Dangerous druggie doctors not stopped by regulators

Which shows how much use the regulators are.

Stephen Rabone was a known drug addict back in the early 1990s when he infected 11 patients with the viral disease hepatitis C at a South Australian country hospital. A South Australian inquiry into the Medical Board heard evidence that nursing staff alleged the doctor would order pethidine and other narcotic drugs, inject himself with them out of sight, return, and then inject the patient with the same syringe. Victims negotiated a confidential settlement in 2004. But today Rabone lives in Sydney's leafy, well-to-do suburb of Lane Cove, has full registration to practise medicine in NSW, and is a Fellow of the Faculty of Occupational Medicine with the Royal Australasian College of Physicians.

"Our hands are tied," says college chief executive Craig Patterson about the Rabone case, even though issues of drug addiction are "absolutely germane" in deciding whether to grant a doctor a fellowship. If these matters are proven, they are very serious indeed. (But) before we can strike or remove someone as a fellow . . . you need a properly constituted judicial or medical board hearing to have problems aired, facts need to be properly obtained and determinations properly obtained . . . that didn't happen in the Rabone case."

Just how South Australia's medical board handled the Rabone case was highlighted by a scathing inquiry ordered by the state's parliament, which released its report earlier this month. The report cited a handful of cases to illustrate how the Medical Board of South Australia failed to protect the health and safety of the public. "Deeply disturbed" inquiry members recommended the board be stripped of its powers to handle complaints, investigations and disciplinary proceedings. Such lack of confidence in the conduct of a bastion of the medical establishment comes on top of further scandals over how state-based medical boards deal with dodgy doctors.

Medical boards are statutory bodies responsible for registering doctors, monitoring their conduct and fitness to practise and when needed, handling disciplinary proceedings. But now the competency of doctors to manage their own is under fire. Queensland's medical board failed to identify problems with the paperwork provided by the rogue surgeon Jayant Patel, dubbed Dr Death. And in South Australia evidence revealed a litany of concerns. The board took as long as 10 years to deal with complaints, lacked transparency, and has provided two doctors alleged to have drug problems with certificates of good standing, one being Rabone, allowing them to work in NSW. These exposures are placing further pressure on the health sector to better control and manage the flow of doctors across state borders and from overseas.

In January a Productivity Commission report on the health workforce came out in favour of what many within the medical profession regard as an extreme solution: merging Australia's 90 existing registration boards for health professionals into one national entity, possibly swallowing up the eight state and territory medical boards. The report conceded that some functions, such as monitoring codes of practice and discipline "might best be handled on a profession-specific basis or possibly a regional basis". But the report made clear that medical boards should at least have their powers clipped. The radical proposals were discussed by state premiers at the February meeting of the Council of Australian Governments (COAG). Commonwealth and state governments are now considering the Productivity Commission's conclusions and recommendations, with a health working group due to report back mid-year.

Bob Sneath, the plain-speaking Legislative Councillor who chaired the upper house inquiry in South Australia, says it is "bloody dreadful" that shortcomings more than a decade ago allowed Rabone to move to NSW and continue his career with little disruption. Sneath says anything that ensures all information about a doctor's fitness to practise is known by any registering body would have his support. "I would not want to rock up there (in Sydney, to be treated by Rabone)," he says. "His patients would not have a clue."

South Australia's acting board president Mark Coleman also gave evidence that the board may have made a mistake in treating mentally ill, drug-addicted doctor Stuart Mauro, who admitted to a 10-cones-a-day cannabis habit. A coronial inquiry last year found Mauro provided "seriously inadequate" care to a public hospital patient who later died. Back in 2002 a medical board committee, headed up by some of Adelaide's most prominent and senior doctors, investigated patient complaints that Mauro had appeared to be under the influence of drugs while working as a locum. But as the parliamentary inquiry noted, the coroner found the committee "accepted Dr Mauro's denials without further inquiry". Mauro was also cleared to work in NSW, attracting complaints there. He then headed back to South Australia, and wasn't struck off until after the damaging coronial report was released and his case became public.

Dix is limited about what he can say about individual doctors practising in NSW who have addiction issues. In the case of Rabone, laws forbid disclosure of anything but the doctor's address and registration status. "I'm not sure if he's practising," Dix says. If any member of the public contacts the board to get information about Rabone, or any other doctor alleged to have had, or used to have, a drug-related impairment, state laws exclude these problems from being revealed. "We believe in giving a doctor rehabilitation rather than throwing him on the scrap heap," Dix says.

President of the Medical Practitioners Board of Victoria Joanna Flynn says procedures ought to allow effective transfer of information between the state medical boards. Flynn, also president of the Australian Medical Council, says "no doubt there are slip-ups from time to time". She believes a single national database for doctors would address that. But Flynn opposes a single national registration board for all health professionals. "I don't think that's a very good idea at all," she says, pointing the medical profession's "proud record of self-regulation".

But whether self-regulation has failed the public, as well as the medical profession, is open to debate. Those like Craig Patterson from the Royal Australasian College of Physicians believe that the transfer of data between medical boards is "variable". He says South Australia's medical board has been "cagey" with its information, and that the college, which admitted Rabone as a Fellow, needs to rely on medical boards, rather than media reports, to make decisions about their membership. The problems arising from the Rabone case are "the sort of issue that the medical boards need to be able to get on top of. What I can say is that national registration, a national database, is one of the things we have to start getting right . . . we call upon the medical boards to get it right, and it hasn't happened yet".

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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