In May 2017, Patrick Pritzwald-Stegmann, a dedicated heart and lung surgeon was punched outside his Melbourne hospital after asking his attacker to stop smoking in a non-smoking area. Four weeks later, he died from the catastrophic brain injury.
It was a shocking case, coming amid rising numbers of violent acts committed against Victorian health workers at the time.
An auditor general report, released two years earlier, heard from staff who had been verbally abused and physically assaulted by patients and their family members. Reported incidents included an attempted strangulation, a pregnant woman kicked in the stomach, sexually inappropriate conduct and several instances of staff being kicked and punched.
Dr Stephen Parnis, a senior emergency department physician and former deputy president of the Australian Medical Association, says he used to have a saying about occupational violence.
“If you spend more than six months working in any sort of emergency setting you will be, at the very minimum, a witness to physical and verbal violence,” he says.
The auditor general report, as well as a subsequent taskforce made up of health workers and their union representatives, called on the government to update its occupational violence training for frontline workers.
It appeared the government had listened.
Standing alongside the secretary of the Health Workers Union (HWU), Diana Asmar, on 23 October 2018 the premier, Daniel Andrews, announced a $2.2m election commitment towards targeted and tailored training for 1,000 frontline workers to recognise and respond to occupational violence.
“We want to make sure that … those dealing with patients and family, visitors, that they have the skills to keep themselves safe,” Andrews said at the time.
A week later – hours before the government went into caretaker mode ahead of the election – a $1.2m contract between the health department and a HWU-related entity, the Health Education Federation (HEF), was signed to cover occupational violence training.
This contract, along with the government’s 23 October announcement, was at the centre of an Independent Broad-based Anti-corruption Commission (Ibac) investigation, dubbed Operation Daintree, which was released this week.
The investigation found the public interest was not met in awarding HEF the contract, with the union “given privileged access and favourable treatment” to the government.
At the same time, government advisers “improperly influenced” the health department to award the HEF contract and then to “dissuade” it from terminating it in following years, Ibac said.
“The combined effect of these failings and unethical conduct resulted in a contract that should not have been entered into with the union and an outcome which was not in the public interest,” the report read.
Stephen Charles KC, a director of the Centre for Public Integrity, is more blunt.
“What they had here was a situation where people in cabinet wanted to give the union a large infusion of funds and the good justification for it would be if they gave them a very large contract under which they had to train health workers,” he says.
“They wouldn’t have been given the contract if they had to go through a competitive tender process, because the union didn’t have the ability to provide the training that was required.”
The contract came from an “unsolicited” proposal, drafted with the help of a senior adviser to the health minister. Ibac heard the department felt “pressure” to award it to the HEF despite reservations – including that it had yet to become a registered training organisation at the time.
Under the contract, the HEF was required to develop its content by January 2019, with pilot programs to be run in March and training delivered to 575 workers between May and October of the same year.
According to Ibac, by January, health department officials formed the view the HEF “might be incapable of developing and delivering the training”.
According to Ibac, when the first draft of the training materials – developed by a subcontractor – were first provided to the department by the HEF, a manager at the department raised serious concerns about its contents.
The manager believed nearly all of it appeared to be plagiarised from other resources, while the learning modules it used were lifted from other training programs that were already compulsory for staff, Ibac said. There were no case studies and there were grammatical errors “throughout the whole document”.
The manager warned if the program was rolled out without “substantial changes” there could be “risks to the safety of patients, health service staff and community members” as well as “reputational risk” to the department, according to Ibac.
Ibac found similar feedback was made by participants in the pilot programs at Bendigo Health and the Royal Children’s Hospital .
Some 60% of hospital staff who attended the training believed the trainers were not organised or prepared, while nearly 80% believed the trainers did not have in-depth knowledge of occupational violence and aggression.
Four-in-five did not think the program that was relevant to the health sector.
Monash Health told the department that three of their staff who had attended the training had “significant concerns” about it, especially “the standard of the instructors and their lack of expertise and knowledge of the hospital security environment”.
Monash Health, Eastern Health and Mildura Base hospital each indicated to the DHHS that they would not send their staff to the training due to quality and safety concerns.
Jenny Mikakos became health minister after the 2018 election and took over responsibility for the program. She told Ibac she would not have entered into the contract had she been the minister responsible at the time.
When it came to selecting a contractor for the election commitment, she went through a competitive tender process. Ibac did not make any findings of corruption against Asmar, Andrews, health ministers Jill Hennessy and Mikakos, or staff working in their offices.
In their responses to a draft report from the investigation, the HWU and HEF contested the negative findings on the quality of the training materials, trainers and the courses it delivered, which Ibac rejected. The commission said it was not persuaded the training would have improved were it not for the pandemic.
In the end, the HEF delivered five training sessions to 83 participants before it was abandoned due to Covid. It was paid a total of $335,000 under the $1.2m contract.
Parnis says while violence against health workers was “widespread” in 2018, “it has only gotten worse” since Covid.
“It’s a dangerous place to work. Just this year alone, we have had the stabbing of the senior doctor in Tasmania and we have had the death of the paramedic in Sydney,” he says.
“We don’t want politics. We want the political leadership to support solutions to these problems and not distract from them.”
