Obstetrics in Naracoorte: What does the future hold?

Naracoorte has narrowly avoided the precarious situation of having only one full-time GP offering obstetric services.

Long-time Naracoorte GP Dr Tony Cohen was facing not having his credentials renewed after he did not score a satisfactory mark in a Fetal Surveillance Education Program test.

That would have meant that after 26 years in Naracoorte, he would no longer be allowed to deliver babies.

After initially withdrawing his right to continue in obstetrics, Country Health SA has offered Dr Cohen a temporary reprieve, meaning he can continue in obstetrics for now.

But Dr Cohen believes the issue has exposed a serious long-term problem for Naracoorte and surrounding districts.

If Dr Cohen was not able to continue obstetric services, it would leave only Dr Jeff Taylor as a full-time obstetric GP with caesarean section skills in Naracoorte, and one part-time obstetric GP without those skills.

In a scathing letter to Country Health SA after receiving the test result, Dr Cohen said if his obstetric credentials were withdrawn, he had grave concerns for the community. He questioned if the latest development was part of a secret grand plan for Naracoorte.

“Since 1992 when I arrived here, the Upper SE region has gone from seven obstetric doctors in Naracoorte and obstetric units in Bordertown, Keith, Kingston, Penola and Edenhope to two and a half doctors, in Naracoorte alone,” he wrote.

How do you propose to support non-obstetric doctors on call when the occasional obstetric emergency presents? Is there actually a plan or just hope?

Dr Tony Cohen

“Where has Country Health SA been for the past 26 years? Nothing at all has happened since I wrote...four years ago.

“Is this part of a covert attempt to shut down obstetrics in Naracoorte? I know that this has been denied in the past, but this is how the current situation could be interpreted.

“Country Health has known how precarious our situation has been for years now and yet no solution has been proposed.

“How do you propose to support non-obstetric doctors on call when the occasional obstetric emergency presents? Is there actually a plan or just hope?”

In response to a series of questions posed by the Herald, Country Health SA issued a brief response: “We are working with Dr Cohen and the local clinic to find a workable solution going forward and remain committed to the strategic importance of the Naracoorte Hospital in providing a comprehensive and sustainable range of quality services to the South East.”

Dr Cohen said after devoting a large part of his working life to Naracoorte and CHSA, he felt wronged, humiliated and wounded at his treatment.

While Dr Cohen didn’t blame anyone else for his failure to reach a satisfactory mark in the test, he said revoking his credentials based on the result of a “not at all fit for purpose” test was not right when there was so much more to obstetrics than fetal heart tracing.

He felt it was unfair that “one single evaluation, made at a time of considerable personal difficulty and stress, was the basis for this exclusion”.

He added: “Using that one test as a measure is silly.

“Nothing has been said about my cognitive skills, technical capabilities, or decision making. I believe that my surgical skills and manipulative dexterity have not deteriorated.

“What really upsets me is that after 26 years of usually one-in-two on-call, dealing with emergencies and the occasional heartbreak at all hours, that I leave with such uncertainty ahead for accessible maternity care close at hand in our community.

“I have nothing but respect for Dr Taylor – his skill, clinical acumen, energy and vision – but there is only one of him and he cannot carry it alone.”

Naracoorte Hospital

Naracoorte Hospital

Dr Cohen said he had thoroughly enjoyed his time in obstetrics and the many connections with people and experiences it had given him, and he had wanted to continue in obstetrics for some years yet.

But he said the constant “demands for increasing recertifications, validations and so on (are) tiresome”, and he can understand why GPs of today are less inclined to take on obstetric duties than they were when he first arrived in Naracoorte.

He didn’t have a simple solution for addressing the shortage of obstetric services in the local area, as the challenges related not only to funding but also staffing.

“There’s an overwhelming issue of providing services and I hope Country Health take it seriously, because something needs to be done.”