This article is from the source 'guardian' and was first published or seen on . It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at http://www.theguardian.com/world/2013/dec/23/christmas-island-patients-endangered-by-it-flaws-and-drug-shortages

The article has changed 2 times. There is an RSS feed of changes available.

Version 0 Version 1
Christmas Island: patients endangered by IT flaws and drug shortages Christmas Island: patients endangered by IT flaws and drug shortages
(35 minutes later)
Asylum seekers in detention on Christmas Island are often dangerously misdiagnosed due to a complicated and inadequate IT system, and can regularly go without basic medicine including paracetamol due to frequent shortages, according to the letter signed by 15 doctors who have practised on Christmas Island.Asylum seekers in detention on Christmas Island are often dangerously misdiagnosed due to a complicated and inadequate IT system, and can regularly go without basic medicine including paracetamol due to frequent shortages, according to the letter signed by 15 doctors who have practised on Christmas Island.
According to the doctors, the IT problems have led to an HIV-positive patient being lost in the system.According to the doctors, the IT problems have led to an HIV-positive patient being lost in the system.
The letter, obtained exclusively by Guardian Australia, provides a forensic description of the detention centre’s health information system, describing it as “complex, time consuming and error prone”, which often results in pathology requests, test specimens, and results being lost, prescriptions and diagnosis dispensed in an “unsafe” manner, with doctors required to “learn on the job” as they navigate the system.The letter, obtained exclusively by Guardian Australia, provides a forensic description of the detention centre’s health information system, describing it as “complex, time consuming and error prone”, which often results in pathology requests, test specimens, and results being lost, prescriptions and diagnosis dispensed in an “unsafe” manner, with doctors required to “learn on the job” as they navigate the system.
The letter states “the errors within IHMS’ medication processes are manifold, represent significant risk to patients and likely to constitute medical negligence”.The letter states “the errors within IHMS’ medication processes are manifold, represent significant risk to patients and likely to constitute medical negligence”.
The letter says that as of the end of October the IT system, named Chiron 2, makes requests for medical transfer “prohibitively” difficult and involves 12 time-consuming steps. As doctors receive no formal training, the letter says, the system makes errors highly likely.The letter says that as of the end of October the IT system, named Chiron 2, makes requests for medical transfer “prohibitively” difficult and involves 12 time-consuming steps. As doctors receive no formal training, the letter says, the system makes errors highly likely.
The letter gives the example of one patient who returned a positive HIV test but whose records did not match the name and boat ID it was attached to on the IT system. Doctors were therefore unable to locate who the patient was.The letter gives the example of one patient who returned a positive HIV test but whose records did not match the name and boat ID it was attached to on the IT system. Doctors were therefore unable to locate who the patient was.
“This leave the possibility of an unidentified HIV-positive patient that has not been appropriately referred for specialist input,” the letter says.“This leave the possibility of an unidentified HIV-positive patient that has not been appropriately referred for specialist input,” the letter says.
According to the letter, Chiron 2 has multiple design flaws. It does not allow doctors enough space to adequately describe a patient’s diagnosis and instead operates on a “drop down box system”. The system does not allow for changes to diagnosis, meaning doctors have to add to a “warning box”.According to the letter, Chiron 2 has multiple design flaws. It does not allow doctors enough space to adequately describe a patient’s diagnosis and instead operates on a “drop down box system”. The system does not allow for changes to diagnosis, meaning doctors have to add to a “warning box”.
The letter also describes serious flaws in the medication prescription process. Patients have both a paper and electronic prescription record which often do not correspond to one another.The letter also describes serious flaws in the medication prescription process. Patients have both a paper and electronic prescription record which often do not correspond to one another.
For example, the letter says, if a course of medication has been cancelled by a doctor it can continue to be administered, because it is “rarely” cancelled on both records. In addition, if changes to medications are made on the paper chart they are “lost to and invisible from the electronic chart”.For example, the letter says, if a course of medication has been cancelled by a doctor it can continue to be administered, because it is “rarely” cancelled on both records. In addition, if changes to medications are made on the paper chart they are “lost to and invisible from the electronic chart”.
Further, the letter adds: “When medications are changed on Chiron a new paper copy is printed, resulting in the old medication chart being removed from the patient’s dispensing folder. This chart is usually lost and means there is no way to check the dispensing history. It is infrequently scanned to Chiron.”Further, the letter adds: “When medications are changed on Chiron a new paper copy is printed, resulting in the old medication chart being removed from the patient’s dispensing folder. This chart is usually lost and means there is no way to check the dispensing history. It is infrequently scanned to Chiron.”
Alarmingly, the letter says, the system of actually prescribing medication is “dangerous”.Alarmingly, the letter says, the system of actually prescribing medication is “dangerous”.
Whilst the electronic copy of a prescription carries the dosage instructions, the paper copy, which is used for actually dispensing the medication, does not. Further, the “strength” field of the prescription is carried only electronically. The letter says this “can result in inadvertent overdose, for example in the case of antibiotic syrups of varying strengths being prescribed only in ‘mls’.”Whilst the electronic copy of a prescription carries the dosage instructions, the paper copy, which is used for actually dispensing the medication, does not. Further, the “strength” field of the prescription is carried only electronically. The letter says this “can result in inadvertent overdose, for example in the case of antibiotic syrups of varying strengths being prescribed only in ‘mls’.”
As Guardian Australia has previously reported, the letter says all asylum seekers who arrive by boat to Christmas Island have their essential medication and medical records discarded on arrival without being recorded by doctors. The letter also says asylum seekers can spend hours queuing for each dose of their medication every day, because they are not allowed to self-administer.As Guardian Australia has previously reported, the letter says all asylum seekers who arrive by boat to Christmas Island have their essential medication and medical records discarded on arrival without being recorded by doctors. The letter also says asylum seekers can spend hours queuing for each dose of their medication every day, because they are not allowed to self-administer.
Guardian Australia has been told of the case of a 30-year-old woman with severe intellectual disabilities who arrived on Christmas Island in late July. Advocates representing the woman say her medication including sodium valproate, which is used to treat epilepsy, were confiscated on arrival and have not been replaced.Guardian Australia has been told of the case of a 30-year-old woman with severe intellectual disabilities who arrived on Christmas Island in late July. Advocates representing the woman say her medication including sodium valproate, which is used to treat epilepsy, were confiscated on arrival and have not been replaced.
The woman was moved to to Perth Immigration Detention Centre (PIDC) after her state severely declined. She was separated from her mother and is currently in Perth with her father.The woman was moved to to Perth Immigration Detention Centre (PIDC) after her state severely declined. She was separated from her mother and is currently in Perth with her father.
Victoria Martin-Iverson of the Refugee Rights Action Network told Guardian Australia the woman has a mental age of about five. Martin-Iverson said she is calling: “I want my mummy, I want my mummy” and has been lifting her clothing and exposing herself to other detainees.Victoria Martin-Iverson of the Refugee Rights Action Network told Guardian Australia the woman has a mental age of about five. Martin-Iverson said she is calling: “I want my mummy, I want my mummy” and has been lifting her clothing and exposing herself to other detainees.
The immigration minister, Scott Morrison, issued a statement on Friday to say the woman would be moved to community detention within a fortnight.
The letter says many of the criticisms of the prescribing process were raised “at least two years ago and none have been resolved”.The letter says many of the criticisms of the prescribing process were raised “at least two years ago and none have been resolved”.
The letter also criticizes the “culture” of identifying patients by their boat ID. It describes it as “both dehumanising and degrading” whilst acknowledging that photo identification badges, which have been introduced, have helped.The letter also criticizes the “culture” of identifying patients by their boat ID. It describes it as “both dehumanising and degrading” whilst acknowledging that photo identification badges, which have been introduced, have helped.
“There is an example of a Muslim asylum seeker that has drawn a Jewish star of David onto his shirt with his identification number written underneath it,” the letter says.“There is an example of a Muslim asylum seeker that has drawn a Jewish star of David onto his shirt with his identification number written underneath it,” the letter says.
The letter also says basic medicine and equipment is regularly lacking on Christmas Island. Equipment as fundamental as scalpels, needles, syringes, IV fluids and lines have “frequently been unavailable when required by staff during busy clinics”, the letter says.The letter also says basic medicine and equipment is regularly lacking on Christmas Island. Equipment as fundamental as scalpels, needles, syringes, IV fluids and lines have “frequently been unavailable when required by staff during busy clinics”, the letter says.
It adds that supplies of basic medicine such as paracetamol, cephalexin, and Bicilliin are frequently exhausted.It adds that supplies of basic medicine such as paracetamol, cephalexin, and Bicilliin are frequently exhausted.
In particular, the letter says medical facilities in Aqua and Lilac camps are poorly equipped.In particular, the letter says medical facilities in Aqua and Lilac camps are poorly equipped.
“The clinic at Aqua has only one room where a medical officer can see a patient. This limits the ability to see patients and contributes to the difficulty in meeting the demand in that compound. The Lilac facility has no bed and no computer,” the letter says.“The clinic at Aqua has only one room where a medical officer can see a patient. This limits the ability to see patients and contributes to the difficulty in meeting the demand in that compound. The Lilac facility has no bed and no computer,” the letter says.
The letter says a new IT system named Apollo was being introduced. Guardian Australia asked IHMS to respond to the specific allegations in the letter relating to the medication processes and lack of resources on the island, as well as when the new IT system, Apollo, would be introduced.The letter says a new IT system named Apollo was being introduced. Guardian Australia asked IHMS to respond to the specific allegations in the letter relating to the medication processes and lack of resources on the island, as well as when the new IT system, Apollo, would be introduced.
IHMS said it remained in “frequent discussion with the signatories of the letter, and with the Department of Immigration and Border Protection about the matters raised”.IHMS said it remained in “frequent discussion with the signatories of the letter, and with the Department of Immigration and Border Protection about the matters raised”.
The statement continued: “These discussions are in confidence and with the shared objective of ensuring appropriate care of people in immigration detention. IHMS will not provide any further comment on these matters.”The statement continued: “These discussions are in confidence and with the shared objective of ensuring appropriate care of people in immigration detention. IHMS will not provide any further comment on these matters.”
Previously, IHMS told Guardian Australia the letter’s principal author was Dr Jean-Paul Sanggaran. IHMS said Dr Sanggaran was employed on Christmas Island in September and October 2013. "This was during a period of high intensity, with an unprecedented number of arrivals and an increased number of people presenting with a range of significant, complex medical conditions."Previously, IHMS told Guardian Australia the letter’s principal author was Dr Jean-Paul Sanggaran. IHMS said Dr Sanggaran was employed on Christmas Island in September and October 2013. "This was during a period of high intensity, with an unprecedented number of arrivals and an increased number of people presenting with a range of significant, complex medical conditions."
In October 2013, 339 asylum seekers arrived by boat. In July, the month of highest arrivals in 2013, 4,236 asylum seekers arrived in Australia by boat.In October 2013, 339 asylum seekers arrived by boat. In July, the month of highest arrivals in 2013, 4,236 asylum seekers arrived in Australia by boat.
Our editors' picks for the day's top news and commentary delivered to your inbox each morning.Our editors' picks for the day's top news and commentary delivered to your inbox each morning.