing and standards.
Unconfirmed matters:- I have heard two other matters of concern but I have not yet verified their accuracy. I indicate their nature as federal departments will have better resources to investigate.
2. I learn from US sources that Sun's pharmaceutical subsidiary Sunscript is operating in Australia - presumably after receiving FIRB approval. An informant has indicated to me that Sunscript paid the US government US $130 million to settle some matters relating to medicare billing.. I did not see this in their US Securities and Exchange (SEC) reports so my informant may be misinformed. I am following it up and will let you know. If true then it is disturbing to think that they will be well positioned to squeeze as much as they can from Australian medicare payments. Is our policing adequate? I am worried that Sun will be operating in two areas which have provided fertile opportunities for fraudulently fleecing the system, pharmacy and pathology.
I expect to learn if there is substance to these matters and receive more documents shortly. I trust that your department will not rush into making decisions which will cause Australian elderly the sort of suffering described in the USA.
Vulnerability:- Families are not medical wise and feel powerless. They trust the homes to provide decent care. Note that some of those patients whose relatives acted to protect them, by securing proper medical treatment for their bed sores, malnutrition and dehydration then moving them elsewhere have survived for years and have remained sufficiently mentally alert to describe their experiences. This is neglect.
Neglect and deceit:- The elderly can certainly become dehydrated and waste away as they are kindly helped to die in comfort. This is not what happened here. The homes have hidden the consequences from families who are not constantly monitoring. One daughter with no medical experience had not thought it appropriate to pull down the bedclothes and examine her rapidly ailing mother who was being looked after by the nurses - but when her mother complained of pain she did so and found a massive pressure sore covered in old faeces. She acted. Her mother recovered and survived.
Staffing:- Note the comment by those who investigated that one of the main causes was "refusal to staff facilities at levels to insure adequate care." Compare this with the assessments I made, not only about Sun in my submissions but about staffing failures and their consequences when writing about Tenet/NME, GSI and Columbia/HCA. Note the failure to comply with the regulations supposed to set standards and the failure of authorities to enforce the requirements. In complex areas like this there are always rationalisations which can be used. Justifications can be developed to explain. Legally the hospitals have to be given the benefit of the doubt. It is not that regulating agents on the ground don't try. It is the impossibility and impotence of their situations. The system simply cannot work.
Profit and being human:- I have repeatedly maintained that the drive for profit in integrated corporate systems severely compromises care particularly the human side - time, patience, kindness, empathy, comfort. In addition to staffing the one eyed emphasis on objectively documented efficiency and consumer political correctness in patient/carer relationships impact on care. Together with the alienation caused by currently popular management techniques, all intrude adversely into the human side of care. These deficiencies go to the heart of the humanness of our society. They are experienced subjectively and are not easy to quantify. In the care of the aged and the mentally impaired compassionate relationships are the essence. The consequences are revealed here. I really have become weary from having to say "but I told you so"!
Yours sincerely, J Michael Wynne
I attach a number of documents to illuminate these matters
B. Material Received in digital form.
2. Introductory article - a damning overview exposure in TIME called "Fatal Neglect".
3. WEB SITES - Citizens aware of what is happening have opened web sites to inform citizens and gather information. I have included the text from pages on representative sites.
4. Press Clippings/documents - problems in Sun's nursing homes, not only in California but across the USA
5. Action by the nursing unions
6. The nature of Sun Healthcare and its chairman. Articles which are revealing of the way the corporation and its founder behave and think.
7.` Corporate matters. Information about the company, its operations and its finances.
8. State and federal court actions - recent press report.
9. Regulation and control. The way in which more regulation is advocated in the face of repeated failure.
11. The financial perspective - an article by health care financiers which is revealing of the way in which such people thing and the paradigms they use.
The comments and criticisms reflect my
opinions about the material and are intended to highlight the issues.
Make up your own minds.
Almost identical letter sent to
Health Insurance Commission
P O Box 1001