A woman whose baby died after it was born in distress at Sydney’s Northern Beaches hospital had a vaginal birth 50 minutes after doctors called an emergency, according to staff present on the night.
The hospital’s policy states a caesarean should happen within 30 minutes of a category one emergency being called.
The facility, run by private provider Healthscope, does not staff theatres on weekends and relies on on-call staff to respond to emergencies – an arrangement the hospital says is typical for its size.
The incident is currently subject to an inquiry and the hospital has been forced to answer questions about it in NSW parliament.
New information about the delay in response and theatre staffing has come to light after Guardian Australia spoke to several staff who were working at the time.
Leah Pitman, 34, went into labour with her second child on Saturday 22 February and presented at the hospital in Frenchs Forest, a large modern facility that serves 350,000 people living from Palm Beach to Manly.
Shortly after Pitman arrived, it became apparent the baby was in distress and a category one emergency caesarean was called, staff say.
The hospital’s chief medical officer, Peter Thomas, initially told NSW parliament estimates on 27 February a caesarean was performed, but subsequently corrected his answer to say that it was not.
Instead, Pitman had a vaginal birth 50 minutes after the emergency was called and her baby was born in a distressed state, the staff member says. She and her baby, Harper, were then rushed to Royal North Shore hospital, where the newborn died the next day.
The hospital’s protocols state if a category one urgent birth is called, the baby is to be delivered within half an hour.
On Monday to Thursday nights a theatre team is on site, but on Friday, Saturday and Sunday nights the theatre team is on call.
A spokesperson for the hospital confirmed the on-call arrangement.
“The on-call system is not uncommon for hospitals with the size and acuity of NBH and is common in many of our peer group hospitals,” they say.
The secretary of the Health Services Union for NSW and the ACT, Gerard Hayes, says: “That seems very strange to me, for a hospital the size of Northern Beaches hospital.
“It’s a very large hospital and like every hospital it would experience unplanned emergencies that require theatre staff at all hours of the day and night.”
The NSW government’s Bureau of Health Information considers NBH a “major hospital”, in the same category as Blacktown and Hornsby hospitals.
Thomas was asked in estimates how long Pitman had waited for the caesarean but could not answer and took the question on notice. The hospital did not answer questions this week from Guardian Australia about how long it took for on-call theatre staff to arrive, or on the staff claim that the baby was delivered 50 minutes after the category one emergency was called.
In a statement, Northern Beaches hospital says it “extends its deepest condolences to the family for their loss and ask[s] that their request for privacy be respected.
“Out of respect for patient and family confidentiality, we will not be discussing an individual patient’s condition or treatment. An investigation is under way in line with NSW health policy.”
‘There are holes in the roster everywhere’
Northern Beaches is the only hospital in NSW where public services are provided by a private company, Healthscope, under a complex contract. Last week the Australian Financial Review reported that Healthscope had called in the reconstruction and insolvency specialists KordaMentha.
Some staff say they are concerned the company’s financial pressures might risk compromising patient care. One nurse who asked not to be named claimed: “There are holes in the roster everywhere, and they’ve just cut staffing in medical wards.”
The NSW Department of Health was unable to comment on staffing levels at the hospital. Healthscope’s CEO, Greg Horan, was asked about staffing levels in NSW estimates last month after the NSW Nurses and Midwives Association recommended in writing the hospital be staffed at a higher level.
Horan told parliament: “To my knowledge, we have continued to staff the hospital appropriately based on the acuity of the patients that we have and have always staffed it in that way.”
Deaths of babies in childbirth are rare. The Australian Institute of Health and Welfare reports the national rate of neonatal death ranged between 2.2 and 2.9 deaths per 1,000 live births between 2010 and 2020.
The incident is the subject of investigations by health authorities and the hospital. It will also be the subject of a parliamentary inquiry, together with the death of another child – two-year-old Joe Massa – at the hospital’s emergency ward in September. Its terms of reference will be published soon.
‘Something’s got to give’
The incident occurred against a backdrop of growing financial concerns for Healthscope, Australia’s second-largest private hospital operator, and some staff believe the two are intertwined.
Calling in a company such as KordaMentha is a step generally taken when companies are on the financial brink. Usually an insolvency firm will first try radical surgery to try to save a company, such as delaying debt repayments or selling off or closing assets. But if that fails, it will put the company into administration while it searches for new buyers or – in the worst-case scenario – close it down and sell off anything of value.
A spokesperson for Healthscope says: “Healthscope is working with stakeholders including lenders on a consensual solution to the current challenges. It remains very much business as usual in our hospitals and our No 1 focus is caring for our patients.”
Closure of a hospital as large as Northern Beaches is almost unthinkable. So if the crisis cannot be averted, it will inevitably involve the state or federal government.
Healthscope’s problems have been years in the making.
The company, which operates 37 private hospitals as well as the Northern Beaches contract, was acquired by the Canadian investment giant Brookfield in 2019 but has struggled under debts that have reached $1.6bn. In the past year, Healthscope has been negotiating with its lenders and has previously warned it may have breached the conditions of those loans.
In February it announced plans to close maternity services at its private hospitals in Hobart and Darwin due to falling patient numbers and lack of midwives.
On 3 March Healthscope was issued breach notices for 11 hospitals after it failed to pay rent due to its landlord, HealthCo Healthcare & Wellness REIT – an investment vehicle run by HMC Capital, which owns the buildings.
The AFR reported this week that Healthscope had bought itself a short reprieve from its lenders, giving it breathing room until May to find a “longer-term solution” such as selling its business or individual hospitals.
All private hospital groups have been facing headwinds since prolonged shutdowns during the pandemic. Since then, private hospitals and private health insurers have been locked in a protracted battle over how much private hospitals should be paid from health insurance premiums.
The health minister, Mark Butler, last week called an emergency meeting of the sector’s chief executives to try to force a more generous deal for hospitals out of the private health insurers.
“I’ve asked the CEO forum to take immediate action to increase payments to hospitals to ensure patients are able to access important services,” Butler says.
The NSW health minister, Ryan Park, says it was “unhelpful” to speculate on the future of Healthscope but says he had never supported the former Coalition decision to structure Northern Beaches hospital as a public-private partnership.
The independent state member for Wakehurst, Michael Regan, says he was concerned that cost-cutting pressure had affected staff and patients at the hospital.
“With the liquidators almost knocking at the door, we know they are looking for savings high and low across staffing, equipment and more. Something’s got to give, and too often it is staff welfare and patient care.
“It is completely unacceptable for this private operators’ financial woes to compromise outcomes for public patients in our community.”
Regan says the ultimate goal is for the hospital to be brought back into public hands.
“The Northern Beaches community deserves access to a truly public hospital. We can’t change decisions of past governments, but we can influence what happens next.”
