A failure to communicate lies behind revelations of deaths in an aged-care home, write Gary Hughes and Stephen Lunn - The Australian

The best guess by the nursing staff at the home, which also houses 50 low-care hostel residents, was they were dealing with an outbreak of viral gastroenteritis.

On Good Friday it was decided to alert Victoria's public health authorities. A call was placed to the main health department switchboard but, in the words of Sharon Callister, the chief executive of Benetas, the Anglican Church's aged-care organisation, "the phones rang out". It was a public holiday. The home's staff had the option of calling an after-hours emergency number. "They chose not to take that option," Callister explained yesterday. "But that was based on their professional expertise at the time and the symptoms that were prevailing."

Things at Broughton Hall started to deteriorate, with more residents falling ill. The total would eventually reach 21. The first death, that of a 73-year-old man, occurred on Easter Sunday. A second male resident died the next day. But staff did not at first associate it with the gastro outbreak racing through the home.

"These deaths were not unexpected as both residents were elderly and frail," Broughton Hall's executive manager Sharon McGowan says. But more deaths were to come.

On Tuesday, April 10, Broughton Hall staff finally called the health department to alert it of the outbreak, as required by law. But no mention was made of the two deaths. It was only the following day, when a third male resident died, that the home told the department of the mounting death toll.

The fourth victim, an 88-year-old woman, died the next day.

On Friday, tests from a Broughton Hall resident taken to hospital showed she was suffering from salmonella; in layman's terms, food poisoning. Salmonella is particularly deadly in the very young and very old.

While public health officials swung into action to try to identify the cause of the deaths, no one within the health department had apparently thought it necessary to tell state Health Minister Bronwyn Pike that people were dying just down the road in Camberwell. She learned of the growing tragedy on Saturday, the same day her department issued a media release revealing the deaths.

On Sunday, a "very distressed, very angry and very disappointed" Pike took what she described as the drastic step of sacking the state's top public health bureaucrat Robert Hall, saying the communication breakdown was the latest in a string of such failures that had caused her to lose confidence in him.

The last to discover the tragedy were the people of Victoria. Asked why it had taken so long to make the details public, the assistant director of the health department's communicable diseases control unit, Rosemary Lester, says authorities had been "very busy" dealing with the matter.

Lillian Jeter, founder of the Australian Elder Abuse Prevention Association, says she hopes the political brawl doesn't overshadow what was an apparent failure of risk management at the facility. "Whether it's a fire, abuse case or a salmonella outbreak, we are still talking about risk to the patients, and the policies and procedures should be gone through to the letter of the law," Jeter says. "This is what they don't appear to have done."

"These are questions on the ground. How many people working that day were regular staff and how many were temporary? When did the staff tell the management and then when did the management on the day report to head office? How easy or difficult was it to practically implement a risk management strategy?" Jeter says the families of the patients were a critical priority that apparently had been overlooked by the home. "They, of all people, have a right to know if something remiss is going on."

While Broughton Hall's management took full responsibility for the delay in alerting state health authorities, yesterday it was defending its handling of the crisis. Callister said a range of protective measures was put in place from April 5 to deal with the suspected gastroenteritis outbreak, including isolating affected residents and taking steps to stop the spread of infections. "We're scrubbing the place clean," Callister said. But, crucially, the home's kitchen, where residents' meals were prepared, was not closed until Friday, when the first test raised the possibility of food poisoning. Food samples have been taken away for testing and the kitchen area disinfected. Whether salmonella was to blame for the outbreak is unlikely to be known until later this week when further test results are expected. However, no new cases have occurred at the home since the closure of the kitchen.

In the meantime Broughton Hall, which withdrew yesterday behind the protective screen of a public relations consultant, is continuing to treat the problem as gastroenteritis, not food poisoning. "The symptoms that are being presented by our residents and the advice we have received from our doctors at this point in time are saying this is gastroenteritis," Callister says.

Benetas, known as the Anglican Aged Care Services Group until a name change in 2003, runs 13 nursing homes and hostels in Victoria caring for about 2000 elderly residents and has a string of awards to its credit. "At Benetas, we differentiate ourselves from other aged-care service providers through the quality of care we provide and our philosophy of caring both for and about older people in our society," the group says on its website.

But even Benetas had to admit yesterday, amid growing fallout over the mishandling of the crisis, that it had a previous food poisoning outbreak in one of its other aged-care facilities in Melbourne's western suburbs.

The four deaths at Broughton Hall are the latest chapter in Victoria's long and unhappy history of problems in its aged-care facilities and nursing homes. In 1999 the Aged Care Standards and Accreditation Agency found Victoria to have the nation's worst standards for nursing homes. The finding came just a year after a federal government investigation uncovered 41 Victorian centres failing to meet basic standards of care.

Then in February 2000 the Riverside Nursing Home in Melbourne came under scrutiny for forcing 57 residents to use a kerosene bath as a treatment for scabies, which caused burns and bleeding to sensitive skin. There were accusations it took the Howard Government a month to act after the incident was first reported. (The federal health minister at the time, Bronwyn Bishop, closed the facility.)

It was also revealed the agency charged with monitoring health and safety at that time had not conducted one surprise inspection of an aged-care facility in two years.

In February last year, allegations emerged of four women in their 90s being sexually abused by a male staff member of a Melbourne nursing home, including alleged digital rape. The incident led to a federal government inquiry into the reporting of abuse in nursing homes, and in turn the then federal minister for ageing, Santo Santoro, announced a $90million reform program including new laws making it compulsory for aged-care facilities and personnel to report actual, suspected or alleged cases of physical and sexual abuse.

Victoria's Health Services Union is calling on the Government to extend that mandatory reporting regime to nursing homes where there is suspected cases of infectious diseases such as gastroenteritis.

"We have a situation where the health and welfare of elderly residents is at stake," the union's assistant secretary Shaun Hudson says. "It's time to act."

While Victoria's history is littered with other one-off examples of neglect, it is by no means the only state that has had difficulties with the standard of care in nursing homes and aged-care facilities.

In 1996, the NSW parliament heard complaints about nursing home patients being administered drugs to keep them quiet. Then NSW health minister Andrew Refshauge said at the time the problem was systemic and one of a "litany of horrors" discovered by the state's Health Care Complaints Commission.

The deaths at Broughton Hall are being investigated by the Victorian Coroner, who yesterday took possession of the files relating to the medical management of the four residents. The commonwealth Department of Health and Ageing, which is responsible for the standard of care in nursing homes, sent officials to the home on Sunday.

The verdict of relatives of Broughton Hall residents on the way the latest crisis has been handled differ widely. On Sunday the family of one 84-year-old man suffering from gastroenteritis symptoms was unhappy staff had opted to treat him at the facility rather than send him to hospital. They insisted an ambulance be called immediately. The man's son, who wanted to be identified only as David, said the family was not told about the four deaths until Saturday, despite management claims that all residents' families had been notified earlier last week. "He should have been hospitalised. He was looking very ill. He was dehydrated. He was obviously not well," David said.

At the other end of the spectrum was Libby, a relative of one of those who died, who rang ABC radio in Melbourne yesterday to defend Broughton Hall. "It is just a wonderful place. It has a waiting list a mile long," she said, describing care at the home as "just wonderful and top class". But even she admitted that the man's family had not been told the death was from suspected food poisoning. "No one related it to food poisoning. They were told he had a bit of gastro," she said.

CAUSE AND EFFECT

• Gastroenteritis is an inflammation of the stomach and intestines. It is caused by a virus.
• Most infections are transmitted through food prepared by people who have not washed their hands.
• Symptoms include diarrhoea, vomiting, abdominal pains, nausea, sweating, joint pain and fever.
• Severity depends on the immune system's ability to resist the infection.
• The virus can be found in contaminated food or drinking water. Symptoms usually appear between four and 48 hours after contamination.
• Those with the highest risk are the young, the elderly and those with suppressed immune systems. In developing nations, it is the leading cause of death in children.
• Primary treatment is fluid replenishment to prevent dehydration. In serious cases, fluids have to be given by intravenous drip.
• Electrolytes (including sodium and potassium) may be lost by vomiting and diarrhoea.
• Infections will usually go away without specific treatment. Most people recover easily but, for babies and the elderly, lossof fluids can cause life-threatening dehydration.
• Salmonella is a form of gastroenteritis usually transmitted in undercooked meat or poultry. It does not often cause death in healthy people but the elderly are vulnerable. 

Source: The Australian - Gary Hughes and Stephen Lunn