One man lodged a submission to the inquiry on behalf of his wife, a senior specialist with over 12 years’ experience in a remote country hospital.

He said multiple adverse events at the hospital had been downgraded in order to avoid “executive accountability”.

Among the incidents was “the avoidable death of a young man, who after four successive presentations at the hospital emergency department died from sepsis due to an infected toenail”.

“There has been no accountability for this avoidable health disaster at a LHD board, hospital executive or ministerial management level,” he wrote, adding that his wife and her colleagues who raised concerns had been subject to a campaign of “bullying, defamation and intimidation”.

Shadow Health Minister Ryan Park said the claims painted a picture of a system in “complete crisis”.

“The fact that senior clinicians have raised concerns that serious incidents are getting covered up or downgraded so that an appropriate investigation can’t take place is quite simply appalling,” he said.

When asked whether Local Health Districts were engaging in a cover-up by deliberately downgrading adverse events, NSW Health did not directly answer.

However, a spokesperson said NSW Health promotes a just culture, where staff are encouraged to report problems openly and honestly, and learn from mistakes.

“Reporting and analysis of clinical incidents and sentinel events is an important part of clinical
care that health professionals and managers take very seriously,” the spokesperson said.

“This work focuses on finding system issues that lead to service improvements across NSW Health.

The NSW Health spokesperson said it had a new incident management system that provided an
objective scoring to all clinical incidents notified by staff.

“Incident reporting is increasing and is testament to the clinical and managerial staff in NSW
Health continuously promoting the reporting of incidents, patient safety and system
improvement.”

There are seven Local Health Districts across regional NSW, each with its own clinical governance unit tasked with investigating serious incidents and complaints, and making recommendations to hospitals to improve their quality of care.

Incidents that occur in hospitals are ranked according to a “Severity Assessment Code” (SAC) hierarchy of one to four.

The most serious are SAC1 events, which require a root cause analysis to investigate whether systemic problems contributed and that a brief be submitted to the NSW Ministry of Health.

The NSW Medical Staff Executive Council said it had been provided with examples from regional doctors of the clinical governance units “inappropriately downgrading” SAC1 incidents and failing to “investigate preventable deaths”.

Some of the units had a “culture of opacity aimed at keeping the Ministry of Health unaware of the LHD’s true performance”, the council alleged.

The council called for an independent review of all SAC1 critical incidents in rural and remote areas and the response to them by the LHDs.

Ongoing external audits of the units were needed, it argued.

“Inquiries commissioned by either NSW Health or by an LHD are paid for by the public and should have greater public transparency of their findings and recommendations,” the council said.

The council said that even in instances where NSW Health intervened to conduct its own investigation, the problems identified were rarely reported to doctors or the public and the LHD was still in charge of implementing solutions.

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“The problems have often occurred under the direction of the same managers charged with the remedy”.

Doctors from the major regional centre of Orange in the Central West told the inquiry sometimes no information was given by the Clinical Governance Unit as to why it was downgrading a serious incident.

“This can change whether a poor patient outcome is investigated at all,” the Orange Health Service Medical Staff Council said. “Clinicians would like to be more involved in the review of serious adverse events.”

The council added that more transparency would help rebuild the trust that was “eroding away”.

“There is no formal avenue for clinicians to raise issues with the ministry, in the event that they are unable to address them within the LHD,” the council said.

The husband of the doctor who blew the whistle on the patient’s death from an infected toenail said the matter was now the subject of a coronial inquiry thanks to “the efforts of my wife and a small group of clinicians”.

However her efforts to reduce the risk of similar outcomes for other patients had been “ignored or resisted by hospital administration executives”, he said, and she was ultimately forced to leave the hospital.

The submission said that a “widely held impression is that the LHD executive and Ministry manage upward and prioritize budget over health outcomes”, particularly in regional areas.

Other submissions to the inquiry have told of wards that look like they’ve been hit by tornadoes, hospitals requesting patients bring their own bandages and doctors trying to mend broken bones over videolink.

The NSW Health spokesperson said lessons from a recent review of Root Cause Analysis reports undertaken by the Clinical Excellence Commission (CEC) was informing system
improvement work.

“The CEC is a dedicated NSW Health agency that works closely with local health districts and the Ministry of Health across two broad areas of responsibility including setting standards for safety, and monitoring clinical safety and quality processes; and improving performance of individuals, teams and systems in prioritising safety.”