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| Acting against error |
2-Apr-2008 |
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NEWS REVIEW: The case of disgraced obstetrician Graeme Reeves has brought a patient lobby group into the media spotlight.
By Stephen Pincock and Megan James
LORRAINE Long doesn’t look much like an activist. Sipping tea in a cafe by SydneyHarbour, the founder of the Medical Error Action Group (MEAG) wears a crisp linen blouse matched by a tailored cream suit and diamond earrings glinting behind neatly bobbed fair hair. She radiates calm and assurance.
Yet this is anything but a calm time for Long’s 11-year-old group, which is closely involved in the case of former obstetrician and gynaecologist Graeme Reeves, accused of mutilating and mistreating several patients.
Long and her colleagues have reportedly been deluged with about 1200 e-mails and 800 calls about Reeves’ activities. She says they have documented more than 500 complaints against him, all backed up with details and medical records.
“Anyone who contacts the group has got to provide details,” she says.
The lay press not only quotes these figures (‘Butcher victims top 1200’, Daily Tele
graph, 9 March) but credits the group with exposing the true scale of the case against Reeves. Yet MEAG’s tally contrasts starkly with the number of complaints that have been gathered by the NSW Health Care Complaints Commission, even after the story hit the front pages.
“While the MEAG may have hundreds [of complaints], since 26 February we’ve had 74 inquiries, 24 new complaints and three requests for reviews of previous decisions,” says the commission’s executive officer, Mr Kim Swan. “We’ll decide which raise criminal allegations and pass them on to police strike force Tarella.”
In addition to the NSW Police investigation, the Reeves case has also been referred to a special commission of inquiry into the NSW health system, headed by Peter Garling SC. Last month NSW Health Minister Ms Reba Meagher said her department had made “specific provisions to ensure early evaluation of medical negligence claims prior to the commencement of any formal legal proceedings”.
Since then, the MEAG has appointed Sydney-based Keddies Lawyers to advise former patients. Keddies partner Mr Scott Roulstone says that as well as 10 Sydney women, he has signed up 14 new matters after a public meeting in Bega in March. Current plans are to take separate actions against either the NSW Health Department or NSW Medical Board, with the possibility of a class action later.
SO what exactly is the MEAG? The group’s genesis, at least, is well documented. Lorraine Long founded it in August 1996, after a two-year battle to uncover the circumstances of her mother’s death at Melbourne’s AlfredHospital. June Long had been admitted after an asthma attack in June 1994 and died 14 hours later.
On the MEAG web site, Long describes a litany of alleged cover-ups, hostility from hospital administrators and accusations that hospital lawyers tried to intimidate doctors from giving evidence at an inquest. Ultimately, as Long describes on the site: “In August 1996, State Coroner of Victoria Graeme Johnstone found Melbourne’s AlfredHospital contributed to June Long’s death.”
“It was the circumstances of my mother’s death that propelled me to set the group up after the State Coroner of Victoria had handed down his finding,” Long says. “I decided I’d set something up so no one would have to go through such extraordinary circumstances just to find out how their mother died.”
Her first call was to a woman whose husband’s body had been lost after he died in hospital.
“We talked for hours and although the circumstances were different, what we’d been through was identical,”she says.
From her home in Sydney’s Eastern Suburbs, Long began contacting other bereaved families who felt they had been mistreated by the hospital system. One by one, they told her similar stories.
“They’d been through identical circumstances; every door had shut in their face. No one would assist you, no one told you that you had to fight to be heard, even fight to get the coroner to investigate,” she says.
“It became the family doing the pushing. No one did the pushing for you, not the health department, the health complaints commission, the health minister, no one assisted. And the hospital was hostile, so it just became a pattern.”
Eventually, Long decided to approach Channel 7 and, about a year after she established the MEAG, the network aired a series of programs detailing mishaps in hospitals. Other media coverage followed and, with the oxygen of publicity, the group grew. By 1999 it had moved into an office above a shop in a busy street in suburban Edgecliff. (Long prefers to keep the exact location private, saying they have received threats and had a break-in.)
The office is staffed by a handful of volunteers, supported by co-ordinators in state capitals and regional centres. It runs on donations, Long says, and now has about 17,800 families in its network, mostly relatives of people who died in hospital.
“The basis of the group was with bereaved families. We didn’t expand into — for want of a better word — surviving patients for many years.”
Long sees the group’s support of bereaved families as its most important work.
“The support network was 85% of it. I find that the best part of the group. That’s been the most successful and has been the most therapeutic solution for a lot of families. They’ve got someone to talk to, they can sound off.”
But forcing change onto the health system has also been an important goal for Long and her colleagues.
“Our major success has been in raising public awareness due to big support by the media over the years,” the group’s web site says.
Long’s group has become an important point of contact for many media outlets. As a result of that prominence, the group now receives referrals from hospitals, forensic pathologists, health complaints commissions and even government departments, Long says.
“Every person who contacts us, we ask them how they got onto us, and it’s amazing how many tell us their respective health department did.”
Politicians have even been known to contact Long, looking for information on which hospital to attend, she claims. “It’s been a number. Senators and MPs … I find that quite surprising.”
AFTER 11 years in existence, MEAG has taken several departures with its involvement in the Reeves affair. Perhaps most importantly, it is the first time the group has named an individual doctor, says Long, who argues the group’s aim has never been to target physicians.
“The focus is always on error-prone hospitals. In our reports we never, ever name clinicians.”
She comes from a medical family herself, she says, and has no beef with the profession as such.
“Heaps of doctors support us,” Long continues, declaring that the group has relationships with GPs and hospital specialists who advise them on how to interpret case notes.
“Some of them are pretty high up in the medical world,” she says, although she is unwilling to say who they are.
Ask her about health system administrators on the other hand and the response is decidedly less complimentary. Health care complaints commissions? She leans forward. “They’re absolutely, dismally woeful. They antagonise families. They are the main cause of infuriating families.”
Last month, the Age newspaper quoted Long as saying “heads must roll” within the NSW Government over the Reeves matter and that the handling of the case by the state’s Health Care Complaints Commission and NSW Medical Board was “absolutely appalling”.
The HCCC’sMr Swan refutes MEAG accusations that it is basically a complaints suppression agency.
“They allege we hadn’t been prepared to investigate Reeves,” he says. “At most we could bring disciplinary procedures, yet he was already deregistered.”
Better communication will ensure that area health services and the health department check that practitioners are abiding by restrictions imposed by medical boards, Mr Swan says.
Dr Joanna Flynn, president of the Medical Practitioners Board of Victoria (itself recently accused of mishandling complaints against Melbourne dermatologist David Wee Kin Tong), says medical boards are only responsible for ensuring information on a practitioner’s restrictions is readily accessible.
“It’s not the board’s responsibility to ensure potential employers abide by those restrictions. That’s the responsibility of the health service itself,” she says.
As far as NSW is concerned, state AMA president Dr Andrew Keegan believes MEAG’s complaints mostly pre-date important improvements in handling medical errors.
“The HCCC has greatly improved and we’ll soon implement major improvements from the Clinical Excellence Commission established in 2004,” he says.
MEAG’s views do have support within the profession. Dr Steve Bolsin, a UK whistleblower who’s now director of anaesthesia at Geelong Hospital in Victoria, first dealt with the group in 2001, while lobbying for use of hand-held medical performance data collectors.
“Experience shows that the system is not balanced,” Dr Bolsin says. “Professionals and medical organisations have all the relevant information and release only as they’re forced to.
“Most professionals feel threatened that the MEAG is trying to upset the status quo. They shouldn’t, because evidence suggests the earlier we inform patients or their relatives an error has occurred, the lower the compensation.”
Dr Bolsin does not believe MEAG’s claim that ‘Publicity is the very soul of justice’ risks the destruction of a doctor’s reputation before a proper hearing.
“If there was open access to patients’ treatment information, the MEAG wouldn’t need to publicise doctors’names. They’re very aware that it’s often not an individual bad doctor but whole hospital systems at fault. In my experience, they’re trying to constructively contribute to solutions.”
Nor is the AMA concerned about MEAG’s ‘Dob in a Doctor / Tell Us a Scandal’web page, which invites anonymous contact.
“We live in a democracy,”Dr Keegan says. “We should get input from all groups, whatever their expertise. I’ve seen a similar ‘dob in a doctor’ in the US, I’ve no problem. My view is that, if something is good for the patient, it’s good for doctors too.
“I’d prefer complaints weren’t anonymous except in very personal matters, but the MEAG should put pressure on the system, funnel their information through proper channels, so it can be verified and put to good use. In fact, why not present their data for expert examination to publish in peer-reviewed journals?”
Far from distancing itself from its vocal critic, the NSW HCCC met with the group recently over the Reeves case.
“It was a very productive meeting,” Mr Swan says. “While I won’t comment on their methods, it’s clear many people have gone to them rather than established complaints channels. Their work is of value, along with input of all patient perspectives through our consumer consultative committee.”
LORRAINE Long, meanwhile, remains hopeful her group’s activities will generate change among those charged with tackling medical errors.
“Oh, I have great hope,”she says. “Because one day they will end up in hospital and something will go wrong and they’ll now know what we’re talking about —because the frequency of the mistakes is all too high.”
A
DECADE OF CAMPAIGNING AGAINST MEDICAL ERROR
The MEAG web site pulls no punches: “Patient death toll worse than 45 plane crashes per year.”
The site goes on to list the causes of what it claims are unnecessary deaths: “Wrong diagnosis, wrong patient surgery, wrong-site surgery, mix-ups in operating theatres, wrong procedures, wrong medicine, wrong dosage, faulty interpretation of test results, old and contaminated blood products, deadly hospital-acquired infections, equipment sterilisation failures, hit-and-miss hospital care, Third World treatment, rogue clinicians ...”
One MEAG campaign focused on a patient who died after his pacemaker malfunctioned during an MRI at the AlfredHospital in Melbourne.
‘The MEAG was very supportive of all the professionals — doctors and radiographers — involved in the Alfred case,” says Dr Steve Bolsin, director of anaesthesia at GeelongHospital in Victoria. “It was the systems, not the doctors, they attacked.”
The Victorian coroner later found the death was avoidable and the Alfred gained a top place on the group’s ‘worst hospitals’ list.
But the thrust of the web site is that, despite more than a decade’s efforts, too little has changed.
Under the heading ‘do-nothing health-o-crats’, the site lists inquiries and reports into medical error and associated areas, and the hundreds of recommendations made.
“We have churned out 18 reports and 14 submissions,” the site says. “Conclusion: Health care in Australia is a pretty slip-shod operation. But who cares? No one but us.”
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