Doctor and activist


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Category: Health

iCare= Hopeless in Two Reports but the Bad Joke Continues

30 April 2021

Two reports on iCare have come out on the same day- how convenient, one lot of publicity rather than two.The report of the Parliamentary Committee was one report, the other was a report by Robert McDougall, a retired Supreme Court judge.The political report looked at the disgraceful evidence given by John Nagle which showed almost no care for the injured workers and an appalling attitude of entitlement in him and his crony staff. iCare had not even known what workers’ Pre-Injury Average Weekly Earnings (PIAWE) were, and had not tried very hard to find out so that they could underpay them and minimise their costs. They relied on computer algorithms rather than staff to manage the claims, only getting staff on the case if there were problems, which there usually were, as the poor patients were having their treatments delayed or denied.
The McDougall report had its terms of reference set by Treasury, who were also the department being investigated, and they also staffed the inquiry. The Treasurer, Dominic Perrottet did not agree to be interviewed by McDougall and got away with this. Is this some sort of bad joke? The McDougall report found incompetence etc, but no actual corruption that anyone could be charged with. As such, the McDougall report was a political success. It took the heat off the Treasurer from November to now, and will result in a bit of publicity, no serious recriminations and the usual promises of future action. John Robertson, an old union hack is the new CEO, so Labor will not criticise iCare now.
My poor patients will be mucked around, be underpaid and have their treatment denied as usual. And Treasurer Perrottet will sail on hoping to be Premier as Gladys falls. What a joke!


www.abc.net.au/news/2021-04-30/damning-reports-released-over-nsw-icare/100107076?fbclid=IwAR34I_blTADSxa2OoWxrzOpvgNPZ3KUFmhQmpSFZHd4LSOIVdof0nx8yMGs

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Clotting Risk from Vaccines and COVID19 Infection

28 April 2021

A new Oxford Study compares the incidence of Cerebral Venous Thrombosis with the Astra-Zeneca vaccine, the Pfizer or Moderna mRNA vaccine and the risk if you get COVID19. The risk from the A-Z vaccine is 5 per million, the Pfizer and Moderna 4 per million and the risk if you catch COVID19 is 39 per million. The sample size is large with over half a million cases in each group, so the reliability of the research is quite good.While there is no COVID19 about, it is obviously safer to have no vaccine and no risk, but the COVID19 situation could change at any time. The Business Council and other non-medical political groups are calling for a more open society and for the case chasers to try to keep a certain level of infections once the gates are opened. i.e. We get the money- someone else fix the problems. Presumably they will try to stop further lockdowns, particularly as the percentage of the population who have been vaccinated increases.The bottom line is that the A-Z vaccine is almost as safe as the Pfizer one, and it is a good idea to be vaccinated ASAP in case the situation changes for the worse. I had the A-Z almost 2 weeks ago and only noted a slight headache, and tiredness on the evening of the vaccine, and a bit of local tenderness at the injection site the next day. I will have the second shot in 10 weeks.

www.ox.ac.uk/news/2021-04-15-risk-rare-blood-clotting-higher-covid-19-vaccines-0?fbclid=IwAR2TIjtz8C7ku_M1OXcELaa2BfrC4hBTwBSoD_svCfdhwWQORr6K4sx4BOI

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Politicisation of Vaccine Rollout has caused the Problems

13 April 2021

Scott Morrison’s objective was to have a low risk strategy. He got the States to handle the COVID19 crisis, while he merely took the credit for its success. Then he wanted to have a successful vaccination programme, and go quickly to an election. He announced a lot of vaccine deals, waving a chequebook with our money to put us high in the world’s vaccine queue. (Tough luck poorer countries with much more cases).

But the deals were soft, the Qld vaccine had problems with false positives for the HIV/Aids test, and it seems the Astra-Zeneca vaccine is not quite as effective as the others, and had a few side effects. So his loudly-touted intervention has just made him look ineffective.

The problems in the health system with the overlapping Federal/State responsibilities and cost-shifting, and the starving of Medicare with subsidies to the private system have all been swept under the carpet in the crisis. But the government’s new dynamic, which is to ignore good advice and treat everything as a political problem, with Morrison giving advice on every subject from weather forecasts, to fires to vaccines is part of the replacement of knowledge by politics, which is a problem in many areas.

Here is an analysis of this fiasco by Steven Duckett, one of Australia’s leading health economists.

https://theconversation.com/4-ways-australias-covid-vaccine-rollout-has-been-bungled-158225

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Vaccines and Probabilities

April 9 2021

Many years ago as I tried to tell sceptical people that smoking killed people, the research was all about the probability of smokers getting diseases more often than non-smokers.  People would often reply, ‘Lies, damn lies and statistics’ as if this was some sort of frightfully clever response that neutralised any sensible discussion.

Statistics have been used by researchers for years and are the basis of the experimental method to get towards scientific truth.  Things are rarely ‘proved’ in science, they are just rendered more and more likely, so that the probability of their not being true becomes infinitesimally small. 

Where there are number of variables the statistics become ever more complicated and the proofs more arguable.  Some of us get a bit lost as the complexity rises, and try to retreat to ‘common sense’, with is another way of saying what is most probable based on facts we are already sure of. 

The Astra-Zeneca vaccine has been pushed in Australia, and there is a world shortage of vaccines, despite Prime Minister Morrison running around with an open chequebook for a long time and boasting that we were at the front of the queue for was it 4 different ones ‘in development’?

The loss of the Uni of Qld. vaccine because it gave a false positive in the HIV/Aids test was a bad blow, given that it was ‘ours’ and the vaccine against cervical cancer had been so successful. 

As more and more countries expressed reservations about the A-Z vaccine, it was becoming harder and harder to stick to the line that they were panicking and there was nothing in the stories about blood clotting in dangerous body locations. 

Now A-Z  is not recommended for the under 50 age group, which is most of the country.  Presumably this means that because under-50s are less likely to die of COVID19 even if they get it, the risk of dying from a clot becomes more significant.  Obviously in Australia, if we can keep COVID isolated forever, we will not need a vaccine at all unless we want to venture overseas.  So we are looking at the probability of the virus escaping, and the probability of other vaccines being available as well as the chance of dying at whatever age we are with whatever existing medical problems we may have, versus the chance of having a bad reaction to the vaccine. 

I want to get vaccinated so I can go on an overseas holiday at last, but the A-Z vaccine may be less effective against new and dastardly strains, and if I take that risk will I be stuck in a hotel in Mongolia unable to fly home because the government has changed its policy on my vaccination status or the absolute numbers who can be quarantined?

It is very hard to answer all these questions for anyone, and when older patients who have clotting problems ask for advice, it is very hard to give them an answer.  Doctors will have to spend a lot of time on this.   Our practice is not vaccinating at all, the red tape scared us off, despite the fact that we had bought a new vaccine frig and have been vaccinating people for 40 years.  Call me a coward if you will.  But for myself, I do have an appointment to have the A-Z vaccine next week.

Here is the SMH article:

AstraZeneca blood clot cases force major vaccine shake-up; Pfizer now preferred for under-50s

By Rachel Clun

April 9, 2021

Pfizer is now the preferred vaccine for people aged under 50 and the timing of Australia’s rollout is in doubt after medical experts expressed concerns about rare blood clots potentially linked to the AstraZeneca vaccine – the mainstay of the country’s existing COVID-19 strategy.

Prime Minister Scott Morrison said on Thursday night the government will review Australia’s vaccine portfolio and accept medical advice that will preference the Pfizer vaccine over AstraZeneca’s in adults aged less than 50 years old who have not already received a first dose of AstraZeneca, putting plans to vaccinate the entire population by October in doubt.

Australia’s decision follows changes by European medical regulators after a review of data confirmed a rare blood clotting condition seen in a small number of patients was linked to the AstraZeneca vaccine.

Mr Morrison said the new advice from the Australian Technical Advisory Group on Immunisation was not a prohibition on the use of the AstraZeneca vaccine in people aged under 50.

“This is not a directive. This is not an instruction,” he said, noting they were taking “an abundance of caution” with the new advice. He said the impact of this decision on the timeline of the rollout was uncertain.

“Tomorrow, and over the weekend, there will be a recalibration of how the program will need to be adjusted to take into account decisions the government’s taken tonight to accept those recommendations from ATAGI,” he said on Thursday evening.

Chief Medical Officer Professor Paul Kelly said the rare but serious blood clot disorder was discussed in the meeting, taking into account what was decided overseas and looking at what that would look like in Australia.

“This is a rare event,” he said. “But it is serious and can cause an up to 25 per cent death rate when it occurs.”

For those over 50, Health Department secretary Professor Brendan Murphy said AstraZeneca was strongly recommended.

“It is a vaccine that is very, very effective,” he said.

ATAGI spent hours on Thursday considering the medical evidence. It then issued new advice on the AstraZeneca vaccine, which it provided to the government just after 7pm.

The medical experts made three recommendations, including that AstraZeneca was preferred in adults over 50, after a lengthy meeting. They also recommended adults under the age of 50 should only be given AstraZeneca where the benefits clearly outweighed the risks. Third, it recommended that adults under 50 who had already received their first doses without experiencing serious side effects could safely be given their second dose.

Professor Kelly stressed the data on the rare clotting side effect, venous thromboembolism, was still only preliminary.

Britain’s vaccine advisory committee says adults under 30 should be offered an alternative to AstraZeneca’s COVID-19 vaccine when possible, due to a very rare side effect of blood clots in the brain.

“There are very few cases of this extremely rare event that have happened anywhere in the world, but the ones we’ve seen, there’s definitely a tendency for the younger people [to develop it],” he said.

The UK regulator has decided to offer an alternative vaccine for those aged under 30.

Australia has purchased 20 million doses of the Pfizer vaccine and has been relying on the AstraZeneca vaccine as the workhorse of the rollout. The country is expecting its first deliveries of the Novavax vaccine, pending regulatory approval, some time in the fourth quarter of the year.

Late on Thursday, Australian pharma giant CSL said “it remains committed to meeting its contracted arrangements with the Australian government and AstraZeneca for locally produced AstraZeneca COVID-19 vaccines.”

AstraZeneca Australia added that it respected the decision outlined by the government.

“Regulatory agencies have reaffirmed the vaccine offers a high-level of protection against all severities of COVID-19 and that these benefits continue to far outweigh the risks.” a spokeswoman for the company said.

Earlier, the Prime Minister said the risk of severe side effects with the AstraZeneca vaccine is much lower than with common drugs including paracetamol and the oral contraceptive pill.

Mr Morrison said it was important to know the risk of developing venous thromboembolism was much lower following the AstraZeneca vaccine than the risk of death from COVID-19.

“Let’s note that in the UK, the advice is that some 6000 people’s lives have already been saved by this very vaccine. So we need to consider the positive benefits,” he said.

From UK data, the risk of venous thromboembolism following the vaccine was about one to five per million people.

“To put that in some sort of perspective, the combined oral contraceptive pill, that can include adverse side effects of venous thromboembolism – that’s seven to 10 per 10,000,” Mr Morrison said.

The advice has been shared with the expert medical panel, the Australian Health Protection Principal Committee, which comprises all state and territory chief health officers and led by federal Chief Medical Officer Professor Paul Kelly.

The matter will also be discussed in national cabinet on Friday and in meetings with state and territory health ministers, who were due to meet on Thursday night to discuss the revised advice and its implementation.

On Wednesday 75,880 doses of the Pfizer and AstraZeneca vaccines were administered across the country, Scott Morrison said, taking the national total to 996,214 doses administered so far during the rollout.

The states and territories have administered 509,802 doses. Through the federal government, 486,343 doses have been administered, including more than 125,260 through aged care.

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Labour Hire Companies facilitate Wage Scams

5 April 2021

When I was in Parliament the then NSW Labor Government had an inquiry into WorkChoices, which was the Howard Federal government’s preferred industrial relations model. It was, as the Liberals said, an political inquiry designed to criticise what Howard was doing. (Historians will recall that it cost the Howard government s lot of votes).

But both Unions and Employers came and lobbied me, as did Labour Hire business owners. The Labour Hire companies said that they could get a better deal for the employees as they were negotiating on their behalf with employers and if they had special skills the employers would have to pay for these. I asked them how much commission they took on this as obviously employers would have to pay their commission as well as the subcontractor’s payment. They were very reluctant to be specific on this point as it was ‘variable’. But it did seem to me that the chief objective was to make the worker a private subcontractor rather than an employee and thus remove award pay rates, holidays, sick leave, workers compensation, and bargaining power. The Labor Hire company was often just a commission agent, though some employed the workers.

It seems that this model of getting rid of direct employees has evolved and is now standard in many industries. I have seen a woman accidentally stab herself in the forearm while boning chickens at 3.30 am on a 12 hour shift, a man shoot himself in the heart with a nail gun trying to assemble flat pack kitchens alone and RSI in a hotel worker so advanced that it has made no recovery in 3 years, after being expected to clean high-end hotel rooms, including making the bed, vacuuming and cleaning the bathroom in 12 minutes each.

‘Subcontractors’ may have no awards, no unions, no OHS and no redress when people are ripped off. The lumbering ‘Fair Work Commission’, out of sight and out of touch seems to make very little difference to a Darwinian model.

Let us see if criminalising wage theft makes any difference. There are a lot of laws on the books that are never enforced.

https://l.facebook.com/l.php?u=http%3A%2F%2Fwww.smh.com.au%2Fbusiness%2Fworkplace%2Faustralia-s-shocking-wage-theft-scandals-keep-coming-by-the-truckload-20210312-p57a5p.html%3Ffbclid%3DIwAR3FoKWzuLj-nv9W5moUs7K-HmlfV8msxTXhOicq62KM83zMerzWwcFiJYM&h=AT3RrEZXGjEyZeQ7rNBoGGgl9Flo0_zzfDuqRAnUxguMlUcU-J9oiuQGDpT01vJnqPsdtFErgLw0g92bkmtQt_TQ-vPzVqPsWvYaVFbIYosdg1YBYAm5Fke4e4-OdaDB8JwYckGgwuhNR5mltMZO&tn=-UK-R&c[0]=AT2ipxj2y11laB8hdM-suLNA2ij5tamnMBYbjAGX5r25jhtlSzzvd-Dn6kj1lQ88fBiyw1dyFFnNXi8tEuTfOVY_74RgrorvDvqc2EuyAIWBJMbsZjzjqyCneyp7HOlhnr8r_bd9dZtlDER2pMrWsThzMw
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Sex, God, Anger, Mental Health, Guns, and Racism

20 March 2021

In a recent article about a mass shooting in a number of brothels in Georgia, USA, the Police were criticised for saying that the alleged killer had ‘had a bad day’.  Obviously his day was not as bad as those who were shot.  The Police were in trouble for not being condemnatory enough in their statement.  There was a lot of discussion whether the shootings were racially motivated as they were in Asian massage parlours.  An alternative explanation was that he was getting rid of the outlet for his temptations.

The study of accidents or ‘adverse events’ is a somewhat neglected science.  The legal system has graduated from ‘guilty or not guilty’ to ‘at fault or not-at-fault’, as this makes it simple to dispense justice.  The more nuanced study of adverse events has been mainly done in the aviation and oil industries where a number of small errors or omissions may magnify each other.  The oil industry has tried to quantify the probabilities, which of course is much beloved by the insurance industry, which wants to set its premiums on some sort of rational basis. (How many valves are there in the plant? What percentage of valves leak? What percentage of the valves control volatile liquids?  How many areas can form explosive clouds? What sources of ignition are there? etc.)

A common analogy used for major accidents is that there are a series of discs with a hole in each of them all revolving at different rates, and if all the holes line up, something can get through.  So if each disc is something that can fail, the combination of failures leads to the disaster.

There is then discussion of the environment, the primary, secondary and tertiary causes and the immediate precipitant.

So the headline of this article was an attempt to put some discs in line to look at why the shooting happened.  It is obviously a tragedy and totally unethical, but it is still helpful to discuss its elements coldly and logically.

Sex is a primal drive. An explanation offered for many species is that the males try to reproduce as much as possible, with the females acting as ‘quality control’ selecting who they will mate with and when.  Male libido is rarely discussed except as an embarrassment to harmony or a non-justification for unwanted sexual advances.  The Christian churches have generally had a very negative attitude to sex.  It seems that sex is defined as only acceptable in a monogamous relationship, the alternatives being states of either abstinence or immorality.  The word ‘morals’ has come to mean sticking to a sexual code, rather than behaving ethically in business, commerce or anywhere else.

This attitude to sex has made it an exceptional act.  When a baby girl first rolls over, everyone claps. When she first sits, stand, walks, talks or rides a bicycle everyone is similarly delighted.  But when she first has sex, the world seems terrified.   With boys it is similar, but there is much less terror.  Christian-ethos-based  societies do not seem to have come to terms with our basic humanity and its natural functions.  In consequence prohibitions and guilts are major elements in our society.

In Shakespearean society the serfs had nothing to inherit, so were not really concerned who fathered the village children. The middle class had money to inherit, so were very fussy who slept with who, and the kings staffed the Court with eunuchs just to be on the safe side.  In some Asian societies the men visit the brothels on the way home so that they will leave their wives alone. This also occurs in Western societies, but with the sex industry more marginalised. 

So if a man is at the extreme end of the libido spectrum, but due to personality characteristics is continually denied sex, he may become angry and frustrated.  This is unsurprising.  If his libido is then defined as abnormal, he may be termed ‘sex-addicted’.  Is this then a psychiatric diagnosis?  Probably not.  There is no real connection between psychiatric diagnoses and physiological brain function, and mental illness is often a question of definitions, which change significantly with time.  The diagnosis ‘nymphomaniac’ has gone out of use.

In the US with guns readily available, killing people is much easier; uncontrolled anger is much more dangerous.  Obviously an angry man is far more likely to kill 8 people if he has a gun that if he does not.

In that brothels tend to be staffed by people who are marginalised either by race or income, it is observed that many are staffed by Asian women.

If one accepts that there were 6 discs that had holes in them, one could argue which causative factor was the most important.  The Police may have been keen to play down the racist element.  They may assume that the guns and the ‘moral framework’ are not able to be changed, hence not worthy of mention.

Australia has no gun problem like this, but sexual consent is certainly the topic of the moment. A more natural and secular approach to sex education would seem to be necessary, and an obvious approach is to put it into a civics and ethics class into schools.  The crunch question will be whether it displaces scripture, which increasingly seems an anachronism.

www.smh.com.au/world/north-america/alleged-killer-says-sex-addiction-not-racism-motivated-atlanta-shooting-spree-20210318-p57bqb.html

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Aged Care Reform Now

20 March 2021

Aged Care Reform Now is the name of a group that is working to try to get the Aged Care Royal Commission conclusions implemented. Like many inquiry reports, implementation is by no means certain.

John Howard’s Aged Care Act of 1997 allowed the sector to be ‘for profit’, and a poor system was made worse. At a webinar that I attended geriatrician, Joseph Ibrahim was of the opinion that when the dust settled, the government would do what the big for-profit companies wanted as they had a direct line to the government, and there was no serious organised advocacy as there had been for the gay lobby in the AIDs crisis or for disability. (The write up of that seminar is on this website- search Ibrahim).

Here is group trying to do advocacy. They will need all the help that they can get!

https://agedcarereformnow.com.au/

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Mutual Obligation and ‘Noblesse Oblige’

18 March 2021

‘Mutual Obligation’ is the new buzz word for unemployed people.  If they are to get ‘welfare’ they have to be trying to get a job.   An index of this is to make a lot of job applications, that surely must be the bane of every employer in the land, with an obligation of job seekers to apply for 20 jobs a month and about 8 job seekers for every vacancy.

‘Noblesse Oblige’  is a French term dating from when English royalty spoke French after the Norman conquest (of 1066)  and refers to the benevolent, honourable behaviour considered to be the responsibility of persons of high birth or rank.  The term is so quaint and medieval that is often used ironically. But these days with the growing gap between rich and poor, and the lack of sanction on poor behaviour by the empowered class, it may be that old fashioned ethics is all that remains to help poorer people. And they are in short supply.

If there were mutual obligation, a government would be obliged to give its citizens a decent life.  In the 1950 and 1960s it was considered a government responsibility to get everyone a job and governments fell if the unemployment rate was over 1%.  In the 1980s when I worked at Sydney Water, it ran employment programmes for ex-prisoners, people who had been unemployed for more than 3 months, and people with disability.  The employment was for a 6 month term, and my job was to check that applicants were physically able to do the job.  There was a programme to separate sewage and rainwater in inner city areas and a pipe replacement programme.  Both of these programmes were simply canned.  The Apprentice School, which had about 180 apprentices including plumbers, electricians and carpenters was closed.   Sydney Water’s staff went from 17,000 to less than 3,000, and all the wages saved were simply turned into ‘dividends’ from the State Owned Enterprise’.  A tax in short.  Contractors were used, and mains repaired when they burst.  The government had out-sourced the work and outsourced the responsibility for employment.  The latter was less obvious. 

The Global market place that was created in 1944 to lessen the chance of wars allowed countries that produced things cheaper due to cheaper labour costs to prosper, and multinational corporations moved their factories.  The Americans call it ‘off-shoring’.  But our governments have acted as if none of this exists. An abstract entity, ‘The Economy’ is now responsible for job creation and unemployed people are responsible for getting them.  The government has outsourced job seeking to private corporations, and as we know, their duty is to make as much money for their shareholders as possible.  So if it is better to churn many people through short-term jobs to get a commission every time someone starts, hey that is the way to go.  So it is about how the rules are written.  If the old CES (Commonwealth Employment Service) clerks could find someone a job they did.  No one complained that they did not try to place people, and there was no incentive for them to do anything other than to try to place people in the best way possible.

I work with the Workers Compensation insurer, iCare, whose remit seems to be to minimise the cost of claims by saving on both claims managers and payments to injured people, and they are still paid a bonus if the ‘customer’ (i.e. patient) gets back to work, so there is pressure to force them back.  The CTP insurers are always in a total conflict of interest position. They get the premiums and every dollar they avoid paying out goes to their bottom lines.  The idea that a private market will fix things is complete nonsense.

Now we have revelations of gaming the system in the privatised job placement agencies.  The whole dismantling of the public system relies on the assumption that people will not work without incentive payments and private is always better than public.  I was in the public sector for many years as a salaried doctor and then in Sydney Water.  My experience was that the public sector did its job quite well and thought about better ways to act, undistracted by incentive schemes that would distort resource and time allocation.  The Dept. of Public Works built most of this state; Sydney Water built Warragamba Dam.

Privatised rorting is now a major industry draining resources from CTP insurance, Aged Care, the NDIS and now job search. This is not to mention over-priced private monopolies in toll roads, transport, land titles office or oligopolies gaming electricity supplies.

Will there ever be a government that rebuilds the public sector to put an end to this?  Will Labor just roll over as Liberal Lite as they did to get an extra $3.50 on ‘JobSeeker’?

But the key issue is that everyone has the right to decent life, and if the government cannot provide jobs, it should provide income support.  Noblesse Oblige.  As one of my more insightful friends said, ‘There is no shortage of work. Everyone I know can think of things that need doing. It is not a shortage of work, it is an unwillingness to pay’.

Watch this video re the privatised employment agencies.

https://nsfuw.com/?secure_token=8fb90d8862532ccff17c55370720566372b28b851af78200f9c4a13b9171c28e&t=GZ1ZJT09R&utm_campaign=Expose_predatory_job_agencies&utm_content=30518&utm_medium=email&utm_source=blast
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iCare Doesn’t Know and Doesn’t Pay Underpaid workers

7 March 2121

The incompetence of Perottet’s iCare never ceases to amaze.

It underpaid injured workers but was not sure how many. It was initially 240,000. Then it changed its to estimate to 52,000 people underpaid up to $80 million. Then possibly as little as $5 million. In March it is 23,000 and $20 million. They don’t actually know. After 18 months 25 have actually been compensated!!!
This is all treated as some of ‘management error’ as if this makes it OK. These are a lot of abstract words, but few concrete ones. The idea of abstract words is that the concepts can be discussed better. But mostly management words are so general as to be meaningless, and principally serve to make everything non-specific and also euphemistic. No one says, ‘They did not know or care and their incompetence led to immense suffering for the families who were underpaid’. It becomes, ’There was a lack of management understanding and focus and some workers may have been paid less than their entitlement’.
Naturally no one will be punished.
All I know is that even the routine service takes about 3 weeks to get anything done. I had a patient doubly incontinent after a spinal injury. It takes up to 10 working days to get a claim approved, then up to 10 working days for them to approve an MRI and a specialist consultation. This is normal. When they delay things it is worse, and sometimes they refuse to pay at all.
www.smh.com.au/national/nsw/scathing-icare-review-finds-a-need-for-cultural-change-20210301-p576tq.html

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