Indigenous Advocate Ms Gracelyn Smallwood "said the coroners's finding that there was "no callous disregard" was disturbing for the family when it was clear the system had failed Vaggs". "If no one person" of those involved in his treatment was accountable then who is responsible? The answer to the question is simple, The government controlled and monitored health system.
The State Government department 'Queensland Health' is the system. The head of government is the Premier, Ms Anna Bligh.
The Health Quality and Complaints Commission *(HQCC) Report 'Why are we waiting' clearly states that "Delay due to inadequate coordination and management was linked to the highest level of reported harm to consumers (patients). It was associated with 11 of the 14 deaths reported in the top three access issue complaints and 17 of the 24 complaints in which it was reported the consumer suffered permanent harm"
Therefore, the Queensland state government must be held accountable and largely responsible for these 11 deaths including that of a mentally ill indigenous man on April 15, 2010. If Townsville hospital doctors claims that "-they were confronted by an "extreme" situation when Mr Vaggs became agitated - there were initially no psychiatrists or senior doctors on duty in the unit at the time" (TSV Bul Wed Dec 14) are true; then one could be forgiven for suggesting that the government's oversight of, 'the system's, Queensland Health's staffing policies, coordination, management and and funding was not just incompetent and grossly inadequate but frighteningly deadly. The 'System failed".
Ultimately the responsibility for provision of adequate health services for the people rests entirely with the state government. Please Ms Bliigh let there be no more deaths by your government's hands.
Additional references:
Health Quality & Complaints Commission