Uralla general practitioner Dr Ricardo Alkhouri, the doctor who threatened to close the clinic recently, has called for Uralla Shire Council to take over the medical centre in a rambling Facebook Live that lasted almost four hours.
Dr Ricardo held his Facebook Live video broadcast as planned at 5pm on the 22nd of January to discuss the future of the Uralla Medical Clinic, which he threatened to close after a minor issue with paperwork resulted in Medicare denying him around $150,000 in block funding and threatened to close the clinic. The decision was overturned after political intervention from our local members and Health Minister Mark Butler.
Over 130 people joined the live video stream in which Dr Ricardo, as he is affectionately known, he explained his background – Syrian born to Argentinian and Lebanese parents, the now Australian citizen has been working in Uralla since 2012. The sole doctor at the Uralla Medical Centre and the only full time GP in the small village clearly wanted to get some things off his chest.
“Covid changed everything,” Dr Alkhouri said.
“We started having new guidelines, and the work tripled.”
He said he was working 14 hours a day, 5 days a week, and his secretary, Renee, was often at work until 9pm trying to do the paperwork. He claimed his costs increased 200%, blowing out the weekly cost of running the clinic to $12,000.
He tried to explain the series of events that led to the drama earlier this month, in a profanity spiked rant about the accreditation requirements he must meet. He argued that the 2021 accreditation inspection found nothing of substance, but they required him to write a business plan because he didn’t have one. More paperwork that he considered unnecessary.
They submitted the business plan on time, but they had to wait 4 weeks for the assessment. They did not know they were considered unaccredited during that time.
Accreditation authority AGPAL then rang and said there was a document missing – there was no evidence of staff training for the steriliser. They were given only until the next day to provide it.
The scan of the training record that was provided was rejected. They provided a document version and it was also rejected because it was not in the template AGPAL provided, and they needed to transcribe all the information from their paperwork to the AGPAL template. The small clinic was not able to meet the deadline.
Dr Alkhouri said that AGPAL then began to bully the clinic. Dr Alkhouri fought back, and dared them to continue to do what they were doing, saying he would close the clinic if their behaviour cost him the block Medicare funding.
The missing paperwork was sent when they were able to complete it, and on the 5th of December the clinic was reaccredited. But it meant they were ‘pending decision’ – not accredited – for 7 weeks, and the rules stipulate that a clinic must remain accredited to get the block Medicare funding. Most of the 7 weeks fell in the November quarter, but two days fell in the February quarter, meaning he was denied 6 months of funding. During this time he trained medical students and did vaccinations, both of which could only be done from an accredited surgery.
Dr Alkhouri blamed the low rates of bulk billing for his business being reliant on a bank overdraft to function, and completely dependent on the bulk quarterly payments to cover his GST payments and keep the practice afloat. Without the block funding payments he claimed he would have been bankrupt.
“If I relied solely on bulk-billing I would have closed long ago.”
So, with the block funding not coming through and the GST bill due, he felt he had no option but to close the clinic, and that he needed to let people know.
He started emailing stakeholders on the Friday, and posted on Facebook on Sunday night about the situation. On Monday night Health Minister Mark Butler’s office and rang and said they were on it. On the Tuesday, he resubmitted his application for the funding as directed, and on Thursday, the problem was resolved and he received the first lot of money, $88,000 for the Practice Incentive Payment.
He acknowledged the panic that his actions caused but said he had no choice.
He described the bureaucratic actions of AGPAL in denying accreditation based on paperwork, rather than any real safety issue, as “bullshit” multiple times. He said AGPAL hides behind the RACGP, and challenged them to research the effectiveness of such requirements for accreditation. He was critical of the AMA and RACGP for ‘doing nothing’ for GPs, calling them “bloodsuckers” who are only in it for the money, and arguing that if the RACGP really think that doctors do the ‘right things’ because of their accreditation, then the organisation suffers from Narcissistic Personality Disorder.
Dr Alkhouri was somewhat prone to exaggeration during his long monologue, including claiming that India graduates 800,000 doctors every year (in reality it’s 140,000), and that he was the only doctor in the entire country that puts patients records into My Health Record. He further claimed that half the patients in the aged home would die with 2-3 weeks, the pharmacist would close, and home values in Uralla would drop 30%, if he closed the medical centre.
He claims he did 11,000 Covid-19 vaccinations last year, working 7 days a week, and that action “saved the whole system in all New England”. He claimed federal Member for New England Barnaby Joyce personally arranged to get more Pfizer vaccine to his clinic at the time when the NSW Government was restricting supply for the intense outbreak in Sydney. He said he “did well from the vaccinations”, making some $370,000, and this “saved him”.
Much of the time was spent with him giving examples of things he thought were done wrong, were conspiracies of companies making money, or instances where he felt he had been mistreated. He felt the two level system – both State and Federal government being involved in health, and fighting over who pays for what, makes it hard for doctors and endangers patient’s health.
“Doctors are treated like trash, like garbage bags,” he said.
He also revealed the clinic building has asbestos, and that a complaint was made about him over-prescribing or dealing drugs.
He claimed he contacted Uralla Council, after learning that there was other centres where the local council owns the clinic, and the doctors who work there do not have to worry about accreditation or overheads. The story he told of a colleague in Grenfell working under this system was peppered with references to the other doctor’s wealth, including how many investment properties he owns in Sydney. Dr Alkhouri said he has offered a number of solutions, including that the council takes the practice and employs the GP, or gets the funding to build a bigger health facility. He said that Uralla Shire Council did not reply to his communication.
He claimed that grants and incentives offered by the various programs are “all about the propaganda”, rather than actually being about rural health services. In a spiel that might be better told to any decent accountant than concerned patients, he claimed he was paying 47 cents in the dollar in tax, would not apply for any more grants because they were taxed, and made multiple references to the burden of paying GST.
One would not want to speculate what was in his ‘Ricardo’ mug that he sipped throughout the evening, but he was laughing quite a bit, and he expressed his love for ‘Adam’s cat’ (presumably Member for Northern Tablelands Adam Marshall’s Cyril the Wonder Cat), during hour 4.
At the three and half hour mark it looked like he was wrapping up when he indicated what he wanted was to not pay tax for 5 years. He also wanted accreditation reformed, and Council to build a new clinic for him to practice from without the overheads. He finally ended the session, after asking for questions, and without setting a date, time, or venue for the public meeting he wants held, at 8.52pm.
About the only thing that was clear by the end of it is that Dr Alkouri was feeling stressed, was aggrieved that he was not making as much money now as he was when he first arrived, and that he wanted someone else to organise the public meeting, to be held at either the bowling club or the golf club, on a Sunday in February, and for the Council to be invited.
The video is available to view on Facebook. https://www.facebook.com/100063580401469/videos/1529754467511515/