(Image via abc.net.au.)

Dr Leong Ng examines recent "fixes" in the medical regulatory process and finds little change to the systemic problems of bullying and discrimination.

DURING WORLD War II, MI 5 used the double-agent recruitment strategy coupled with careful planning and perseverance to shatter the prospects of victory for the Nazis. This slowly changed what was a bleak situation into one of tremendous success and finally, victory.

Earlier on, it was claimed that Dr Josef Goebels gave Hitler this infamous advice:

"If you tell a lie and keep repeating it, people will eventually come to believe it."

Goebels, a philosopher by training, and later, the Reich Propaganda Minister, was a clever student of human nature. The initial success of the Nazi regime was ensured with this tactic. Those who did not agree with the regime were usually exterminated. Finally, people gradually discovered the truth and began to oppose the regime from within. This, eventually led to freedom and the rule of law.

Current issues

Australians have always been vehemently associated with and have upheld freedom across all spheres of daily life. Injustices are opposed, frowned upon and even publicly resisted. 

However, there appear to be many gaps in the law and many injustices still prevail today — unlike in many other developed countries. Medicine and Health Care, including their regulation and management are in that category.

In Cairns, a private members’ motion in the lower house of Parliament in October 2010, brought to light the discretionary recommendation of non re-registration of a UK-trained cardiologist in regional Queensland by the Royal Australasian College of Physicians (RACP).

It was an impassioned campaign led by their MP Bruce Scott and supported by a large petition from the people of Far North Queensland, who also held several rallies and meetings to keep their beloved cardiologist. In a way, the rallying was an expression of the desire of the people for freedom and justice.

Another recent community effort in 2014 involved the repeated medical audits of (French-trained) Dr Richard Emery. It appeared that the former then triggered a swiftly announced but slowly and carefully conducted Parliamentary Inquiry into the Registration Processes and Support for Overseas Trained Doctors. The terms of reference were clear but limited in scope.

With the tense scenario, politicians had to placate the public, manage rapidly escalating concerns and demonstrate that they cared. “Safety” and the “protection” of the public had to be major concerns in the administration of all medical practice regulatory policies. Little did they realise that, as shown later, there should also be protection from maladministration by bureaucrats.

Background furphies and distractions

It was natural to assume that the system was not at fault but that the fault lay with (overseas-trained) practitioners — by sheer virtue of their vulnerability as conferred by the law. Also, bureaucrats had to show that they were doing their “best”, presumably to justify their continued employment.  

A constant major newsmaker during this time, was the persistent trial by media of Dr Jayant Patel, labeled Dr Death, whose case, though seemingly concluded has many unanswered questions. Ex-Chair of a suddenly changed inquiry, QC Tony Morrissubmission to parliament in 2005 reveals a toxic culture in Queensland Health, which is strikingly similar to that in NSW.

Additionally, in the background were complex evolving processes set up in 1996 which culminated in an internationally-publicised hunger strike by some doctors in Sydney. This led to a “brokered” NSW Government Inquiry and Report (privately published in 1998 as “The Race to Qualify”) by Stepan Kerkyasharian AO (until recently Chair of the Anti Discrimination Board of the Attorney General’s Office in the NSW Government, now retired). This has been largely ignored  a copy of the report can only be obtained privately from Mr Kerkyasharian himself.

 

Another background event was the conclusion of a Special Commission of Inquiry (the Garling Inquiry) in NSW in 2008 with a 6 cm thick report, virtually eclipsed and allegedly sidelined by successive NSW governments.

Both these reports concluded that there were serious systemic faults which plagued the system (and continue to do so). In particular, there are major issues with processes related to non-adherence to the principles of natural justice and entrenched bullying at all levels.

Amidst all this, the continued shortage of health workers in Australia (long recognised by the Productivity Commission) means that whether Australia likes it or not, it will need support from overseas via recruitment of a variegate nature.

Therefore, some serious lies need to be debunked: contemporary Australian research addresses this from the psychological perspective, independently stating that entrenched misinformation remains difficult to remove. One implication of this is that medical board or college-initiated opprobrium on a medical practitioner – whether true or false – is impossible to completely eliminate.

The report

On 19 March 2012, Inquiry Chair Steve Georganas tabled the report in Parliament. It was aptly named, Lost in the Labyrinth.

The timing may have been coincidental but it heralded the anniversary of the planned assassination of Roman Emperor Julius Caesar, whose authoritarian rule was to cease together with the dawn of a new era.

Not surprisingly, the inquiry independently demonstrated what had already been published in the Kerkyasharian Report, the Garling Inquiry Report and the prematurely terminated Morris Inquiry in Queensland because of what the Supreme Court had ruled as 'ostensible bias'. The additional features were that there were names and incidents appended to this report in the form of submissions and interview transcripts.

It was further documented in the preface by Mr Georganas that his Committee had been contacted by a number of doctors who,

‘… while keen to air their concerns informally, refused to make formal submission to the inquiry fearing negative consequences. … Many International Medical Graduates (IMGs) also felt that they had been the subject of discrimination, and anti competitive practices and that this had in some cases adversely affected their success in registering for medical practice in their chosen specialty.’

The 45 recommendations – though fewer than the 135 recommendations of the Garling Inquiry – into issues within the acute-admitting public hospitals of NSW Health and the similarly, extremely serious, systemic dysfunction, did not pay any attention to the many allegations of injustice and human rights abuse as revealed by various parties throughout the Inquiry period.

There is nothing technically wrong with this Government Inquiry and the Standing Committee of Health and Ageing should be congratulated for their efforts in keeping within the scope and jurisdiction of the Inquiry whilst boldly revealing some generalised details of the very disturbing personal stories disclosed during public hearings. There was no documentation of private (confidential) hearings or of their being held – although the author is aware that some such were held – as recounted by the then Opposition Chief Whip, Warren Entsch.

Despite regular mention of what was a lack of accountability and possible administrative misfeasance by some Australian medical colleges, none of the published recommendations accepted that non-accountability flourished. Neither were there calls for legislation to compel the colleges into accountability.

Many accept that the national law -- which flowed from the formation of the Australian Health Practitioners Regulatory Agency (AHPRA) -- is presently “sufficient”. But it is likely that business will be “as usual” in the absence of specific legislative reform. The published evidence given before the Inquiry corroborates, with little change, the evidence published before a different Senate Inquiry, which was hastily announced and concluded during the first half of 2011.

In the author’s opinion, the benchmarks driving change should be reports and recommendations made for previously documented, outrageous administrative conduct – the already published Kerkyasharian Report and the Garling Report -- from NSW. A more subtle example is the 2003 Walker Report, where a culture of bullying and an “old girls’ club” were also described.

Anyone reading these reports will readily see that business remains as usual despite the clear recommendations — particularly in relation to addressing lack of accountability and egregious conduct by those in power. In essence, there has been nothing new since the response to the internationally publicised hunger strike by Ooverseas-trained doctors in 1997.

Conclusion

There are problems. These are extremely serious systemic problems despite “fixes” like the introduction of a Health Ombudsman in Queensland. The system is not only dysfunctional but also badly broken with bullying being the major issue — but some authorities (and those with “assumed authority”) are denying it. The reckless and ruthless bureaucrats) who not hold only court but also erroneously damage careers. Parliament cannot be like the proverbial flock of ostriches, with their heads in the sand and remain ‘lost’ in the labyrinth of the esteemed house: it is nonfeasance. The public may not be as unaware as is believed by the Governments and the medical colleges, though the RACS President has taken the lead to publicly apologise and promising an action plan.

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