Losing Patients

Australia's doctors are getting some bad headlines.

上海性息

Authorities are seeking extradition for Dr Jayant Patel on offences including manslaughter and gruesome allegations have emerged about Dr Graeme Reeves' work as an obstetrician in Bega, NSW.

Against this background of allegations and scandals, Insight asks: just how accountable is your doctor? Do we too readily take our doctor ( and their diagnosis) on face value?

In response to the Reeves' allegations the NSW Government has just approved draft legislation for a big overhaul of the medical regulatory system. Once enacted, this will be the toughest in the country.

Have Your Say: How do you choose your doctor/surgeon? What do you look for?

But how do we really compare to other countries?

In the US and the UK patients can access their surgeon's success rates with some procedures. But does such a system lead practitioners to avoid risky patients?

Much has already been made of a newly agreed system of registration for doctors in Australia. But how much difference will this actually make?

Join Insight for 'Losing Patients' as we bring together the doctors, medical associations, and the people with first hand stories of things going seriously wrong.

Meet the guests.

TRANSCRIPT

Most of us place enormous trust in doctors. But recently we have heard shocking allegations against some medicos. There have been gruesome claims about Graeme Reeves' work as an obstetrician in Bega, in regional NSW. Hundreds of women have reportedly come forward with claims of genital mutilation, unauthorised hysterectomies and inappropriate conduct. Another former doctor, Jayant Patel, is linked to 17 deaths at Bundaberg Base Hospital in Queensland. He now faces extradition from the US and three manslaughter charges.

JENNY BROCKIE: So how were these men able to keep practising as doctors for years? What measures are in place to protect us as patients? Even with the best intentions, doctors – like everyone – make mistakes, but how readily do they admit them, especially when they're serious? Here's Amy Laging.

KURT HALVERSON’S STORY:

REPORTER: Amy Laging

Kurt Halverson made this home movie of himself at his house in regional NSW. Just weeks later his life changed dramatically. In 2001 the 18-year-old from Cessnock had a cardiac arrest in the middle of the night. It temporarily stopped the flow of blood to Kurt's brain.

KEN HALVERSON, FATHER: Massive injuries, catastrophic injuries, but he pulled through. He stayed alive, but he's quite a different person.

This is Kurt today.

KEN HALVERSON: He can't communicate, he can't move, he can't do his own thing. He's dependent on other people for every – I mean, every aspect of his life apart from breathing.

JAN HALVERSON: Because he can't move or he doesn't have very much voluntary movement, we have to basically move his arms and legs for him.

Kurt now has spastic quadriplegia.

JAN HALVERSON: I believe that he recognises us. Probably the best indication of that is that you can say, Ken can say, “Where's Mum? Find Mum's eyes,” and he will turn his head and find my eyes, and reverse, you can say, “Find Dad's eyes.” So I believe he recognises us. That's pretty much it. There's – you can't say for sure anything beyond that.

Before the cardiac arrest, there had been signs for years that Kurt had some kind of problem.

KEN HALVERSON: He was about 13 or 14 he lost consciousness at the dinner table and fell forward into his food. That provoked some examination into him for epilepsy, which was

JAN HALVERSON: Ruled out.

KEN HALVERSON: Yeah, ruled out.

Years later there were more health problems. Although the symptoms were correctly diagnosed, the family doctor, Kenneth Dobler, failed to investigate whether Kurt had a heart problem.

KEN HALVERSON: Too many things were happening. We were told he had glandular fever, we were told he had a migraine, we were told he had a heart murmur, we were told he had a distonic reaction. You think, “What's happening?” You know, and it just, yeah. I was starting to worry. In every other facet of my life I would have drove them mad asking questions, but there's some people in life that you automatically trust and up until that time that had been doctors for me.

Several months after Kurt's cardiac arrest, Kurt's parents, Ken and Jan, decided to try and find out exactly what had happened. So they asked for Kurt's medical records.

KEN HALVERSON: You know, we'd really like to look at the notes and just go through and just for some sense of closure to find out what happened. And that was rejected by both the doctor and the hospital on the basis that it would only upset us, that, just accept that he was ill, that had an impact on his heart, he had a cardiac arrest.

REPORTER: How did you feel when that was refused?

KEN HALVERSON: Annoyed. And that went on for a while.

JAN HALVERSON: Annoyed and suspicious.

KEN HALVERSON: Yes, and we thought, “Why?”

REPORTER: Once they'd looked at the documents and shown them to lawyers, they decided to sue.

KEN HALVERSON: You have to persevere. There was some really low times. And the investigations and building the case, it took a long time.

In 2006 the NSW Supreme Court found that had Dr Dobler ordered a simple heart test known as an electrocardiogram, or ECG, then Kurt's heart problems would likely have been identified and a cardiac arrest probably avoided.

REPORTER: And how did you feel at that point?

KEN HALVERSON: Horrified to find out that there was a possibility that what happened to Kurt wasn't fate, that

JAN HALVERSON: It could have been prevented.

KEN HAVLERSON: And that was a huge thing to overcome in your mind.

The court awarded damages of $8.7 million. But there's one thing the family still hasn't received.

KEN HALVERSON: He did make a mistake and that mistake has had huge impacts on Kurt and I would have liked the doctor to apologise.

REPORTER: And has he ever apologised?

KEN HALVERSON: No.

The doctor has declined to comment to Insight.

KEN HALVERSON: Can you see the sky? Look up high. That's it. Everyone makes mistakes in their profession and we all have to stand up and say, “Yes, I made that mistake.”

JENNY BROCKIE: Well, welcome everybody to Insight tonight, and Rosanna Capolingua in Perth, I'd like to start with you. You represent the nation's doctors. How good do you think they are at admitting mistakes?

DR ROSANNA CAPOLINGUA: I think that doctors sometimes struggle to do just that. They always – we are, in fact, very keen not to make errors and we understand that patients put their trust in us completely and expect 100% of us to never make an error 100% of the time. So the expectations on us are very high and we strive very much to fulfil them and don't like to let anyone down, to disappoint anyone or indeed to do harm. Very occasionally there are those doctors

JENNY BROCKIE: Or to admit you're wrong? Is there a culture amongst doctors not to admit it?

DR ROSANNA CAPOLINGUA: I'm a GP and I have to admit that I have very frank and open discussions with my patients and I say to them, “Look, I don't know, I need to go and find help, I need to look this up,” “OK, maybe that wasn't the right test to do, we have to do another one.” That it is important, in fact, to say to patients, “I'm sorry that this hasn't worked out the way I thought it was going to work out, I was doing it in your best interests and something has happened so that the outcome is not what we expected it to be.”

JENNY BROCKIE: Graeme Alexander, you're a GP, I wonder how you felt watching that story just then? I'm interested in what your perception is of the culture in the medical profession about admitting errors.

DR GRAEME ALEXANDER: I think overall historically because we live and work in such a litigious environment we are probably not good at doing that. But let me just use a different example. I've spent two decades being a GP, can you imagine how many febrile, unwell, flu-like symptom children I've seen? Now, among that group there will be a small percentage that might go on to have meningococcal meningitis, the sort of disease that hits the headlines big-time. Do I then see every child, put an intravenous line in, give them penicillin and send them to hospital? No, I don't. I have to live with the uncertainty that I make the best judgment that I can on the situation at the time and sometimes that will not have a good outcome.

JENNY BROCKIE: Charlie Teo, you're a neurosurgeon who specialises in high-risk operations. What were you thinking when you watched that?

DR CHARLIE TEO, PRINCE OF WALES PRIVATE HOSPITAL: I felt sorry for the GP. I think he probably did do the best he could do. He made a mistake and the mistake had a tragic ending. I think the video showed very nicely that the major problem here was that he didn't apologise to the family. I think if he had apologised to the family, I think if he came out and said that, you know, he tried his best and unfortunately it didn't work out, I think the family would have been less hostile and maybe even avoided a lawsuit.

JENNY BROCKIE: Have you ever made a serious error yourself?

DR CHARLIE TEO: Oh yeah, absolutely. I've made serious errors that have ended up in death and ended up in impairment of patients and it's high-risk surgery that I do. Of course I've always explained to the patient preoperatively that this could happen. See, neurosurgery, it's an unforgiving speciality. You coagulate one vessel which takes the blood supply from the brain tumour, but unfortunately can also result in a stroke. So I go and tell the patient afterwards, the family afterwards, “Look, I took a vessel, it was a decision that I made at the time, obviously in retrospect it was wrong because the patient's woken up with a weakness or a paralysis,” and they usually understand and they usually appreciate the honesty.

JENNY BROCKIE: Andrew Buck, you're a senior registrar working in hospital emergency. Have you ever made a serious mistake with a diagnosis?

DR ANDREW BUCK, EMERGENCY REGISTRA: Oh, of course. Yeah. In the environment I work in I work with long shifts with no breaks often. sometimes dealing with an unchecked flow of people into a busy department, you know, I work regular night shift in charge of busy departments. As I become more senior I think you get better at avoiding making mistakes, and again, you're aware of the litigious nature of society, so you're acutely aware. And in emergency the people are so sick that you often, you know, again you have their best interests at heart, but you make a concerted effort not to make an error, because one wrong move can result in a catastrophe.

JENNY BROCKIE: Charlie, is there pressure on doctors not to say something when something's gone wrong? What is the culture inside the medical profession if something goes wrong? Are doctors open about it with one another and with patients or is there is a tendency to shut down and not talk about it?

DR CHARLIE TEO: I personally think there's a culture to shut down. I mean, it's multifactorial, the problem. Doctors almost by definition are high-achievers, they see a bad outcome as a personal failure. We're in an environment that does not encourage admission, for medico-legal reasons, mostly. So you have all these factors basically telling you, don't go and say you're sorry because if you do it's an immediate admission of guilt and then you'll be sued. I mean, it's good to say you're sorry that the condition happened, not so good to say, “Sorry, it's my fault.”

JENNY BROCKIE: Sandy Brooks and Toni Hoffman, you're both nurses and you've both been at the centre of the most well-known recent cases of doctor misconduct. We're going to talk about those cases in a moment, but first of all, as nurses, I wonder what you think about doctors in general and how you think they react generally if there are complaints – as nurses?

TONI HOFFMAN: As a nurse I'm always – I would hope to be very supportive of the doctors that I work with if they make an error, the same as I would expect them to be of me if I made an error. So it's not just about errors. It's about the type of mistakes that are made, I think.

JENNY BROCKIE: Sandy, what do you think?

SANDY BROOKS: I'd have to agree with Toni. The incidents of – those other incidents are outside the scope of what, you know, the normal mistakes that get made in a hospital.

JENNY BROCKIE: And that's an important context I'm wanting to establish to start with, because we are going to go on and talk about these cases and what they tell us about the system.

SANDY BROOKS: However, doctors are not really open in actually admitting mistakes, but then I don't suppose anybody is in most professions.

JENNY BROCKIE: But most professions don't potentially deal with life and death situations.

SANDY BROOKS: That's true, that's true, but doctors don't openly admit mistakes – well, certainly not to the nurses, they don't.

JENNY BROCKIE: Rick you've just evaluated a nationwide program where doctors were encouraged to be open with patients when things had gone wrong. What sort of examples did you see and what did you find in that evaluation?

RICK IEDEMA, HEALTH COMMUNICATION, UTS: Well, the examples that we found were at times quite shocking. People who had fallen out of their wheelchair and hadn't been spotters and who dehydrated and died a couple of days after, babies who lost their hearing due to an overdose, people who were discharged and had to travel 300km to get back home and died on the way. Some of the things that we talk to patients about are really quite eye-opening.

JENNY BROCKIE: And so the doctors were encouraged in those incidents to talk to the patients about those episodes?

RICK IEDEMA: That's right. These people were referred to us as having partaken in open disclosure. Now, admittedly these were self-selected people, people who put their hand up to be part of this program that was rolled out in 42 sites around Australia.

JENNY BROCKIE: I'm very curious to know why there had to be a program for this? I mean, why isn't that happening already?

RICK IEDEMA: Well, I mean the context, as has been said by other people, is such that people are not encouraged to disclose.

JENNY BROCKIE: So disclosure is the exception rather than the rule?

RICK IEDEMA: I think, well, at the moment I can't really answer that particular question, but the people that we talked to who were self-selected into this program were all in favour of open disclosure. Now, what that says about the degree to which open disclosure is done around the rest of Australia is something that we will need to look in next.

JENNY BROCKIE: We are talking about doctors, how willing they are to admit mistakes and whether they're called to account when they do make them. And Cheryl Jeffrey, I'd like to talk to you now. You were a patient of Graeme Reeves, who was a doctor who worked in Bega and Pambula in NSW, who's allegedly mutilated a number of women. Now, no charges have been laid against him at this stage. You were referred to him with a bladder condition, is that right?

CHERYL JEFFREY: Yes, that's right.

JENNY BROCKIE: And he said you needed a full hysterectomy, which he then performed. What was the outcome of that?

CHERYL JEFFREY: Well, the outcome was that my bladder prolapsed again almost immediately. I was having extreme pain across my lower back, my whole vaginal area. I kept getting urinary tract infections, I was in awful pain and discomfort, I had to go to the toilet every half hour or so, I still do, I was in a mess. I just didn't know what to do. I saw my local GP who said, “Well, go back and see, ring him up and see what Dr Reeves has to say,” but Dr Reeves on my second call told me to stop bothering him.

JENNY BROCKIE: Now, there were real problems with the operation for you. Can you explain what those problems were?

CHERYL JEFFREY: Well, when he operated on me, apparently – I didn't find this out until quite recently – apparently he'd sewn me up too tightly firstly to have sex. Well, we knew there was a problem, but we didn't realise exactly what it was until I'd seen another gynaecologist and he said I'm sewn up too tightly and he couldn't examine me until he had operated, cut me open to see more clearly. And then he told me that my vagina had been a V-shape, made into somehow, I don't know, sewn into a V-shape and he had to reshape it into the usual U-shape.

JENNY BROCKIE: You said that Dr Reeves told you to go away.

CHERYL JEFFREY: To stop bothering him.

JENNY BROCKIE: To stop bothering him, but what happened when you did see him? How did he treat you?

CHERYL JEFFREY: Very, very oddly. He was very crude in the way he spoke, his whole manner was very strange. The operation – the examination table was rumpled, stained, there was no sheet with which to cover myself. When I asked should I undress, he said no, which I thought was odd, and I got up onto the table and the next thing he ripped my underpants off himself and completely horrified me and I don't know how much I can say on television, but he made some very crude remarks.

JENNY BROCKIE: And he didn't use gloves.

CHERYL JEFFREY: No, that's right. When I went back after the check-up he just used two fingers and he said to my husband, “Oh well, two fingers are all you need,” and then he said to my husband, “Oh well, she'll be right now, I've sewn her up like a virgin.”

JENNY BROCKIE: Ian, you were present when all this – you witnessed all this happening, didn't you? What did you make of this as it was happening?

IAN JEFFREY: I was dumbfounded. I thought, what's this bloke doing? I don't know, like what can I do, hit him on the head with a brick? I'd be in trouble myself. He just made this accusations, he also said to Cheryl, “Use your muscle, your pelvic muscles to draw your bladder back,” you know, “See what you can do,” and he then he said, “You'd be good to have sex with, you would.”

CHERYL JEFFREY: Because you had good muscle control.

IAN JEFFREY: Good muscle control, you know, real unappropriate things.

JENNY BROCKIE: Cheryl, did you complain about him?

CHERYL JEFFREY: Well, I spoke to my local GP at first and he said, “Oh, well,” I was complaining not so much about his behaviour as my medical problems, which seemed the main thing at the time and he sent me for various checks and sent me to another GP. I didn't complain about his behaviour. I suppose I was too intimidated, embarrassed, it's not easy talking about these things even now. And when he was finally, I think it was in the Bega newspaper he was finally – when was it, 2004.

IAN JEFFREY: 2004, yeah.

CHERYL JEFFREY: When they disclosed the fact that he'd been struck off, I then rung Dr John Mortimer, the greater area, greater southern area health or whatever it's called, and he said to me, “Oh well, there's nothing we can really do about it. I've had several ladies like you ringing up complaining, but Dr Reeves has been struck off for three years. I'll send you a form, if you like, you can fill it in and I'll send you a brochure on what your rights are, but there's little point in doing it because there's nothing else we can do.”

JENNY BROCKIE: Lorraine Long, you're working with the police task force on the allegations against Graeme Reeves. How many other complaints are there against him?

LORRAINE LONG, MEDICAL ERROR ACTION GROUP: Documented, 574.

JENNY BROCKIE: Over what sort of time period?

LORRAINE LONG: Well, since it went public in February, but the cases go back to the 1980s. There's a real pattern in the 1990s and the early 2000.

JENNY BROCKIE: Andrew Dix, your medical board had banned Dr Reeves from practising obstetrics in 1997 and ordered him to continue psychiatric treatment, so presumably he was already having some sort of psychiatric treatment. The Professional Standards Committee found him guilty of unsatisfactory professional conduct. You knew then that he suffered from personality problems and depression, that – and I'm quoting here the report – “that detrimentally affected his mental capacity to practice.” Why was he just banned from obstetrics? Why wasn't he struck off altogether in 1997?

ANDREW DIX, NSW MEDICAL BOARD: The case in 1997 – and there are constraints on what I can say, but it's covered quite comprehensively in the Medical Tribunal decision which led to him being struck off in 2004. It dealt with a number of particular cases which focused on his obstetric practice and there were concerns about those cases which led to the results. There was no evidence placed before it about his gynaecological practice. The question of his psychiatric state was raised by him as a defence that he argued that he'd been depressed at the time when these things occurred and that was the basis for the ongoing psychiatric monitoring. But the level of concern which the Professional Standards Committee – which is an independent statutory body – when the case had been presented by the Health Care Complaints Commission – the outcome of that was the one of the finding of unsatisfactory professional conduct, but not one that warranted referral up for deregistration.

JENNY BROCKIE: But that committee investigated nine of his cases then back in 1997, one had led to a patient death, in another case a baby had died, and the life of another patient had been endangered. Wasn't that enough? I mean, if someone is connected in that way to an obstetrics problem, why just limit their banning to obstetrics and allow them to go on as a gynaecologist?

ANDREW DIX: Jenny, I understand it appears like that. I think I'd go back to one of the comments that I think Dr Teo raised about the question of the complexity of dealing with unwell people and the fact that there is always two sides to the story. This matter was considered, it was presented by the Health Care Complaints Commission. As I said, it was considered by an independent panel of a lay member and two doctors who came to the view that there were circumstances within those individual cases – and I'm not in a position to go behind their reasoning – but that was a quasi judicial body which led to that decision and that's where it ended up.

JENNY BROCKIE: Cheryl, if you'd known that, if you'd known that Dr Reeves had

had this problem, would you have gone to him?

CHERYL JEFFREY: No way, no, I wouldn't have, of course not.

JENNY BROCKIE: Andrew Dix, you knew that Graeme Reeves was breaching that order not to practise obstetrics from November 2002, when you wrote to him about breaching the order, and he admitted he was breaching the order in his correspondence with you. Why did it take until 2004 for him to be struck off?

ANDREW DIX: Because we didn't have the grounds to do it, Jenny, and I think that's the point that I've got to make. That the legal provisions – and I would comment on the announcement the Health Minister made on Sunday – that the powers are being extended to enable us to suspend in the public interest, which is something we haven't had that power before, but at the time the legal position was we had to do the bare minimum to ensure that on the evidence before us the public was being adequately protected.

JENNY BROCKIE: Andrew, what happens once a problem doctor has been identified – and by 'problem doctor' I mean somebody who – there's been a serious complaint that's been found to be a serious complaint or someone's been banned from practising obstetrics. Who actually monitors then that doctor's behaviour?

ANDREW DIX: It depends very much upon the type of conditions that have been placed on them. Generally speaking, there will be conditions where they're required to report to us, we will have communication with Health Insurance Commission or Medicare Australia on a regular basis to make sure they're not acting outside of those conditions.

JENNY BROCKIE: And did that happen in Dr Reeves's case?

ANDREW DIX: In Reeves's case there weren't any conditions – there weren't any specific reporting requirements of that sort.

JENNY BROCKIE: Joanna Flynn, you're from the Medical Board of Victoria. What does a doctor have to do to get deregistered in Victoria and how effective is your board at monitoring these sorts of things?

DR JOANNA FLYNN, MEDICAL BOARD OF VICTORIA: I think we all learn from what happens in other jurisdictions and in our own jurisdiction, and I think that we're all more effective than we were some years ago, but I think the public can rightly can ask the question about how effective medical regulation is. In Victoria we have the power to suspend doctors if we think there's a serious risk to the health and safety of the public, while the allegations are being investigated and we certainly take that action in some circumstances.

JENNY BROCKIE: Sandy, you mentioned before that you'd worked alongside Graeme Reeves, I think – or you mentioned to me earlier – in Sydney in the '90s, is that right?

SANDY BROOKS: Yes, in the '90s.

JENNY BROCKIE: And you made a complaint about him?

SANDY BROOKS: I did.

JENNY BROCKIE: But you didn't follow that complaint up.

SANDY BROOKS: No.

JENNY BROCKIE: Why?

SANDY BROOKS: That's a good question. Nurses and doctors had – there was a culture, whether it's still like that I don't know, and I wrote a letter complaining about his behaviour, but I wish I had followed it up now and I wish I knew then what I know now that I could follow it up and probably

JENNY BROCKIE: What stopped you, though? What stopped you from following it up?

ROBIN MOON: I also wrote letters, we worked together, and we gave – I gave my letters to my immediate nursing supervisor, the unit manager, and I think we put our trust in her because she said she would take care of it from there. So she was the mediator between the midwives and the obstetricians, so as the nurses, we trusted that she would take care of it.

JENNY BROCKIE: And what sort of complaints were they, just in general, what sort of things?

ROBIN MOON: Complaints about Graeme Reeves's behaviour, as I said before, being sexually inappropriate to the patients, poor technique, lack of compassion exuded towards his patients, and on and on and on.

JENNY BROCKIE: So the complaints went nowhere?

SANDY BROOKS: Nowhere, never heard another word about them.

JENNY BROCKIE: Toni Hoffman, you're a senior nurse at Bundaberg Hospital, you blew a whistle on Jayant Patel, who's linked to 17 patient deaths there at that hospital and he's now facing extradition proceedings and three manslaughter charges. How long had you been worried about him, about Dr Patel, and why?

TONI HOFFMAN: The first complaint that I made about Dr Patel was five weeks after he started, and that basically was regarding the first patient, the first manslaughter charge that's been brought against him.

JENNY BROCKIE: That's currently being brought.

TONI HOFFMAN: It also was looking at other aspects of his behaviour with sexual harassment and there were a few other things that we were very concerned about.

JENNY BROCKIE: Now, who did you raise your concerns with? You had a lot of concerns over quite a long time, who did you raise those concerns with?

TONI HOFFMAN: The director of nursing, who was my line manager, the medical director, the director of medical services, the district manager, and I think towards the end of the two years we counted 12 different groups of people that I'd raised my concerns with.

JENNY BROCKIE: And how did they respond when you raised those concerns all through the line?

TONI HOFFMAN: They turned on me and said that I was the problem and, you know, that I lacked conflict resolution skills and I had poor communication skills and I was a poor nurse unit manager. So I became the problem, and it was much easier to try to get rid of me than to get rid of Dr Patel, because he was a doctor who was bringing in a very large amount of money for the hospital, basically.

JENNY BROCKIE: How long was it before action was taken?

TONI HOFFMAN: Well, no action really was taken until after I went to the member of parliament and it all came out in the media, really.

JENNY BROCKIE: And that's how it all came out in public?

TONI HOFFMAN: Yes.

JENNY BROCKIE: Rosanna Capolingua, how do you think that reflects on the medical profession and the system in general, Toni Hoffman's experience?

DR ROSANNA CAPOLINGUA: That example is one where the doctor was protected in spite of very clear concerns by senior nursing staff, protected because he was doing the “work” that was needed at the hospital and I think we have to be always very careful that the patients are protected, and that we're not actually just trying to deliver a service or fulfil a work force need.

JENNY BROCKIE: Rosanna, can I just read to you what the Queensland AMA said at the time. This was the day after the Patel case was first raised in Parliament, and this is a quote from the Queensland AMA: “There's every probability that there was no negligence involved in the surgeon's practice and the issue before the Medical Board mostly relates to the scope of the surgery being completed in a country centre.” And the AMA press release went on to say: “The Opposition has acted irresponsibly by accusing a Bundaberg surgeon of professional incompetence in the interests of cheap political gain and perverting the course of justice.” That was the AMA's response the day after this was raised in Parliament. Why did the AMA go straight to a fierce defence of Dr Patel before it knew the facts?

DR ROSANNA CAPOLINGUA: That's exactly what happened, wasn't it, by the statements that you've just read out to me. It sounded like there was a defence put in place before the facts were evident. They did make a comment, however, on scope of practice, and in Patel's case I understand that he had a registration which was restricted, and that his scope of practice and his place of employment was then extended by the employer because they had a desperate need for a senior surgeon.

JENNY BROCKIE: But the AMA accused the Opposition in Queensland of acting irresponsibly by accusing a Bundaberg surgeon of professional incompetence and accused the Opposition of cheap political gain and perverting the course of justice. Why buy into it at all? Why leap to a defence before you know the facts?

DR ROSANNA CAPOLINGUA: I wasn't involved in what evolved there at that particular time, and as I said, I agree that indeed the evidence has shown quite clearly that that statement was perhaps one that should have not been made at the time and judgments such as that should have been reserved until more information was revealed.

JENNY BROCKIE: I guess what I'm getting at, Rosanna, is that it gives the impression that the AMA's more concerned with protecting its own than with sitting back and waiting to see what the facts of a case really are against a doctor. Would you agree with that? That's the impression it gives?

DR ROSANNA CAPOLINGUA: That's the impression that that example that you've brought forward gives, The AMA is here principally to protect patients. I think that we need to stand up and be counted and look at ways of complaining, of having action taken, of reporting a colleague when we see that there is something to worry about. And it's been difficult in systems in the past to do so, because even doctors, sometimes like the nurses, may have been in a position where they're vulnerable, that they might feel their careers are in jeopardy, that they might be discredited if they speak up and say something, so we need our professional ethical conduct to be able to stand up and we also then need the protection around that so we can stand up and make a comment and say something about a doctor and have an investigation without it all falling back and destroying our own careers. We are quite vulnerable as well.

JENNY BROCKIE: Andrew Sutherland, do you think the profession leaps to protect its own too quickly sometimes?

DR ANDREW SUTHERLAND, ROYAL COLLEGE OF SURGEONS: I think it does sometimes. I think we're improving. I think there has been an enormous change during my career compared to what it was like 30 years ago, which I think was very much a closed shop. What has been left out of the argument so far is the responsibility of the hospital on which this was occurring, because I believe the problem here was with the nurses at the Bundaberg, the hospital administration should have clearly dealt with their concerns and I suspect in Bega too, promptly and appropriately, and it never ever would have got so far and I can see the difficulty with the AMA man who sees a political – isn't it appalling that they had to go into a political forum in order to raise this, and then, of course, you start to get a political answer and it should never have got to that.

JENNY BROCKIE: Beryl Crosby, you started a support group for the patients at Bundaberg Hospital after the revelations about Jayant Patel. You were a patient yourself of Jayant Patel.

BERYL CROSBY, BUNDABERG HOSPITAL PATIENTS GROUP: Yes, I was a patient.

JENNY BROCKIE: What happened to you?

BERYL CROSBY: I was a misdiagnosis. He told me that I had cancer when I didn't. But I think my view in all of this is that in talking to so many patients – not only the Bundaberg patients, I talk to patients all over the place, even in Western Australia – and they want somebody to acknowledge that something has gone wrong and they want the apology, and what I learnt from Bundaberg is that an apology and somebody who heartfeltly said, “We're sorry this happened to you,” would have been enough for these people. I don't believe that everyone would have gone off and got compensation, I don't believe that for a moment.

JENNY BROCKIE: Cheryl, you were nodding your head then. Even in your circumstances, would an apology have helped?

CHERYL JEFFREY: Certainly it would have helped, I don't believe so much from the doctor, because I honestly don't think he's right mentally, but perhaps from the hospital, from the whole administration.

JENNY BROCKIE: Someone in the system to acknowledge that you were suffering?

CHERYL JEFFREY: Yes, that's the point. I have the greatest respect for the nurses, I think they're doing their best, I certainly don't blame them.

JENNY BROCKIE: Beryl, you're meeting with the Queensland Health Minister this week to ask for laws to make it mandatory for health professionals to report gross misconduct of their colleagues. Why, why are you pushing for that?

BERYL CROSBY: It's not only gross misconduct for cases like these, I believe that you should report – if you've made a mistake in dealing with a patient, you need to own up to that mistake. It should be mandatory that if you see an adverse event happen and you see a doctor make a mistake, if that doctor doesn't own up to that mistake, and that should be mandatory, then the nurse or the anaesthetist who sees that mistake occur should also be accountable.

JENNY BROCKIE: And that's what you'll be pushing for with the Queensland Minister?

BERYL CROSBY: Yes. We're talking about people who are harmed, we're talking about trying to reduce it. So if it's an issue where a doctor may need to be retrained in a particular procedure, or it might be an operational issue like we've talked about, how are we going to fix this if we don't admit it?

JENNY BROCKIE: What happens when doctors make mistakes or abuse their positions of trust? And Rosanna Capolingua, the NSW Government has just announced some tough new laws which are going to make it mandatory for medical practitioners to report their colleagues for serious misconduct, as well as automatic suspensions for doctors who breach conditions of their registration. There are other laws as well. Is that a good move, and do you think it could be applied to other States in Australia too?

DR ROSANNA CAPOLINGUA: It is indeed part of our ethical obligation, part of our professional conduct to make a report, to take action when we see a colleague that is harming patients. So the NSW proposal to enshrine that in legislation is something that I hope will afford the doctors who want to do, to report, afford them with the protection – I guess protection for the whistleblower and indeed, of course, provide justice to the doctor that they are reporting about.

JENNY BROCKIE: Do you think it could be applied elsewhere, in other States?

DR ROSANNA CAPOLINGUA: I think that the cases that we've been talking about contribute towards the need for this sort of protective legislation to evolve so that doctors can make clear complaints about their colleagues if they're concerned without feeling that they're jeopardising themselves in the process and I think that's something that probably could be replicated across Australia.

JENNY BROCKIE: Andrew Dix, what about the medical boards, do they need a shake-up? Do they need more power? Do they need more capacity to actually act against these doctors?

ANDREW DIX: The Medical Board supports the legislation that's been announced. It's more than a code of ethics in NSW, it's a professional legal obligation on doctors, but now putting in the legislation will give encouragement to those who might just be wavering and are not quite sure. So certainly we support it.

JENNY BROCKIE: Toni Hoffman, do you think mandatory reporting would have made it easier for you in your situation?

TONI HOFFMAN: I think it would have made it definitely easier for me, because there would have been a lot of other complaints that went in with mine, it wouldn't have been just, you know, “Why is it only you who's complaining,” because there were so many people that were talking about what was happening, but, you know, that hadn't put in formal complaints.

JENNY BROCKIE: Andrew Sutherland, what do you think of mandatory reporting?

DR ANDREW SUTHERLAND: I think it's probably a good idea. My concern is even if you have mandatory reporting it's the issue of what happens with those reports once they're made, it's the dealing with the complaints and the reports in an appropriate and fair way that also takes into account a fair process for the person who is being complained about, and a fair process for those who are doing the complaints.

JENNY BROCKIE: Justin, I know you're a bioethicist and you like the idea of doctor report cards. What are they?

JUSTIN OAKLEY, BIO-ETHICIST, MONASH UNI: Doctor report cards at this stage have been used mainly for surgeons, and in particular cardiac surgeons. So in New York State for the last 17 years patients have been able to find out on the Internet what the mortality rates of individual, named cardiac surgeons actually are. These have just been introduced in the UK about two years ago.

JENNY BROCKIE: And Danny Keenan in London, you're there in Britain, and you have report cards for cardiac surgeons like yourself. How do they work there?

DANIEL KEENAN, UK HEALTHCARE COMMISSION: Well, we have a public disclosure of individual surgical results for coronary surgery and one or two other open-heart surgery procedures. They have been a driver for improvement. It's fair to say, however, I believe the big driver for improvement was when we did unit-specific reports.

JENNY BROCKIE: What do you mean by 'unit-specific'?

DANIEL KEENAN: That's hospital-specific, each hospital doing open-heart surgery declaring its results.

JENNY BROCKIE: OK, rather than the individual doctors?

DANIEL KEENAN: Yeah, well, we have both, but I believe that the real increment in improvement occurred when the units – the hospital-specific results were released. That focused colleagues in each hospital into actually setting to and improving results by small increments which, adding together, made an important contribution. Just one further thing to say is when patients come to see me in my clinic for open-heart surgery, they never ask me for my results. The hit rates on the Internet looking at this in my own unit are small. That is because patients come actually believing that we are going to provide a good service to them. That is why it's so important that we have structures in place to reciprocate that trust that they put in us, so that actually we are going to be providing them an excellent service.

JENNY BROCKIE: Andrew Sutherland, what do you think about this idea?

DR ANDREW SUTHERLAND: I agree with everything that's been said, really, and it's interesting, score cards would be fine, but they have only really been a success in cardiac surgery, where it's a fairly defined operation, where the end point is fairly tough in that probably you're either alive or dead and so the score is a bit easier to publish. Most of medicine, surgery included, it's not really possible – it's very, very difficult to score an outcome, which is a soft outcome, with a number. And it's very, very difficult to risk-rate these things, because it does depend so much on the severity of the patient.

JENNY BROCKIE: So do you support the idea of the cards or not?

DR ANDREW SUTHERLAND: We're very, very supportive of the collection of data and of audits of outcomes, we're not in favour of publishing them in a daily newspaper as a number.

JENNY BROCKIE: So you're not in favour of that data being public to patients, patients being able to access it?

DR ANDREW SUTHERLAND: We are in favour of data being available, because we publish data all the time about people's results and about audits that have been done, but I'm against – and the college is against – the concept of a score card that you can look up your doctor's name and he's 10 out of 10 or 5 out of 10.

JENNY BROCKIE: But so a report card but don't report it?

DR ANDREW SUTHERLAND: No, no, it's not a report card. It's a very, very complex thing. Surgery's not like a football game. We need a multifaceted group of bit of information, which should be publicly available, but to have a single score card may work for cardiac surgery but doesn't work from many other things.

JENNY BROCKIE: Charlie, what do you think?

DR CHARLIE TEO: Oh, look, it's so sad. I mean, I think the good thing about this forum is that everybody agrees there's a problem, so there's one common ground. What we haven't agreed on is the best way of achieving the best treatment for our – best care for our patients. I mean, the ideal situation, of course, is if you could pick doctors based on the fact that they care for their patients, you know, self-assessment, and no-one else needs to monitor us because we care for our patients, if we have a bad outcome we're going to learn from it, we're not going to do operations that are too difficult for us. We're going to communicate well with our patients.

JENNY BROCKIE: But any system is only as good as its weakest example, isn't it, really?

DR CHARLIE TEO: Absolutely, and that's why we're all debating the best way of monitoring and making doctors accountable, but they all have their flaws, that's the trouble.

JENNY BROCKIE: Justin, it seems like you've got a bit of work to do to try and convince people of this idea of report cards and publicly available information, and even Danny is saying that patients don't use it, so if they don't use it why would you have it?

JUSTIN OAKLEY: Well, what they've done in the UK is they've tried to restore public confidence in the health system after the Bristol inquiry into the scandal in paediatric cardiac surgery at the Bristol Royal Infirmary. I mean, how can people say the public are not entitled to give their informed consent when it comes to having surgery and which surgeon you have affects your risks of surgery? So I just think the public has a right to know.

JENNY BROCKIE: Charlie, what about the idea of video cameras in theatres?

DR CHARLIE TEO: Well, I mean, I wouldn't like it, but if it's going to help, then, you know, we've got nothing to hide when we operate and so again it's this problem of trying to make us more accountable, but everything is flawed.

JENNY BROCKIE: Andrew Sutherland, video cameras in operating theatres – why not, if there's nothing to hide?

DR ANDREW SUTHERLAND: There is nothing to hide. I think they have a very, very small benefit for a lot of expenditure. You know, many of the problems relate to the wrong diagnosis, the wrong operation – not a wrongly performed operation, but the wrong operation, inadequate post-operative care, it's the whole experience from the time you see the patient to the time the problem's solved.

JENNY BROCKIE: But these are all reasons not to do things. What are you suggesting you should do then to deal with these situations that have come up that are causing so much public concern?

DR ANDREW SUTHERLAND: There is no universal answer because it's an extremely complex system. It's like life, there is no one single answer to make it perfect, but I believe, and our college believes, you do have to collect good data and we're very strong advocates of audit of surgical outcomes. That material should be available. But more importantly, when people do complain or do raise issues they must be dealt with in a fair and appropriate fashion.

JENNY BROCKIE: But that's a motherhood statement, it's not happening, it just doesn't happen. I mean, we've got examples here of midwives and nurses and hospital – people at various levels who have tried to raise things and it's not dealt with like that.

DR ANDREW SUTHERLAND: I agree, I agree, and it must happen and we must have rules, regulations and legislation where possible, where it enables people without fear or favour to raise concerns.

JENNY BROCKIE: Lorraine?

LORRAINE LONG: That's a classic case of what happened with Reeves. They collected all these data and everybody ignored it. Every hospital in Australia is collecting data and no-one's doing anything with it. It's got to be put up on the Internet for everyone to have access to it.

JENNY BROCKIE: Rick?

RICK IEDEMA: I think the important thing here is data is often very gameable, as people have said, and the idea of video cameras is a fantastic one. We have had several projects now where we go into hospitals and film what people are doing and the amazing thing is you show the footage to clinicians and they say, “We didn't know we work like that,” because these people have no time to actually think about how they're working.

JENNY BROCKIE: We are going to have to wrap up shortly, but there are just a few general questions I'd like to throw out here, because I think we've covered a lot of ground tonight, but some of the issues that are coming up again and again that interest me are whether we on one hand place too much trust in our doctors but on the other hand expect too much of them as well. Charlie, do you think people place too much trust in doctors sometimes?

DR CHARLIE TEO: Well, actually I like the fact that patients trust their doctors, but sometimes, I think, yes. I mean, I've had a lot of patients come to me that have been seen by another neurosurgeon and I've said to them, “Well, why didn't you come to me in the first place?” “Well, we thought that they knew exactly what they were doing, we thought that we couldn't get a second opinion, we were on a treadmill and we couldn't get off,” and I almost think to myself, look, you know, when you get your car repaired you get three quotes. It's odd that when you get your brain operated on you only get the one quote.

JENNY BROCKIE: Graeme, what do you think?

DR GRAEME ALEXANDER: I think across this country patients do trust their doctor and it is essential that they trust their doctor. We have to negotiate our patients through a health system that is a minefield and they rely on us heavily to weave their way through a health system that is absolute crisis, and that word gets thrown around a lot, but it could not be used more appropriately in health.

JENNY BROCKIE: Just to sum up, though, I wonder, Lorraine, everyone makes mistakes, doctors included. What is it, do you think now, that's needed? We've had these cases, people are thinking about this issue, what do you think is most needed now and what do most patients really need at the end of a bad experience?

LORRAINE LONG: What patients need first off is the truth, all of it, no matter how brutal it is, they need the truth, because someone in the family will find out what's gone wrong years down the track, and that's when the hatred sets in and the resentment, because the doctors lied to them and they've believed it, but the answers they got were always inadequate.

JENNY BROCKIE: Beryl? You want mandatory reporting, what else do you want?

BERYL CROSBY: I want mandatory reporting right from when a doctor makes a mistake and I want it to be able to be a nurse that can report so there would be no more need for whistleblowers, there would be no need for whistleblowers, because it would be mandatory that you actually report seeing a mistake happen, and then I want an apology for the patient, I want them to sit down and they've done a pilot scheme on open disclosure in Queensland and they went around quite a few hospitals and they found from that that most of the patients were grateful. They were grateful for the apology, they accepted that something had gone wrong. We don't think doctors don't make mistakes, we like to trust, but we know they make mistakes, and the whole idea is to how we're going to reduce patient outcomes – bad patient outcomes, and how we're going to save lives, and that's what we should be thinking about.

JENNY BROCKIE: Cheryl, final word from you – what have you learnt from the experience, the horrific experience you've been through?

CHERYL JEFFREY: Well, what I've learned is, or what I knew is that doctors do make mistakes and I don't blame any doctor. I didn't even blame Dr Reeves when I realised the operation had gone wrong. I realised that he'd made a mistake and I thought, that's human, but when I realised that he'd made not just one but literally hundreds of mistakes, I was horrified that the whole system, how it could let such a thing happen? This is what's so incredible. It's not making one or two mistakes. Doctors are human, of course they'll make mistakes, but the fact that that doctor had been allowed to make so many and nobody did anything until the press virtually got into it. I don't know. I suppose all I've learned is that it needs a lot of publicity before anything's done.

JENNY BROCKIE: Well, thank you very much for joining us tonight. I know it wasn't easy to tell your story, but we really do appreciate you coming here and thank you to everyone tonight for taking part in this discussion. Rosanna Capolingua in Perth, thank you very much for joining us, and Danny, thank you very much for joining us from London too.

DANIEL KEENAN: OK, cheers.

JENNY BROCKIE: OK, and that is Insight for this week.