Required: A royal commission into AHPRA and the health profession

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Experienced Queensland thoracic physician Don Kane says a Royal Commission is required to cure the disease eating away at the heart of the health profession.

I support fully (IA contributors) Professor Paddy Dewan and Dr Leong Ng in calling for a Royal Commission inquiry into health services, administration and clinical.

Health services delivery in Queensland is at risk of decline, despite the findings of the 2005 Davies Commission of inquiry into the surgery catastrophe at the Bundaberg Hospital and the Forster Review of the Queensland Health Department in the same year. Recommendations made by both have been largely ignored and there have been few changes as recommended by them. The systems in the public and private sectors have not improved and some would say there has been a decline in some areas.

How can this be?

The structure and systems need to be improved considerably. There has been misuse and abuse of the system by rogue elements in the professions and the bureaucracy and this extends into the regulatory bodies and organisations such as the Australian Health Professional Registration Authority (AHPRA), specialist colleges and the Australian Medical Association (AMA).

Some sections of the medical profession are particularly involved in disreputable activities that target colleagues mercilessly. The vexatious and vindictive allegations that are raised are usually for non-clinical reasons, but related to either personality differences, professional jealousy or perceived commercial disadvantage of those who lodge notifications and complaints against colleagues. The knowledge and skills of those targeted are, in many cases, superior to those of their accusers. Junior doctors and trainees in specialities are particularly vulnerable to harassment, bullying and threats to their careers.

The results are:

  • The community is deprived of services and practitioners of excellent quality with high quality knowledge and skills.
  • The stresses on targeted doctors and their families psychologically and financially are enormous.
  • Overseas trained personnel are particularly vulnerable and form a significant proportion of those targeted.
  • The reputation of the health services delivery institution is damaged and makes recruitment difficult.

How do these things happen?

The perpetrators, in the main, have a large network of contacts in their workplace, the bureaucracy and the legal system. Politicians are at a disadvantage to correct the situation as they are captive of their departments, have political advisers with either no or limited knowledge of health services and their delivery, and take advice from them and/or their department. These sources have been identified as unreliable and to have failed in previous investigations.

Bureaucracy in the present structure is culpable of using the system to delay, manipulate and frustrate correct procedure and, in the main, adopts a different approach to managing complaints against administrative staff and clinicians. The former tend to be shielded by redeployment within the system, whilst the latter are denied due process and natural justice by immediately being assumed to be guilty and summarily dealt by being required to prove their innocence, often having been suspended at the same time. There is typically no effort by administrators, nor indeed by regulatory bodies, to enquire of the accused what their view might be.

The media add to the problems by poorly informed reporting by journalists, who are disadvantaged by having a deficient knowledge of the workings of health services. Their frequent identification of victims as “overseas trained” is damaging in that these practitioners often have Australian qualifications and adequate knowledge and skills. Furthermore, Australian trained doctors are not immune from charges against them. There should be no distinction made between the two groups.

The problem is not unique to Queensland and is a national one.

What is the solution?

The answer is it will be difficult and, some say, impossible to correct. This is a furphy. It requires a commitment by bodies such as the specialty colleges, the AMA and politicians to do what should be done.

The AMA and colleges monitored ethical and professional behaviours of members in the distant past but in more recent times these have not been a focus unlike their educational programs, and membership numbers.

Political parties need to develop a bipartisan approach to do their part and a national inquiry appears to be the only solution on offer. The ball is in their court as they are best placed to correct a situation that if left unattended will eventually irreparably damage our health system.

The plight of one of the many cases that I have been involved with is an illustration of what has been happening. A clinician who had completed his undergraduate medical course, junior doctor, surgical specialist and cardiac surgery specialty training in his country of birth. Following three years of service at a London hospital during which he gained qualification for cardiac surgery in the UK and was appointed as the inaugural fellow for cardiac surgery registrars in the UK. He then worked for five years in the leading cardiac surgery unit in Australia. Admission to fellowship of the Royal Australasian College of Surgeons was gained after an intense battle waged on his behalf by his mentor at the unit in which he worked. This is a scenario common to many often without the successful outcome achieved here. A regional hospital headhunted him to become the director of cardiac surgery where he reduced the unacceptable mortality in the unit to that of world acceptable levels.

His reward was to be driven out of Australia by the actions and inaction of some colleagues and Queensland Health administrators from local to Director levels. This is an all too familiar tale!

Dr Don Kane is a former president of Salaried Doctors Queensland (2006-2010). You can sign the petition he refers to here.

DR DON KANE COMMENT

 

COMMENT:

‘…that public notice and government action was taken, not­withstanding the apparent reluctance of hospital administrators and officers of Queensland Health to take appropriate action to permit the matter to be exposed.’

Don Kane: MINIMAL, INEFFECTIVE GOVERNMENT ACTION

‘The revelations of Mr Thomas and others, leading to my inquiry and report, have already resulted in a huge increase in the health budget and sub­stantial worthwhile reforms.’

Don Kane: DID NOT HAPPEN 

‘More importantly, these benefits will ultimately be lost unless government and the bureaucracy maintain the will to put patient care and openness ahead of economic rationalism

Don Kane: IS NOT HAPPENING

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