SNSW LHD Keeps Saying NO To Low Carb Diets!

I was warned this would happen.

The joke is that when you write to a Government Minister in Australia with a problem or concern, the objective of the Minister’s office is to make you go away.

But not in this case, surely? What others and I have to say is important; it’s about peoples’ lives and their health. It’s even about the blow-out of the Health budget. It’s how to turn around the rising rates of diabetes and obesity. It’s what the Health Minister would want to hear and act on. Surely???!!!!

Apparently not

If a government department wanted something to go away, here’s the blueprint from the NSW Health Minister’s office:

Step one.

 Receive many requests from researchers, scientists and the public for an inquiry into a mistake that could cost some people their health and potentially their lives.

In this case, the mistake was the CEO of the Southern NSW Local Health District dictating that low carb advice must not be given to any person within the Health District.

Step two.

 1) Ask said CEO to explain the basis for his decision

or

2) Give said CEO the opportunity to say whether or not he’s satisfied with the decision he made.

The NSW Health Minister, Jillian Skinner, unbelievably went for option 2.

And the CEO of the LHD in question responded that he was fine with his decision.

Specifically: “The position in relation to your diet and acceptable dietary advice provided by NSW Health professionals may change over time, however the Local Health District continues to follow the advice of NSW Health and the DAA with regard to dietary advice provided to clients.”

Outcomes

  1. People of the SNSW LHD are denied access to science based low carb dietary advice that could improve their health.
  2. Ministerial get-lost objective achieved.
  3. I have to write another damn letter to the Minister.                                                     This is an edited version:                                                                                             21.10.2015                                                                                                                              Dear Minister Skinner                                                                                                    Further to my request for an inquiry into the actions of the SNSW LHD, which I submitted to your office on 17.9.2015. In that correspondence, I requested these issues be investigated:
    1. Abrogation of responsibility by the SNSW LHD to the Dietitians Association Australia (DAA) for my dismissal

     

    1. The basis for the decision that low carb diets are not evidence based.                            It is an understatement to say that I am disappointed in your response. Instead of your office asking the CEO of the SNSW LHD to provide you with answers regarding my questions, your office passed my inquiry to him, leaving it to him alone to evaluate his own, and his staff’s decisions. Unsurprisingly, his response was that everything is in order; he’s happy with all the decisions and no inquiry is warranted.I would like to reiterate my concerns and provide the CEO’s comments.
      1. Abrogation of responsibility.

      The LHD’s investigation into my case found no hint of professional incompetence (as there is none), however they took DAA’s word for it, without details or explanation, and dismissed me on that basis. This abrogation of responsibility by a government body to a self-regulated membership organisation without knowledge of the standards and processes employed by that organisation (LHD representative admitted this) I believe to be a serious dereliction of duty.

      I would be happy to provide you with full details of DAA’s findings; in short, it appears that I was deregistered either on the basis of my recommendation of LC diets or because DAA did not like the way I kept my notes on one client.  http://www.babyboomersandbellies.com/blog/2015/08/my-case-with-daa-revisited-or-revisiting-my-case-with-daa-or-daa-revisited/

      CEO’s determination: “I am satisfied that there has been no abrogation of responsibility by the Health District to the Dietitians Association of Australia DAA.”

      How nice for him to be able to ignore the fact that in 29 years of my employment with NSW Health there has never been a hint that I was anything less than a competent and experienced professional. The DAA however could say otherwise and NSW Health just accepted that decision without question.

      That is abrogation of responsibility whether the CEO wants to admit it or not. His response is insulting.

       

      1. They got it wrong

       

      SNSW LHD’s decision that low carb diets are not evidence based and are not to be recommended in the LHD is simply wrong and potentially harmful to many people. It may also leave NSW Health open to litigation by people who are being denied advice on reducing carbs, despite this approach being supported by science and the American Diabetes Association guidelines that dietitians are advised to follow.

      I requested that the people who made this decision be asked to answer how they concluded that low carb diets are not evidence based.

      CEO’s response: “The position of the technical advice may well change over time with further research. However, at this time the SNSWLHD is following the advice of NSW Health with regard to dietary advice to clients/ patients.”

      Me: What is NSW Health’s advice exactly?

      To my knowledge, prohibiting the recommendation of low carb diets is not a directive in any other NSW Health District, nor anywhere else in Australia or probably even the world. In addition, the CSIRO backs low carbohydrate management of diabetes. Their recent 2-year study of very low carb versus ‘traditional guideline’ higher carb dietary management showed that low carb gave significantly better results in blood glucose control and cardiovascular risk factors. The low carb participants had a significant reduction in their medication requirements.

      The LHD has gone out on a dangerous limb in making this a directive.

      More from the CEO: “The position in relation to your diet and acceptable dietary advice provided by NSW Health professionals may change over time, however the Local Health District continues to follow the advice of NSW Health and the DAA with regard to dietary advice provided to clients.”

      As I have previously stated, DAA defer to American Diabetes Association (ADA) guidelines for dietetic management of diabetes. ADA guidelines support the use of low carb diets.

      This issue is no longer just about my case, as no doubt you would be aware from the number of letters you have received from scientists, researchers, dietitians and others from around the world.

      I would ask again that the following issues be investigated properly and not referred back to the CEO responsible for the decisions in question.

       

      1. Abrogation of responsibility.

      Request: Explanation as to why DAA’s finding of professional incompetency against me was accepted without question by NSW Health, and subsequently used as the basis for my dismissal, when in 29 years and regular PDPs with my managers, there was never a hint of criticism of my expertise or competency.

       

       

      1. Getting it wrong.

      Request: CEO to provide supportive evidence for the directive that low carb diets are not to be recommended to clients in the LHD.

       

      Specifically: 1. What exactly does NSW Health advise in regard to dietary advice for clients/ patients that the CEO refers to? (needs referencing)

       

      1. What does he believe DAA’s position is concerning dietetic advice for diabetics? (needs referencing)

       

      Thank you again for your consideration of these issues.

       

      Yours sincerely

       

      Jennifer

       

Local health district says no to low carb diets for diabetes

 

Now my saga with the Southern NSW Local Health District administration.

The Southern New South Wales Local Health District (SNSW Health), my former employer, oversees health services for about 200,000 residents. When somebody lodged a complaint about my low carb approach for patients with metabolic syndrome and type 2 diabetes with the DAA (Dietitians Association of Australia), SNSW Health also got into the act.  They came up with specific conditions for my return to practice — this was before I was officially sacked.

Remarkably, they specifically said:

“Nutritional advice to clients must not include a low carbohydrate diet. Jennifer will be advised on the information that she may provide to clients…. ”

Can you imagine having to tell a client with diabetes, who has lowered his BGLs, lost weight and come off all diabetes medications by reducing his carb intake, that he now has to start eating more carbs because SNSW Health says so !?

In any case, I was prepared to go back to work and fight this from within the organisation. That was not to be.  As I was getting my head around returning to work, DAA informed my employer that the Association had found me guilty of professional misconduct and deregistered me.  DAA’s “Far Deeper Issues” Revealed . SNSW Health immediately went along and fired me.

To bring their obsession into clear view, just before my dismissal, SNSW Health circulated a memo to their executive and dietitians.

It read: “As a result of a recent investigation, please be advised that Southern NSW Local Health District requires adherence to the Dietitians Association of Australia (DAA) Practice Guidelines for Dietitian Management of Diabetes.”

Of course, they admitted that DAA doesn’t actually produce clinical practice guidelines, but that it has produced a Nutrition Manual for use in hospitals and other facilities. So: “As an interim measure, all dietitians employed within Southern NSW Local Health District are directed that all diets prescribed for Diabetics must reflect the principles of Diabetic Diets outlined in the 2014 DAA Nutrition Manual”, which unsurprisingly doesn’t include low carbohydrate diets. In fact, for people with type 2 diabetes, the DAA manual recommends ensuring a regular carbohydrate intake and to spread carbohydrate over the day.

And to make sure all bases are covered, just before firing me, as described above, a suggested script  had been prepared saying that “specific referrals that are received for a low carbohydrate diet from GP’s will be directed to the attention of the local Allied Health Manager who will contact the GP regarding the PP directive.” and, “Further discussion may then occur about the notion of a low carbohydrate intake diet not currently supported by the DAA.”

It’s not easy to be a dietitian in Australia advocating carbohydrate restriction, but even worse to be a person with diabetes in the SNSW Health district where you are denied the choice of a low-carbohydrate diet.

This breakdown in health care may not be evident to the government and a lack of oversight may have allowed this to get out of hand at the local level. I’d like to think that my experience could allow me to be a catalyst for positive change and I would like to suggest that, if you agree that this is a serious problem — not being allowed to offer all beneficial therapies to patients — you might join me in bringing this to the attention of the NSW Health Minister. Hopefully she will initiate some action.

If you think that this is a serious matter, could you please write to the NSW Health Minister, Jillian Skinner, expressing your concerns;  an inquiry or hearing on this issue is reasonable to ask for.

Could I ask that you also post your letter here or leave a comment? Thank you.

Postal:
The Hon. Jillian Skinner, MP
GPO Box 5341
SYDNEY NSW 2001

Email:   office@skinner.minister.nsw.gov.au