"Refusal of admission as a child"

About: Armadale Hospital / Emergency Department Bentley Adolescent Unit East Metropolitan Youth Unit (EMyU) Perth Children's Hospital Princess Margaret Hospital for Children

(as a parent/guardian),

My family member is a teenager. They have an eating disorder and were diagnosed earlier in the year at Princess Margaret Hospital following episodes of extreme distress and self-harm necessitating an admission to Bentley Adolescent Clinic. They were in their early teens at the time. Since then they have had a further three admissions to the BAU last year, and two admissions to Princess Margaret Hospital this year for medical reasons. Following discharge, they have been monitored at the eating disorder outpatient clinic on a fortnightly basis.

Recently, I brought them to the emergency room of Armadale Hospital as they had been purging and had an extremely rapid pulse and felt faint. Bloods were taken and they had a potassium count of 2.2. The doctor said it was fortunate that I had brought them in, as they could have dropped dead. Chilling words to hear.

They were admitted via emergency to an adult medical ward at Armadale Hospital where the next youngest patient was in their 50’s. They were refed and became medically stable, but the nature of their disorder saw their mental health begin to deteriorate. They became increasingly agitated and distressed, and began threatening self-harm. I believed they needed to be in the new Perth Children’s Hospital, but they were not accepted there on the basis of their age. They attend the outpatient clinic there, and historically when the clinic was at PMH, adolescents between 16 and 17 have been admitted. PMH had stated that they would not accept any ED patients over 16 at their ED during the transition to the new hospital, hence our presenting at Armadale Hospital Emergency.

On three occasions during their inpatient stay at Armadale Hospital, their agitation was so great that they had to be restrained by three security guards, and injected with a sedative. On one of those occasions they got hold of a razor and cut their arms.

They had a medical emergency on one day when their blood sugar and blood pressure dropped very low.

Although Armadale Hospital were taking advice from the consultant at PCH, as well as one of the dieticians, they were ill equipped to treat my family member. As one of the ward doctors said they may see two eating disorder patients a year, so their expertise and experience is limited.

At no time was my family member seen by a psychiatrist specialising in adolescent/child mental health. At no time were they seen by an eating disorder specialist. Adult psychiatrists saw them on a number of occasions. My family member was formed under the mental health act on the day they cut their arms.

At one point, PCH accepted them as a patient, but before transfer was arranged they rescinded the offer of a bed. I am still uncertain who made that decision and why. I believe it came from the executive level.

My family member remained in a state of limbo in an unsuitable facility and in a deteriorating state of mental health, and fluctuating physically, until recently, when the newly opened East Metropolitan Youth Unit accepted them as a patient. They had initially refused as they did not accept eating disorder patients. The only other facility which would have accepted my family member was Fiona Stanley Hospital, however they had no beds available. They were finally transferred over to the East Metropolitan Youth Unit, and this was the first time they were seen by an adolescent specialist.

They remained an inpatient for two nights and were finally discharged for care in the community, as they had been managed prior to this crisis.

I am very angry that, in my opinion, the executive of PCH discharged themselves of responsibility for my family member. The level of distress they experienced, and the length of stay they had, would have been significantly lowered, had they been in the appropriate facility. I would appreciate a review, and an explanation from the executive as to their particular rationale for their decision in this particular instance. I am appalled at the lack of compassion and appropriate response from the hospital where my family member’s treatment team practice.

Responses

Response from Victor Cheng, Executive Director, Health Service Managament

picture of Victor Cheng

Dear cygnusds65

I’m so sorry to hear about your child’s recent experience, and I thank you for providing such comprehensive and considered feedback.

Your story has been discussed extensively between executives and senior staff from Perth Children’s Hospital (PCH) and CAHS mental health. In relation to the age of admission at PCH, I can advise that PCH can accept patients up until their sixteenth birthday. In relation to your concerns around your child being offered a bed at PCH and this offer then rescinded, we would need to know further information about your child to provide you with the reason for this occurring. I encourage you to contact the CAHS Child and Family Engagement Service on 6456 0032 or via CAHSfeedback@health.wa.gov.au to provide identifying information about your child, for us to investigate this further for you.

The Child and Adolescent Health Service (CAHS) Chief Executive, Dr Robyn Lawrence, has also read your feedback and has asked me to extend her thanks to you for taking the time to write to us about your experience. At CAHS, we are committed to improving the patient and family experience, and the feedback that we receive through Patient Opinion is a key mechanism through which we can improve services.

Please accept my sincere best wishes for your child.

Warm regards

Dr Victor Cheng
Executive Director
Perth Children’s Hospital

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Response from Aresh Anwar, Executive Director, Royal Perth Bentley Group We are preparing to make a change

picture of Aresh Anwar

Dear cygnusds65

Thank you for coming forward and sharing your story about your family member. The story was confronting and I can only apologise unreservedly for the distress that you and your family member have endured.

The East Metropolitan Health Service, which includes both Armadale and Bentley Hospitals, prides itself on providing compassionate and patient centred care. I acknowledge and accept, that on this occasion, we have got it wrong. Your family member’s story has been the subject of much discussion in our health service, including by the executive, and I have requested that the Armadale and Bentley teams explore how this situation is prevented from occurring in the future, in consultation with the other health services.

Please be assured that we are already looking at more effective and age appropriate patient pathways and would welcome the opportunity to talk with you further about your experience in order to better understand how we might make the necessary improvements. I encourage you to call me directly on 9224 2219 as your input would be invaluable.

Kind regards

Dr Aresh Anwar

A/Chief Executive

East Metropolitan Health Service

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