Homophobia still rampant, survey finds

Eighty-four per cent of Victorian gays and lesbians have experienced discrimination or abuse ranging from insults hurled from a car to severe beatings, according to a new survey.

The incidence of bashings has fallen compared with results of a similar survey five years ago (from 19 per cent to 7 per cent of respondents). But verbal abuse during assaults makes it clear most attacks are motivated by homophobia, says the report, Enough is Enough, published by the Victorian Gay and Lesbian Rights Lobby.

The report, based on a survey of 929 gay, lesbian, bisexual and transgender people, is to be launched today by State Attorney-General Rob Hulls. Of those reporting discrimination or abuse, most had experienced it in relation to assault or harassment in a public place (79 per cent), followed by employment (48 per cent), education (31 per cent), provision of goods or services (28 per cent), medical treatment (27 per cent), police/law enforcement (20 per cent) and parenting (16 per cent).

Eleven per cent of men and 6per cent of women said they had been bashed because of their sexual orientation. Sixty-three per cent had been verbally abused in a public place and 25per cent threatened with assault.

By contrast, the report said Australian Bureau of Statistics surveys have found that fewer than 2 per cent of Victorians have been bashed or threatened in public.

One woman reported being attacked by a neighbor who found out she was a lesbian and another was set on outside a gay pub by a group of men who thought she was a gay male; when they found out she was a woman, they continued the assault on the grounds that she was “too butch”.

In the workplace the most common complaint was harassment (38 per cent), followed by being pressured out of a job (16 per cent).

One man said his fellow workers organised a gang bashing after he told them he was gay, while a woman wrote that “A fellow employee attempted to rape me to `change your mind about being a lesbian”‘.

The report found complaints about discrimination from medical providers had risen but complaints about police had fallen nearly 40 per cent, which it attributed to a review of police practices after the controversial 1994 raid on the Tasty nightclub.

Some discrimination related to the fact that same-sex partners are not automatically recognised as next of kin: one woman told the survey she was charged with “impersonating a family member” at the Coroner’s Court after her partner committed suicide.

A co-convenor of the lobby, Kenton Miller, said the report made a mockery of recent claims by the RSL that gay people do not face discrimination.

The lobby called on the government to outlaw discrimination based on a person’s sexual orientation, to extend the legal definition of “de facto” to same-sex couples and to legislate against hate language.

A spokeswoman for Mr Hulls said the government was looking at the issues and would discuss proposed changes to the Equal Opportunities Act with the independents over the winter recess. Anti-vilification legislation was also being drawn up.

First published in The Age.

Inside the male `no go’ zone

IN MY early 20s, I moved to an area of work where I was the only woman among a group of senior men: a desk of subeditors. I was uncertain of my welcome in such a male enclave. I was not uncertain for long. A big, stony-faced man I had never met came over and threw a story on my desk, saying in a voice audible to all, “Sub this, moll.”

In genuine disbelief, I asked, “What did you say?” He repeated himself. I stood up and kicked him hard, once, on the shin. “Don’t call me a moll,” I said. And I sat down and took up my pen with trembling fingers.

Luckily for me, he took it like a man. He held no grudge and we later developed a straightforward, easygoing relationship. A boundary had been set and was respected. It seems like an advertisement for Helen Garner’s advice in ‘the first stone’ to girls being harassed: try a stiletto heel on his instep.

But I would never try such a tactic now. Now I know it’s not always that simple. Unfortunately, the fact that it’s not always that simple has been almost obliterated from view by a decade of media hysteria over “the Ormond College affair”.

The case’s notoriety has made “sexual harassment” a household phrase, but for all the wrong reasons. It has created a social atmosphere so fraught that it has in some ways become harder to deal with the problem.

This is because the public debate was conducted mostly around the terms Garner set. Why did the young women go to the police over minor allegations of touching? Why did they let it get to the point where a man’s career was destroyed? What lay behind their “ghastly punitiveness”?

The point Garner failed to get her head around is the same one that remains obscured today, and the one I had no sense of the day I administered that kick. It is the question of institutional power.

The direct-rejection approach is fine with your average drunk at a party. But it could backfire disastrously with a man who controls your work life or university career.

What if he takes it not like a man but like a weasel? He could go on to play “How do I loathe thee? Let me count the ways”. In an office, he could confine the woman to low-status or difficult work, block her pay rises or promotions, or post her to the workplace equivalent of Siberia. On a university campus, he might compromise her marks, her scholarship or bursary prospects, or her references.

If a man grabs a woman’s breast at a party, it is indeed, to use Garner’s term, just a “nerdish pass”. But if the man is in a position to punish the woman for her knockback by manipulating her circumstances in a formal organisation to which they both belong, that is sexual harassment. This is particularly so if he goes the grope in the first place partly because he knows he has one over her.

The serial sleazebag with delusions of modern-day droit du seigneur poses the biggest moral dilemma for a young woman. If she stays silent, she knows her passivity will leave him free to harass other women. If he holds a position of trust – doctor, priest, the person overseeing pastoral care at a boarding college – his job offers him a bulk warehouse of potential targets.

But why should she be the sacrificial lamb?
Because that is the main lesson from the Ormond affair: that everyone will be scalded and nothing resolved, with the man’s career destroyed and the woman demonised as vindictive, unnatural and unwomanly.

Mass media that had been largely uninterested in sexual harassment issues gave splatter coverage to the first book on the subject that affirmed male anxieties. Commentators seized upon the story in ‘the first stone’ to call the Ormond women bitches, monsters, femi-nazis and man-hating harpies. Garnerism became a magnet for misogyny the way Hansonism became a magnet for racism.

Yes, everyone is more conscious of sexual harassment now. Observation of the gender niceties in many workplaces is the best it has ever been, although this is probably due as much to women’s increasing numbers as to raised awareness. But serious abuse is still not uncommon, according to the Equal Opportunity Commission, and harassment complaints have been steadily rising in the decade since Ormond.

Complaints that reach the commission are complaints that have not been resolved by employers. They are management failures.

I suspect the most profound lesson taken from Ormond has been “Cover thine arse”. A lawyer I spoke to last week told me that while many companies have terrific written policies, their complaints procedures often collapse quickly because managers’ first instinct is still to quash an allegation rather than investigate and resolve it.

The number of women reporting that they were victimised in the workplace because they dared to lodge a formal complaint has skyrocketed in the past couple of years, from 209 in 1997-98 to 346 in 1998-99.

Analyses of the Ormond affair trawled the women’s psyches and motives. But where was the analysis of the male-dominated group dynamic that dictates an organisation’s response to harassment complaints? This was, after all, the reason the Ormond affair was taken to so many arenas: the women believed they did not get a fair hearing.

The real question is not: Why can’t women just let it go? The real question is: Why can’t bosses deal with this without either party being shamed or losing their jobs?
Until that changes, there will continue to be women who limit discussion of dirty deeds to urgent undertones in the ladies’ room; who cop it sweet or handle it one on one, despite the risks of retaliation; who resign from workplaces where they were otherwise happy because they couldn’t bear to make a fuss. There will be women who shield male misbehavior from view and bear its consequences themselves, as women have done for centuries.

This means public spaces such as work and university are still dotted with “no-go” signs for women. Because that’s what harassment does; it tells women that this is a male place where they are interlopers. The unwanted touch and the sexual epithet amount to the same message: You’ll be judged here not on what’s inside your head, but on what’s inside your undies.

Is that what we want for our daughters?

First published in The Age.

This is your life: privacy and health

THE girl was rushed to hospital with complications following an abortion. She begged staff to shield her from a relative working in the hospital who might tell her conservative Indian family.

Staff put the girl in a different ward to where the relative, a nurse, was stationed, but failed to tell the girl she had the right to a “manual” admission, with her details kept in an old-fashioned paper file. Instead, her case was recorded on the hospital’s computer database. Here it was found by her relative, who was allegedly in the habit of trawling the system for familiar names.

The result, says New Zealand Privacy Commissioner Bruce Slane, was “a complete breakdown in family relations”. He tells the story to illustrate the sensitivity of health information and the sometimes devastating consequences of its improper release – as well as the ease with which health databases can be violated.

It is a New Zealand story, but it has implications for Australia. The computer revolution is about to hit your doctor’s surgery – and link it with your pathologist’s lab, your local hospital’s emergency room and even those discreet clinics where you might seek treatment following a less-than-discreet sexual encounter.

A Federal Government taskforce is investigating what form this country’s national “E-health” records system should take, and the Victorian and NSW governments have already launched pilot programs for cyberspace sharing of information between doctors and hospitals at a state level.

The information age has opened up Orwellian possibilities for the detailed tracking of individuals’ use of health-care services and the linking of all their medical encounters on one electronic health record (EHR). It could contain all the clinical information now recorded on paper: the symptoms that led you to seek a consultation, the doctor’s diagnosis and the treatment offered.

There are potentially great benefits. Patients should face fewer unnecessary repeat tests or medical accidents. Doctors would be able to get a complete patient history at the press of a button. Researchers could scan the experiences of millions of people to identify nationwide trends in illness and the effectiveness and safety of treatments. And governments hope to cut costs and better assess the performance of doctors and hospitals.

But computerisation raises big questions about how to mediate the sometimes competing goals of all these “stakeholders” in the health system.

Who decides what should and shouldn’t go on to an electronic record? How should privacy be protected, and to what degree must patients relinquish it to satisfy goals identified as being “the common good”? Should organisations collecting information patients reveal as part of their confidential health care encounters be able to use or sell it for profit?

Bureaucrats keen to contain costs and researchers hungry for mass data are among those who have pushed for a centralised database to which every Australian would be connected lifelong. Such a database would be overseen by the Health Insurance Commission, which administers Medicare and the Pharmaceutical Benefits Scheme.

The centralised model was supported by a 1998 report of the House of Representatives Standing Committee on Family and Community Affairs inquiry into health information management. It recommended that individuals carry health “smart cards” and that the medical details on the cards be backed up in a national data warehouse.

“Centralised” has since become the “C-word” of the debate because of concerns that it might arouse public alarm. Parties privy to discussions on the issue privately say there are still some in Canberra who want the centralised model. Publicly, however, stage proponents are talking now only of a system for linking multiple databases.

This means that your separate carers – GP, specialist, chemist, hospital – would each keep their own computerised file on you, but it would be possible for each to access material from the others electronically.

If you arrived in casualty unconscious, hospital staff could call up your GP’s notes to check on your history of blood-clotting problems or allergies to medication; if you needed a new prescription from your GP, he could call up your hospital records
to confirm that today’s prescription would not react adversely with medicine you were given last time you were admitted.

Theoretically, doctors would need your authorisation, and perhaps your smartcard, to do so, although they would probably have the right to override lack of permission in an emergency. And more sensitive information might be “masked” so that a higher level of access was required to read it. “There’s no need for the GP at the 24-hour clinic to know about the three abortions you had when you were 15,” says Dr Sandra Hacker.

Hacker is the AMA representative on the National Health Information Management Advisory Council, the organisation charged with assessing the options. Its Electronic Health Records Taskforce is due to report to health ministers on the issue in July.

Hacker says the AMA is opposed to a central warehouse because of privacy concerns, and she believes the public would be outraged by it. But while she thinks it an unlikely option, she cannot rule it out. “If that’s what the Government legislates, that’s what will happen.”

Patient advocates are not even reassured by the more moderate alternative of links between databases. “The effect (on privacy) may be much the same either way,” warns Meredith Carter, executive director of the Health Issues Centre.

Supporters of a comprehensive system, such as Dr Chris Kelman, a researcher with the National Centre for Epidemiology and Population Research, point out that computer systems containing sensitive information are already in use in banking and the military.

In an article he co-authored in the Medical Journal of Australia , it was suggested that an EHR could even be stored as a secure web page. He says, “The technology is capable of maintaining privacy. Look what’s happening with encryption.”

But if computer hackers can turn a NASA satellite in space, how safe is even the most highly encrypted health records system?

“Scary, isn’t it?” says Dr Sam Heard. Dr Heard, director of the general practice education and research unit at the Northern Territory clinical school of medicine, Flinders University, is not opposed to e-health. He has been working for 13 years on a project called the Good Electronic Health Record. He favors what he calls the “radical” model, where patients themselves would carry their record or choose a trusted third party to store it for them.

Databases worry him. “The more people have access (to a system) and the larger the database, the more valuable it is and the more at risk it is,” he says. “How many people would be using it at any one time? Imagine the security nightmare.”

Dr Heard warns that hackers can download from the Internet “Trojan horse” software that allows them to infiltrate a system and force it to spit out information. It is possible to make a system completely secure, he says, but that would also make it close to unusable.

A less sinister but equally worrying problem is internal computer glitches. Last year, several thousand Americans’ patient records were accidentally displayed on the Internet for two months. A gremlin in the database of the University of Michigan Medical Centre left records detailing treatments for specific medical conditions, employment status and social security numbers available to anyone tapping into the centre’s website.

While the debate about the security of the technology is important, patient-advocate Carter sees it as a secondary one. The real point is that “any system you build is going to rely on human beings to operate it, so you will always get human corruption and human error”.

Carter says the NSW Independent Commission against Corruption reported in 1992 that it had found “a widespread commercial trade in personal information, including Medicare data, between officers of government agencies and other institutions which should know better such as banks, insurance companies and debt collectors”.

Dr Heard worries about the potential for celebrities or even ordinary individuals who have aroused animosity to be targeted and blackmailed or humiliated by the exposure of their health history. “How much would knowledge that (a former prime minister) had cirrhosis of the liver due to alcohol be worth?” he says.

Violation of computer systems by government employees is still being reported. In February, a Queensland inquiry into the misuse of that state’s police database was told that more than 30 officers at one station had given individuals’ details to the station’s cleaner, who moonlighted as a debt collector.

In January, the Melbourne Magistrates Court was told that a customer service officer for the Health Insurance Commission, Mieng Tang, had used his position to access the Medicare histories and personal details of up to 90 people a day. Most were Asian women and women who had been on IVF treatment. His defence was that he had been “bored”.

Here was illustrated both the blessing and the curse of computerisation: Tang was able to flick through many more files than would have been possible if he was handling more cumbersome paper folders, but it was the audit trail of the computer system that detected his illicit access.

Carter points out that these audit trail safeguards were set up because the law requires it of databases held in the public system. But she says the private health sector, which will self-regulate privacy matters under legislation currently before Parliament, will not face the same stringency.

Lastly, there is the potential for deliberate privacy “breaches” for reasons that those controlling the data think justifiable. There was an outcry in 1987 when teenage girls were listed to testify about their under-age abortions in a court case against a disreputable Melbourne gynaecologist. “People said, `Forget the charges; what are you doing to these girls?”‘ Carter says.

In America, pharmaceutical companies have bought health insurance companies so that they can access patient records and direct market to both patients and doctors. Hacker says Australian doctors are now being approached by companies looking to buy their practices.

In Canada, the Privacy Commissioner, Bruce Phillips, reported that information technology also puts a great deal of power into the hands of public servants. He told of an Ontario woman who, supported by her doctor, sought breast reduction surgery to alleviate chronic pain in her back and shoulders. “The health bureaucrats responded by demanding photographs before agreeing to foot the bill,” Mr Phillips said.

On a bigger scale, the greater political acceptance of the role of market forces has led to widespread “data mining”, the sale of mass health information for commercial use. In Iceland, every citizen was tested so that their genetic makeup could be recorded on a DNA databank now managed by a commercial biotechnology company.

Medical data originally given by patients to Britain’s National Health Service in good faith is now under the control of organisations free to sell it to the highest bidder, according to Professor Stuart Horner, the 1998 chairman of the British Medical Association ethics committee.

And Australia’s Health Insurance Commission is already examining how best to sell “de-identified” material from the Medicare and PBS databases. “They are going to do whatever they can within the bounds of their political ability to exploit and mine that resource to get revenue,” says Stephen Millgate, executive director of the Australian Doctors’ Fund.

He says the HIC’s sales aims, expressed in its 1998-99 annual report, “are written in hard-core commercial language; it’s aggressive, it’s about customers and marketing and being competitive”.

Millgate is the greatest doomsayer in Australia’s EHR debate. He is convinced any model adopted by government will be a disaster because its goals will be administrative and budgetary rather than patient-focused. “And there will be no savings; the cost of putting up a system which is accurate is enormous. It will chew its own head off in costs in the first two or three years.

“There are some moral issues here too. Half the world doesn’t have basic health care, while we’re going to spend millions in Western democracies to know everything about everybody’s health. What groups will be unfunded so you and I can have a continuous record of every ache and pain?”

Millgate doubts promises that patients will remain free to choose whether to “opt in” to the system. “What you will find happening is that if you don’t `opt in’, you won’t get certain rebates. It’s quite easy for governments to say something’s not compulsory and then change the financial incentives to make it crazy for someone to resist it.”
A spokeswoman for the federal Health Minister, Dr Michael Wooldridge, says the Government knows that Australians are very protective of their health privacy and that any system would have to be voluntary, with information kept only in summary and patients having the right to edit their records. “If they didn’t want to admit that they were on a psychiatric drug, for instance, they could just take that off.”
While protecting privacy, this raises its own problems. A patient might suffer an adverse event because doctors acted on the assumption that the EHR was complete when, in fact, essential information had been left off it. Who is then legally responsible: the patient who requested the information withheld from the record, the doctor who agreed to withhold it, or the doctor who made a mistake because he was uninformed?
But accurate, accessible records could be invaluable for the chronically ill. Dr Wooldridge’s spokeswoman points out that almost a third of hospital admissions are of elderly people, and most of them have been made seriously ill by interactions between their many medicines.

It is these people that Hacker predicts will use and benefit from linked EHRs. But groups such as her own customers, psychiatric patients, are likely to avoid them, she says. Electronic records of therapy consultations accessible to anyone other than the treating doctor “could make psychiatry almost unworkable. I see politicians, judges, other doctors: they’re not going to want to reveal things to me if they think others will see it”.

Slane, New Zealand’s privacy advocate, is concerned that systems in that country have too often been set up to spread an unjustifiably wide net over patients whose views have not been taken on board. “It seems to be assumed that having people’s health information is a jolly good thing and a use will be found for it sometime in the future … with public opinion a risk to be managed later,” he says.

This ignores the central issue. “The essence of privacy is respecting what other people think is important to them as private, rather than us saying what the values are and that they should apply to everyone always.”

Health Records: The upside

While away on work, Mr Smith, a truck driver, sees a GP. He complains of severe headaches and asks for strong pain relief. What the doctor sees is an unkempt man from out of town requesting a drug of addiction. With Mr Smith’s permission, the GP calls up his medications history to check that Mr Smith has not been misusing prescribed painkillers. He hasn’t.

But a prompt pops up on the screen telling the doctor that the national adverse events register has recently detected an interaction between two drugs Mr Smith is taking for other conditions. Surveillance of the national health records system had found that people taking both often suffered hypertension and severe headaches. The GP prescribes alternative medication for Mr Smith.

– An imaginary scenario from “An integrated electronic health record and information system for Australia?” Medical Journal of Australia.

Health Records: The downside

At the height of Western Australia’s abortion law row in 1997, a woman who had suffered several traumatic childbirths and miscarriages, followed by a severe stroke, found herself pregnant again. Her husband’s vasectomy had failed. She feared another difficult pregnancy might kill her and booked a termination.

The following day, an elderly man phoned and asked for her by her full title, including her middle name. He told her he knew she was due for a termination and sterilisation at the hospital concerned, and that she would rot in hell. More abusive calls followed and a poem “written” by an aborted child to its mother was hand-delivered to her home. An investigation failed to discover how her details were accessed and leaked, although it noted that a staff member had phoned an anti-abortion group from the hospital during the relevant time-frame.

First published in The Age.

The last stone – what the judge said this week

LIKE DRACULA, the Ormond affair has resisted a natural death. One lawyer who has followed the case couldn’t believe it was back in court again this week: “I thought `Oh God, the hand out of the grave! Kill it! Kill it!”‘

This is probably the one point on which all the parties concerned could reach heartfelt agreement. But this week’s Supreme Court defamation case has not only reignited the story; it has resulted in the legal “outing” of the two young women.

This defamation case resulted from an attempt by the academic who had advised and supported the young women, Dr Jenna Mead, to respond to author Helen Garner’s 1995 book, the first stone. Mead’s 1997 book of essays, ‘bodyjamming’, included a chapter entitled “Sticks and Stones”. It was written anonymously by one of the young women, now known to be Olivia Mayer, and is the only public comment either has ever made.

In it Mayer described what it was like to be at the centre of such a maelstrom: “I could be driving my car, switch on the radio and tune into an argument between several strangers on the topic of my breasts.”
She did not write about the alleged incident with Gregory but did attack the way the complaint had been handled by the then vice-chancellor of Melbourne University, David Penington, and Suzy Nixon, the university psychologist he called in to conciliate between Gregory and the young women.

Nixon sued Jenna Mead and bodyjamming’s publisher, Random House, for defamation. In her statement of claim to the court, she argued that the chapter wrongly suggested she had breached professional confidentiality and used her position as conciliator to try to shut down the complaints.

Nixon’s statement says the chapter suggested that her recommendation that Gregory remain in his position was wrong and dishonest because “she was merely following the instructions of the Vice-Chancellor, to whom she directly reported”.

This week Nixon won a resounding capitulation: an out-of-court settlement that included a retraction, an apology, costs and an undisclosed amount of damages. “Random House and Jenna Mead now accept that this chapter contains serious errors of fact concerning the role of and behavior of Ms Nixon as conciliator and that the chapter was damaging to her,” the publisher’s lawyers told the court.

“Random House and Dr Mead unreservedly withdraw the false allegations contained in the chapter and apologise for the hurt and distress caused to Ms Nixon.”

The settlement came soon after the judge, Justice John Hedigan, had ruled that the two young women would have to give evidence under their own names, which had been suppressed for nearly a decade.

He said they could not expect to remain anonymous forever and it would be “curious and unjust” if they could write about the past anonymously while those they wrote about were denied such a “luxury”. By writing “Sticks and Stones”, Mayer had ignited “the fires of the past” and could not now expect to stay shielded. By the next day Mayer and the other original complainant, Kirsten Campbell, had been named in the press.

Mayer and Campbell are maintaining what is left of the barrier around their privacy. They still refuse media requests for interviews and their supporters will not reveal anything of the women’s circumstances.

Nor will anyone else associated with case talk about it, including Alan Gregory, who still lives in Melbourne.

Jenna Mead and her husband, poet and academic Philip Mead, have left Melbourne to lecture in English at the University of Tasmania. Author Helen Garner has returned to Melbourne after more than five years in Sydney. Suzy Nixon left Melbourne University in 1996 to set up her own practice as a therapist and organisational consultant.

All of them want to put this saga behind them. Only with hindsight will we know whether this week’s events give them their wish; whether this case is the final stake through the heart of “the Ormond affair”.

First published in The Age.