Outraged by treatment - is this ethical...?

[sonny82]

This is my first ever post on Mumsnet - and I'm a Dad not a mum, so I feel a bit scared! However, I hope you can help me with your objective opinions on an ethical issue I'm pretty angry about.

My wife and I are expecting a baby in the next month and we are both very excited about this.

My wife is under the 'shared care' of her community midwife (attached to the GP surgery) and the local hospital down the road.

The local GP surgery is quite advanced and has an Ultrasound scanner, where our 20 week scan took place. This scanner was purchased following an extensive fundraising campaign in the community and following generous donations from local residents.

On two occasions, my wife has needed a further ultrasound scan because of complications later on in pregnancy. The first was a bit of a scare, but the second was because we had had a growth scan take place at the local hospital which had been done incorrectly, with the results showing growth problems when actually there wasn't any problem at all. I won't go into details, but all was actually fine. Either way, my wife was very upset and distressed, and we asked for a rescan to take place to reassure her. It was quite clear that the original scan had been done incorrectly (it showed the baby as having shrunk!!).

Anyway, on both occasions we made appointments with the Doctor but was then told by the Sonographer at the surgery that even though they had availability and the sonographer was free that day, the surgery only offers ultrasound scans to patients who pay privately. In fact, the surgery's website links to the sonographer's private business.

In other words, the 20-week scan was free at the surgery, but all other scans you need to pay for, even though we're under shared care.

On each occasion, we simply drove 30 minutes to the local hospital where they were much more sympathetic and did the ultrasound scan there and then, for free, with absolutely no fuss.

What I want to know is whether I am right to be angry about the fact the local community has raised money for a facility which was (during the fundraising process) advertised as being for the benefit of all, but which in practice is being used as a money-spinned either for the surgery, or more likely for a private commercial business run by the sonographer.

In other words, it's like a huge fundraising campaign has taken place to raise funds for a scanner, and now someone is using it to make money, with a policy in place to deny those who need it the chance to use it unless they pay privately.

I have written to the local newspaper and also to my MP (who was conveniently on-hand to open the scanner and appear in the papers at the time!), but am I right to be really angry by this? Is it worth fighting further?

I think it's pretty disgusting that women can find themselves in such a vulnerable situation, where they have concerns and anxieties over their pregnancy, but where their community health centre refuses to investigate unless they pay them to do so. It's taking advantage of people and essentially blackmailing them for reassurance, isn't it?

I'm afraid to say from my experience, you will continue to be at a lose to the way you are treated by some (by no means all) health care professionals during your wife and babies care. You should continue to fight her corner whenever she needs you in the next few months. I think if you have the energy to create some bad publicity about this, continue to do so but protect your wife from any associated stress surrounding this. I dont know that it will change anything however...

As with any job there are gooduns and baduns. Do bear in mind that they may be charging you if they dont think there is a "risk" factor in needing the scan. Perhaps your surgery is seeing the additional revenue as a means of supporting the running costs of the machine rather than make a profit.

You are not unreasonable being angry, you are protecting your family and that is a good quality to have.

Worth phoning the papers? That's a shocking misappropriation of charity funds. :(

Ultrasound running costs? Sonographer's pay?

I'm actually a Fundraising Manager for a Healthcare Charity, so I read your post with interest.

First and foremost, a good starting point is the Charities Act and the Charity Commission Website. But this assumes that a charity was registered by which to raise funds for the scanner.

BondiBaby is absolutely correct. The GP surgery may well not be making a profit, but simply needing to fund the service. In my experience people love to donate cash in return for tangible objects so that they can say "I helped to fund that", but completely forget that it's all very well having a shiny machine, or a gorgeous looking building but the professionals who operate the service come at a cost (most people have bills to pay)! It's impossible to run a service without ongoing funding. If the appeal raised enough to purchase the scanner, but then there was no money left over, they still have to pay a skilled sonographer to run the service and operate the machine. It may well be that they are charging at cost and not making a profit for additional scans.

What's interesting here is it is likely that the PCT has agreed to fund the scans you would get anyway to provide patient choice, but has obviously not opted to fund additional scans because they have contracted the hospital to provide these. It's possible that the benefits of doing this did not outweigh the additional costs of providing a sonographer on site. Perhaps at the moment a sonographer is shared between the hospital and the community health centre, but should you offer a full service at both, you'd have to employ an additional sonographer and the throughput of patients doesn't justify the cost.

From what I can see what they are doing is legitimate. They have raised money to fund an ultrasound scanner, which is in place at the community health centre. They have obviously negotiated a contract with the PCT to provide the standard scans eg 20 week, which gives the patient choice. Therefore this does benefit all. It may be that they have not been funded to provide additional scans and so they charge for these as they have to pay a sonographer to undertake them. I could be wrong, but I don't think this would count as a failed appeal. It would depend on the exact terms of the capital (equipment) appeal in the first place.

If, however, they had made it clear (when appealing for funding for the scanner) that scans in addition to the standard 12 week and 20 week ones would be offered to anybody who chooses within the community free of charge, then there might be grounds on a "failed appeal" basis. If that was upheld, the "charity" (assuming it was) would have to refund the donations unless the donors agreed to the change of use of funds.

Thanks for your replies. Just to clarify a few things.

What I understand to be happening is that the Sonographer runs a private business, for private clients. She has her own company, own website and so on.

The Health Centre owns the scanner, which was purchased using funds raised by the local 'Friends of Health Centre' group. These funds were raised in the community and were achieved by telling people that the scanner would be for the benefit of everyone.

The Sonographer offers the 20 week scan for free to NHS patients (but presumably is paid by the health centre) but then runs her private business from the health centre on other days, using the scanner.

Obviously I don't know the arrangements between the Health Centre and Sonographer, but it seems outrageous that basically the community have raised funds to be used by a private individual to make money for their private business?

I think there's an important distinction to be made between the Health Centre using the scanner to make money privately, versus a private person running a private business using the scanner, under an arrangement with the health centre (which is what I assume exists). Does that make sense?

Obviously my priority is my wife and my focus is on her in the later part of her pregnancy, but I want to stand up here because there will be others after here who find themselves in a similiar situation.

Pregnancy is immensely scary at times - and full of concerns and anxieties even for those who have a smooth time of it. If you're under the care of your local health centre and are distressed and upset because something is wrong - and your doctor agrees that a rescan is appropriate because the previous scan was done incorrectly - then it's shocking to be put in a position where you have to pay for a scan to investigate your concerns further.

As it happens, we visited a hospital further away (where we want to give birth) and they did the scan without any fuss immediately. The results were totally different to the original scan and confirmed that there was absolutely nothing wrong. The original sonographer had measured the baby incorrectly - and then typed in the figures onto the system incorrectly - so the consultant afterwards had incorrect data on which to provide advice (we were given a horror story, told my wife she needed to be induced because the placenta wasn't working!), when actually there was no problem at all.

When we turned to the doctors surgery for support, for a rescan (which they could do there and then), the very same sonographer using the very same equipment refused to do so unless we paid privately.

I just find it quite outrageous that a publically-funded resource is withheld in those situations from those who need it, if they can't pay.

I wonder if those who donated know that they are funding a private business?

Sorry, just to add onto this.

I do understand that the scanner has associated running costs (including the upkeep and sonographer), but what I don't agree with is that the sonographer runs a private business providing scans using the equipment that was purchased using funds raised within the community.

It is surely right to assume that the private fees go towards her as a private business - given that she promotes her business as using this scanner and facility - rather than towards the 'running costs' of the scanner for NHS patients, if that makes sense?

I think they should possibly charge for non-necessary u/s - comfort scans at request of the patient. But if they recommend extra scans due to potential issues they should absolutely be free.

As regards the fundraising publicity about benefitting the community: if the Health Centre owns the scanner, then I would presume the sonographer pays a fee or hire charge to the Health Centre for using it? So the Health Centre (and thus the whole community) is still benefiting from owning the scanner and the fundraising publicity was not wrong. It's just not benefiting the community in the way that you assumed/would prefer, i.e. free scans.

If the sonographer isn't paying then yes that does seem odd and wrong. But I can't imagine the Health Centre are allowing her to use for free an asset they own.

As regards not getting the additional scans for free at the Health Centre: I would imagine that the Health Centre only has an arrangement with the local PCT to get the costs of 20 week scans funded by the NHS. Therefore they could not give you other scans on the NHS. I don't know why the local PCT would make this restriction - perhaps they think hospitals are a better judge than local health centres of when a scan is truly needed?

The sonographer will be paying a 'hire' fee surely? If so then that will be bringing money back into the surgery.

Is it used for things like breast scans as well?

Minipie Completely agree with you.

Perhaps the PCT doesn't fund additional scans because if anything untoward is found at the 20 week scan, you'd need to be referred for further investigations in a Consultant-led clinic. Consultants aren't going to pop down to the local community health centre, I very much doubt.

A friend of mine is currently in a very difficult situation. She had her 12-week antenatal scan at her local community hospital, but due to an NT anomaly found she was referred to the teaching hospital 8 miles away. There she is being managed under the care of a Consultant obstetrician. So that may be why a PCT would not fund any additional scans at a community centre.

I also assume the sonographer is probably renting the equipment and space from the GP practice. Perhaps that income is being used to fund other healthcare services for the community?

I think the main point to be annoyed about is that the sonographer at the local hospital did not perform the scan correctly, potentially causing an unnecessary course of monitoring/action re possible failure to grow etc.

The place to request a rescan was at the hospital that performed the faulty scan so that they bear the cost consequences of their error and hopefully learn from the incident.

The practice have fundraised for equipment to be able to provide 20 week scans locally rather than having to go to the hospital. They will however have running costs to meet each year and additional scans need to be funded to cover the additional costs.

I'm fairly certain their business plan would include the contribution to the running costs to be made by this private scanning enterprise arrangement in order to make it a viable proposition in the first place so overall I'd say direct your outrage at the sonographer causing alarm by failing to perform the scan correctly.

Yes scans can find many false alarms & unnecessary stress.
This is entirely normal & common with all medical care. False alarms can lead to much pointless & distressing worry and in worse cases, unnecessary interventions that can even create extra risks & complications. Always a risk with all forms of modern medical care (but was probably even much more likely in the past). No less so with antenatal scans.

As for funding for scans being limited, yes, we do indeed have rationed health care in the UK.

Sorry these facts come as such a shock.

Presumably if the sonographer is a private business they will pay for the use of the equipment. It makes no sense that the GP would just hand it over with nothing in it for them?

I think it is likely that if the sonographer was not using the scanner for the private work then it would likely be sat unsed as it does sound like the PCT has only contracted out certain work to the health centre. So to make it financially viable to the healthcentre they hire out the machine to a private business to make some money from it.

I wouldn't like any antenatal scans done at a healthcentre through choice as the aftercare should an anomoly be found is unlikely to be as good as if you are at a hospital with access to other sonographers/mws/Drs etc. This is a personal opinion.

I would be interested in discovering whether the surgery is actually making a profit from the sonographers hire of the machine. If this is the case then yes it is entirely inappropriate for the scanner to have been funded by patients and the local community. If it was bought using fund raising for the community then the practise itself should not be making a profit or any profits should go into buying more NHS services from the sonographers by her providing more scans for NHS patients.