Dangerous drugs, cash and assets handling at Melba Health Centre have been attacked by an internal audit prompted by an employee’s whistle-blowing.
A copy of the audit, by Coopers and Lybrand, obtained by The Canberra Times revealed that many of the employee’s allegations about sloppy cash and drug handling procedures and missing assets were correct.
No procedures to ensure all cash received is receipted and banked. No procedures to ensure Medicare bulk-billing reflected the nature of the consultation provided. Nearly half the items on the assets register could not be found at the centre.
There was no assets register for “”portable and attractive” items under the normal assets register threshold of $5000. (“”Portable and attractive” is accounting language for “”likely to be knocked off”.)
All staff could get to the drugs store with an easily accessible key; whereas only the nurse needed to get to it. The drugs store contained dangerous drugs.
There was no formal monitoring of the issuing of drugs.
Purchase orders were made without authorisation.
Flextime records were not good enough to verify staff entitlements.
The Minister for Health, Terry Connolly, responded by saying the Government had taken the allegations seriously and had commissioned the independent audit.
The findings would be acted upon promptly. Specific problems at Melba would be addressed. Any sign of systemic problems would result in checks at all eight government-run community health centres.
All centres were subject to standard departmental checks and audits and reports by the Auditor-General. The special Melba audit had been commissioned because of specific allegations about the Melba centre. The audit, was delivered to the chief executive of ACT Health, Greg Fraser, last month (DECEMBER).
It described other allegations of shortcomings by the employee which could not be specifically verified but which correlated with findings in the review. These included charges being waived; invoices not checked to ensure items were delivered; drugs going missing; drugs to secured in compliance with the Dangerous Drugs Ordinance; and assets going missing.
The audit noted further allegations by the employee: of abuse of government cars; staff accepting money to drive patients home; excessive use of phones for private use; private business activities conducted at the centre. But it said as these were of a general nature further work would not be able to confirm them.
The eight health centres have a mix of private and salaried GPs and in addition offer community health services like immunisation, aged care, physiotherapy, counselling, women’s health services, nutrition and speech help. Some have specialised services. Each centre has about 20,000 client contacts a year on average.
The audit said, “”The findings of our review emphasise the importance of management review and monitoring of the transactions and operations of the centre, particularly as the size of the centre and the number of staff mean that a complete segregation of duties is not possible.
“”Such a review and monitoring could take various forms, including management authorisation for certain transactions, subsequent review of transactions or the review and follow-up of certain performance indicators, for example the volume of drug usage or volume of billings expressed as a percentage or ratio to the number of doctors or consultations.”
It said invoices should only be paid on proof of goods being received at the centre. Drug security should be improved. A register of “”attractive and portable” assets should be made and the general assets register should be updated. Procedures to control and authorise Flextime should be set up.
It recommended that ACT Health should consider including guidance on all the matters in its procedure manual which is used throughout the ACT health system.