Medical indemnity insurers have been advising contracted doctors that they should consider quitting because of the “medico-legal risk’’, as evidence emerges of a spike in preventable illness and deaths in the communities.

Veteran health practitioners are resigning in droves because of dangerous workloads, inadequate record-keeping of patient medical files and poor support services.

A recent survey found 80 per cent of doctors and nurses working for one of the three health providers on Cape York saw adverse events in relation to patient safety at an unacceptable level.

Health workers complain of a chaotic recall system — which is supposed to prompt and monitor follow-up treatments for patients — and poor sharing of medical files between health services.

Cape York mayors have report­ed a massive jump in deaths in recent years and scoffed at official­ records used to influence government health policy.

Dr  Wenitong, the public health chief of Apunipima, a Cairns-based service that prov­ides preventive health programs, said government death records were “completely unreliable’’.

The Australian Salaried Medic­al Officers Federation of Queensland, which represents public-sector doctors, has claimed the number of deaths across Cape York jumped fourfold between 2014 and last year.

The RFDS, contracted by the Queensland government to suppl­y GPs in Cape York, has been at war with doctors’ groups over their changes to the staffing of community clinics.

Legal advice show that medic­al-indemnity insurers have told doctors they should consider resigni­ng or changing roles because­ of the risks of continuing working under the conditions.

The legal advice is at the centre of the dispute between doctor groups and health service management, with ASMOFQ president James Finn recently warning that the RFDS had to act.

“It would be indefensible in the first instance, if an adverse patient outcome occurred as it was found that RFDSQ failed to address known medico-legal risks present at the time,’’ Dr Finn said in a letter in September.

In Kowanyama, on the western Cape, the RFDS wound back a five-day-a-week service to the 1200-strong community and now sends two doctors to the clinic from Monday afternoon to Wednesday lunch.

Records show the two doctors have been seeing more than 100 patients each day, leading to the departure of the community’s two long-serving GPs this year.

Doctor Cheryl Choong said patient safety was suffering and she quit the RFDS this year after her repeated concerns were ignored­ and she was branded an “outlier’’.

Dr Choong, who worked in Kowanyama for nearly four years, said an equivalent-sized population in regional Queensland would have twice as many doctors and nurses.

“We were drowning in work, it was overwhelming, and I was told just to suck it up,’’ she said.

In Kowanyama, official births, deaths and marriages records show that four people died last year. But official records from the local health clinic show there were 27 burials in Kowanyama that year, compared with an average of seven to 10 a year about a decade ago, with no marked population change.

It is believed the statistics are distorted because many people are treated in the community before­ being flown to Cairns, where they die and where their deaths are recorded.

The Australian has spoken to health workers across Cape York who told similar stories of having to turn away patients or of being unable to investigate possible seriou­s health issues because of the workload and poor systems.

All three services — Queensland Health, Apunipima and the Flying Doctors — have different patient medical file systems, which are not compatible.

Local Kowanyama ranger John Clark told The Australian he took his six-month-old granddaughter Sharntai to the clinic recently after she had vomited at least five times in a morning.

“We waited there for hours, but at the end of the day they said they couldn’t see her, there were so many people,’’ he said.

“It was frightening, there had been a bad flu going around and these things can go really bad, but thankfully she got better.

“A big problem now is that becaus­e most of the permanent staff have been forced out, we are being treated by a different doctor or different nurse every time, and have to go through the same questioning over and over.’’

Kowanyama Mayor Michael Yam told The Australian yesterday the health service in his community was “sick and neglected’’.

“There are too many funerals, too much sadness,’’ he said.

“We need doctors that are here every day: it is a big community and we needed the services to be delivered in a better way.

“Where is the health funding going?’’

A spokesman for Queensland Health Minister Cameron Dick issued a statement saying that it was unaware of data supporting claims of increased deaths on Cape York communities.

The statement also conceded there were problems in retaining staff and said that the government was trying to develop a system so that the health services could share information.

“The Cape and Torres HHS (Hospital and Health Service) is also working with the AMAQ, RFDSQ, Rural Doctors Association and the commonwealth-funded PHN (Primary Health Networks) to improve the sharing of clinical information across orga­nisations,’’ it said. “This work will support the development of the new electronic platform.

“Attracting and retaining qualified staff in rural and remote areas is challenging and the Cape and Torres HHS works collab­orat­ively with hospital and health services to maintain ­appropriate levels of staffing in the Cape and Torres communities.’’

Chief Health Officer’s 2016 Torres and Cape Hospital and Health Service Population Health Status Profile

Apunipima’s Response

Apunipima Cape York Health Council is an Aboriginal community controlled health organisation which provides comprehensive primary health care to 11 Cape York communities, advocates on behalf of another six and services around 7000 Aboriginal and Torres Strait Islander patients.

Primary Health Care Manager Paula Arnol said the Chief Health Officer’s findings showed the huge amount of work to be done to bring Cape York’s Aboriginal and Torres Strait Island population to achieve health parity with the rest of the state and the country.

‘Apunipima is working hard to address not only the health issues in remote communities but the social and economic ones as well.

We believe that community knows what’s needed and our role is honour and facilitate that. These statistics show how much work there is to be done but also some real successes. As community controlled health model is rolled out across Cape York we can expect to see some real changes in terms of health outcomes for our people.’

96 percent of pregnant women attended five or more antenatal visits

What Apunipima is doing

• Apunipima’s award winning health worker led home visiting Baby One Program™, which runs from pregnancy until bub is 1000 days old, engages and educates women about the value of antenatal checks
• Fruit and vegetable vouchers given away at key points during pregnancy to ensure high engagement
• Regular visits to community by maternal and child health nurses who provide antenatal care
• Local, trusted maternal and child health workers provide the link between community and maternal and child health nurses / midwives

95 percent on 5 year olds are fully immunised

What Apunipima is doing

• Apunipima’s award winning health worker led home visiting Baby One Program™, which runs from pregnancy until bub is 1000 days old, encourages and educates families to immunise their children
• The Baby One Program™ is led by trusted, community based maternal and child health workers who provide the link between families and Apunipima’s doctors, nurses and allied health staff
• Regular visits to community by Maternal and Child Health Nurses who provide the full immunisation schedule

21 percent of adults are daily smokers

What Apunipima is doing

Apunipima received a Tackling Indigenous Smoking Regional Grant as part of the National Tackling Indigenous Smoking program. Nationally, the program aims to improve the health of Aboriginal and Torres Strait Islander people through local efforts to reduce harm from tobacco.

The Apunipima Tackling Indigenous Smoking (TIS) Team is working closely with Cape York communities to deliver locally appropriate programs and activities that aim to:

• Engage community members in tobacco cessation activities
• Improve access to culturally appropriate quit support
• Encourage and support smokers to quit
• Encourage and support non-smokers to avoid uptake
• Raise awareness in communities about the health impacts of smoking and passive smoking
• Support communities to establish smoke-free homes, workplaces and public spaces

31 percent of adults are obese

What Apunipima is doing

• Piloting the Better Health Program in Napranum, a family focused healthy lifestyle program to manage and reduce overweight and obesity in children through encouraging families to eat well and become more active one along who would like to make healthy lifestyle changes.
• Leading a two year project focused on building the capacity of remote communities and councils in Cape York to implement local solutions to reduce high consumption of sugary drinks and promote water as the healthy drink of choice.
• Delivering Need for Feed cooking program with high school students at Western Cape College in Term 1 2017

Aboriginal and Torres Strait Islander Queenslanders made up 70 percent of potentially preventable hospital admissions – among the top contributors were dental and diabetes complications

Diabetes

What Apunipima is doing

• Building capacity for self-management through access to the latest technology to improve understanding of blood glucose control and its relationship to food, exercise and medications.
• Targeting prevention of diabetes through engagement with women of child bearing years to prevent gestational diabetes or achieve exceptional control if pre-existing type 2 diabetes mellitus.
• Working with Health Promotion teams as able to promote healthy lifestyles and diabetes prevention.
• Provision of diabetes risk assessments and clinical health assessments to enable early detection and management of risk factors for diabetes.
• In-depth education and case management of clients with pre-existing diabetes around complications risk and management of same to improve outcomes.
• Due to the increasing number of children and youth with type 2 diabetes mellitus in our region, engagement with partners to prevent, detect early and manage effectively this concerning new trend.
• Development of appropriate educational tools, materials and literature to improve health literacy around the understanding of diabetes self-management and inter-generational prevention to achieve best outcomes.

Dental conditions

What Apunipima is doing

Leading a two year project focused on reducing children’s exposure to sugary drinks in remote communities and promote water as the healthy drink of choice. The initiative will be a collaborative effort involving multiple agencies and service providers in Cape York working together and will see rollout of social marketing campaigns, development and implementation of community driven plans to improve the food and drink environment

80 percent of the deaths were considered premature;

68 percent of the people who died were of Aboriginal and Torres Strait Islander descent, and half of those deaths occurred in people under the age of 53.5 years compared to 64.5 years

What Apunipima is doing

• Expanding our network of community driven, community run health care centres which provide culturally appropriate primary health care, increase access and take up and positively affect local socioeconomic indicators.
• Launching the Chronic Conditions Strategy 2016-2026 which details the 10 vision and organisational approach Apunipima will take to work with Cape York communities in the prevention, treatment and management of chronic conditions. This strategy reflects current best practice, is based on research and in line with national and other state approaches.
• Launching a Position Statement on Food Security for Cape York, calling for action to improve food supply and affordability in remote communities. Food insecurity directly impacts on people’s ability to maintain adequate nutrition status to support good health. People experiencing financial difficulty are typically constrained to a poor diet which fuels an ongoing cycle of inadequate nutrition, obesity and chronic disease.

Please note that the Chief Health Officer’s report refers to entire population (25,498) of the Torres and Cape Hospital and Health Service. Apunipima looks after around 7000 Cape York patients, around 27 percent of the total population.