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Medical maladministration harms professional in all parts of the health sector (Image via ama.com.au)

Bullying of junior doctors is only one part of Australia's dysfunctional system of health administration, in which an old boys club sets the rules and then acts as judge and jury. Dr Don Kane, from the newly formed Health Professionals Australia Reform Association, explains. 

THE MONDAY, 25 May 2015 story on ABC Four Corners about sexual harrassment and bullying of junior doctors was very long overdue.

It is a small part of the tip of a very large iceberg regarding the culture in Australian health services. Sexual harassment is offensive and intolerable. Is it bullying? Bullying occurs in the flow on effects after the sexual harassment is resisted. Both are unacceptable.

Senior health professionals are subjected to the same wrongful activities as junior doctors. Sham peer review and wrongful use of mandatory notification to the Australian Health Professionals Regulation Authority (AHPRA) are used to attack senior health professionals. Too often, the system is manipulated not in the public interest but in the interests of the notifiers. The reasons appear to be personal and commercial.

Both juniors and seniors are affected by the stress, threats to career and family distress, often causing marital breakdowns and financial troubles when these events happen. There have been deaths of some victims following being targeted in this way. Misuse and maladministration of the regulatory system is frequent in Australia. 

Employers have the responsibility to address the culture in the workplace and eliminate problems. Employers in the health services sectors have failed to deal adequately with these problems and often are part of the problem. There is a culture that condones protection of the offenders. There is denial of due process and natural justice for victims. The Australian Medical Australia (AMA) and other organizations that represent health professionals and specialist colleges to which they belong are also at fault for not placing a high priority on the ethical and professional behaviour of their members.

The Royal Australasian College of Surgeons (RACS) has belatedly instigated an internal review of sexual harassment and bullying. Several members of the review committee appear to have a conflict of interest in that they have had involvement in regard to failure to take appropriate action when requested to act on a complaint*. They appear to have shielded others from being held responsible for apparent questionable activity.

Internal reviews are open to criticism for lack of independence, lack of transparency, whitewashing and cover up.

An independent broad inquiry into the culture in Australian health services is needed. They should be subjected to the same scrutiny as union activities and paedophilia, as the damage being wrought within the services is very great. It involves not only loss to the unfortunate individual targeted, but also the loss of services to the community that, in many cases, will be difficult to replace.

The creation of financial wealth has become a central focus in Australia. This has displaced satisfaction from performing tasks and helping others in our society. A consequence is the replacement of co-operative, collaborative and collegiate activity by a competitive approach in the workplace. The health professional sector is not immune and a small but significant number of practitioners has succumbed to this approach. They have grasped the change for personal and commercial reasons. They have misused and abused the regulatory system, aided and abetted by officers in the regulation authority and administrators in health services. The consequence is distress for and attempted destruction of perceived competitors at the expense of the community.

In response, the Health Professionals Australia Reform Association (HPARA) has been formed as a limited guarantee not for profit organisation to represent and advise allied health professionals, medical officers and nurses who are victims of a system that is in need of reform. There is not only a need to protect health professionals from the misuse and abuse of the system, but also a need to remove the adverse effects these have on delivery of health services to the community.

Attempts to achieve change through the Australian Health Practitioner Regulation Authority (AHPRA), state medical boards, tribunals, specialist colleges, the AMA, legal redress and political avenues have all failed to bring change to a defective system. No comfort comes from knowing this is not only a national but also an international problem. We must achieve reform in Australia.

A common thread to the modus operandi of those who abuse and misuse the system is evident in a medico legal hypothetical conducted in Sydney September 2013. It involves misuse of the mandatory notification (in the public interest) requirement of AHPRA to fullfill self interest for personal and commercial reasons.

A multitude of examples exists for HPARA to seek reform of health professional regulation and administration in Australia. The victims and their families suffer some or all of stress, family breakup, professional reputation damage, ruination of career, loss of employment and financial hardship. There has been loss of life following subjection to the process.

CASE STUDIES

The cases of Dr Paddy Dewan and Dr Leong Ng have been well documented through their own efforts and reported in the Independent Australia on several occasions in the last few years.

The recent case of Dr Antonio Vega Vega is a typical example of how officers in AHPRA act and the adverse effect this has on victims of their actions. Dr Vega Vega was suspended from his position at Rockhampton Hospital, Central Queensland, and this was announced in the media – local, state and national – with unseemly haste. AHPRA immediately placed conditions on his registration. His appeal to a tribunal was successful and AHPRA was ordered to remove the conditions. Dr Vega Vega took action in the Supreme Court against those who had participated in the saga and the Judge found in his favour. The judgement identified a denial of natural justice for the doctor.

This is a common feature of most cases in the files HPARA holds plus there is denial of due process as well. Some of  the many cases that are known to HPARA not previously placed in the public arena are typical of what has been happening (names withheld for reason of privacy).

Case 1

A highly skilled senior specialist was confronted with a complaint to the executive director of medical services (EDMS) in a large regional hospital. The complaints were not justified and factually incorrect. There was no attempt by the EDMS to obtain the specialist's version of events before summoning him to a meeting with the EDMS and the accuser. A rebuttal of the allegations was presented to the meeting and the specialist took leave from the hospital.

He was offered a position in a metropolitan teaching hospital while on leave and accepted the offer. The regional hospital refused to remove the complaints from the work record and declined to deliver the findings, if indeed there were any. He is highly successful in his present roles in the public and private sectors but once again has been targeted by his peers for reasons other than clinical competence and seemingly based on personal and commercial issues.

Case 2

The head of an internationally recognised leading Australian unit identified a senior specialist as one of the very best clinicians with whom he had ever worked. The specialist was working overseas when contacted by the EDMS in a large regional hospital to head up a unit with a poor performance record. He produced excellent results in his first year, which continued during his years in the unit.

Administrators and a group of colleagues eventually forced his dismissal for reasons other than his clinical work — that is, personal animosity towards him. He won a legal battle against the State health department and was awarded the maximum compensation by the commission. Re-employment was refused by the department.

He moved back overseas, where he has been engaged by a very large hospital in the capital city. The number of cases with which he has dealt in his new role is far in excess of that he was permitted to do in the regional hospital in Australia. One of the issues he had there was the unwillingness of administrators to increase the number of cases upon whom he could operate because apparently the budget was more important than patient waiting times.

Case 3

A young specialist, who had skills not possessed by local colleagues, was subjected to bullying and harrassment then notified to AHPRA.

He departed from Australia after a long battle in which he was denied due process and natural justice. The specialist held a leading position on the Asia-Pacific education program for his speciality and accepted invitations in two successive recent years to lecture to trainees and specialists in a major overseas country while working in Australia.

His departure has deprived a large regional community of the services he provided and the chances of engaging a replacement are very slim indeed.

Case 4

A medical graduate experienced bullying and harrassment during the university course. This continued in the doctor's internship and subsequently permanent registration as a medical practitioner was denied on spurious grounds. There was further grief for the young medical officer when legal representation and the court system failed to provide justice as a result of misrepresentations from witnesses.

There has been no change in the situation for the doctor following return to Australia after working successfully overseas as a junior doctor with good reports on performance.

Case 5

A young registered nurse employed at a regional centre endured a seven year battle to clear her name after being wrongly accused of unprofessional behaviour.

She, unlike many others before her, fought the system and eventually won after finally succeeding in having an appeal tribunal decision overturned. There was a huge cost to her with break up of her marriage, becoming a single parent to her two young children, stress and financial loss.

Case 6

An allied health professional trained as a technician at a large regional hospital when working as a nurse. This training was before any structured study course was created for the work involved. The employee was given a position classification as a technician within the employment award and then worked at another large regional hospital for ten years.

The technician moved to another facility in a near metropolitan hospital, where the technician was requested to establish a service. The department administration was transferred to a major metropolitan centre after several years of local administration. An intense period of harassment and bullying followed, that included an attempt to reduce the level of classification and salary. This was successfully challenged.

The technician was dismissed after an incident in which they were wrongly accused of an action for which a specialist medical officer was responsible. A commission hearing to seek a reversal of the dismissal failed. The proceedings were flawed in that evidence and witnesses for the department was selective. All the facts and all persons involved in the alleged incident where not presented to the commission.

This technician is a single parent, suffered from health issues, severe stress and financial loss that threatened home ownership and necessitated using superannuation to avert the threat. Survival has involved updating nursing skills leading to registration and working as a casual, along with casual work as a technician in the private practice of a specialist who visits the hospital from which the dismissal occurred.

The following is an extract from correspondence sent by a victim of bullying, harrassment and sham mandatory notification leading to maladministration in AHPRA and the local hospital in which the doctor worked.

I have been forced to leave Australia following motivated compulsory reports to AHPRA by my direct competitors.

The Medical Director of my hospital tried to help me by showing evidences of harassment, bullying, discrimination and conspiracy but had to resign as a result and actually was unfairly reported to AHPRA.

Surgery is a very complex profession where unexpected outcomes are sometimes difficult to avoid despite your best ability. I have been assessed regularly by 2 senior well recognized Australian spine surgeons specialists (mostly on my demand) and all reports showed satisfactory level on competency and my audit has always been comparable to what is expected in Australia.

Despite all this, it has not possible for us to stay in Australia (my wife and 2 boys are Australian).

I am totally disgusted with the system and I now believe that I never had any chance to be accepted in that "boys club" despite performing at a high level. An unbelievable supportive petition of more than 2000 patients has been published. Would that happen if I was bad? I have started a new life now where I am accepted by my colleagues and recognized. Would that happen if I was bad?

If you would like to learn more about the Health Professionals Australia Reform Association (HPARA) please email hparacommittee@gmail.com or call 0499 399 081.

* NOTE: RACS internal review members with potential conflicts interest include the Hon Rob Knowles AO, chair of review committee — previous minister of health in Victoria and current chair of the Royal Children’s Hospital in Melbourne; Mr Graeme Campbell, president of General Surgeons Australia and incoming College vice president as well as current chair of its professional standards committee; and Dr Joanna Flynn AM, chair of AHPRA and chair of Eastern Health Victoria.

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