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(Image via ABC Four Corners / @4Corners)

One outcome of bullying can be indirect harm, whether to the public or the professional – and action must be given priority in health care regulation reform. A hushed example is the deaths of four junior doctors in Victoria in 2014. Also in 2014. a Harvard medical student insightfully described the unintended outcomes of bullying. Last week, the Expert Advisory Group released its explosive findings into bullying by Australian surgeons. Dr Leong Ng comments.

INCEST in most countries, cultures and religions is illegal and repugnant, with illustrative ancient Greek fables like that of Oedipus and the wayward Roman emperor Claudius, changing the law to suit his own incest. History goes on with political unions, between genetically related aristocrats or monarchs, whilst a contemporary IA article invites us to think for ourselves.

On 10 Sept 2015, a draft report by the Expert Advisory Group (EAG) of the Royal Australasian College of Surgeons (RACS) suggests just that – metaphorically at least – thus, in my view, devaluing the fellowship diploma and the status of membership.

Synchronously, the president of the RACS, Professor David Watters, swiftly embraced it and offered damage control in a public apology, also posted on its website to all victims, junior and senior, and made promises for reform.

Not unnaturally, he did not admit to "incest" among the old boys and old girls. The ABC further explored the matter with another broadcast the next day.

The prior revelation of the case of Dr Richard Emery, a companion ABC broadcast of a discussion between Dr Sally Cockburn (Australia’s Dr Feelgood) and Senator Nick Xenophon also took place the week before last. The month before, the troubled Medical Journal of Australia (owned by the Australian Medical Association) published an editorial and other articles on the same subject.

IA had earlier and persistently featured articles about bullying, with a key one by Dr Don Kane, FRACP, chair and founder of the new national association, the Health Professionals Australia Reform Association (HPARA), as well as another by IA managing editor David Donovan.

Dr Kane’s article has credibility because he had been a former president of the Australian Salaried Medical Officers’ Federation Queensland (an arm of the AMA) prior to his retirement, and has seen much bullying and other related disputes.

The precipitant event of this present storm was female surgeon Dr McMullin, publicly discussing the reluctance of some surgical women to accede to the sexual overtures of their senior colleagues. She cited Melbourne neurosurgeon Dr Carolyn Tan, who subsequently went public after her case was concluded discreetly in 2008. Dr McMullin’s further comments after the report also showed her surprise.

The problem is that bullying, discrimination and harassment, whether singly or in combination – solo or mobbed – is not confined to surgeons. The RACS President acknowledged that others have suffered but obviously could not authoritatively say that non-surgeons do not bully.

With its collection of varied case studies and increasing membership, HPARA can and will continue to pressure for reforms.

The next question

Although HPARA and its Committee know it, what is widely unknown or unacknowledged is that bullying is extensive, endemic and entrenched.

Indeed, I dare share that some devious Australian patients use the threat of complaints against practitioners in order to bully them to obtain controlled drugs or false certificates.

The week before last, University of South Australia psychologist and senior lecturer Michelle Tuckey published an article in The Conversation suggesting that bullying may be a symptom of dysfunction.  

What needs also to be carefully explored is which is the egg and which, the chicken. The hard evidence (the Cochrane Collaboration and the Campbell Collaboration) appears lacking, but it may be that both are in operation at any one point time.

Bullying occurs also with the regulator, the Australian Health Practitioners Regulatory Agency (AHPRA), allegedly working hand in glove with a "coalition of the willing", such as college bureaucrats, hospital administrators and the Australian Medical Council (AMC). This toxic culture has been inherited from past medical boards and is probably also a global culture — though not conspicuously so.

Dr Lawrence Huntoon, a neurologist from New York, has written extensively about it over the past decade and called the devastating and corrupt part of it "Sham Peer Review".

In the USA (and recently in the UK), it has been demonstrated that sham reviews are commercially driven.

In Australia, it also occurs and the author has published in IA a related article on this topic.

This type of egregious conduct is not novel and history’s first recorded "judicial review" in the Western world was that of Dr Thomas Bonham v the Royal College of Physicians of London in the 17th century – also known as Bonham’s case. Whilst there may be contention on the points of law, it is clear from records that it was an exercise in turf protection and that the college received a ‘cut’ in fines. After Bonham, college dirty linen has generally been kept at home and Parliamentary supremacy ignored.

Taken in the context of the times, it was the era of medieval guilds in Europe. This was when protectionism prevailed over professionalism, something that still occurs in parts of Australia.

Interestingly the RCP is the Mentor College of the Royal Australasian College of Physicians (RACP).

The challenge of defining the regulator’s delegates

Although AHPRA is a set of different state statutory bodies, its delegates are not. They are limited companies with extensive professional and personal networks. These include the AMC and the numerous bodies which are, in turn, "sub-contracted" to perform tasks as delegates of the minister under s3 of the Health Insurance Act 1973 for Medicare purposes. In my view, seldom act transparently or according to the rule of law. But this does not absolve them from the responsibility of being accountable for their actions.

Just as a football or racing club can assemble a gang of individuals to hold court (at a tribunal) to discipline, suspend or exclude anyone on a discretionary basis without consistent standards, these entities can do the same and claim to be acting "lawfully".

The pseudo disciplinary history created on a victim will definitely impact on future job prospects and livelihood, but which may not be sufficiently serious enough for "contracts" for footballers or jockeys, but the opposite for all professionals.

However, recently the ACCC, Australia’s consumer watchdog has begun their scrutiny of the health sector and is commencing to examine individual complaints, which it had rejected up till last year. The first prosecution has commenced and it is hoped that more will take place as there will be cases in which alleged breaches of the Competition and Consumers Act 2010 exist.

This is probably the realisation of the little known precedent case of Shahid v ACDwhere Dr Shahid’s dream of training to be a dermatologist was persistently frustrated by the actions of the Australia College of Dermatology.

Now, the most pressing issue is to define and expose the abuse of the false and frivolous notification processes by victims’ competitors, enemies, or by college mandarins, health institutions and even regulators who, for whatever reason, have decided to target a victim.

Whilst incest, pillow talk and contempt cannot be easily prevented, perpetrators – not scapegoats – will need to be externally identified and firmly dealt with in law.  

Just as the triumvirate could not condemn Julius Caesar.

Conclusion

May health care and its bedfellow, health regulation, live in interesting times: in a period where widespread dysfunction is occurring on a global basis. Asking why may result in more harm to patients but going back to the drawing board helps in the long term reforms and solution.

In my view, these must be tempered with sound policies, including external scrutiny, which "protect the public" and yet not allow the subtle progression to a micromanaged "nanny state".  

It is time for effective action: a full Royal Commission on the issue, like that on Institutional Childhood abuse (in fact, another form of criminal bullying).

'Now that the extent and impact of these issues is clear, there can be no turning back….we have been shocked by what we have heard. The time for action has come.'

~ EAG chair, Rob Knowles, AO,  2015

Disclosure: Leong Ng is an Australian-trained oncologist and former AMA member, who was recruited from the UK to rebuild an ailing politics-ridden regional oncology unit in 2003. He succeeded within six months but was allegedly bullied, discriminated and harassed out of the job, with the alleged connivance of the RACP. As the matter was "settled" (under duress) by an AMA brokered confidential deed (whether right or wrong), this continued to cause a smear on his record and reputation, which has followed him around Australia since. However, in 2015, he is fighting back — being a founder member of the Health Professionals Australia Reform Association

If you would like to learn more about HPARA please email hparacommittee@gmail.com, call 0499 399 081, or follow HPARA on Facebook HERE.

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