Glenn Sterle (WA, Australian Labor Party) Share this | Hansard source

I rise to speak to the Labor amendment to the Health Insurance Amendment (Medical Specialists) Bill 2005. The Labor amendment provides an opportunity to reflect on how well Australia’s system of medical specialist accreditation ensures that Australian citizens have access to quality medical treatment and care. The fact that 90 per cent of the costs of medical services in Australia are funded from the public purse means that the senior levels of the medical profession have a collective responsibility to the Australian public with regard to the quality of medical care in this country. Australia’s system of postgraduate medical specialist training and accreditation has for decades been heralded by the medical profession as being highly successful and amongst the best in the world. It has been the repeated stance of many senior members of the medical profession that the current system of medical specialist training and accreditation should be touched only very lightly by the hand of government. Sadly, it seems to be the view of some members of the medical profession that it is the job of government merely to provide the money and to cop the blame for their mistakes.

In 1995 the Quality in Australian Health Care Study established that adverse medical events were involved in 16.6 per cent of hospital admissions at a cost to the nation of around $1 billion annually. The initial response to this study by many members of the medical profession was lukewarm at best, particularly as the findings of the study went to the very foundations of Australia’s medical specialist training and accreditation system. Since the publishing of the Quality in Australian Health Care Study report there has been the Campbelltown and Camden hospitals inquiry, the Canberra Hospital inquiry, the King Edward Memorial Hospital inquiry and the Bundaberg Hospital inquiry. All these inquiries have been initiated by governments in response to the public’s justified concern about the gross failures in the medical care provided by doctors to hospital patients.

Has anything really changed in recent times? No, not if you believe a recent Victorian university study into the rate of adverse medical events in Victorian public hospitals. That study, which looked at patient admissions to Victorian public hospitals in 2003-04, found that almost seven per cent of admissions to hospital had at least—I repeat: at least—one adverse medical event. In other words, one in 14 people who are admitted to a Victorian public hospital are injured by their medical treatment and care. The Victorian study estimated that the annual cost of adverse medical events in Victorian public hospitals was in the vicinity of $500 million. If we extrapolate this figure to Australia as a whole, the total cost to the Australian public hospital system of adverse medical events is now in the order of $2 billion annually. Where there are breakdowns in the standards of medical practice in this country, medical specialists as a group cannot avoid bearing a significant part of the blame for these breakdowns.

Over the past 10 years the Australian public has seen and experienced enough to be deeply sceptical about the degree to which some sections of the medical profession have an uncompromising commitment to high medical standards and patient safety. There are now volumes of documented evidence that medical error is far from rare. On any reasonable measure medical errors are commonplace. Because these are so commonplace, they appear to be regarded by many in the medical profession as a fact of life. This may explain the clamour of outrage we hear from the medical profession when there is any concerted effort towards greater individual accountability in respect of adverse medical events and of individual medical practitioner competency to perform particular procedures. Sadly, it seems that it is much easier to blame processes and administrative procedures than it is for the profession to audit the ongoing performance and competency of individual doctors. There appears to be a deeply rooted culture of denial that pervades some elements of the medical profession when it comes to accepting blame for medical error.

Representatives of the medical profession have often responded to independent inquiries that seek to get to the truth about medical practitioner error or negligence with fierce resistance. It appears that each time an inquiry finds evidence of a serious breakdown in medical standards, the public is told by representatives of the medical profession that the problems have long since been remedied and the inquiry is only documenting ancient history. However, year by year, new breakdowns in the quality and safety of Australia’s medical services continue to find their way to the surface.

In recent years we have seen the heroic actions of whistleblowers who have taken the lid off major incidences of gross medical incompetence and negligence that have led to major harm to patients and, unfortunately in some incidences, to the deaths of patients. Writing about a number of recent inquiries into breakdowns in hospital medical practice standards in the July 2004 edition of the Medical Journal of Australia, Thomas Faunce and Stephen Bolsin noted:

... none of the substantiated problems had been uncovered or previously resolved by extensive accreditation or national safety and quality processes; in each instance, the problems were exacerbated by a poor institutional culture of self regulation, error reporting and investigation.

They went on to comment that:

... even after substantiation of their allegations, the whistle blowers, who included staff specialists, administrators and nurses received little respect and support from their institutions and professions.

The head of the special commission of inquiry into the Campbelltown and Camden hospitals inquiry also wrote:

This inquiry to date discredits the notion that individual accountability through professional disciplining is inconsistent with the systemic improvement of clinical care and institutional administration.

It is instructive that these inquiries were not demanded by the medical profession; they were demanded by the public. Almost invariably, they were resisted by senior elements of the medical profession.

This was demonstrated in Western Australia when the state government initiated an inquiry into clinical standards and procedures at the King Edward Memorial Hospital. The King Edward Memorial Hospital inquiry found that clinical errors were very common amongst very high-risk obstetric cases. One or more clinical errors occurred in 47 per cent of cases at the hospital. More than half these errors were regarded as serious. Let us be totally clear about this: this situation occurred under the supervision of, ostensibly, Western Australia’s most skilled obstetricians.

Since that inquiry, enormous efforts have had to be made to lift the overall standard of the hospital’s clinical services to a level that can be claimed to emulate best tertiary hospital practice. The response of the medical profession to the formation of the inquiry was regrettable. Before and throughout the inquiry the medical profession, through its peak body, the AMA, did everything it could to denigrate its findings in advance of publication. The Western Australian branch of the AMA was particularly vocal on the matter. It denounced the inquiry as a farce. It is hard to believe, but on 5 October 2005 the AMA put out a press release with the title ‘King Edward inquiry a farce’ in which it complained that the inquiry was a ‘costly, time consuming and stressful episode’. The then state president of the WA branch of the AMA had this to say about the King Edward Memorial Hospital inquiry:

... adverse cases should have been sent to the WA Medical Board rather than wasting taxpayers’ money in this way.

And again, the AMA state president claimed the King Edward Memorial Hospital inquiry findings should be made:

... to a university anthropology unit because they would be outdated and totally irrelevant.

Despite the views expressed by the president of AMA WA, the King Edward Memorial Hospital inquiry report has since become a landmark document and has been used as a template for change and improvement in the quality of hospital medical practice elsewhere.

In November 2005, the Western Australian government released a report titled WA sentinel event report October 2003—June 2005. For the benefit of senators who do not know what a sentinel event is, it is a term similar in its clarity of meaning to the phrase ‘collateral damage’. The term ‘sentinel event’ covers a range of tragedies, including occurrences when a medical procedure is performed on either the wrong patient or the wrong body part, procedures where instruments are left inside patients, requiring further surgery, or medication errors resulting in patient death.

According to the report, in Western Australian hospitals in the 2004-05 financial year, there were 10 procedures performed on either the wrong patient or the wrong body part, six occurrences of instruments left inside patients that required further surgery to retrieve them and, unfortunately, two deaths from medication errors. These events were tragedies for the patients, their families and the medical staff involved.

I searched the AMA WA’s website for any comment on the sentinel event report, but I found nothing. The AMA WA put out seven media releases in November 2005, but not one of them mentioned the sentinel events report. There was a press release welcoming the appointment of a doctor to the Medical Indemnity Policy Review Panel. Another press release warned people to be careful of snakes in the hot weather. The advice warning people about the dangers of snakebites was helpful and timely; 66 people presented to Western Australian hospitals in 2004-05 to be treated for snakebite, and any effort to reduce this number is commendable. But, during that same time, 45 sentinel events were reported to the Western Australian Chief Medical Officer.

I am disappointed that there were no suggestions forthcoming from the AMA WA to reduce the number of times doctors leave surgical instruments inside their patients. As things stand today, it remains extremely difficult to obtain an independent and authoritative picture of whether the circumstances and events that led up to the inquiries into medical care standards at Campbelltown and Camden, Canberra, King Edward Memorial and Bundaberg hospitals are unique to those hospitals or represent a much broader problem in Australia’s hospital system.

Nonetheless, these inquiries have shown that the current system of specialist medical training, supervision and accreditation is, unfortunately, far from perfect. It requires urgent attention, as does the ongoing monitoring of specialist medical practice. The most serious and troubling concern is a reluctance of medical professional bodies to embrace the concept of accountability to the Australian public at its most fundamental level.

In summing up, the medical professional bodies must be willing to exercise discipline over their members, who receive considerable monetary benefits and privileges from the community by virtue of the professional recognition bestowed on them by the individual medical colleges. The Australian people deserve nothing less.