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Anxiety over 2021 border battles prompts call for national solution

A South Australian ophthalmologist and Victorian optometrist are spearheading calls for state governments to embed better decision-making processes around healthcare worker travel exemptions, should COVID-19 outbreaks lead to more hard border closures in 2021.

Dr Arthur Karagiannis, a visiting ophthalmologist based in Adelaide, and Ms Angie Trinh, an optometrist at Eyecare Sunraysia, believe exemption panels need to better cater for health professionals after hundreds of patients they co-manage in Mildura, in north-west Victoria, were cut off from ophthalmological care for eight months last year.

Like many border communities, health services in Mildura rely on visiting specialists from across the border in Adelaide, but Karagiannis and other specialists couldn’t practise in Victoria from April to December due to a requirement to self-isolate for two weeks on return to SA.

Before SA re-opened its border to Victoria in December, Karagiannis applied for at least three exemptions, but was refused each time. This was despite logistics operators being granted waivers, and him learning that an orthodontist – which lends itself to greater infection risk through aerosol generation – was approved for quarantine-free travel.

Sporting organisations could also meet with state governments and formulate a COVID-safe plan, but the same opportunity wasn’t afforded to medical professionals, he said.

“There’s work going into a national definition for a COVID hotspot, and there should be an across-the-board agreement as to what constitutes an essential traveller,” Karagiannis, who has visited Mildura for 16 years, said.

“If you don’t deem a health worker an essential traveller then something is wrong with the system. There also needs to be a method for considering health professional exemptions, rather than sending your application to the same email address as every other person who wants to bring their cat over for de-sexing or a truck driver that’s delivering goods. We are dealing with the health of people – we should in effect have our applications expedited and a point of contact to discuss issues with.”

Hundreds of Mildura patients were denied access to visiting specialists form Adelaide due to hard South Australia border closures.

Speaking before the latest round of border tensions since Christmas, Karagiannis was concerned his Mildura patient backlog could lengthen further if blanket border closures are reimposed this year. He also wants to shine a light on the issue to avoid similar problems in border communities like Albury-Wodonga and towns at the Queensland and northern New South Wales border. 

Agreed hotspot definition could fix issue

Australian Society of Ophthalmologists president Associate Professor Ashish Agar said the problem was not confined to Mildura, with Broken Hill – where he visits in far west NSW – also experiencing similar issues with SA specialists.

At the root of the issue, he said, was a lack of an agreed definition on a COVID hotspot among state governments.

“What Arthur’s case points to is the fact there is still no system in place to manage this if it happens again,” he said.

Ashish Agar.

“It’s a dog’s breakfast across the country, and unfortunately people who have no direct involvement pay the price whether it’s family members stranded across borders or patients on one side, doctors on the other.”

Agar said the ASO had been working with individual ophthalmologists affected by border closures and feed their dissatisfaction back to state governments.

“Firstly, we are strongly encouraging all states and the Federal Government to come to a common definition of a hotspot, so everyone can agree when a border is closed so it’s neither a surprise, nor a political decision. And secondly, we’re urging a proper policy around who is exempt [from quarantine] and who isn’t to make sure patient interests always come first, because that has not been happening,” he said.

Long backlog awaits

On top of their usual patient load, Trinh and her optometry colleagues at Eyecare Sunraysia in Mildura were left to manage many of Karagiannis’s patients with chronic eye conditions and report back to him remotely, while his cataract patients sat idle.

A major frustration, Trinh said, was a lack of clarity around the criteria to obtain an exemption from the SA Government. She pointed out Mildura had only six COVID-19 cases in total, with the last in May. The practice had a COVID-safe plan and Karagiannis even proposed only performing consultancy work, without operating.   

In a letter to the SA premier Mr Steven Marshall, Trinh outlined these concerns and the impact it was having on patients in a regional community where it was difficult to find replacement specialists.

She received a response from the SA deputy chief public health officer Dr Emily Kirkpatrick who said several healthcare worker exemptions had been granted taking into account clinical urgency, location of work and plans for risk mitigation.

However, Karagiannis’s exemption wasn’t approved due to concerns the work was being undertaken in a hospital setting and involved anaesthetic procedures.

Kirkpatrick’s response to Trinh was the first time Karagiannis heard this rationale, despite his own emailed requests. He said it was irrelevant to his situation because he performed surgery at Mildura Health Private Hospital, which was not treating COVID-19 patients, and ophthalmologists typically used sedation/topical anaesthetic, as opposed to general anaesthetic.

“Their fears could have been put at ease in a five-minute phone call. Clearly, they don’t know what we do as ophthalmologists in a hospital setting for them to even make that statement, and the fact they wrote that to a person who sent an email in and didn’t have any kind of correspondence with me speaks volumes about the process,” Karagiannis said.

Although further outbreaks have already prompted border closures in 2021, Trinh hoped that with more time to prepare, state exemption panels could be more nuanced in their decision making.

“Applying the same restrictions over an eight-month period, despite the improvements that happened in Melbourne and without speaking to the actual medical professionals affected, didn’t work,” she said.

“It created a gap in medical care for regional patients that might have been necessary whilst the cases in Melbourne were high but became harder to justify as the situation in Melbourne improved.”

Karagiannis said he would be performing catch up work well into 2021. This included weekly visits to Mildura through December, and working Saturdays.

More reading 

‘Phantom’ COVID cases deny healthcare to cross-border patients

Low vision services and border restrictions

NSW cataract patients waiting 71 days longer post-COVID

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