Doctor’s in the Central West raise safety concerns relating to availability oversight of ‘doctor-in-question’

Three doctors from Dubbo’s medical community are today launching a very public debate about patient safety and supervisory oversight issues within Dubbo Base hospital.

The doctor’s main concern is the hospital’s supervision of a specialist physician, who works both in Dubbo Base Public and two private hospitals.

At the request of interviewees, this doctor, who is well regarded as a respected practitioner, is identified only as ‘the doctor-in-question’.

Frustrated by a series of unresolved complaints, general physician Dr Ari Tagkalidis told the ABC’s 7.30 New South Wales program, that he’s deeply worried about the ‘sanctioned absences’ of the ‘doctor-in-question’.

Dr Tagkalidis says that whilst still on roster as a doctor on-call, the ‘doctor-in-question’ is frequently unavailable to perform ‘on-call’ duties for his patients, because he is away working in the private hospital system, sometimes even hundreds of kilometres away.

He says the public hospital is aware of these absences and is therefore itself responsible for a breach of standards.

“Principally it’s a safety concern but we’re all paid to do a job,” Dr Tagkalidis said.

“If you’re paid to do a job there’s an ethical responsibility to fulfil your obligations.

“This is a very important facility for that community and the management would lead the community to believe that there are certain standards and things available to the community – and they’re not available.”

Dr Ari Tagkalidis, who in protest has resigned from his post, says over two years a series of complaints he and other staff have filed to NSW Health administrators have all, in his view, been inadequately resolved.

That includes the NSW Medical Board, APRHA and the Health Care Complaints Commission.

And despite the best efforts of front-line staff – he fears long-running administrative problems are being swept under the mat.

He is supported by two local doctors, one junior, and one senior, who have requested anonymity as a pre-condition of speaking out.

Both believe the frequent absences are affecting the work intensity for Dubbo’s doctors.

A junior doctor says awkward situations are often created where less qualified doctors are assuming senior responsibility for patient care and assessment.

“It’s not good to have to deal with very unwell patients with limited skill.

“Sometimes when a patient is very unwell, it’s left up to me to transfer the patient out of the hospital.

“The scenario is that patients, becoming very unstable, are suddenly unable to support themselves.

“And the onus is on myself to find another hospital that can take this patient and usually I would do this and transfer the patient, and then notify the doctor in question, who is more than happy for the patient to be transferred out of his care.”

He believes the hospital’s management was aware of the absences and he now questions whether regulations are being flouted.

“In my opinion it is a breach, although it’s hard to define given that these things aren’t written down in law or in a book, but I feel like there is a breach there.”

The senior doctor, who also requested anonymity as condition of interview, says patient outcomes are diminished by the absences of the ‘doctor-in-question’.

“This practitioner, systematically week on week, would not be seen reviewing admissions the following morning.

“And if not the following morning, there would be the extrapolation of whether he was actually available overnight as well.

All three doctors interviewed by 7.30 NSW, have refused to discuss specific patient cases for privacy reasons, but following a 7.30 NSW investigation, action has been taken by authorities to stand down the ‘doctor-in-question’ from duties at Dubbo Base.

The three doctors interviewed by 7.30 NSW are also worried about flow-on issues relating to the ‘sanctioned absences’, such as the regular transfer of public patients into private hospitals by the ‘doctor-in-question’ – who subsequently performs complex medical procedures, sometimes in a distant, smaller facility.

The senior doctor stresses that this raises the real possibility of diminished patient outcomes.

“I believe that patients could have come to harm.

“I find it difficult to believe that on some level harm was not occurring given the nature of the practice, but again at this time I cannot comment because at this time it is very difficult to undertake a clinical review of a private hospital in Australia.”

The junior doctor believes that a haphazard approach to patient transfers also has impacts on standards of care.

“What I’m talking about, the-doctor-in-question would operate on specific days, for example a day later in the week, when a patient required that procedure earlier.

“He would still book that patient for the procedure when he did it, 100 of kilometres away, a day later in the week – when the procedure could have been just done down the road, and it would be easier for the patient, and lead to better outcomes for the patient.”

Scott McLachlan, Chief Executive of the Western NSW Local Health District, says authorities appreciate all of the concerns raised and are responding.

“I’d really like to reassure you and the community that we take these concerns very seriously.

“The quality and safety of services are paramount.”

“We’ve had concerns raised by clinicians in Dubbo, we’ve taken those and started two independent investigations which are still underway.

“We’ve taken the step just recently to suspend a doctor in Dubbo.

“We’ve taken that decision very seriously, because we know that patient safety is absolutely paramount.

“So we do take these things seriously.”

The doctor-in-question has also been approached by the ABC for comment.

A full, updated report will be on tonight’s 7.30 NSW edition.

All doctors speaking out want to emphasise that in general, conditions at Dubbo Base are very good.

According to the junior doctor, “I think that the intentions of most consultants or doctors are very good, especially in the rural setting.”

“I don’t want this to impact on the public’s perception of doctors in the rural setting.

“Most of them are working long hours and doing a very good job.”

NSW Health officials have declined to comment on alleged breaches or irregularities in the hospital until internal investigations are finalised.

The ‘doctor-in-question’ has declined to comment.

Do you know more? Contact 7:30 NSW