Minister for Mental Health Emma Davidson spectacularly revealed last week, while facing a motion of no confidence, that alleged patient privacy breaches were committed by nurses working at the secure Dhulwa Mental Health Unit.
The staff allegedly leaked information about 13 patients over a period of years to the Australian Nursing and Midwifery Federation.
The revelation followed days of pressure about the data leaks, as the government drip-fed information about the alleged breaches after initially refusing to provide details about the "industrial partner" and the employment status of staff involved, citing a police investigation.
There has been a shaky relationship between the ACT government and the union regarding Dhulwa over the years.
The union went public last year with concerns about staff safety at the facility. The federation made extraordinary claims about violence at the unit which prompted the government to announce an inquiry into the centre.
This inquiry delivered a scathing report into governance at the facility, finding "poor standards of care delivery" but it also found claims of violence were "inflated".
The inquiry also hinted at possible human rights breaches over information leaks.
With investigations into the alleged breaches ongoing it could be a while before the public is provided with definitive answers around the reasons why personal information was shared with the union. The union has argued the disclosures were lawful.
Neither the union or the government and health authorities have provided any information about the exact nature of the information that was shared, citing ongoing investigations. Canberra Health Services has only said, in an internal staff email, that it was "whole clinical records".
The union has suggested the information was shared to them as staff had concerns for patient safety, which ANMF said is allowed under law and Canberra Health Services' internal policies. The union has argued executives and managers have also disclosed information under the same policies.
How the Dhulwa inquiry was prompted
Dhulwa is a forensic unit which houses adults with complex mental health needs, including people with mental illness who have or are likely to come into contact with the criminal justice system.
The unit, which opened in 2016, has attracted its fair share of controversy over the years and the inquiry report was absolutely scathing of governance policies within Dhulwa.
The inquiry was led by former Fair Work Commissioner Barbara Deegan. Ms Deegan's report was released in November and it found the standard of care at the facility was well below expectations, patient and treatment procedures were unclear and dysfunction among staff contributed to a toxic work culture.
The inquiry was prompted after the Australian Nursing and Midwifery Federation's ACT branch released a statement on April 5, 2022 which called for an urgent inquiry into the operation of Dhulwa.
This statement made some damning allegations, including that nurses had reported more than 100 assaults over a six-month period and had sustained injuries including a broken arm, broken nose and broken fingers.
It also included a quote from a nurse who had told the union working at the facility was like being "sent into the killing fields".
This prompted several reports on the allegations from the union. The ACT opposition joined calls for an inquiry and pressure was heaped onto Ms Davidson. The Minister did not establish the inquiry until nearly a month after the union's claims were made public.
But the inquiry found reports about the numbers of assaults were inflated. The report said in a six-year period there had been 403 incident reports lodged but there were multiple reports relating to the same incident.
The report said fewer than 15 of these incidents had resulted in an injury where a staff member had to take more than one day off work.
"The inflated claims and exaggerated reporting of occupational violence has damaged its reputation and had far-reaching consequences for both consumers and staff," the report said.
The inquiry noted there were no actual or potential incidents reported in the three weeks prior to the statement from the federation. The report said incidents that resulted in injury were due to poor work practices and not because of the patients.
"While a perception has been created that Dhulwa is a dangerous place to work, only a small minority of the incident reports that were reviewed by the inquiry resulted in the person needing time off work and fewer resulted in serious injury," the report said.
"Of the incidents that resulted in injury few were the direct result of aggression by consumers but appeared to be the result of poorly managed or implemented clinical or work practices."
No approach on work health and safety issues
The inquiry noted that Dhulwa did not have a "clear and documented approach for consultation and communication on WHS issues".
The report said in the absence of a clear process that staff were creating their own methods to raise issues and would engage with unions when work health and safety issues arose.
"When staff bypass the usual workplace channels for addressing issues, management is not provided a proper opportunity to address the issues in a timely manner before union involvement. This is further fuelling dysfunction in the unit," the report said.
When the union was calling for the inquiry, ANMF ACT branch secretary Matthew Daniel said nurses were scared of repercussions from management, saying workers had felt they had been blamed for violent incidents.
"Members are keeping the statistics themselves because they're concerned that the true extent of the number of assaults and the seriousness of the assaults won't be recognised," he said on April 7, 2022.
Inquiry concerns at allegations of privacy breaches
Canberra Health Services chief executive Dave Peffer said the organisation first became aware and started to investigate the alleged breaches in early February.
But the Dhulwa inquiry noted concerns about potential breaches of patient privacy.
"The inquiry is also concerned by allegations by numerous stakeholders concerning breaches of privacy and confidentiality relating to consumers which may have amounted to a breach of their human rights," the report said.
Carers ACT issued a statement last week expressing deep concern at the alleged patient privacy breaches. The peak body said the concerns of carers had been "routinely ignored" in the lead-up to the incidents.
"We firmly believe that trust in health professionals to respect privacy and dignity is central to the commitment to treatment and recovery in the mental health sector and sharing of confidential patient files without knowledge or consent is unacceptable," a statement said.
"It goes against our expectations of ethical, empathetic and caring behaviour."
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