Some doctors are concerned about Jayant Patel’s conviction for manslaughter and his sentence to seven years imprisonment — not because they think he is badly done by but because the precedent may hurt other doctors.
When the Queensland Public Hospitals Commission of Inquiry, known as the Davies Inquiry, recommended manslaughter charges against Patel five years ago I was sceptical. Harry Bailey, the deep-sleep doctor who was responsible for the deaths of 25 patients in the 1970s, was not prosecuted. But attitudes have changed in the last 20 years.
Most deaths in surgery are caused by multiple factors such as equipment failures, inadequate supervision and information, use of wrong drugs or wrong doses, as well as the patient’s condition. That was not Patel’s case; he acted with reckless disregard for his patients’ welfare. These were intentional violations of established professional rules and clinical protocols, not system problems.
Doctors are accountable for their actions. Sometimes the degree of recklessness and disregard for patients may be so egregious that criminal sanctions apply.
The Davies inquiry did uncover system problems but ones relating to the way Queensland Health continued to allow Patel to operate at Bundaberg Hospital despite complaints about his competence. There were 20 documented complaints against Patel that were either ignored or mismanaged, highlighting the importance of adequate and transparent complaints systems.
Thanks to public outrage about this case, there have been many changes both in the states and nationally. We now have one national medical board instead of eight. This makes it easier to check qualifications and impose conditions.
The Health Practitioner Regulation National Law Act 2009 which came into force on July 1 this year requires doctors to notify the Australian Medical Board any practitioner who puts patients at risk through significant departure from accepted professional standards. The new laws will not abolish misconduct and incompetence, but they will impose more rigorous processes around registration and maintenance of standards as well as make regulation more transparent and accountable.
In the event of another Patel, I would be the first to support criminal prosecution.
*Merrilyn Walton is Professor of Medical Education (Patient Safety) at the University of Sydney and a former NSW Health Care Complaints Commissioner
I’m still waiting for someone to go after the AMA who were meant to have checked his credentials.
The Medical registering authorities in Queensland were responsible for checking his credentials, a government statutory body, nothing to do with the AMA.
The lessons that should be learnt from the whole Dr Patel and Bundaberg Hospital saga is that rewarding managers through performance based pay based on the achievement of productivity and efficiency targets can produce terrible outcomes in the health system. But sadly, with the current economic and human resources theologies in the health system, I doubt if this will be the lesson drawn. Interesting to hear a spokesperson of the Queensland medical fraternity say that there were plenty of doctors willing to go to Bundaberg to take the surgical position Patel held, but it was considered more cost efficient to employ Patel.
All credit to Toni Hoffman, the Nursing Unit Manager who kept going to senior management of Bundaberg Hospital over a 2 year period raising concerns about Dr Patel’s standards of care only, to be rebuffed and told that she needed to learn how to get on with overseas born doctors. All credit to Anna Bligh, Premier of Queensland, who paid tribute to Toni as a whistleblower, and recognised the suffering that Toni has undergone because she was a whistleblower. Still no word of any disciplinary action against the Director of Nursing Toni complained to, or the hospital and Area administration who refused to listen to Toni’s complaints.
It is not all over yet, as there is to be an appeal and the suffering of Patel’s patients, and the families of the patient’s who died, continues. To those patients and families, I pay tribute. Despite the callous indifference of some, there are many in the health system who are thinking about you, and send you our sympathies.
Could be that the power differential between the nurse (and a gutless director of nursing) and the docs was an influence as well. Give Toni Hoffman a bravery award.
If only it was so easy. I remember a case where a grossly incompetent doctor took the hospital to court for unfair dismissal. Colleague after colleague testified as to this persons incompetence. At one stage it appeared the judicial officer was most unimpressed with these comments until the hospital lawyer said with great exasperation. “Well Sir, let him treat you and your family!!”