In an almost comical decision, VCAT has ruled against brilliant whistle-blowing surgeon Professor Paddy Dewan, who explains here what happened in and outside Court.
The three rings of the medical circus are the hospital administrative accountability for staff welfare, the Australian Medical Board (AHPRA), particularly their legal team, and the Victorian Civil and Administrative Tribunal. A circus, because they do not have processes that review their outcomes or the performance of their members, making their behaviour at risk of uproarious laughter, as occurred at the panel hearing of Dewan vs the Medical Board on 5th October 2012 – Code Black Day.
As part of understanding the context of the story below, a brief reread of the two previous contributions to IA will assist:
On Friday 5th October, the APHRA showed, yet again, that they are not able to “protect the public and guide doctors”, as they lack the ability to quality control for the behaviour of their legal representatives. They may again suggest I lack insight, because this story has been written.
At the start of the day, some 70 to 80 parents, children and other concerned members of the public came to the Victorian Civil and Administrative Tribunal at 55 King Street in Melbourne. Most were dressed in the code colour “black”, which just happens to be the code in Victorian Hospitals for “personal emergency”. The significance being that the behaviour of AHRPA is a personal emergency for us all, not just in Victoria or Australia, but internationally, when it comes to accountability in health administration.
Children carried banners, the media came along, as did the police. Some of the children looked rather threatening; or so it must have seemed, as the police came along to assist with crowd control. A particularly dangerous looking girl was in a pram having recently had surgery. The police were great; they were only doing their job, and one of them happened to be a cricket playing mate of the father who took the train from Colac for the morning: His wife had drawn the short straw (no pun intended) to milk the cows that day.
I was moved to both write and publish a speech, as the enormity of the VCAT task and the occasion seemed to justify recording what may well go down as an historic occasion. It went as follows:
Code Black - Personal Threat to Quality of Care
In 2003, having seen the untimely death of a young girl who had a renal transplant, and having endured threats because I wanted to have the sequence of events discussed appropriately, I chose to speak out.
Then, I witnessed a father punch a door violently because he felt his son had been neglected, which I only knew because I offered treatment for the urine blockage the boy obviously had. Over the years, I had heard discussion about cases that seemed based on surgical mates agreeing, not good governance and good care. Concurrently, I complained about bullying… then I was sacked.
In 2004, despite the insults, I reported 98 cases to the medical board, and was asked to recruit parents to the process. I was then accused, and found guilty, of unprofessional conduct for having done so. In 2006, the vendetta intensified. What I should have been recently found guilty of, is performing reasonable surgery for a reasonable indication, with a good technical outcome, and with no complications — and in a boy who is “going great guns” according to the father. VCAT have found me guilty of a series of false allegations and SHOULD be obliged to rescind my registration.
Many of you have experience my care of your children, yourself or your grandchild, and many of you have come to me for assistance with your children after unacceptable complications from the lack of care from others. Yet the Medical Board has called for my de-registration.
The events that have unfolded since the surgery of others on the renal transplant girl in 2002 indicate a lack of accountability of the Australian Medical Board, and now of VCAT. Even our right to freedom of speech has been threatened by the AHPRA legal Council.
To which I respond:
'Freedom is never given voluntarily by the oppressor: It must be demanded by the oppressed.' ~ Martin Luther King Jr.
Hippocrates, the man who gave us the Hippocratic Oath, said in 400BC:
"Medicine is of all the Arts the most noble; but, owing to the ignorance of those who practice it, and of those who, inconsiderately, form a judgment of them, it is at present far behind all the other arts."
Not much has changed.
I leave with a quote from the poem “Invictus”, which Nelson Mandela reflects help his survive his years of torment:
It matters not how strait the gate / How charged with punishments the scroll, / I am the master of my fate: / I am the captain of my soul.
Thank you William Henley: thank you ladies and gentlemen.
Please come into the court, AND continue to recruit people to the Code Black accountability of the medical board, because code black means a PERSONAL emergency. The need for accountability of the medical board is your PERSONAL emergency.
The applause gave strength enough to tolerate the events in VCAT, as do the stories of some of the families in the audience on the steps of VCAT.
Pauline and her family came along, despite her having recently been diagnosed with breast cancer and while on chemotherapy; such was the conviction that the medical board must get better at their job. Pauline wrote a letter to the Victorian Medical Board in March 2006 – two weeks before Dr Michael Harari wrote the letter about “the case”. The story of their boy is as follows:
To whom it may concern
I am writing to tell you the story of my son Liam. At my 20 week ultrasound it was discovered that there was something wrong with my baby’s kidneys. I went for subsequent scans over the next two weeks. On the 12th of May, 2005, I was scanned by Simon Magher at the Box Hill Hospital. He told me that the baby’s kidney’s were larger than normal, but at this stage it was not serious and to go home and enjoy the pregnancy. Another scan was arranged for Thursday 9th of June at Simon’s rooms in Box Hill.
The scan on 9th of June was not as favourable. Simon said that the condition was now “severe” and mentioned the possibility of early delivery. He recommended that we transfer from Box Hill Hospital to Mercy for Women under the care of Dr. Sue Walker. Dr. Walker rang me the next day to arrange a meeting on the 15th of June and discuss the best course of action that should be taken.
My first meeting with Sue Walker was arranged. I had another ultrasound and due to the fact that there was a substantial amount of amniotic fluid around the baby, it was decided that we would make an appointment for the following week. During this first meeting my husband and I asked if it was important for us to find out the gender of our unborn child. We were told that it was not necessary.
On the 22nd of June I had another ultrasound and we compared the findings with the previous weeks. We were told that, though the Hydronephrosis was still severe, it had not worsened and therefore the plan would be to monitor by ultrasound weekly, and arrange a meeting with Dr. X at the Royal Children’s Hospital.
Dr Walker helped us to compile a list of questions to ask Dr. X during this appointment as we were understandably upset and confused by all the information that we were being presented with.
On Tuesday 28th June we met Dr. X for the first time. The first question that he asked us was whether our child was a boy or a girl. We said we were unsure and that we were told that this was not an issue. He said “of course it is an issue”. We asked if the pre-natal ultrasounds would help him, and after glancing at them he discarded them and said he was never very good at reading ultrasounds anyway. We proceeded to ask a series of questions, all of which he was hesitant to answer. We asked if kidney problems were a common occurrence in newborns to which he informed us that 1 in 200 children were born with something wrong with a kidney. We tried to find comfort in these statistics only to be shot down and told that that had nothing to do with us, that our child had a problem with both kidneys and that was rare and it was “severe”. We were then informed by Dr. Y that he would not enter into the debate as to when the child should be delivered but that he needed to be contacted as soon as he/she was born. He said that we had 24 hours to get the baby to the R.C.H and that if it went into Renal Failure, not to bother. He explained that the baby would need to go through a series of tests possibly on day two of life and that an operation would take place on day 3.
We were now simply frightened.
We agreed that Dr. X’s manner was appalling, but were under the misguided impression that he was the best in his field and that we were better off saying nothing for the sake of our unborn child.
Over the next six weeks we visited the Mercy Hospital weekly and the baby was monitored by ultrasound. The Amniotic fluid levels remained good and as a team we decided to deliver at 35 weeks.
On Sunday the 7th of August 2005 I was admitted to the Mercy Hospital for Women and on Tuesday the 9th of August Liam Raymond George was delivered by Caesarean Section to very anxious but delighted parents.
So began the uneasy wait for a bed at the R.C.H. He was finally transported by ambulance 54 hours after birth and all that we could think about was our meeting with Dr. X and his insistence of immediate transfer of care.
The testing began on Friday 12th of August with an ultrasound and MCU. A Mag 3 was performed on 16th of August in which some of the radioactive fluid leaked. Throughout this time there was no sighting of Dr. X and we were dealing with Dr Dan Carrol (a visiting Registrar from the United Kingdom) and the medical team from the Neo Natal Department. We were very concerned, confused and not experienced at all in hospital protocol or procedures. Dr. Carrol was very willing to explain the situation, but a combination of stress and lack of sleep left us with more questions than answers. We kept referring back to our initial consultation with Dr. Y and wondering where he was through all of this.
Liam’s first procedure was booked for August 18th. A Cystoscopy was to take place to give a clearer understanding of Liam’s problems. Dr Carrol explained that the piece of equipment was new to the hospital and that he was, in fact, down on his knees while trying to insert it into Liam. Again we wondered where Dr. Y was and if it was normal for a registrar to be performing such a delicate procedure.
On the 24th of August, Liam had another ultrasound that showed that the hydronephrosis had increased on the right side. Regardless of this we were transferred back to the Mercy Special Care Nursery within days where we concentrated on feeding and getting Liam home.
Liam came home for the first time on the 4th of September. A magnificent Fathers’ Day was had by all.
We were under the deluded impression that Liam’s condition was improving naturally and that we would go back in to the R.C.H the following Tuesday for a check up and be sent on our merry way again.
Our first out-patient meeting with Dr. Colin Jones was a real eye opener. He informed us that Liam was far from O.K. and again we were frightened and confused. We spoke to Nurses and Doctors from the Mercy who tried to ease our concerns and they finally rang Dr. Jones to get a clearer picture of Liam’s condition. Dr Dan (Paediatric Doctor from Perinatal Department at Mercy) phoned us later in the day to explain some issues and apologise for the uncertainty and anxiety that had been caused by our first outpatient visit.
The next day Dr. Jones himself called to apologise for our meeting and offer any reassurance that he could.
On the 20th of September Liam had another renal ultrasound that showed, yet again, an increase in hydronephrosis. He also had another Mag 3 study.
We viewed the images of the Mag 3 study with Dr Dan Carrol and commented on how the right Ureter looked remarkably like the drawing that Dr X had drawn of a PUJ Obstruction in our initial consultation with him. Dr Carrol informed us that Liam’s next procedure would be on the 6th of October. He said that they would perform another cystoscopy, at which time DJ Stents would be inserted on both sides. We also discussed the possibility of a pyeloplasty being needed if the DJ Stent was unable to be inserted, particularly on the right hand side. He explained the details of the pyeloplasty and we remembered that this was the operation that Dr. X had told us that Liam would need on day 3. Although hesitant about such a major operation, we were still quite confident that this was the right way to go. We signed a consent form for all of the abovementioned procedures and waited patiently to see what would happen in the operating theatre. Much to our delight at the time, Liam had the DJ Stents inserted and we were assured that there was no need for the Pyeloplasty.
Over the next month we were in and out of hospital unsure as to why Liam was so unwell. A catheter was inserted and after another weeklong stay in the R.C.H we left, yet again, none the wiser. We became increasingly concerned with Liam’s lack of progress and, what seemed to be, the lack of care for his condition.
On the 8th of November, Liam had an MCU, which showed that the right DJ Stent had in fact become dislodged. It was coiled up in his already malfunctioning kidney and we felt that this explained why Liam had been considerably miserable over the past weeks, often groaning with pain. On the same day we met with Dr. Y, whom we had met before. We expressed our concerns and asked when the stent would be removed and the pyeloplasty done. He assured us that the stent needed to removed as soon as possible, within days, but that there was not going to be a pyeloplasty. That it had been decided that it was time to just observe Liam and see what would eventuate. We explained that this operation had been first mentioned whilst I was pregnant and then furthered discussed as an option if the DJ Stents insertion was unsuccessful. Dr Y was unable to satisfactorily answer all our questions and left the office. Dr Y returned minutes later. This would be the second and final time we would meet this man. He entered the room and started explaining that, although Liam’s condition was “severe”, he did not feel it was necessary to do any further testing or procedures, and that Liam would be merely observed to see what would happen. I asked Dr Y about the need for a pyeloplasty, to which he raised his eyebrows and responded “I will try and explain it to you one more time”. He did explain it again. I then asked what his decision meant for Liam long-term, to which he replied with a gruff “mothers are always concerned with long term, I am more concerned with the next six months”. With that, we left the R.C.H., disheartened that what seemed so obvious to us was being dismissed as a bad idea. We could not understand the course of events that had taken place. We could not understand the rude and dismissive manner in which Dr Y addressed us. We could not understand how they could look at our baby, knowing what he had been through, and send us home. It seemed all a bit too hard.
We heard nothing from the R.C.H for the remainder of the week. I contacted Dr. Y three days later to see what had been organised in regards to the removal of the dislodged stent. Nothing had been organised. I asked what was going to happen with the catheter and the DJ Stent in the left side. I felt like Dr Y was again unsure of what was really happening, as he hesitantly replied that “everything would be removed”. Again I referred to previous conversations and asked if they would be performing a Pyeloplasty. I was again told that this was not necessary.
It was not until the following Tuesday that Dr. Y’s Registrar contacted us with details of the procedure to take place two days later. This would have been a total of 9 days from when it was confirmed that the stent was dislodged.
Luckily for Liam, during this 9 day wait, we were put in contact with Professor Paddy Dewan at Sunshine Hospital. Professor Dewan seemed to have a better knowledge of Liam’s condition through phone conversations alone than the Urologists at the R.C.H had after 15 weeks of constant observation. Professor Dewan gave us a better understanding of Liam’s condition and was not bad-mannered or impolite if we were unsure of something and asked him to clarify it. After much discussion, my husband and I made the hardest decision of our lives.
We met Professor Dewan on the 21st of November 2005. Liam had a pyeloplasty on the right hand side that night and one on the left hand side the next night. Within four days, he was no longer groaning and actually laughed for the first time. Within seven days, he was sleeping through the night. This confirmed to me, a mother with no medical background whatsoever, what I had suspected for over a month. This surgery was undoubtedly necessary. I am just astounded that the Urology Department of the Royal Children’s Hospital in Melbourne could not see this.
I would appreciate you looking into this situation for me and endeavour to help me understand the treatment, or lack there-of, that we received from Dr. Y and the Urology Department of the R.C.H.
Of note is that Dr X is the man against whom 25 cases were listed in the letter of claims submitted by me to the Victorian Medical Board in August 2004. Liam’s case added to the 98 scenarios submitted then.
The medical board concluded there was no case to answer.
NICK AND ANDREA’S STORY
Nick and Andrea came along with relatives; parents of twin boys, both born with an abnormality of their penis and both having had three operations by the surgeon who contended that I am “a danger the Australian public” for suggesting doing an operation for an idiopathic megarectum. One of the twins has penile deformity that is permanent, and should not have further surgery until he has undergone significant growth — perhaps not until puberty. The second was cured with a single procedure.
JASON AND KELLY’S STORY
Kelly came with her son; their story is at http://www.independentaustralia.net/2012/life/health/shooting-the-messenger-and-kicking-him-while-hes-down
Richard’s son had a number of operations on his penis between 1998 and 2002, and had seen three other surgeons who had “reassured” the family. When seen in my office, it was evident that the boy had virtually no hole in the end of the penis and the appearance of the end of the organ something like a hammer-head shark. I delicately indicated that there are differences of opinion in medicine, but that mine was that the boy needed an urgent operation, as he was struggling to pass urine and had experience urinary tract infection.
Richard, a strong man, keen on going to the gym, turned to the adjacent closed door, punched it with enough force to knock out the initial treating surgeon, while he used the Australian character expletive. He was angry because he knew I was correct. His son had his urine stream normalised the following day. His parents felt that the initial treating surgeon, and two others, had failed in their duty of care. The internal investigation at the Royal Children’s concluded, without reference to my notes or to the parents, that my complaint about his care was a difference of opinion. The submission to the then Victorian Medical Board did not result in an investigation, despite the family having successfully sued for negligence.
The next episode for a family with a boy who has a permanently and unnecessary deformity of his penis, having had multiple operations to undo the harm was to come along to VCAT on Code Black Day. Mr Ruskin, the barrister was busy slandering me, when Richard stood up, called out, “I’m not listening to this bullshit any more”. He then walked up to the front, past me, at which point he turned, threw his arms around me and burst into tears. He then turned to the panel and said:
“This is corrupt, Paddy Dewan is a saint”.
The look in the eyes of the panel was, “oops, we have backed the wrong horse in finding Paddy Dewan guilty”.
I could have cried too, especially seeing how upset my wife was at having to tolerate another episode of the AHPRA and VCAT abusing their positions of power, and her husband.
Then came the lack of insight diatribe from the AHPRA barrister, reflected in my disdain for the false content of the letter from my accuser, my loss of trust in families resulting in more thorough note taking and for calling VCAT a circus ― 80 people in the audience thought the barrister lacked insight by not realising that he was considered one of the clowns in the circus. AHPRA has called for me to be suspended for 6 months, but is has taken from March 2012 to October 2012 to get to a position of seeking that outcome. They have also demanded that I undergo retraining. Then came the best part. On hearing the demand for my retraining, the audience broke into uproarious laughter, particularly the woman whose child is to have surgery to which a senior surgeon from the Royal Children’s has asked to come along to learn.
As of 9th October, there have been over 12,500 hits on www.paddydewan.com and 653 signatures on the petition at http://www.gopetition.com/petitions/accountability-for-australian-medical-board.html. It would appear the truth about the three ring circus is being heard.
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