Keeping the doctor away

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Blacklisted for life for parking in the wrong place? Managing editor David Donovan details the case of a talented young female doctor and her battle against the intertwined Australian medical establishment.
Dr Helen Tsigounis with her book.

“What tends to happen is that the aggrieved or litigant early on gets labelled as a troublemaker and mentally unbalanced, unofficially or with the help of a hired gun psychiatrist.”
~ Dr Jean Lennane (psychiatrist and Former President of Whistleblowers Australia).

INDEPENDENT AUSTRALIA is contacted on an almost daily basis by people who regard themselves as having suffered a miscarriage of justice. Many of these people seem entirely credible and many of their cases are extremely distressing. Unfortunately, IA  does not usually have the time, nor the personnel, to follow-up these complaints.

Some, however, are too compelling to not investigate, with the story of Jordan Nash being a classic example. Another is the case of Dr Helen Tsigounis, whose tale of alleged victimisation at the hands of the Australian medical establishment has been turned by her into a compelling book, The Red Back Web. After reading this book, and obtaining reams of supporting documents, I believe Dr Tsigounis may very well have been the victim of a grave miscarriage of justice — one which has prevented her from pursuing a medical career within Australia and forced her to practice away from her own country.

It should be noted that The Red Back Web also contains serious allegations about various other matters which remain, at this time, unconfirmed by my investigations. This piece will, apart from providing some background, confine itself to what can be readily verified via extensive court transcripts and source documentation that Independent Australia has in its possession and makes no judgment one way or the other about any of the other matters contained within Dr Tsigounis’ book.

Dr Helen Tsigounis was a graduate of the Monash University Medical School in 1997. She alleges that in her final years of medical school she was subjected to repeated instances of bullying and intimidation from a senior member of the academic staff of a racial and sexist nature after once inadvertently parking in his parking spot. She alleges that after a prolonged period of harassment she made complaints to more senior staff, after which not only did the University do nothing to counsel or assist her, but that this staff member caused her to need to repeat her fifth year of studies, despite her allegedly having received good grades. This prolonged confrontation, and her refusal to “play the game”, as she describes it, are alleged by Dr Tsigounis to be the primary reason she was later to be “persecuted” by the highly interconnected medical fraternity in Australia.
Another clean psychiatric bill of health.[/caption]

Her allegations appear to gain substance when, after only a relatively short period as an intern at Frankston Hospital in Melbourne, in late 1998, Dr Tsigounis was called before the Victorian Medical Board largely over what would appear to be relatively trivial complaints about her performance — such as not answering her pager once or twice, not filling out her timesheet correctly and not properly labelling some pathology jars— all of which were disputed by Dr Tsigounis. Subsequently, seemingly because she did not treat these complaints against her as being especially serious, the Victorian Medical Board contended that although Dr Tsigounis exhibited “no obvious impairment” she suffered from a seemingly amorphous psychiatric disorder called “lack of insight”, and referred her for examination to a psychiatrist, (then) Associate Professor Fiona Judd.

Prof Judd discounted Dr Tsigounis suffering from any “major psychiatric disorder”, but affirmed the Medical Board’s assertion about a “lack of insight”. She did so, according to her report, largely because, she said, Tsigounis felt “concerns that she had been singled out unjustly” and had “minimised the serious nature of the complaints made against her”. Apparently, the thought that Tsigounis may have been justified in her assertions was not contemplated by Prof Judd. The evaluation by Professor Judd appears debatable, since Dr Tsigounis had already received two independent psychiatric assessments before seeing the Professor, both of which said she was quite sane — apart from the very understandable anxiety and stress associated with loss of employment.

Regarding the lack of insight, consultant psychiatrist Dr Michael V. Piperoglou wrote in his assessment that Dr Tsigounis suffered from “no perceptual disturbances or delusions”.

And as for her claims of being singled out for minor errors, Dr Ranvir K Sood said that Dr Tsigounis
“… has a tendency to become defensive if she feels she is being singled out …. But on the description of these incidences, it does appear that the Health Authorities may have exaggerated the significance of at least some happenings.”
Dr Tsigounis alleges her barrister provided the Medical Board with a document detailing far more serious mistakes made by fellow interns that year, including many resulting in patient death, but that these were not considered by the Board.

[caption id="attachment_19531" align="alignnone" width="598"] Other far more serious intern mistakes were allegedly overlooked.

Despite all these factors, Dr Tsigounis says she was advised by the barrister to agree with the Board’s assertion that she sometimes demonstrated a “lack of insight”, as he said this would smooth the road to her completing her training and gaining full registration. Consequently, at a meeting in February 1999 with the deputy chairman of the Medical Board, Professor Robert Adler, Dr Tsigounis signed a letter accepting the “lack of insight” claim. The Board then placed stringent conditions upon her registration and imposed a further term of internship.

Dr Tsigounis alleges that the Board said she would be offered a placement once she signed the letter, however this was not forthcoming.

In The Red Back Web (p.129), Dr Tsigounis recalls:
‘I was assured by Board member Dr Adler that I would be assisted in obtaining a placement once I signed a letter accepting I had a “lack of insight”. Once I signed the letter I was given no assistance by the medical board.

‘I wrote to every hospital in the Melbourne Metropolitan area and many hospitals outside the metropolitan area seeking a placement that would allow me to complete my internship.

‘Surprisingly, considering there was a shortage of doctors, I was unsuccessful.’
Helen Tsigounis had applied for over 70 positions before finally giving up.

Because her career had seemingly been blocked by the Victorian Medical Board, later in 1999 Helen Tsigounis travelled to Greece, where she studied the Greek language intensively for 3 months, passed her medical reciprocity exams, and obtained a European medical licence in August 2000. In her reciprocal medical exams, Helen received a high distinction mark and was placed second in Athens. She then worked as a resident in a Greek hospital in general, anaesthetics and intensive care and received excellent references from her Greek colleagues.

In December 2001, now a relatively experienced medical practitioner, Dr Tsigounis returned to Australia in an attempt and complete her registration in her homeland (she was born in Melbourne to Greek immigrant parents).
Holding Redlich response to the Show Cause notice, laying out Dr Tsigounis' extensive medical experience in Greece.[/caption]

After applying for a placement at the Townsville Hospital, the Queensland Medical Board asked Dr Tsigounis to undergo a psychiatric assessment since psychiatric conditions had been placed upon her registration in Victoria.

Helen Tsigounis met with Board nominated psychiatrist Dr Donna Kippax once for 90 minutes, where she says she was careful not to reveal any information that might cast aspersions on the medical establishment out of concerns it could later be used against her.

From her book (p.137):
‘I was careful during the meeting not to reveal any information of the past that undermined the System, as I was aware that despite its truth, a psychiatrist chosen by the Medical Board could use the information against me. At the end of the meeting I asked Dr Kippax if I would have problems practicing in Queensland and she replied, “Possibly because of what had happened in Victoria”.’
Dr Tsigounis was working in Townville Hospital when the report came back a month later. Dr Kippax said she “…did not note any major signs of psychiatric disorder”, but said Dr Tsigounis suffered from a “paranoid personality disorder” (also known as an Axis II personality disorder).

Dr Kippax further stated:
“Dr Tsigounis saw this process, and still sees it, as one in which the administration is determined to hound her until she failed.”
Dr Tsigounis alleges she said nothing during the meeting to justify this contention. In a later letter to the Queensland Medical Board on 13 August 2003, Helen’s Tsigounis’ lawyers Holding Redlich stated:
“Our client considers the account of her interaction with Dr Kippax provided in Dr Kippax’s report to be an inaccurate account of what was said and not said between them. We submit that it is highly questionable whether a diagnosis of an Axis II personality disorder can accurately be made after a brief and isolated examination, when such a diagnosis is normally made on the basis of particular and consistent character and personality traits exhibited by a patient over time. Such a diagnosis, we submit, is relatively easily made yet, once made, very difficult to dispute.”
[caption id="attachment_19540" align="alignnone" width="585"] Had successfully completed her internship in January 2003 according to Townsville Hospital.

In any case, the Queensland Medical Board placed a page full of stringent conditions upon her registration, including treatment by a GP and psychiatrist of her choice as well as regular reviews by doctors nominated by the Board. Dr Tsigounis saw Board appointed psychiatrist Dr John Allan on three occasions over the subsequent nine months and he reported “no significant issues” and made no diagnosis of “Axis 2 personality disorder”. Indeed, a Queensland Medical Board report details an interview with Dr Allan which stated “Dr Tsigounis required less frequent reviews than she herself requested.” In addition, Dr Tsigounis, whilst on leave in Sydney, received favourable reports after being examined extensively by  two independent consulting psychiatrists: Dr John Shand and Dr Arthur Ouzas.

Dr John Shand wrote the following after three sessions:
‘From my assessment, I consider that this doctor does not suffer from any form of psychiatric disorder. She has functioned well under difficult circumstances at times during her life. She has presented as an attractive, intelligent, young woman of superior verbal capacity and intelligence.’
Dr Arthur Ouzas said the following after six sessions:
‘I have been asked to review segments of the report by Dr Donna Kippax which was completed on the 24th April 2002 and … her diagnostic opinion that Dr Tsigounis meets the criteria for Paranoid Personality Disorder.

‘I do not believe Dr Tsigounis meets the criteria for this diagnosis.

‘In the first instance there is no evidence suggesting that a paranoid attitude has been characterised of her long term functioning and certainly not of her functioning premorbidly prior to the reported difficulties in Medical School and subsequently.

‘She does not present with a sense of pervasive, unwarranted suspiciousness and mistrust of people and she does not present with a sense of restricted affectivity. In fact she presents as warm with a sense of humour and normal range of affect. She is not guarded and she does not present as threatened or defensive.’
After completing the initial six months of internship on 12 January 2003, Townville Hospital determined that she had completed her internship requirement satisfactorily in all respects. She was then promoted from Intern to Junior House Offer — or a doctor that had completed the internship requirements, also known as a second year Resident Medical Officer.  This is confirmed by email correspondence from her supervising doctor Julia Ashley
Email for Dr Ashley confirmed Dr Tsigounis had been promoted from intern to resident by Townsville Hospital.

However, despite this, at a meeting on 14 January, the Medical Board extended Dr Tsigounis’ internship for a further 3 months without providing any grounds for this reconsideration. After completing this in April 2003, with good intern assessment reports, Dr Tsigounis again applied for full registration to the Queensland Medical Board.

In 12 May 2003, after beginning work in Cardiology as a second year resident, but while still awaiting word on her application to the Medical Board, Dr Tsigounis resigned from the Townsville Hospital to return to Melbourne to attend to her father, who was then suffering from a serious heart condition. Two days later, on 14 May, the Queensland Medical Board sent Dr Karen Yuen to the Townsville Hospital to inquire about Dr Tsigounis’ performance. On 11 June 2003, Helen Tsigounis received a notice from the Queensland Medical Board asking to her Show Cause why she should not be barred from the medical profession.

(The nature and the circumstances of the allegations made by the Queensland Medical Board against Dr Tsigounis and the battle by her, mostly as a self-representing litigant will be considered in Part 2. To buy Red Back Web click here.)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Australia License
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