Category Archives: Medicine

Responsibility vs Accountability

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One of the issues to have emerged from the response to the current coronavirus pandemic is the notion that “responsibility” is quite distinct from “accountability”.

In the Australian political arena, this is being played out in two specific aspects, both of which reveal some weaknesses in the Federal and State delineation. The first is the Ruby Princess, the passenger cruise ship that appears to have been a significant source of Covid19 infections from returning and in-bound travellers. In this case, blame or liability for the breach in quarantine measures is being kicked around between Border Force (Federal), and NSW Health (State): who was responsible and/or accountable for allowing infected passengers to disembark?

The second arises from the number of Covid19 cases among aged care residents in the Melbourne Metropolitan area. Here, the issue is the governance of aged care facilities as between privately-run homes (Federal oversight), and public homes (State operation). As an example of the strange delineation between Federal and State, “…the Victorian government mandates minimum nurse-to-resident ratios of up to one nurse for every seven residents during the day, the Commonwealth laws only call for an “adequate” number of “appropriately skilled” staff – both terms are undefined.”

As with all key areas of public policy and administration (health, education, social services), the relationship between different government departments and administrative bodies can be confusing and complex. In very broad terms, public funding comes from the Commonwealth (via direct Federal taxes and the redistribution of GST back to the States), since States have limited options to raise direct revenue (land taxes, stamp duty, payroll tax, and fees from licenses and permits). The Commonwealth funding can be allocated direct, or co-mingled with/co-dependent upon State funding. Likewise, service delivery can be direct by the Commonwealth, jointly with the States, or purely at the State (or even Local) level.

Within Victoria, there is an added dimension to the “responsibility” vs “accountability” debate, largely triggered by apparent failures in the oversight of the hotel quarantine programme. This in turn led to the second wave of Covid19 infections via community transmission (and the tragic number of deaths among aged care residents). The Premier has said he wasn’t responsible for the decision to use private firms to operate the security arrangements at the relevant hotels. In fact, the Premier appears not to have known (or wasn’t aware) who made that decision (or how/why it was made). But he does admit to being accountable for it.

Meanwhile, his departmental ministers have similarly denied knowing who made the decision, or they have said that it was a “multi-agency” response – maybe they are trying to shield each other in a strange show of cabinet collective responsibility, and to avoid apportioning direct blame to their colleagues. But if the government didn’t know who was supposed to be running the hotel quarantine programme, then surely the private security firms certainly couldn’t have known either – if so, who was paying them, and from whom did they take their orders and direction?

We are being drip-fed information on the failures in the hotel quarantine programme: did the AMA “write a letter” to the Victoria Department of Health & Human Services about their concerns over the hotel quarantine programme? did the DHHS provide “inappropriate advice” on the use of PPE by hotel security staff? did the Victorian Premier actually propose the hotel quarantine programme at National Cabinet, and then omit to request support from the police and/or the ADF?

It’s not surprising, therfore, that confusion reigns over who was responsible, and who is accountable; more importantly, who will be liable? What would be the situation if, for example, front line medical staff or employees in “high risk settings” have died from Covid19 as a result of community transmission within their workplace (itself stemming from the hotel breakout), and where there were inadequate workplace protections, especially if the latter were based on government advice and supervision?

The new offence of criminal manslaughter applies in Victoria since July 1, 2020. It will only apply to deaths caused since that date and as a result of “negligent conduct by an employer or other duty holders … or an officer of an organisation, which breaches certain duties under the Occupational Health and Safety Act 2004 (OHS Act) and causes the death of another person who was owed the duty”.

Finally, in reading around this topic, I came across an academic paper which discusses the treatment of responsibility, accountability and liability in the context of professional healthcare. In trying to define each from a clinical, professional and legal perspective, the author concluded that:

“….[R]esponsibility means to be responsible for ensuring that something is carried out whilst accountability moves beyond this to encompass the responsibility but adds a requirement that the healthcare professional provides an account of how they undertook the particular task. Liability moves the definition forward by adding a dimension of jeopardy to the definition of accountability. In a strict legal sense once the accountable person has provide their account they have fulfilled their duty. However, if the healthcare professional is liable rather than accountable for their action then the account they provide will be judged and, if found to be wanting, there may be a penalty for the healthcare professional.” (emphasis added)

I wonder if we should be assessing political and administrative liability by the same standard?

Next week: Startupbootcamp Demo Day – Sports & EventTech

 

 

Counting the cost of Covid19

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Here in Melbourne, we are nearly two weeks into Covid19 Lock-down Pt II, and as we know sequels are rarely as good as the original. The State Government of Victoria has also decreed that anyone under the Stage 3 restrictions has to wear a mask whenever they are outside their home. The irony is that relative to other parts of Australia, Victoria went harder and earlier under Lock-down Pt I, and was later and slower in opening up – in fact, we hadn’t got that far before the second Lock-down was announced.

Some of the details about mask wearing are still a bit vague (what about when I’m driving my car, or playing golf, or in a self-contained space where there is no-one else?), so good luck with the enforcement process. And what significant information do we know now that we didn’t know back in March under the first Lock-down, that somehow made it OK to NOT advocate or require wearing masks four months ago? Could we have made even better progress in suppressing and/or eradicating the virus if we had all covered our faces from the start?

Of course, the major failings by the State Government are evidenced by the apparent human errors associated with the lapses in the hotel quarantine programme, the failure to fully understand the nature (and extent) of key clusters (cruise ships, abattoirs, schools, aged care facilities, fast-food restaurants, logistics centres, public housing towers, and even health care staff), and the inadequacy of community consultation early in the pandemic.

There is also a suggestion that the public became complacent, due in part to the way the politicians and civil servants were telling us how good a job they were doing. No doubt the initial measures were successful in containing the numbers and flattening the curve. So some people over-compensated when Lock-down Pt I ended, and not only disregarded social distancing measures, they started gravitating back to social gatherings, pubs, restaurants and shopping malls. Plus, the undue focus on getting professional sport back on TV helped to suggest things were back to “normal” (even though no games are being held within Victoria).

Some Government spokespeople implied that certain Covid19 conspiracy theories had taken hold in the community, resulting in people not taking the virus seriously. This commentary (that the virus is a hoax, that it is all a plot to curtail individual freedom, and that the “experts” were pushing an authoritarian agenda) has also been linked to anti-vaxers, anti-5Gers and regular members of the tin foil hat brigade. In particular, some conspiracy theories suggest that the pandemic is an attempt to distract us from other issues.

There is a huge human and economic cost to the virus (the number of cases and fatalities, the restrictions on daily life, job losses, business closures and trillions of dollars of government and corporate debt). It will cost a lot more before the pandemic is over and/or we have a viable vaccine. But there has also been a huge cost in terms of public debate and intellectual rigour. Language has become a weapon, science has been politicised (i.e., it shouldn’t get in the way of a political agenda…) and experts have been undermined. Possibly not since Galileo and heliocentrism has science been so poorly debated, irrationally challenged, arrogantly dismissed and badly defended by our leaders – even as some of these same leaders and those around them caught the disease. (OK, the political debate on climate change is another case in point…) If trust in politicians was already at a low, the pandemic is taking a further toll on our democratic institutions. Which suits autocrats, populists, demagogues, fundamentalists and radicals alike in their hatred and contempt for liberal, pluralistic and secular societies.

Choosing to not wear a face mask has apparently become an expression of individual freedom and civil liberty. Whereas I thought wearing a mask during a pandemic caused by a respiratory disease was both common sense and a courtesy to other people.

Next week: Life During Lock-down