AN ELDERLY man in the early stages of dementia has broken his hip. He's in terrible pain. It's Friday afternoon. The orthopaedic surgeon says he's too frail for surgery and fails to prescribe adequate pain relief.
The man's daughter pleads for a palliative care consultation. She's told she'll have to wait till Monday. Meanwhile, nurses come to roll the man over every few hours. The rolling on his broken hip causes him agony. The third time the nurses come to do it, he begs "no roll, no roll" and the daughter places herself firmly between him and the nurses, to prevent them from getting to him.
This is one of many horror stories that informed Professor Colleen Cartwright, of Southern Cross University, in her research for a presentation to the Australian Association of Gerontology's national conference in Brisbane this week, on the incidence of inadequate pain relief in Australian hospitals and aged care facilities.
Prof Cartwright is the Foundation Professor of Aged Services at SCU and director of the Aged Services Learning and Research Collaboration (ASLaRC) established by SCU and the University of NSW.
"The man with the broken hip died within days of being admitted," Prof Cartwright said.
"Many health professionals are afraid to give adequate pain relief because of a mistaken belief that it's a form of euthanasia. They don't get it that leaving the patient in agony will also lead to death.
"I've been getting a lot of stories about inadequate pain relief in terminal illness, mostly in residential care. The doctor will have prescribed properly, but the nurses may have arbitrarily decided not to administer it as prescribed because the patient might get addicted to it.
"Or the nurses simply might not believe the patient could be in that much pain. Or, dare I say it, the nurses may think the doctor didn't prescribe properly."
Prof Cartwright said the overall situation for older people in residential aged care facilities has improved a little in recent years.
"I know of organisations such as Inspired Care and others that are focused on person-centred care. They're trying hard to work out what each person wants.
"You'll always have some staff who are less committed, but it's hard to blame staff when you see their workload and how poorly they're paid - we've neglected this, and warehoused older people."
The assumption of government that most elderly people will be cared for at home is flawed, Prof Cartwright said.
"Many people of my generation don't want to be a burden on their family.
"The carers are not out there in the community. Average life expectancy now is 80 or more, but if we're encouraging people to stay in the workforce longer and have more funds for their retirement, and we're also encouraging elderly people to stay at home, who's going to care for them?"
Prof Cartwright said she had been shocked to discover from a Queensland study how little training in pain management was offered to health professionals. Only 4% had any training, and of GPs surveyed, only 23%, and not all palliative care workers had specific pain management training.
"They believed they could just pick it up as they went along," she said.
"And then there's the confusion about what euthanasia is - it's a deliberate act with the primary intention of ending the life of the patient.
"That's different from pain relief, which may hasten death by a few hours or days, but that death would be an unintended secondary consequence of an intention to make the patient more comfortable.
"Bottom line, end of story is: there's no excuse for leaving someone in pain. It is a human rights abuse."
Prof Cartwright would love to hear from anyone who has had experience of cases where pain management was an issue. She can be contacted at firstname.lastname@example.org.
To read more about her work with our ageing population, go to http://aslarc.scu.edu.au.