A senior clinician says they were encouraged to get patients to access any potential funding sources to pay for their care — including their superannuation funds – in a job interview at a privately run psychiatric hospital in Melbourne.
They said they felt a key focus of the interview, for a management role, was how they would bring more money to Essendon Private Clinic (EPC) and get as many people admitted as possible.
The clinician of 13 years experience, who does not want to be named because they still work in the industry, said there was little questioning around patient care or outcomes.
It comes after the ABC last month revealed allegations of poor treatment and inexperienced staff at EPC, a mental health facility run by the Macquarie Health Corporation.
Several former patients and staff have alleged there was a toxic culture at the hospital in Melbourne's north-west, where profits were placed over patient safety and wellbeing, and there was limited focus on getting patients better.
The Victorian Department of Health said it was looking into the claims.
Macquarie Health Corporation strongly denies the allegations that EPC is unsafe, that staff are not qualified and that profits are put over patient safety. It says high quality care and standards are at the core of its business.
The ABC has seen evidence the worker had the interview with the hospital earlier this year.
The senior clinician said they were asked about a range of management-related issues, but there was a recurring theme of how they could generate business for the facility.
They said part of the discussion was how patients could pay for the hospital's services — for example using their private health insurance or family savings.
The conversation then moved to patients being able to access their superannuation, or their parents' superannuation, if other funds weren't available.
They characterised it as a "strong discussion", with little regard for the repercussions it could have for patients and their families.
"They were asking me to push for any kind of funding option to get them in. If they haven't got another funding stream, go this way," they said.
"It was anything you can do to bring money through the door.
"I came away from my interaction with them horrified."
A spokesperson said the allegation that any candidates were asked how they would encourage patients to access superannuation was "completely false," but did not answer whether it may have come up in the course of the interview.
When asked about the characterisation of the interview as focusing on making money, the spokesperson said job interviews covered a range of topics.
"A Senior Manager interview, which is for a non-clinical position, involves developing an understanding of the applicant's qualifications, work history and clinical experience."
"Senior Manager candidates are also asked some questions to assess their commercial acumen."
Former EPC nurse Jess Anderson, who blew the whistle on the facility over her concerns of poor standards of care, said her experience on the floor of the hospital suggested the bottom line was top of mind.
"It definitely felt that money was more important than patients, and they needed to get people in beds so they can get more money."
A spokesperson for Macquarie Health would not confirm the cost of stay for patients without private health insurance, but private health insurers pay a median price of $739 per night per patient.
Extra fees for patients called into question
Macquarie Health Corporation runs 11 private hospitals in NSW and Victoria. EPC is the only psychiatric hospital.
Despite being paid $7.3 million from the health insurers last year, and receiving funding from the federal government, Essendon Private Clinic also charges patients extra fees directly.
There's a $70 admission fee, and a fee of at least $100 for Transcranial Magnetic Stimulation (TMS), a procedure that uses magnetic fields to stimulate the brain to improve symptoms of mental health disorders.
Former staff and patients have told the ABC the fees were sometimes higher.
Two other major private mental health hospital providers the ABC contacted said they did not charge these fees.
The charges are on top of the roughly $9,500 patients pay to their private health funds each year for gold cover insurance, and any excess they need to pay to the funds per admission — sometimes more than $500.
Patients need gold cover to have their stay in a private psychiatric facility covered by insurers.
Rachel David, CEO of Private Healthcare Australia said there was no reason for Macquarie to charge the payments, and it potentially put them in breach of their contracts with private insurers.
"Charging additional fees for these services is pure exploitation of patients when they are at their most vulnerable," Dr David said.
A spokesperson for Macquarie Health Corporation said the admission fees were to cover the costs of the assessment and planning required to admit someone to the hospital.
It said TMS is a cost intensive service that is provided by EPC for which there is no reimbursement by private health insurers.
"The hospital charges a small fee to offset a small portion of the substantial costs of TMS. "
Former patient raises concerns
Former patient Kate* says she paid a $100 fee for TMS directly to EPC, but when she raised it with her insurer over the phone, they told her it shouldn't be charged.
She alleges once she passed that information on to EPC administration staff and said she was willing to follow it up in writing, they gave her a cash refund.
She said she had never seen extra fees being charged at the two previous private psychiatric facilities she had stayed in, and it was a surprise to be charged one at Essendon.
From the time she arrived at EPC in January, she said budgetary pressures could be seen everywhere — from the amount of food to go round, to the cleanliness of the facility.
She said the level of care was also concerning.
When Kate admitted herself and offered her bags for inspection, so staff could ensure she didn't have anything she could use to self-harm, she says she was waved away with a laugh.
"That really blew me away. You go in, your referral says you're suicidal and you need to be watched," she said
"And they just said 'We don't need to check your bags. We trust you.'"
She claimed that staff avoided dealing with patients in distress, and the treatment of two elderly patients particularly stuck in her mind.
One older person had mobility issues, but instead of nurses looking after him, a fellow patient became his constant carer — doing chores like wiping his face and feeding him, she said.
Kate said another elderly person caught COVID so they needed to isolate in their room, but they were going through clear psychological distress.
"She was crying because she was lonely, complaining because she was lonely," she said.
Kate alleges nurses did little to try and calm her.
"It's a psych hospital, where's the compassion and empathy?"
Kate said she would sometimes stand outside the patient's door and try and soothe her.
Like other patients who spoke to the ABC, she said she was given the wrong medication several times during her two-week stay.
She alleges she sometimes didn't take one of her medications because it required two nurses to sign off on it, and sometimes they were too busy to do so.
When she got home after she left, she realised she hadn't been given her own medication, but a box of anti-psychotics prescribed for someone else.
When she rang the hospital to tell them, she said they told her just to keep them.
Hospital took steps to remedy medication errors
Macquarie Health said it was unable to comment on Kate's case specifically due to confidentiality, but that EPC was most recently accredited under the federal government's National Safety and Quality Health Standards in December.
It said eight out of 32 of its nurses had post-graduate mental health qualifications, and that all completed mental health training as part of their primary nursing qualification.
"EPC provides an in-house continuing education program to nursing staff to enhance and support their professional development."
"EPC has a policy of a patient and belongings search in line with National Standards for Mental Health Services and this includes patient search by two staff on admission and on return from leave of any bags, coats, pockets shoes etc."
A spokesperson said medication errors were a serious concern, and that earlier this year the hospital identified enhanced monitoring was needed.
"Following the commencement of this management intervention, we have noted a reduction in medication errors."
They said a broader review identified several areas for improvement, including the reporting and escalation of issues at the hospital.
"Patient and doctor satisfaction has … also increased as a result of changes that have been implemented," the spokesperson said.
*Name has been changed
