APY Lands: accessing renal dialysis in Central Australia

First posted on 28 November 2009 under APY Lands & Kidney Disease.
This article has been updated and archived.
Tags: cross-border, dialysis & health

Summary

Chronic renal disease affects a significant number of Anangu.[i] In early 2009, the Northern Territory Government decided that it would no longer let people from the APY Lands relocate to Alice Springs for renal dialysis.[ii] This decision has forced a number of Anangu patients to move far away from their home communities, making it difficult for them to participate in significant cultural events, including funerals.[iii]

On 28 April 2010, the Northern Territory Government announced that a new Tri-State Agreement with the South Australian and Western Australian Governments had been formally signed.[iv] At that time, 18 people from the APY Lands were receiving ongoing dialysis treatment in Alice Springs.[v]

The South Australian Department of Health expects up to 20 more people from the APY Lands to need regular dialysis by the end of 2010.[vi] The Paper Tracker understands that most, if not all, of these people will be unable to access that treatment in Alice Springs.

The Paper Trail

Introduction

Across Australia, chronic kidney disease is a serious and growing problem, particularly for Indigenous Australians.[vii]

Between 2003 and 2007, the number of Indigenous Australians recorded as being on dialysis climbed from 772 to 1066.[viii]

Access to dialysis is rarely available in remote Anangu communities.[ix] Typically, people needing dialysis have to relocate to capital cities or large regional centres. These relocations come at great social and cultural cost to the person, their family and the broader community.[x]

In May 2009, the Federal Department of Health and Ageing told a Parliamentary Inquiry that end-stage renal disease was “greatest” in remote and very remote Indigenous areas:

We still have high rates of renal disease in other parts of the country, but as you go into remote Australia it is an absolute critical issue for very large numbers… in some parts of Australia we almost have a diaspora of people who cannot live in community any more. In some communities nearly everyone over the age of 50 who is alive is either in town or with their partner in town on dialysis.[xi]

Accessing dialysis in Alice Springs

For many years, if a person from the APY Lands required regular dialysis, they would – most likely – move to Alice Springs.[xii]

In 2001, Nganampa Health Council – an Anangu-controlled health organisation – reported that six people from the APY Lands had “relocated to Alice Springs” for dialysis and that this number was “expected to grow significantly over coming years.”[xiii]

Relocating to Alice Springs requires Anangu to live hundreds of kilometres away from their home communities.[xiv] As Nganampa Health Council has observed, these relocations are “extremely disruptive for patients and their families, with consequent cultural, social and financial difficulties.”[xv]

In 2001, Nganampa Health Council engaged a Renal Project Officer to support Anangu patients and their families and improve treatment compliance. According to the Council, this position was “very successful” and ensured that people from the APY Lands on dialysis in Alice Springs were well settled into supported accommodation and able to access their social security payments. Importantly, it also provided “transport home to country once a month for these clients so that links with extended family and with community [could] be maintained.”[xvi]

The Renal Project Officer position was established with pilot funding. The Paper Tracker understands that the position ended when ongoing funding was not secured.[xvii]

As of August 2004, Nganampa Health Council was still trying to secure funding to re-establish the monthly “home to country trips” and employ an Alice Springs based social worker to provide support to Anangu on dialysis.[xviii]

Growing pressures in Central Australia

In recent years, the number of people on dialysis in Alice Springs has risen sharply from 74 in 2000 to 198 in 2008.[xix]

In 2007, Professor John Horvath – then Australia’s Chief Medical Officer – highlighted the challenge of delivering renal dialysis services in Central Australia:

Patient numbers threaten to overwhelm the capacity of the staff and facilities to deliver services, and there is a need to have these services much closer to the communities.[xx]

Professor Horvath reported that, in September 2006, he had convened a “highly productive” meeting of clinicians in Alice Springs to examine these issues and that this had resulted in “a lot of progress.” More specifically, Professor Horvath noted that the Federal Department of Health and Ageing was now:

working with the Northern Territory, South Australian and Western Australian health departments to expand and improve current models of service delivery and care for renal patients.[xxi]

NT Government policy change

In February 2009, the Northern Territory Department of Health and Families introduced a policy whereby no new clients from outside of the Northern Territory would be able to access any of its renal dialysis treatment centres.[xxii]

This dramatic change in policy means that if a person from the APY Lands needs to go on dialysis, they are not able to relocate to Alice Springs but, instead, have to move much further away to Adelaide or Port Augusta. (The policy has also affected Aboriginal people living in remote Western Australian communities).

Click here for information on the distances between APY communities and renal dialysis units

According to the Northern Territory Minister for Health (Hon Kon Vatskalis MLA) the decision to introduce this policy “was made after consultation and agreement from, [among others] Executive and Directors of Renal Services in South Australia.” The Minister stressed that making this decision had been “very difficult” and “occurred in the absence of any other immediate alternatives.”[xxiii]

In September 2009, the Northern Territory Department of Health and Families advised the Paper Tracker that, “prior to the implementation of the policy,” 16 people from the APY Lands had been receiving dialysis in Alice Springs and that:

The average length of time on dialysis for this group is 4 years and ranges from 6 months to 8 years.[xxiv]

A revised figure of 18 people was subsequently provided.[xxv]

Access to dialysis services in South Australia

As it happens, the introduction of the Northern Territory Government’s new policy coincided with the expansion of dialysis services in non-metropolitan South Australia. This expansion occurred, in part, in response to the findings of a comprehensive review of the State’s health care system.

Completed in 2003, the Generational Health Review highlighted community and client expectations that, in future, the health care system would:

deliver services as conveniently as possible to the person, predominantly in a primary care setting, in the home or an easily accessible local facility.[xxvi]

The Generational Health Review also called on the South Australian Government to:

review the level of investment in programs addressing the quality of life of Aboriginal people and changes in the way services are delivered, with greater emphasis on community, kinship, family and social connectedness.[xxvii]

In June 2007, some four years after it accepted the review’s findings, the State Government launched a new State Health Care Plan that included reforms to the way health services are delivered outside of metropolitan Adelaide.[xxviii]

According to the State Minister for Health (Hon John Hill MP), the reforms aimed to provide:

more services locally so that country South Australians [would] not have to travel to Adelaide as often for treatment.[xxix]

On 25 June 2008, the Minister reiterated this commitment in an open letter to South Australia’s Rural Doctors Association:

We are … committed to repatriating services to the country from the city… We want to ensure that as many people as possible receive treatment closer to home and avoid the need for patients and their support networks to travel to Adelaide.[xxx]

The Minister also noted that the expansion of dialysis services was an “important feature” of the new State Care Health Plan.[xxxi]

In July 2008, Minister Hill launched a new dialysis service at the Maitland Hospital in rural South Australia. In doing so, he emphasised the benefits that the service would have for local Aboriginal people:

This valuable asset is another example of the State Government’s commitment to providing services closer to home for country South Australians … having this service centrally located to serve the Aboriginal people on Yorke Peninsula, including Point Pearce, is very important.[xxxii]

Five months later, in December 2008, a $1.8 million expansion of the Port Augusta Renal Unit was completed. The redeveloped unit was officially opened by Minister Hill on 23 April 2009 as “another example” of the Government’s strategy of “putting improved services closer to patients.”[xxxiii]

The State Government subsequently reported that the expansion of the Port Augusta unit meant:

patients from the APY Lands can now be treated at Port Augusta instead of travelling to Alice Springs for treatment.[xxxiv]

For patients from the APY Lands, however, the facilities in Port Augusta are approximately 400 kilometres further away from their homes than those located in Alice Springs.[xxxv] The Paper Tracker notes that attempts to divert APY dialysis clients from Alice Springs to Port Augusta are clearly inconsistent with the State Government’s strategy to make it easier for people living outside of Adelaide to access health services closer to home.

On 13 August 2009, the Paper Tracker asked the South Australian Department of Health for information on the immediate and likely long-term impact of the Northern Territory Government’s policy decision on people from South Australia’s remote Aboriginal communities, and what steps, if any, it had taken to address those impacts.[xxxvi]

In reply, the Department noted that:

  • the Northern Territory Government’s decision had “resulted in four new renal patients from the APY Lands being redirected to South Australia to receive dialysis,” and
  • “the referral patterns for South Australian patients [would] be reviewed once construction of a new satellite dialysis unit in Alice Springs had been competed “in early 2010.”[xxxvii]

Click here to read the Department’s full advice (file size 341KB)

Responses to Northern Territory policy change

Across Central Australia, a number of key Aboriginal organisations condemned the Northern Territory Government’s new policy and called for it to be reversed or alternative arrangements to be put in place.

For example, the Aboriginal Medical Services Alliance Northern Territory (AMSANT) argued that “sending people from remote communities to Perth or Adelaide is creating enormous psycho-social impacts on individuals, their families and their communities” and that some people were refusing treatment “so they can go back to their country to die.” This was, AMSANT noted, “an intolerable situation.”[xxxviii]

On 5 August 2009, the NPY Women’s Council wrote to the SA Minister for Health (Hon John Hill MP) to express its “extreme distress” at the impact that the policy would have on renal patients across Central Australia. The Council noted that:

the recent decision to force new patients to undergo treatment only in their home state… is likely to make end stage kidney failure even more distressing and unsettling for suffers.[xxxix]

Their letter continued:

We hardly need to let you know that it will be virtually impossible for clients to visit home or family to visit them when they live so far away from home and from the main regional centre of Alice Springs.[xl]

In a reply dated 16 October 2009, Minister Hill advised the NPY Women’s Council that a new satellite dialysis unit, due to be completed in early 2010, was being built in Alice Springs, and once open, would enable APY patients “if clinically appropriate” to “have the option of being treated in a South Australian facility … or at the new unit in Alice Springs.”[xli]

Shortly after receiving this information, the NPY Women’s Council obtained what appeared to be conflicting advice from the Northern Territory Minister for Health (Hon Kon Vatskalis MLA).[xlii] Whereas Minister Hill had indicated that APY patients would be able to access expanded facilities in Alice Springs once these had been opened, Minister Vatskalis’ advice suggested negotiations between the affected jurisdictions were much less advanced. He wrote (in part):

negotiations are currently underway with SA and WA Health Departments to consider a proposal for the continued management and care of patients in the Central Australian region and to develop comprehensive cross border agreements and partnerships.[xliii]

Indeed, on 10 November 2009, Minister Vatskalis called on the South Australian and Western Australian Health Ministers “to urgently address and expand renal dialysis services and infrastructure in Central Australia to cater for interstate renal patients.”[xliv]

The Minister urged his Health counterparts to “come to the table to meet their obligations to their patients’ clinical, social and support needs,” and continued:

I do understand that residents of Central Australia region identify Alice Springs as their cultural service centre, so I am calling on health officials in WA and SA to provide the resources necessary for the NT to expand its infrastructure and services to cater for their patients.[xlv]

Three days later, on 13 November 2009, the Northern Territory, Western Australian and South Australian Ministers met to consider these issues. According to Minister Vatskalis:

  • this meeting represented the “first steps towards an agreement about the treatment of renal dialysis patients in Central Australia,”
  • the Western Australian Health Minister (Dr Kim Hames) had agreed that Alice Springs was “the preferred option for patients from WA communities near the NT border,”
  • the South Australian Minister (Hon John Hill MP) had acknowledged that Alice Springs was “part of the solution” but also stressed that the expanded dialysis services in Port Augusta would “assist in catering for remote South Australians on dialysis,”
  • WA, NT and SA departmental health authorities would meet again in early December 2009 to “progress the terms of the Agreement.”[xlvi]

December meeting

On 4 December 2009, representatives of the South Australian Department of Health met with their Northern Territory and Western Australian counterparts to discuss Central Australian dialysis services.[xlvii]

From the Paper Tracker’s perspective, the results of this meeting were mixed.

On the positive side, the Western Australian and Northern Territory Governments reached “an exceptionally positive outcome.”[xlviii] Specifically, under a new agreement, Western Australian renal patients living east of Warburton would be able, once again, to access dialysis services in the Northern Territory.[xlix]

Unfortunately a similar arrangement was not established with the South Australian Government. Instead, at the conclusion of the meeting, the South Australian Government noted that it would “not be providing any additional funding to the Northern Territory government” and that “newly diagnosed renal dialysis patients” from the APY Lands would “be treated in South Australia,” specifically in Port Augusta, Whyalla and Adelaide. [l]

The Paper Tracker believes this response is inconsistent with the South Australian Government’s previous commitment to “ensure that as many people as possible receive treatment closer to home.”[li]

The Chief Medical Officer of Australia, Professor Jim Bishop, also attended the December meeting. In a letter dated 11 January 2010, Professor Bishop advised the Paper Tracker that the South Australian, Northern Territory and Western Australian Governments had reached an agreement at the meeting “to work together to address the needs of current and future renal dialysis patients in Central Australia.”[lii]

The Paper Tracker notes that any agreement “to work together” comes:

  • more than three years after Professor Bishop’s predecessor – Professor John Horvath – convened “a highly productive roundtable in Alice Springs” to examine the delivery of renal dialysis services across Central Australia,[liii] and
  • more than two years after the Federal Department of  Health and Ageing reported that it was “working with the Northern Territory, South Australian and Western Australian health departments to expand and improve current models of service delivery and care for renal patients” and that “a lot of progress” had been made.[liv]

In his letter, Professor Bishop also advised the Paper Tracker that the Federal Government was:

encouraging and supporting the relevant States and Territory to reach swift agreement on a sustainable long-term solution to the delivery of renal dialysis services in Central Australia.[lv]

The Paper Tracker considers that the social and cultural difficulties Aboriginal people experience when forced to move considerable distances to receive dialysis treatment are well-documented. We believe any “sustainable long-term solution” must ensure that people from the APY Lands are able to access renal dialysis services in Alice Springs.

The Paper Tracker is disappointed that recent efforts to resolve this issue have resulted in little more than a reiteration of earlier statements that governments will continue to work together.

First Senate resolution and response

On 17 November 2009, the Australian Senate resolved to call on the Federal Minister for Health (Hon Nicola Roxon MP) to negotiate an end to the Northern Territory’s policy of banning South Australian and Western Australian patients from accessing dialysis within the Territory.[lvi]

The Minister’s response to this request was tabled in the Senate on 3 February 2010. It noted, among other things, that:

  • “dialysis services are predominantly administered by State and Territory Governments,”
  • the Federal Government “is committed to finding solutions to the dialysis situation in Central Australia,”
  • State and Territory Governments had agreed, at the 4 December 2009 meeting, to “work together to address the needs of current and future renal patients in Central Australia,” and
  • the Northern Territory Government had agreed to “develop a new proposal, in consultation with South Australia and Western Australia outlining:
    • an agreed model of care;
    • current and projected health needs; and
    • appropriate service development.”[lvii]

The Paper Tracker notes that the Minister did not provide any information on when this new proposal is expected to be completed.

Second Senate resolution

On 10 March 2010, the Australian Senate passed another resolution focused on access to renal dialysis in Central Australia. Among other things, the resolution:

  • asked the South Australian Minister for Health to indicate “what impediments, if any” were “preventing his government” from entering into a new access arrangement with the Northern Territory Government, and
  • highlighted “the need for the Commonwealth Government to play a more active role in the development of a properly-funded, long-term response to renal disease across Central Australia.”[lviii]

State Election: commitments and clarifications

In February 2010, the South Australian Liberal Party announced that, if elected to government on 20 March 2010, it would:

negotiate an agreement with the Northern Territory Government to ensure that people from the APY Lands suffering end-stage renal disease can access renal dialysis in Alice Springs.[lix]

The Paper Tracker welcomed this commitment.

On 12 March 2010, the South Australian Labor Party announced that “an in-principle agreement” had been finalised between the South Australian, Western Australian and Northern Territory health departments, under which eight dialysis patients from the APY Lands would be able to access dialysis in Alice Springs. The Labor Party noted that it would “sign this agreement without delay” if re-elected to government on 20 March 2010.[lx]

On 15 March 2010, the Paper Tracker met with representatives of the South Australian Department of Health to discuss the proposed agreement and access to dialysis more generally.

In the course of that meeting, the Department confirmed that:

  • the agreement did not secure any additional dialysis places in Alice Springs for people from the APY Lands,
  • under the terms of the agreement, the total number of dialysis places available in Alice Springs to people from the APY Lands would fall – over time – from 18 to eight,
  • as existing patients died or transferred to another location, their places would be filled by Northern Territory patients and that this process would continue until the total number of APY dialysis patients in Alice Springs had fallen to eight,
  • no existing APY dialysis patients in Alice Springs would be forced to relocate to South Australia,
  • new dialysis patients from the APY Lands would – for the foreseeable future – need to relocate to Adelaide, Port Augusta or Whyalla, and
  • the Department expects up to 20 more people from the APY Lands to commence dialysis in South Australia by the end of 2011.[lxi]

Click here for a summary of matters discussed at the meeting (file size: 34KB)

Tri-State Agreement (added 30 April 2010)

On 28 April 2010, the Northern Territory Government announced that the new Tri-State Agreement with the South Australian and Western Australian Governments had been formally signed.[lxii]

The Paper Tracker is disappointed with the terms of the Agreement under which the number of APY dialysis patients in Alice Springs will most likely fall from 18 to 8 as existing patients die or transfer to another location.

The Paper Tracker continues to believe that people with end-stage renal disease from the APY Lands should be able to access dialysis as close as possible to their home communities, including from facilities located in the Northern Territory.

Click here to download a copy of the Agreement (file size: 195KB).

This article was last updated in April 2010. It has been archived and will no longer be updated. It will, however, remain accessible online as a source of background information for anyone wishing to undertake further research on this issue. Information included in the article was current at the time it was archived. Keep in mind, however, that Ministerial changes and names of departments, among other things, may have since changed.


[i] In 2001, Nganampa Health Council reported that on the APY Lands, “29% of females and 20% of males … over the age of thirty years have diagnosed diabetes. More than half of the diagnosed diabetics also have diagnosed renal disease” (Nganampa Health Council, 2001. Annual Report 2000/2001, p27).

[ii] Huntington, K. (Office of the Hon Jenny Macklin MP). 12 August 2009. Letter to Rev. D. Whittaker. Note: the South Australian Minister for Health (Hon John Hill MP) subsequently indicated that the Northern Territory Government had signalled a change in policy in February 2009 (Hill, J. 16 October 2009. Letter to A. Mason (NPY Women’s Council.)

[iii] Brow, C. 8 November 2009. Letter to Hon W. Snowdon MP, Federal Minister for Indigenous Health, Rural and Regional Health.

[iv] Vatskalis, K. 28 April 2010. “NT, SA and WA Sign Renal Agreement,” media release.

[v] Gorham, G (NT Department of Health and Ageing). 15 March 2010. Email to J. Nicholls.

[vi] UnitingCare Wesley Adelaide. March 2010, “Record of meeting between SA Health and UnitingCare Wesley Adelaide held on 15 March 2010,” p3.

[vii] Australian Institute of Health and Welfare. May 2009, An overview of chronic kidney disease in Australia, 2009, pv. In May 2009, AIHW reported that Indigenous Australians were “six times as likely as other Australians to be receiving dialysis or to have had a kidney transplant.”

[viii] Figure 1.8: “Prevalence and Incidence by Indigenous Racial Origin, 2003 – 2007,” in Australia and New Zealand Dialysis and Transplant Registry, 2008, The Thirty-First Report, Section1.4.

[ix] The Western Desert Nganampa Walytja Palyantjaku Tjutaku (WDNWPT) Aboriginal Corporation is an exception to this rule. In 2004, WDNWPT established a dialysis machine in Kintore (Walungurru). The machine not only supports people in Kintore, it also provides dialysis to people from surrounding homelands and communities (some of whom live in Western Australia).

[x] Thomson, N & Stumpers, S. 2007, “Summary of Indigenous Health: End-stage renal disease,: Aboriginal and Islander Health Worker Journal; 31.1, p33-35. A PDF version of this article is available online at: http://archive.healthinfonet.ecu.edu.au/html/html_health/specific_aspects/chronic/renal/reviews/AHWJ_renal.pdf Accessed: 6 November 2009.

[xi] Podesta, L (DoHA). 28 May 2009. Transcript of evidence presented to the House of Representatives Standing Committee on Aboriginal and Torres Strait Islander Affairs, p4 and p18.

[xii] Singer, J (Nganampa Health Council). 2 August 2004. Letter to Aboriginal Lands Parliamentary Standing Committee, Parliament of South Australia.

[xiii] Nganampa Health Council, 2001. Annual Report 2000/2001, p25.

[xiv] In 2001, Nganampa Health Council reported that , moving to Alice Springs required Anangu to live “between 450 and 750 kilometres away from home communities.” (see: Nganampa Health Council, 2001. Annual Report 2000/2001, p25).

[xv] Nganampa Health Council, 2001. Annual Report 2000/2001, p25.

[xvi] Nganampa Health Council, 2001. Annual Report 2000/2001, p25.

[xvii] Nganampa Health Council, 2001. Annual Report 2000/2001, p25.

[xviii] Singer, J (Nganampa Health Council). 2 August 2004. Letter to Aboriginal Lands Parliamentary Standing Committee, Parliament of South Australia.

[xix] See: Australia and New Zealand Dialysis and Transplant Registry, 2001, ANZDATA Registry 2002 Report, Appendix 1, p33; Australia and New Zealand Dialysis and Transplant Registry, 2009, ANZDATA Registry 2009 Report, Appendix 1, p33;

[xx] Horvath, J. 2007. “Chief Medical Officer’s Report” in Federal Department of Health and Ageing, Annual Report 2006-7, p13.

[xxi] Horvath, J. 2007. “Chief Medical Officer’s Report” in Federal Department of Health and Ageing, Annual Report 2006-7, p13.

[xxii] It is difficult to pin down the exact date on which the policy was announced and/or commenced. The South Australian Government has stated that the Northern Territory Government signalled a change in policy in February 2009 (see: Hill, J. 16 October 2009. Letter to A. Mason (NPY Women’s Council.). In contrast, the Northern Territory Government  has advised the Paper Tracker that the policy came into effect on 4 March 2009 when the South Australian Government advised it that it “would be organising for the 4 patients known to them in the APY Lands to commence treatment in SA” (see: Gorham, G. 23 November 2009. Email to J. Nicholls). Finally, the Federal Government has reported that the policy began in April 2009. (See: Huntington, K. (Office of the Hon Jenny Macklin MP). 12 August 2009. Letter to Rev. D. Whittaker).

[xxiii] Vatskalis, K (NT Minister for Health). 2 November 2009. Letter to A. Mason (NPY Women’s Council)

[xxiv] Ashbridge, D (NT Department of Health and Ageing). 8 September 2009. Letter to the Rev. P. McDonald.

[xxv] Gorham, G (NT Department of Health and Ageing). 15 March 2010. Email to J. Nicholls.

[xxvi] Government of South Australia, 2003, Better Choices, Better Health: Final Report of the South Australian Generational Health Review, pxiii.

[xxvii] Government of South Australia, 2003, Better Choices, Better Health: Final Report of the South Australian Generational Health Review, piii.

[xxviii] Hill, J. 6 June 2007. “New Plan for Country Health”, media release.

[xxix] Hill, J. 6 June 2007. “New Plan for Country Health”, media release.

[xxx] Hill, J. 25 June 2008, “Open letter to Rural Docs Association from State Govt,” media release.

[xxxi] Hill, J. 25 June 2008, “Open letter to Rural Docs Association from State Govt,” media release.

[xxxii] Hill, J. 16 July 2008. “New dialysis service for Maitland,” media release.

[xxxiii] Hill, J. 23 April 2009, “New Renal Unit up and running at Port Augusta Hospital,” media release. Also: SA Health, August 2009, Renal News: Statewide Clinical Networks, Issue 4, p1.

[xxxiv] SA Health, August 2009, Renal News: Statewide Clinical Networks, Issue 4, p1.

[xxxv] For example: Indulkana is 415km from Alice Springs but 825km from Adelaide.

[xxxvi] McDonald, P. 13 August 2009. Letter to T. Sherbon (SA Dept of Health).

[xxxvii] Sherbon, T. (Dept of Health). 30 November 2009. Letter to Rev. P. McDonald

[xxxviii] AMSANT. 3 November 2009, “Deaths in the Desert Must Stop,” media release. See also: Northern Territory Council of Social Service. 29 October 2009, “Kidney Crisis threatens lives,” media release.

[xxxix] Mason, A (NPY Women’s Council). 5 August 2009. Email to Hon. J Hill, SA Minister for Health.

[xl] Mason, A (NPY Women’s Council). 5 August 2009. Email to Hon. J Hill, SA Minister for Health.

[xli] Hill, J. 16 October 2009. Letter to A. Mason (NPY Women’s Council).

[xlii] Vatskalis, K. 2 November 2009. Letter to A. Mason (NPY Women’s Council).

[xliii] Vatskalis, K. 2 November 2009. Letter to A. Mason (NPY Women’s Council).

[xliv] Vatskalis, K. 10 November 2009, “Minister Calls on SA and WA to Address Renal Dialysis,” media release.

[xlv] Vatskalis, K. 10 November 2009, “Minister Calls on SA and WA to Address Renal Dialysis,” media release.

[xlvi] Vatskalis, K. 13 November 2009, “States and Territory Work Together on Renal Dialysis Treatment,” media release.

[xlvii] Government of South Australia. 4 December 2009. “Northern Territory Renal Services,” media release.

[xlviii] Vatskalis, K. 10 December 2009. “Positive Outcome for Central Australian Renal Patients,” Northern Territory Government, media release.

[xlix] Vatskalis, K. 10 December 2009. “Positive Outcome for Central Australian Renal Patients,” Northern Territory Government, media release.

[l] Government of South Australia. 4 December 2009. “Northern Territory Renal Services,” media release.

[li] Hill, J. 25 June 2008, “Open letter to Rural Docs Association from State Govt,” media release.

[lii] Bishop, J. 11 January 2010. Letter to Rev. P. McDonald.

[liii] Horvath, J. 2007. “Chief Medical Officer’s Report” in Federal Department of Health and Ageing, Annual Report 2006-7, p13.

[liv] Horvath, J. 2007. “Chief Medical Officer’s Report” in Federal Department of Health and Ageing, Annual Report 2006-7, p13.

[lv] Bishop, J. 11 January 2010. Letter to Rev. P. McDonald.

[lvi] Siewert, R. 17 November 2009, “Renal Health Services,” Hansard, Senate, Parliament of Australia, p31. Also: Siewert, R (and other Senators). 18 November 2009, “Matters of Public Importance: Dialysis Services,” Hansard, Senate, Parliament of Australia, p68-77.

[lvii] Roxon, N. 2010. Letter to Senator Hon John Hogg. Tabled in the Australian Senate on 3 February 2010.

[lviii] Siewert, R. 10 March 2010. “Dialysis Services,” Hansard, Senate, Parliament of Australia, p31.

[lix] See ABC News. 24 February 2010, “Dialysis treatment hope for APY Lands,” Available at: http://www.abc.net.au/news/stories/2010/02/24/2828504.htm?site=news. Accessed 26 February 2010. Also: McFetridge, D. 27 February 2010. Email to J. Nicholls.

[lx] South Australian Labor Party. 12 March 2010, “More renal dialysis for patients from the APY Lands,” news release.

[lxi] UnitingCare Wesley Adelaide. March 2010, “Record of meeting between SA Health and UnitingCare Wesley Adelaide held on 15 March 2010,” p3.

[lxii] Vatskalis, K. 28 April 2010. “NT, SA and WA Sign Renal Agreement,” media release.

The Paper Tracker works hard to provide accurate and up-to-date information. We will correct any inaccurate information as soon as it is brought to our attention. Please contact us if you have additional information or can provide us with an update.