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During 2005 public hospitals in Queensland were racked by a number of major scandals. A number of government reviews were set up.
Waiting lists:- Public hospitals had been underfunded and mismanaged for at least 20 years by a bureaucracy out of touch with the health care content. Market managerialism had been introduced in which targets were set. Credibility, remuneration, careers and hospital funding were linked to goals set by politicians. This was simply the culmination of something which had been going on for years. I am aware that doctors had been complaining about the way the system was run for that period at least.
Because the system could not cope hospital waiting lists had grown until they were a disgrace and there had been much publicity. The government put pressure on to hospitals to increase productivity and the central health administration passed the pressures down the system. Government published waiting list times regularly boasting of them as a measure of productivity as they were reduced.
What had actually happened was that the administration in the hospitals had blocked appointments to see specialists. Instead of waiting to have their surgery patients were waiting to see the specialists to be investigated and diagnosed. What this meant was that patients with urgent conditions were not seen and diagnosed so they were not put on to the urgent waiting lists. Patients with cancers and other urgent conditions were not getting priority and their care was being delayed much more than before. The situation was actually far worse than it had been.
Doctors:- During the 1970s and 1980s the current ideology decreed that doctors generated work regardless of the real need and so kept costs up. There were far too many doctors. Government ignored doctors and university advice and reduced the medical school places. By the 1990s there was a major shortage of doctors and this shortage was maximal in the country, particularly in Queensland.
Foreign doctors were required to write the AMC exams to see that they were safe. If they were specialists then they were vetted by the specialist colleges. Many foreign doctors could not pass the exams or did not want to do so.
In desperation government went recruiting around the world and arranged for doctors to have temporary registration with the medical board that would allow them to work under supervision. The idea was that they would eventually sit the exam but many did not. In addition to this the staffing was such that there simply were not enough trained Australian doctors in these hospitals to properly supervise and train these doctors.
The scandal:- The bubble finally burst when an Indian trained surgeon, Dr. Patel who had been working in the USA was contracted to go to the Bundaberg hospital. His competence had been a problem in the USA where there had been scandals. He was barred from operating in one state and precluded from performing major surgery in another. This information was missing from his registration documents but the board did not follow it up. He was not vetted by the college of surgeons.
The doctor's personality clearly impressed and not only was he soon doing large numbers of major operations but he was made head of surgery. He was hard working and productive doing large numbers of major operations which brought the hospital more funding. Management was delighted. These were the operations he had been prevented from doing in the USA.
Complaints about complications and deaths made by staff to the hospital's administration were simply ignored. Complaints to the Health Department were not promptly dealt with. It was not until an intensive care nurse persuaded a Member of Parliament to raise it under parliamentary privilege that the scandal was exposed. Multiple patients had died. Dr Death as he is now known is to be charged with manslaughter - but he had long since fled to the USA assisted by one of the hospital administrators.
In the resulting inquiries system wide failures, maladministration, and several other examples of problem doctors were exposed. It was found that an unregistered psychiatrist from Russia who had been accused of paedophilia in that country treated patients here and was quietly sidelined without telling anyone when it was discovered. In another hospital the doctors were doing surgery for which they were not trained without proper supervision. It all became a huge political issue.
I do not intend to write further about this, as there has been extensive publicity. I simply want to stress that because this was in a public hospital it does not invalidate my arguments (pdf file). As in corporate scandals there were financial implications and carrots. The primary problem was that the strong pressures introduced by politicians were extraneous to the care of patients. Because of them failures in care were simply ignored and as a consequence they operated in exactly the same manner as pressures for profits do in corporate hospitals.
The progress of the investigation was in fact complex and there was a trail of legal conflict, political hot air. and investigation.
Here is the link to the investigation web sites
Queensland Public Hospitals Commission of Inquiry ---- http://www.qphci.qld.gov.au/
The Forster Inquiry -- I have been unable to find a web site
This page created Sept 2006 by Michael Wynne