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February 4, 2006

Fears Ballarat base hospital may close newborn hearing program

From: ABC Regional Online, Australia - Feb 4, 2006

Reporter: (Online) Jarrod Watt

Presenter: Stephen Martin

A local audiologist claims Ballarat Health Services could be about to drastically cut hearing tests for newborn and preschool children.

Since 1983 Richard Roper has operated the Ballarat Hearing Clinic, providing hearing services to Ballarat and the western Victoria region; this week he authored an open letter to hundreds of medical practitioners throughout the region stating this may be about to end.

The cause of his concern is a tender advertised in Ballarat's daily newspaper on behalf of Ballarat Health Services.

"The advertisement in the Ballarat Courier last Saturday [January 28] advertised for expressions of interest to provide a new audiology service, basically saying... it appeared to be limited to babies born at Ballarat Health Services, that is, babies born at the Base [Hospital]. So it does mean that about half of the population would be cut out of that service. That strikes me as rather odd, because the vision statement of the hospital says that they strive to serve the people of the Grampians region," he says.

So it does mean that about half of the population would be cut out of that service...

Roper is a nationally recognised advocate of neonatal hearing tests to detect hearing problems quickly and allow children to be more easily diagnosed and/or fitted with technology such as Cochlear implants.

"Over the last 30 years or so the Ballarat base hospital has been funded to provide audiology services, and the prime focus has been to detect hearing loss early. Of course over the years the technology has improved, and over the last five years or so, babies have been tested at two days of age, and that's been a very succesful program," he says.

"There are roughly 2,000 babies born in the Grampians health region, at seven maternity units. All those babies are currently having a hearing assessment at two days of age in the ward. Three per cent of those babies usually fail that hearing screening. The maternity units where they're testing - Horsham hospital, Stawell hospital, Ararat, Bacchus Marsh, and of course within Ballarat it's St John of God hospital and the Ballarat base. Roughly half are born in Ballarat, and the other half from the rest of the region are born anywhere from the South Australian border to - that's the definition of the Grampians health region - north to the South Australian border, west of Horsham, down to Melton."

In response the Ballarat Health Services chief executive Andrew Rowe says:

"We seem to have taken responsibility for paying for all of these tests in the entire region you're talking about. So what we're saying is we're happy to continue paying for the tests of those babies born here, but there is nothing to stop direct referral to Mr Roper's service and people can claim the cost of that test on Medicare," he says to ABC South West Victoria journalist Marita Punshon.

We seem to have taken responsibility for paying for all of these tests in the entire region...

Mr Rowe re-emphasises the cost of the service being born by patients via the Medicare scheme, going on to say:

"Assuming Mr Roper is happy to continue providing the service, those tests can be provided under Medicare, and Medicare pays the costs of those tests, so unless Mr Roper is changing the access to services, the service is still available," he says.

Mr Roper has since provided a letter signed by Dr John Ferguson of the Ballarat Health Service dated 2nd December 2005, in which Dr Ferguson rejects Mr Roper's offer to continue the service and restates the intention of stopping the service at the end of January 2006. Mr Roper also states that audiology services are already claimed on Medicare by most hospitals and that it is impossible for children to be referred to his practice privately, as paediatric audiology requires hospital resources such as sedation and rescuscitation facilities, meaning only adults are allowed to be referred to his practice privately.

His letters to the medical community have so far begun to bring response.

"At this stage some very concerned paediatricians. We had to notify them - because they've been referring to us, and calling our receptionist to book children in - we've had to notify them that we won't be providing a service, and weren't sure there was going to be any service available. [We] explained they had to contact the hospital to find out what was going on."

[If] your baby fails that hearing screen, you have nowhere to go unless you're prepared to travel to Melbourne...

Mr Roper again questions the wording of the public tender for new audiology services, saying it is unclear whether Western Victoria's most major hospital will even offer treatment of hearing problems to newborn babies, and unclear whether children already in preschool or primary school will be offered treatment.

"Basically it's not even clear that diagnostic audiology will be available to anyone, even at the Ballarat base, because it's saying, as I read it, that it's only supporting the screening. Of course if you have a screening, and your baby fails that hearing screen, you have nowhere to go unless you're prepared to travel to Melbourne, and of course that's very expensive. And it simply doesn't work - all the research indicates that if you're going to provide a service like that you really have to provide it on a reasonably local basis. We've actually taken the trouble to set up a travelling service to Stawell hospital and Melton, so that people don't have to travel huge distances with a newborn baby," he says, adding that while his primary focus is on the neonatal testing for hearing problems, the potential number of patients affected could be more numerous.

"It's not just newborn babies. Hearing loss can be progressive, and of course, there are lots of toddlers out there with speech delays, attention deficit disorders, autism, etcetera, and glue ear is another one - one in five preschoolers develop glue ear at some stage. We've been testing about 1,000 preschool children each year to differentially diagnose whether the problem is an ear problem or some other disorder - that's an important service I feel, to parents of all schoolchildren before they start preschool, and the other issue is the maternal and child health nurses also perform a hearing screening test on all three year olds, and of course they refer to us all the children who fail those tests."

Related Links:
Some of these links may be to sites outside the ABC and as such the ABC has no editorial control over such sites.

ABC Science - The Lab
Detailed information on different kinds of deafness, how a Cochlear implant works and how Australia leads the world in assisting children with hearing problems.

Audiological Society of Australia
Details on Richard Roper's work locally and nationally with neonatal and childhood hearing difficulties. (Scroll halfway down page).

© 2006 Australian Broadcasting Corporation