Portfolio: Rec?d l0 SOUTH AUSTRALIAN gale :3 s? coeonnrs Fue?gopy is. COURT ?mg; or 0t L: Telephone: (08} 8204 0616 Facsimile: [08) 8204 0615 E?moil: caronechourls.sg.gov.nu Comnet's Court 302 King William Street Adelaide SA 5000 For the personal attention of the Honourable Jock Sneiling MP Confirmation of receipt by the Minister is requested 8 September 2015 Hon Jack Snelling MP Minister for Health GPO Box 2555 Adelaide SA 5001 Dear Minister Re: Enterprise Patient Administration System (EPAS) In June I met with Mr Swami and other members of SA Health about EPAS and the coronial system. As you may be aware, I am responsible under section 7 of the Coroners Act 2003 for the oversight and coordination of coronial services in the State. A very significant part of that service is the determination of cause of death of persons who have died after admission to the public hospital system. In order for the forensic pathologists at Forensic Science SA (FSSA) to perform effective autopsies they have traditionally had speedy access to the hospital records of people who have been treated in the public heapital system. As you would appreciate, the paper records may involve one or more hospitals. Under the current system they are previded in a reasonably timely manner after the relevant hospitalts) has had an opportunity to copy them. The FSSA pathologist can then carry out the autopsy with expedition to ensure that the family can have a funeral at the earliest opportunity. The system is certainly not perfect, and mishaps occur, but generally it operates with reasonable efficiency. Early reports from the pathologists a couple of years ago when EPAS was commenced at the Repatriation Hospital and one of the other smaller southern hospitals were to the effect that the EPAS printouts. from even relatively short stays in the order of two or three days. were extremely difficult to work with. Towards the end of last year I attempted to arrange a meeting with SA Health to discuss EPAS and the coronial system. and a meeting was held in June this year. Mr Swarm attended, as did Professor Phillips and some SA Health staff involved with EPAS. Dr Wills of FSSA (a pathologist) and Ms Williams of FSSA were also present. I expressed my concern that the EPAS system must be able to produce information in a manner suitable for the coronial system in the State to utilise. Bearing in mind that .2. neither the Coroners Court nor ESSA has any spare capacity or resources to devote to accommodating EPAS. my message was that EPAS will have to accommodate us. I made it as plain as I could that I and the coronial system (by which I mean my office, the Court. FSSA and its staff) would need to have either the same paper records we have always had. or some easily navigable record that is capable of being used by court staff and by court users. including members of the legal profession. I pointed out that delays in the provision of records, or an inability on the part of the coronial system to decipher the EPAS records. would lead to potential delays in funeral arrangements. Depending on the delays involved. the coronial system could be compromised. My understanding was that the Chief Executive would have some further discussions with FSSA staff. Today I spoke with Dr Wills and Ms Williams. They told me that to date they have been provided with access to SA Health?s online EPAS training system in order for them to be able to inform SA Health staff of how they would like the EPAS system configured to suit their needs. They have been working their way through it but. given their core duties. progress has been slow. I was surprised to learn that this approach had been agreed between FSSA and staff of SA Health. I had envisaged that SA Health staff would proactively work on the task of determining how to provide FSSA and the coronial system with access to the patient?s medical records in a comprehensive but convenient way, given that EPAS is an SA Health initiative. and was not instigated by the coronial system or FSSA. The fact that Dr Wills and Ms Williams agreed to approach the matter as they have without my knowledge was beyond my control and. as I say, I only learnt about it today. However. I am disappointed that access to SA Health's online training system appears to be the extent of assistance FSSA have received from the Department to date. Furthermore. I do not understand why there is a need for Dr Wills and Ms Williams to do EPAS online training in order to make their needs clear to SA Health staff. They need to be able to achieve what they have always been able to - namely to find out. by reading the medical records, what occurred in the patient?s treatment. That hardly requires that Dr Wills and Ms Williams undertake online EPAS training. I was. following the meeting with the Chief Executive. perplexed by the acknowledged inability of the EPAS system to be able to produce a written record of a patient?s medical history in the same way that the hospital system has always done. I would have thought this would be a simple matter. The updated information I have now received has raised my level of concern. As I told the Chief Executive in June. early access to medical records after death is essential to the coronial system if families are not to have their funeral arrangements disrupted. But the coronial system is more than just the early gathering of information to determine cause of death. It requires the ability to determine all of the circumstances surrounding and leading up to death. In a hospital case that means an ability to see the records made by the people involved in the patient?s treatment. If a case goes to Inquest. then there are many people who need to be able to do that including the presiding coroner. counsel assisting. medical expert witnesses. lawyers and experts engaged by interested parties. The process of deciding whether a case will or will not go to Inquest requires such access by those members of the court's staff who are involved in that decision making process. .3- The information I have received to date has caused me disquiet, in that I am not confident that if and when EPAS is fully implemented, the comma] system will be able to continue to operate in relation to deaths in the public hOSpital system. I thought it as well to put my concerns in writing to avoid any doubt about the requirements of the coronial system when and if EPAS is implemented, and the implications for the coronial system if EPAS is implemented and the coronial system can no longer ascertain that which it has always been able to ascertain in the past. To put this matter into perspective, the entire budget for coronial services in this State. including the fees charged by FSSA for autopsy and other pathology services, is $5.6 million. I note that on 26 June 2013 you informed Estimates Committee that is a $422 million project. By my calculations you could run the State's coroniai services for more than three quarters of a century on that amount of money. You will readily appreciate therefore that I see it as entirely unreasonable that SA Health expects any resources of the coronial system to be diverted as a result of the implementation of EPAS. Yours sincerely Mark STATE CORD CC: Mr David Sivan, Chief Executive, SA Health Dr Chris Penrmon, Director, Forensic Science SA