Northern Beaches Hospital Implements Urgent Upgrades Following Review Into Toddler’s Death

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Northern Beaches Hospital (NBH) in Sydney is undergoing critical upgrades following a review that linked the death of two-year-old Joe Massa to systemic failures in clinical response and equipment availability. The New South Wales (NSW) Health report identified serious deficiencies, including the absence of essential high-definition cameras used by the Newborn and Paediatric Emergency Transport Service (NETS), which are standard in other public hospitals across the state.

Joe Massa was taken to the NBH emergency department on September 14, 2023, suffering from hypovolemia. His mother, Elouise Massa, expressed deep concern that despite repeated requests, staff delayed administering an intravenous drip. Joe later went into cardiac arrest and died at Sydney Children’s Hospital after being transferred there and placed on life support.

A key finding of the Clinical Excellence Committee (CEC) review was that NBH lacked NETS cameras, which enable remote video consultation with pediatric specialists. Without this visual capability, NETS clinicians were unable to provide a real-time assessment of Joe’s condition. Ms. Massa called the oversight unacceptable, questioning how a “state-of-the-art facility” could have been developed without standard equipment expected in public hospitals.

The Northern Sydney Local Health District confirmed that three NETS cameras will be installed at NBH within four weeks. The devices are being integrated into NSW Health’s IT systems and will be placed in the emergency department, children’s ward, and special care nursery. According to the district, the upgrade will align NBH with the technology access found in other public facilities, enabling improved emergency care and retrieval coordination for critically ill infants and children.

The review also revealed staff hesitancy in escalating care concerns without full clinical certainty. When Joe was initially assessed, he was categorized as a Category 3 patient, which required treatment within 30 minutes. His parents argue he should have been triaged as a Category 2 “Red Zone” patient, which would have required treatment within 10 minutes due to the severity of his condition. The delay in triage and treatment was identified as a contributing factor in the review.

Ms. Massa described the hospital’s shortfalls as evidence of a broader structural inequity impacting the roughly 300,000 residents of the Northern Beaches region. In an interview with 2GB, she said the report left her and her husband feeling “sick to the core.”

The CEC issued 13 formal recommendations, including improvements in clinical governance, triage safety, staff training, risk management, and the hospital’s digital systems. It also called for mandatory pediatric resuscitation training and greater senior medical oversight in emergency settings.

Healthscope, the private operator of NBH, acknowledged the findings and expressed support for the report’s recommendations. A spokesperson for the company confirmed the hospital would work with the CEC and the Northern Sydney Local Health District (NSLHD) to implement all changes within the proposed timeframes. The spokesperson noted that while the review outlined serious challenges, it also recognized NBH’s committed workforce and strong clinical performance in areas such as emergency response, elective surgeries, and ambulance transfers.

The report further highlighted limitations stemming from the hospital’s public-private partnership model, citing complex reporting structures and restricted access to clinical systems that are standard in publicly operated hospitals.

The NETS cameras are expected to be fully operational by September 4, pending a period of configuration and staff training. The upgrades are seen as a necessary step toward ensuring higher standards of pediatric emergency care and preventing further tragedies.