Media Conference - Dr Kerryn Phelps, AMA President - Launch of AMA/ACOSH National Tobacco Scoreboard 2002

We find that the biggest issue we have currently is the environmental tobacco smoke and people in the hospitality industry having greater exposure to environmental tobacco smoke and the harm that actually causes them. So we have still got a lot of work to do. I encourage all the other states to take courage from what has happened here. We were doing some work last year and we've jumped ahead. I urge you to do the same. It is important that we get this message across the whole of Australia. We've got a good record and we've got to get it better. Thank you.

DR PHELPS: I'll now run through the scores on the scoreboard. Tasmania has come second with 49 points. There was a tie for third between Western Australia and New South Wales, both on 48 points. South Australia was fifth with 46 points. The ACT is sixth on 38 points. Queensland was seventh on 36 points. This year's Dirty Ashtray award, we believe for the fourth successive year, goes to the Northern Territory, with 31 points. However, we do wish to point out that the Northern Territory has also been recognised with the most promising award this year because of the range of impressive legislative proposals it has in the pipeline. The judges have said if these proposals come into effect, the Northern Territory may well be at the top of the scoreboard next year. I would like to call forward the AMA Northern Territory Branch President, Dr Paul Bauert, to accept the dirty ashtray.

DR BAUERT: I give up. Four years in a row. It gives me no pleasure to accept this. I'm sure our new Health Minister is going to be as equally devastated as I am. There has been a big consultative process going on in the Northern Territory. There have been 160 submissions for new legislation, which really should leapfrog us to the top of the pack. Only one of those has been against the proposed legislative changes. We hope that they will be introduced at the new sittings of Parliament and that they can have this back. Thank you.

DR PHELPS: Thank you, everyone. Do we have any general questions?

QUESTION: Dr Phelps, we have a question about the medical indemnity issue. Are you satisfied now that the NSW Supreme Court has rubber-stamped the letter of comfort that the indemnity issue is now resolved.

DR PHELPS: The indemnity issue is far from resolved. We are very pleased that the court has shown commonsense in agreeing to the letter of comfort between the UMP liquidator and the government. That provides some short-term security for doctors to continue to be able to provide services to their patients, but only until 30 June. It does not have anything to do with claims from prior to 29 April or what happens after 30 June. We hit another brick wall early next week when we find out whether the UMP liquidator is comfortable to be sending out notices of renewal. If those notices of renewal won't go out, we will have progressively thousands of doctors who are unable to renew their insurance with UMP who will have to try to find alternative cover elsewhere. Some of them may not be able to find that cover at an affordable rate and we'll once again face a workforce crisis.

QUESTION: What's the vibe with how you see the government acting with regard to the letter of renewal sent out by UMP?

DR PHELPS: We're not happy to go on vibes. What we really need is a clear indication of the direction of the government on this. It must come from the Prime Minister. We have a range of different portfolios, all of whom are trying to work on this behind the scenes. What we are lacking at this stage is leadership from the top. We need to see the Prime Minister, who is now back in the country, give us a clear indication of exactly where the government is heading on medical indemnity. We need a comprehensive solution. It doesn't just depend on the Federal Government. It also depends on every one of the states coming on board and making sure that they too put in place tort law reforms in a coordinated way and work with the Federal Government so that we get a solution right around the nation.

QUESTION:: What does this mean for the security of patients?

DR PHELPS: Patients have short-term security for most of their health services at the moment. It may be a different matter next week. Our concern is not only for the doctors who are under threat but for the patients whose services are under threat. They will at the moment be finding it is more difficult to find an obstetrician who will deliver their baby. It may well become very difficult for them to find a neurosurgeon to operate on their brain tumour or their spinal problem, and so it will go through the other procedural specialties. Rural medicine is under severe threat. We know that there are a number of rural centres around New South Wales at the moment and in Queensland who have limited services because of this crisis. We have not heard whether they are prepared to re-open those services early next week.

QUESTION: You mentioned the other day that you were giving the government 24 hours before doctors would close their doors. Are you saying that that threat has eased or that it's just as real?

DR PHELPS: I think the threat has eased for the moment. But it is a short-lived reprieve. We will have to get some indications from the government within days of what their long-term strategy is. We do not need to see every little fine detail, but we need to see an indication of the direction the government is travelling so that doctors can have the confidence to continue working.

QUESTION: Surely you've been discussing that with the governments over the last few days. With the court case decision last night, there was no indication at all that they were heading in that direction?

DR PHELPS: I think they have been quite consumed with the short-term issue at the moment. We need answers not only on the short-term issues but also on the medium and long-range issues. We need a statement of commitment about things like tort law reform in the states. We need a commitment about things like a long-term care and rehabilitation scheme which is nationally coordinated for the severely disabled. These are elements of a jigsaw puzzle which must all come together if we are to get a solution to this issue.

QUESTION: Do we have the capacity to extend the guarantee?

DR PHELPS: I think it is inevitable that the guarantee will have to be extended. It is one of the indications we would like to see from the government - whether they are prepared, in the event that UMP cannot solve this issue by 30 June, to extend the guarantee and what form that guarantee might take.

QUESTION: What is your understanding, or at least impression, of their preparedness to do that?

DR PHELPS: My understanding is that the Prime Minister has given this issue a very high priority. He has the heads of five government departments working closely together on this. It is a very complex issue, and I think it is important that we do not underestimate the complexity of the issue. It is similarly very important that government doesn't underestimate the seriousness of the threat if we don't get this right. Similarly, it is important to point out that this is probably the greatest opportunity that we will ever have to get this right and to make sure that we can plan our health services into the future with confidence.

QUESTION: What was your view to the reaction of the judge. He seemed clearly unimpressed with the pressures.

DR PHELPS: I think the judge came out with a solution that was common sense and reflected the urgency of the situation. If he had to be pressed to come to that conclusion in a timely fashion, that is the way it had to be.

QUESTION: What is the likelihood of the Prime Minister coming here. Have you had any response at all from his office?

DR PHELPS: I haven't spoken to my CEO in the last hour or two, but I believe not.

QUESTION: In the past, the Prime Minister has ruled out extending the guarantee beyond 30 June. Do you think there is other ammunition? Is there no other option?

DR PHELPS: I don't like to speak of ammunition. This is not a war. This is a serious crisis situation that we are trying to solve in a measured and careful way. I think the government is beginning to understand the seriousness of the situation. This is not a threat by doctors; it is a threat to doctors and it is a threat to our health services. We are trying to preserve health services for our patients. We have to do that in a way that doctors can feel confident and secure that they are able to provide services. If something goes wrong for their patients, we want to know that a system is in place to take care of those patients.

QUESTION: Are you also concerned about the doctors who miss out on claims prior to 29 April?

DR PHELPS: We are very worried about the tail. The tail is probably one of the greatest concerns for doctors, because we need to see some government guarantees around that issue. At this stage, we have received no indications whatsoever about what might happen to the tail. Come June 30, if UMP is not able to continue, the tail becomes a very significant issue.

QUESTION: On euthanasia, there is a report today that Mrs Crick may not have had cancer. Are you aware of that, and what is your response?

DR PHELPS: Yes, we are. Dr Mudge is Chairman of our Ethics Committee at the AMA, and he will take that question.

DR MUDGE: I recall reports in the paper, but we have no other details about this. I am not sure to what extent it would be responsible to comment until we are a bit more certain of the medical facts. On the face of what we have been seeing, I think that what we have here is exposure of one of the flaws in the pro-euthanasia argument. If we have here a woman who has taken her own life in the perhaps mistaken belief that she was terminally ill with cancer, and she was subsequently found not to be, then you have to look at the quality of the advice she is being offered. It clearly makes the point that licensing the death of an individual, no matter what the motives, in a human environment is always going to be fraught with danger.

QUESTION: Could it also mean a failure in the duty of care?

DR MUDGE: Medical services involve a complex relationship between patient and doctor. I understand that in this particular case there have been some complexities in that relationship. It would not be proper for me to comment any further. I am not in possession of the facts.

QUESTION: The issue of the actual condition was that she was in pain. She felt she was in excessive pain. Does it matter what the diagnosis was?

DR MUDGE: In one sense, if Mrs Crick decided to take her own life, that is a decision that she is entitled to make. What the law says she is not entitled to do is involve others in that decision making. Therein lies the risk.

QUESTION: Do you think this new information that has come in about the Crick case changes the lobbying of the pro-euthanasia issue?

DR MUDGE: I do not think we should be using the unfortunate death of an individual in pain to make a case for or against in what is really a very complex argument, which we will be debating at length tomorrow. It is a terribly sad coincidence of events that this death and this controversy should be so close to it. I really wouldn't, as I said, especially without full possession of the facts. I don't think it's responsible for either side in this argument to use this unfortunate woman's situation.

QUESTION: Apart from the fact that many doctors do make life and death decisions for their patients, do you think the high profile of this issue will help lead to a resolution of it, given that doctors do take a position on it?

DR MUDGE: I think in the complexity of this argument there are many false statements made by people on both sides of the debate. As I said, now really is not the time to be using people's lives as pawns in the debate, in my view.

DR PHELPS: Are there any other questions?

QUESTION: Dr Phelps, are you going to win?

DR PHELPS: The vote will decide that tomorrow. The winner will win tomorrow. I'd love to leap out of the chair and give you an answer, but I think it is important that the democratic process takes its course. Thank you.

ENDS

CONTACT: John Flannery (0419) 494 761

Sarah Crichton (0419) 440 076