Health Services in Public Hospitals - Radio Interview Transcript

My pleasure to welcome President of the AMA, Dr Mukesh Haikerwal. Good morning.

MUKESH HAIKERWAL: Good morning Leon, how are you?

COMPERE: Obviously, there can be a conflict between religious beliefs and medical practices but surely this is a conflict which has already been addressed and dealt with over the years, hasn't it?

MUKESH HAIKERWAL: Well, in general terms, that's right. These comments were made yesterday around any person contracting the hospital services needing to provide a full set of services if they're doing those in the public hospital system. If they can't and they receive a contract, they need to be up front about that, and people need to be aware that they may need to find other sorts of treatment outside of that setting.

I suppose that was the long and the short of what was being said. It's important to have access to services that they require and that they have access close by and, obviously, there's no question about the very important role of any of the church organisations in the hospital services of the whole country.

COMPERE: It's become quite a complicated and confusing set of circumstances, hasn't it? Because nowadays there's not only private hospitals which may be run by the Catholic Church or another church, but there's also the practice of public hospitals having their management contracted out to private bodies such as churches. It's getting very confusing, isn't it?

MUKESH HAIKERWAL: It is certainly confusing with the number of different people running both the public hospital system now, as well as who have obviously run the private hospital system in the past. And, of course, there have been many acquisitions and changes in ownership over recent times, so it's often difficult to know just who's actually running your local private hospital, or, indeed, your local state hospital.

So, when people attend the front door of their public hospital they expect a whole range of services that are right for them, that they would expect anywhere in the country. If those services aren't available, and that's because of the contracting agreement or arrangement, that needs to be something that's upfront, so people understand that. And if the hospital can't provide certain services - whether it's IVF services or sterilisation or whatever - they need to be able to provide an alternative setting for someone to go and have those treatments performed.

COMPERE: Of particular concern this week was the idea that rape victims would be denied access to the so-called morning after pill. That seems to be a fairly extreme reaction but it's one that's divided opinions somewhat, hasn't it?

MUKESH HAIKERWAL: Well, that's right. What happens is that these stories come out and then they get blown up out of proportion in many degrees. Of course it's important if someone has suffered at the hands of, and has been raped or whatever, they need proper, urgent treatment for their physical condition and mental condition and so on. And if there is ongoing treatment required, and they need to have a full choice of whatever those treatments are, if the hospital concerned won't or can't provide services such as contraceptive pills, then they need to say these services are available but we can't provide them. There are other places you might want to try.

And that's the ongoing thing, not simply saying no, and that's it. It's no, but here's an alternative. I think that's really where the argument needs to sit and I think that's probably what happens but, of course, the second part gets left out.

You know, the services provided by all of our church groups and the hospitals that they run are first rate.

COMPERE: The thing is becoming increasingly complicated. though, when we also consider that the Health Minister is quite well known as being a devout practising Catholic and many people have considered that his decisions have been coloured by his religious beliefs and some people are not very happy about that either. In particular with relation to the pregnancy counselling that's been in the news lately. The whole thing is quite a minefield, isn't it?

MUKESH HAIKERWAL: It is a minefield and, you know, as an organisation we have to be very careful how we deal with this because, obviously, we represent a vast range of people who have a variety of backgrounds and the patients that we see also come from a vast variety of backgrounds. And we think that people should get access to services that they need and require.

I actually think that Tony Abbott's been a very good Health Minister and good on him for sticking to his beliefs and being quite up front about it. And he's actually approached the whole political process with all the controversial decisions and gone through the Parliament and had a discussion there, which is where the discussion should happen, and then abiding by the decision.

I don't think he's particularly coloured the argument because of his religious belief but he's been strong about it and told people what his opinions are, which I think is to be commended - that somebody's actually taken a strong belief into Parliament and come through with it.

But at the end of the day the Parliamentary process is what's run out the victor … and the democratic system. I think that's going to … people need to be convinced both ways. If somebody wants to be convinced one way, then they should be prepared to be convinced the other way if the argument can be made.

COMPERE: With the prospect, though, of church controlled hospitals not, for example, referring rape victims to rape counselling for fear that they'll be given the morning after pill, does that mean that, really, governments ought to, at the very least, place regulatory requirements upon any organisation which is given a contract to manage a hospital?

MUKESH HAIKERWAL: I think the list of services that are there - the comprehensive list of services - needs to be spelt out before the service goes out to tender. Obviously a public hospital can't manage it from within the health system, the state health system….and that's the question. Why is that happening anyway? They should be able to manage it but if they can't and they want an outside tenderer to do it, but the tenderer should be able to provide all those services. If they can't, the point I made is perhaps they ought to consider twice whether they want to tender at all, or not. If they do tender and they are successful and there are things that they are not prepared to do, then again they need to be up front about that. When the public walks through the front door, they don't know who runs it or what they do and don't do for their beliefs.

COMPERE: Well, they would need to be up front about that with the tender process, wouldn't they? So that the Government knows what it's actually paying for.

MUKESH HAIKERWAL: Sure, but even when the tender's gone through, and say an organisation's won it and won't do certain things, patients don't know that and they need to know that at the time they enter the emergency department or whatever so they can then be provided with alternative sources should they require them. So the hospital doesn't sort of wash its hands of the situation. It says, here's the next step. And that's an individual thing for the individual practitioner too. They have that dilemma that they may say, look, I don't prescribe the pill but if you want that you may see the alternative person down the road.

These things happen all the time. We respect people's views and their rights to hold those views but the patients of Australia need the choice, they need to have access, and they need to have that access close by and the State Government providing that - and if their tenderer is not able to provide that then there needs to be an alternative mechanism in place.

COMPERE: According to the report in The Australian today, you've been accused of being anti-Catholic.

MUKESH HAIKERWAL: Look, the AMA aren't anti-anybody and, you know, this is more about being pro-patient and pro-Australians' access to health services and being aware of what service is available in the area and, you know, ensuring that they do get access to things like IVF or genetic counselling or whatever if it's not going to be provided locally.

COMPERE: Logically, and I don't know what the number is, but there would have to be a significant proportion of your organisation's members, doctors, who are also Catholics.

MUKESH HAIKERWAL: Absolutely.

COMPERE: So, how do those individuals deal with whatever perceived conflict there might be in dealing with patients who want to be prescribed, for example, contraceptive or sterilisation processes or any of these other contentious treatments?

MUKESH HAIKERWAL: Well, it's a very common dilemma that people face and they need to talk to patients straight up and say, you've asked for the pill, for argument's sake, I'm not able to prescribe that because of my beliefs. Here is someone else that can help you. Perhaps you'd like to go and see them. I think that's the way that you can therefore keep your own beliefs intact.

COMPERE: Well, I know we could get bogged down in arguing semantics but if you are not prepared to prescribe it yourself but you're prepared to recommend somebody who will, aren't you still in breach of your own ethical standards?

MUKESH HAIKERWAL: Oh well, look, the patients obviously need to be looked after and that needs to be up front and first. And if a particular course of action is something that a doctor is uncomfortable with or a hospital is uncomfortable with then alternative provisions of service need to be made available to them.

COMPERE: The point, though, of course is that Catholics who are doctors are not new. They've obviously been dealing with this conflict for a very long period of time and it hasn't been any great source of discussion or controversy, has it? So, it must have been dealt with relatively effectively.

MUKESH HAIKERWAL: Well, there's always been a choice, I suppose. And I suppose what's happening is with consolidation of ownership and so on of some hospitals, and, indeed, increasing numbers of hospitals out to tender, the question becomes asked more often.

I mean, I think the people are dealing with it and, as you say, dealt with it for quite some time and dealt with it well and to have the alternative sources provided. I suppose the comments that were made and reported in the paper were very much about emphasising that people have an entitlement to good access to services close by and especially in smaller areas and in remote regions where there is not much choice. And if it can't be provided by the local doctor or the local hospital then there needs to be an alternative provision made available for them.

COMPERE: Indeed. And whilst it can be dealt with on an individual level, is it appropriate for churches and church organisations to actually be running whole hospitals where it might be more difficult to deal with the conflict?

MUKESH HAIKERWAL: Look, I think that they do deal very well with the services they do run. I think Government needs to be clear with people that are tendering for services, this is the expectation. And if the tender still goes to a provider that can't provide the whole range, well so be it. But then there needs to be a process to make sure that services that are normally expected in the course of one's life through society, the rest of society, are available to people through the public sector.

COMPERE: Dr Haikerwal, thanks very much for your time today.