How two Jehovah’s Witnesses were paid millions to restrict WA blood transfusions

[1gemstone]

he national body charged with overseeing a safe blood supply to Australians says more evidence is required to support the use of PBM programs. Source: Supplied

THE WA Departmentof Health has paid almost $4 million to two Jehovah’s Witnesses, neither of whom is a medical doctor, to roll out a statewide program to cut blood transfusions to thousands of patients being treated in public hospitals.

The Sunday Times can reveal the two men, Axel Hofmann and Shannon Farmer – whose religion is vehemently opposed to blood transfusions – won the lucrative five-year contract in 2008, with an American associate, without having to bid for the job.

The contract was approved by the Health Department for exemption from the usual open-tender rules because, according to the department, the trio were the only ones with the skills to plan and implement a “patient blood management” (PBM) program in WA.

The aim of the WA PBM is to identify patients “at risk of transfusion” and implement a management plan aimed at “reducing or eliminating” the need for transfusions using donated blood. It also aims to reduce the potential risks to the patient and cut the costs associated with transfusion.

However the national body charged with overseeing a safe blood supply to Australians says more evidence is required to support the use of PBM programs and the WA Health Department has failed to provide conclusive data that confirm the program has proven health benefits across the whole patient population.

The Sunday Times can also reveal:

The man who championed the introduction of PBM to WA was the former Chief Medical Officer, Dr Simon Towler, who has known Mr Farmer professionally since the early 1990s.

The PBM rollout was given the go-ahead by the Health Department after receiving presentations from Mr Farmer and Mr Hofmann in 2007.

The department told The Sunday Times the religion of the two men was “known to the Department’s State Health Executive Forum prior to contracts being rewarded (sic)”.

However, Dr Neale Fong, who was WA Director-General of Health and head of SHEF at the time, told The Sunday Times that he did not think he was told that the men were Jehovah’s Witnesses.

“I don’t believe so,” he said. “You’ve surprised me by mentioning it. I think it should have been declared.”

Shannon Farmer. Source: Supplied

 

However, Dr Fong said it probably would not have made any difference to the decision.

“If they are just motivated out of their own religious background, well, that just goes to the motivation, but the issue should still be able to be adjudicated on its own rights,” he said.

“But I think from an ethical point of view it would have been useful for them to declare it.”

Dr Fong said Dr Towler was the sponsoring executive of the program, which meant he was responsible for the policy related to it and for making sure “all the ducks were lined up” and that it made sense.

Dr Fong said the PBM proposal had made sense in terms of health economics and he had been very pleased to support it.

He stressed that the key consideration for any initiative was the welfare of the patient.

“Patient safety is always the highest issue here,” he said. “It’s not savings or efficiencies, it certainly is always a case of patient safety, always.”

When told that the consulting doctors’ orders for blood were sometimes overridden at Fremantle Hospital, Dr Fong said, “I would have some concerns over that.”

Dr Fong stood down as Director-General in January 2008, three months before the contract was awarded.

“God knows what happened to (PBM), I don’t know,” he said.

The contract was for the “Implementation of a System Wide Patient Blood Management Program to the Department of Health” – the first time in the world, it is claimed, that a PBM program has been applied across a whole taxpayer-funded health system.

According to the Health Department, PBM is now operating at Fremantle, Royal Perth, Sir Charles Gairdner and King Edward Memorial hospitals.

 

 

 

The Sunday Times has established that the contract was awarded on April 10, 2008, through an Austrian entity called “Medicine and Economics” (M&E), which is owned by Mr Hofmann, a health economist who has a base there.

Under the contract, M&E was paid $3,901,703. The money was paid into a bank account in Austria, according to the Health Department.

It is not clear why the contract was awarded to German-born Mr Hofmann’s Austrian business entity, since he does not appear to have had any previous experience in establishing and operating a PBM program. He does not have a degree in medicine but he has a Master’s in economics and a PhD in health science.

 

 

Dr Simon Towler. Source: Supplied

 

 

Mr Farmer, who has no tertiary qualifications, and a California-based associate, who also is not a medical doctor but has degrees in economics and health science, have been involved in implementing such hospital programs, even though on a much smaller scale than the statewide program in WA. Mr Farmer was the co-founder of a “bloodless” surgery program in 1990 at Fremantle’s Kaleeya private hospital.

During the term of the M&E contract, it is also apparent that Mr Hofmann and Mr Farmer received payments as consultants or guest lecturers from the pharmaceutical companies that make the often expensive drugs used as substitutes for blood transfusions.

Mr Hofmann has declared payments or travel support for consulting or lecturing from at least 14 pharmaceutical companies. Mr Farmer has declared that he received lecturing or consulting payments or travel support from at least six pharmaceutical or related companies.

The Sunday Times has tried to contact both men without success.

Dr Towler, who has long been interested in alternatives to blood transfusion and has published articles on the subject in peer-reviewed journals, told The Sunday Times that he commissioned the strategy document for the WA PBM program.

 

 

 

“It was my idea,” said Dr Towler, who is now the clinical co-lead at Fiona Stanley Hospital. “It was a completely legitimate project. We chose to engage people with substantial expertise in delivering hospital-based programs.”

Dr Towler referred questions about the tender and terms of the contract to the department, but told The Sunday Times: “Through PBM, we have saved more than we spent on the project.”

Chief Medical Officer Gary Geelhoed Source: News Limited

 

Current Chief Medical Officer Gary Geelhoed said the M&E contract – which was awarded several years before he came into the job – had undergone due diligence and had been given a formal exemption under the tender rules.

“This concept was so new,” Dr Geelhoed said. “They got selected because there was no one else around in Australia.”

However, programs along the same lines had been operating in hospitals in the US and western Europe for years before the plan was put forward for the WA health system.

Asked why an Austrian entity was awarded the WA contract rather than tenders being sought from around the world, Dr Geelhoed said, “Well, I could not comment on that.”

He said the five-year contract was not renewed last June 30 when it expired because the consultants had fulfilled their role, which was to spread the PBM concept across the health system, introduce the idea to clinicians and hospital staff, give lectures, produce written material, and provide a “blueprint” of how to implement the program.

“The outside consultants educated people. They got people onboard,” he said.

Both Dr Towler and Dr Geelhoed argued strongly that they believed Mr Hofmann and Mr Farmer’s religion was irrelevant to their getting the contract.

 

 

 

Health Minister Kim Hames told The Sunday Times he was aware of the circumstances surrounding the PBM contract because questions had been raised in 2012. The questions were raised by one of these reporters.

“After then reviewing the information on the program, I was fully satisfied with the way it was implemented,” Dr Hames said.

WA Health Minister Kim Hames. Source: News Limited

 

“I remain confident that there is nothing inappropriate about the nature of the contract or the program itself.”

The program officially started in WA in July 2008, but the rollout of PBM across the whole hospital system was not announced until April 2011, with a brief media release quoting Dr Towler. There was no mention of the involvement of any external contractors.

The Sunday Times does not suggest that Dr Towler, who is not a Jehovah’s Witness, obtained any financial benefit from the PBM contract or was motivated by any other factor other than a genuine belief in the project.

The WA PBM initiative has been promoted, at international doctors’ conferences and in medical journals, as being a world leader.

However, there has been no mention that Jehovah’s Witnesses, whose religion not only prohibits transfusions but also bans blood donation by members, have been key players driving the WA PBM project or that millions of dollars were spent on their services.

And the results of the introduction of PBM, in dollar terms or patient outcomes, have not been published in any of the WA Health Department’s annual reports between 2008 and 2013.

There is not a single mention of it in the Health Department’s 2012-13 annual report for the Metropolitan Health Service, which includes Fremantle Hospital.

Dr Geelhoed told The Sunday Times: “It’s been a very successful program and saved a lot of money. The program pays for itself. I’m happy to say that.”

In March, The Sunday Times asked Dr Hames whether he believed the $3.9 million M&E contract was “value for money” for WA taxpayers. The Minister has failed to respond.

 

 

 

 

 

Fremantle Hospital Source: News Limited

 

The Patient Blood Management (PBM) program has resulted in improved patient outcomes such as fewer complications, reduced length of stay, fewer infections and reduced usage of red cell blood products, the WA Health Department claims.

The Sunday Times asked the Health Department on March 28 to provide the results of patient outcomes from more than five years of PBM initiatives in WA.

More than five weeks later, the department provided four graphs on superficial (skin) infection rates and hospital length of stay.

There was no rationale provided to show how superficial infection rates might be caused by blood transfusions.

According to the US Centers for Disease Control and Prevention and other medical establishments, superficial infections involve the skin only.

The four graphs showed data from 2008/9 to 2012/13 in selected patients.

Two graphs showed the superficial infection rates along with red cell transfusion rates in hip and knee replacement patients.

The graphs showed superficial infection rates generally went down as transfusion rates went down.

But both graphs showed superficial infection rates in one year went up as the red cell transfusion rate came down. In another year, superficial infection rates in knee replacements went down as transfusion rates went up.

The two other graphs supplied showed changes in length of stay in hip or knee replacement and heart surgery patients.

The graphs show that the length of stay was higher in patients who had a blood transfusion.

There were no data to show how blood transfusions directly affect length of stay, including whether patients who had a blood transfusion had a longer length of stay because they were sicker.

In all graphs, no actual patient numbers were given, only percentages, so it is unknown how many patients in these select groups were included in the statistics.

The department did not produce any results for “fewer complications” apart from the superficial infection rates.

The “reduced usage of red cell blood products” is not a patient outcome.

The department also did not provide any data on whether patients who were refused a blood transfusion or received a restricted amount of blood under the PBM program suffered any adverse effects or were readmitted to hospital.

The department said it would not be commenting further on the issue of the PBM program.

In an online medical journal article last year, the WA PBM team reported on the implementation of the PBM program from 2009 to 2011 at Fremantle Hospital, in which some requests by doctors for blood for their patients were refused and some patients were given restricted amounts of blood.

The only specific patient outcome reported for the three years was that in some patients undergoing knee surgery, the average length of stay in hospital decreased from six to just under five days.

The main outcome reported was that there was a decreased number of blood transfusions.

There were no reported results on whether patients’ health benefited or was adversely affected by not being given a blood transfusion, or by being restricted to a single unit of blood at a time.

The article’s conclusion was that the PBM program “likely improved outcomes” by reducing patient exposure to donated blood transfusions.

http://www.news.com.au/national/western-australia/how-two-jehovahs-witnesses-were-paid-millions-to-restrict-wa-blood-transfusions/story-fnii5thn-1226921294173

 

 

 

 

 

 

 

 

 

 

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[GrumpysWife]

Very interesting. Thanks for posting that article.

[Old]

WA must refer to Wester Australia, not Washington state. When fist reading this I jumped to the conclusion that the Seattle Times was doing a hatchet job on the well established Blood Management Program at Swedish Hospital. Of course common knowledge is that that program was set up by a Jehovah's Witness and last I heard was still well received by the medical community.

It is interesting how the Sunday Times made this story about JWs. Who are you going to get if you want to start a blood management program?

Shannon Farmer is recognized as an expert on issues of bloodless surgery. I have an autographed book titled "Your Body Your Choice" authored by brother Farmer. I fail to understand how the how even in the 'outback' the ministers in charge could not have known that Shannon was associated with Jehovah's Witnesses. Just Google him.

I hope there aren't to many typos in the above, just had cataract surgery in my second eye and can't use my glasses. My PC died and I am having to squint at my tablet.

[GrumpysWife]

You done good, Jerry.

[Julsey]

If they had been any other religion, this article would never have been written! 

[pnutts]

I saw the article yesterday and did not notice any author, unless they posted it to one side. Those who wrote the article, what is their background? Did they or a relative/friend been removed as a witness?  Dr Towler did a tour of other hospitals with PMB programs in eastern US, which included Bangor, Maine & Englewood, NJ. thus the 'witnesses' never pulled a fast one.

Edited May 19, 2014 by pnutts

[bronwyn]

Very interesting article and pictures~

[palmhat]

Why is it that the religion of others in the article are not mentioned?

Answer:

Because when it comes to other faiths they're "not interesting". Lol

Sent from my SAMSUNG-SGH-I717 using Tapatalk

[retroHelen]

 Looking at this from a non-religious point of view:

 

Don't hospitals everywhere have contracts with managers/administrators who are not trained medics to see where the organisation can make savings?

 

What exactly is the Sunday Times complaining about? The 2 men have Health Economics degrees like other contracted hospital economy managers. One has managed a similar contract at another hospital.  They presented their plan to Doctors who agreed it was a good plan and the 2 men were overseen by a Doctor Towler to put forward the plan for the contract. Then they were paid an amount that the hospital would agree with to fulfill a contract to save money and the doctors say they have delivered and saved money. They haven't completely stopped transfusions, just restricted their use, which is true of many hospitals here in UK too.

 

Why was Dr Fong interviewed when he stepped down from his position 3 months before the contract to do the job was awarded and admitted that he didn't have a clue as to the details of it and knew little of the persons involved.It was 7 years ago, yet the newspaper seems to be making much of Dr Fong's lack of knowledge of the men as if he were a key player who had been kept in the dark, which he seems not to have been as he was stepping down while the process of looking into the contract was going on with another doctor.In one part of the article they write that 'it' was 'rolled out in 2007' yet later in the article they say the contract didn't get going until 2008 after Dr Fong had left.

 

If the gripe of the Sunday Times is that 'using less blood transfusions is not evidence based', then they admit to having not enough data/evidence presented to them to state their case with. If it were true, then the many doctors to whom the program was presented and the doctor overseeing the 2 managers were the ones that were medically trained and should have flagged this up if it were a problem.
 

 This type of contract has been used in many hospitals around the World, as we know, so The Sunday Times should ask advice with some of the surgeons in the bloodless hospitals in other countries and UK and learn with an open mind rather than seeming to be clinging to old medical practices and perhaps wanting to make a prejudicial case  against 2 men (perhaps because of their faith) doing a job they were asked to do by those with medical training - well what about those with similar hospital program contracts who aren't Witnesses?

 

I notice that they emphasize the expense of the blood substitutes, but not the expense of transfusions per unit and average number of units of blood needed & costed for the operations mentioned and expense of match testing for them.

Edited May 21, 2014 by retroHelen

[Musky]

Well said Helen!

 

The link to this article was sent to a family friend in Australia. A retired DO who knows two of the brothers involved personally. He contacted them and they said the "Sunday times" is a "tabloid" paper in Australia and many of the facts in the article are incorrect. He also, said that the real issue comes down to money. The Blood banks which are a big business down there are not making the money they once were. So discrediting the bloodless program is an act of desperation on their part.

[Astrid]

oh dear, Axel Hoffmann! I know him so well, he was in our neighbour congregation for years!

[sunshine]

Thank you Chuck, I always view mainstream media with a critical eye and am aware how they can be very liberal with the truth.  The choice of wording in the heading speaks volumes of the newspapers bias
 
The mention of "Two Jehovah's Witnesses" is totally irrelevant.  If the contract had been appointed to two Methodist or an atheists and a Catholic their religion would not have been mentioned at all.  The religion of contractors is never mentioned in medical matters as the only contributing factor for the decision should be their expertese.  The mention of "two Jehovah's Witnesses" is made in the hope that the reader will unconsciously believe that the Jehovah's Witness organization itself is behind this move.
 
I doubt if the brothes were "paid millions" for their work (I suspect that the budge for the program was millions) but in any case the headline is again trying to create in the mind of the readers that "Jehovah's Witnesses" (they hope the reader will believe the Society) get money to "RESTRICT" blood transfusion.  You only restrict something someone (legitimately or not) is trying to access, so we have the image of JWs stopping patients from accessing "life saving" (in the minds of the ill informed public) medical care. For example, you don't say "Firemen RESTRICT fire damage" because although technically this might be true it is understood that fire can be damaging so the neutral "limit" or even "safe public from [fire]" would be more appropriate.   The world "restict" again emotive and it is used to create in the mind of the reader the feeling that patients are being denied something they want or need.
 
So basically although the headline reads "How two Jehovah’s Witnesses were paid millions to restrict WA blood transfusions" what it IS TRYING TO COMMUNICATE IS "Jehovah's Witness religion pays some bribes and influences corrupt authorities to harm patients while making millions out of tax payers".  Nuff said.
 
 
Still the fact is that the Australian health authorities have chosen to take this decision because they see it as a viable option and that in itself speaks volumes.

Edited June 26, 2014 by sunshine

[Dave]

As mentioned, the reporting style in this article is very biased and apparently designed to feed or encourage prejudice against Jehovah's Witnesses.

 

The problem is, any unsuspecting reader is being influenced by the author to think something underhand was taking place. For example, 2 or 3 times throughout the article, mention is made of certain questions that were put to 'key players' but that they 'weren't available for comment' or that the answer was 'no comment'.

 

However the inference was made that such a response (or lack of it) was an attempt to evade the question or duck for cover as if they were trying to hide something.

 

In some cases the author's line of reasoning was off too. Take this sentence for eg...

 

"There were no data to show how blood transfusions directly affect length of stay, including whether patients who had a blood transfusion had a longer length of stay because they were sicker."

 

Umm hello? Well, of course they were sicker! I'll give you one guess as to why – they just had a blood transfusion. Chuck summed it up. It's desperation on their part.

 

Australia has made a bold move in the matter of Patient Blood Management. If you haven't seen it already this video issued by the Australian Blood Authority says it all: 

 

http://www.noblood.org/forum/threads/7872-Blood-Transfusions-What-is-the-evidence-telling-us

 

It would good if the Author of this article were to watch it.

[Julsey]

Great video.  Especially liked how they compared what was going on in the microvasculature when using volume expanders vs. blood.

[Josho]

I think it's wonderful when brothers and sisters find employment that is in line with Jehovah's laws/purposes, such as jobs like this or those that involve cleaning the earth or reducing pollution and so on.

[Greg Dent]

Ok so how about a law suit against these idiot for Libel? Slander in the written word? Its obvious that it was written to only discredit these Brothers and drag Jehovah's name through the mud and filth that this paper spreads. Jehovah's anger must be burning this sinuses by now with this kind of garbage being spread.