Issue 23 / 27 June 2011

HIGH-profile cases of doctors behaving badly always raise the question of why colleagues did not step forward earlier to sound the alarm.

How did Dr Jayant Patel manage to keep operating for as long as he did at Bundaberg Hospital? And why did it take so long for the murderous Dr Harold Shipman to be exposed in the UK?

Psychiatrist Dr Tanveer Ahmed raises similar questions, writing about the case of disgraced neurosurgeon Suresh Nair in the June issue of The Monthly.

Nair had continued to practise despite ongoing concerns about his use of illegal drugs, his inappropriate attitude to patients and a police investigation into the discovery of a woman’s body in his inner Sydney apartment.

The reasons for a lack of action in that case were complex — including an apparent failure by various regulatory bodies to communicate with each other — but Dr Ahmed also discusses longstanding suggestions that doctors may be reluctant to report one of their own.

You can understand why patients might be upset when they read in the media that colleagues of a disgraced doctor had long avoided referring their own patients to that doctor, yet had not taken any steps to inform authorities of their concerns.

The mandatory reporting requirements introduced last year were supposed to change all that, but these things are not always as clear-cut as some of the more sensational cases would suggest.

At what point does a hazy sense of unease about a colleague’s conduct become the “reasonable belief” that is supposed to trigger a report?

For doctors struggling with that question, it doesn’t help that the mandatory reporting requirements are not terribly precise about what exactly constitutes notifiable conduct.

The obligation to report a colleague who practises while intoxicated or whose impairment places the public at risk of substantial harm seems fair enough. But an undefined, cover-all criterion such as a belief that a colleague is practising in a way that constitutes “a significant departure from accepted professional standards” seems a much shakier foundation for a mandatory report.

At a recent Senate inquiry into national registration, which reported earlier this month, former AMA president Dr Mukesh Haikerwal argued that the threshold for triggering notification was low, making the process vulnerable to potential abuse through complaints made in bad faith.

Dr Haikerwal could hardly have been more scathing about the way the new national registration body handled one unsubstantiated complaint about a doctor, describing its attitude as “high handed, officious, thoughtless, unprofessional, [and] unforgiving”.

The Australian Health Practitioner Regulation Agency had ignored the principles of natural justice, access to common law rights and the presumption of innocence, Dr Haikerwal told the inquiry.

Even though it ultimately exonerated the doctor concerned, AHPRA showed no recognition that this was a distressing situation that needed to be handled with care and sensitivity, he said.

A number of professional bodies also made submissions to the inquiry about alleged abuses of the system.

One doctor was said to have reported a competitor in an attempt to drive him out of business and there were claims of anonymous complaints made by ex-spouses during the course of a relationship break-up.

So, can the undoubted need to protect the public from dangerous or unethical health professionals be balanced against the right of practitioners to be treated fairly and protected from dishonest or vexatious complaints?

As the evidence before the Senate inquiry makes clear, that balance has certainly not been achieved yet.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 27 June 2011

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