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| Collateral damage |
26-Mar-2008 |
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Allegations against deregistered obstetrician Graeme Reeves have shocked GPs in the small community of Bega. By Heather Wiseman
WHEN the lay press dubbed deregistered doctor Graeme Reeves the ‘Butcher of Bega’ it cast a dark cloud of stigma and suspicion over the picturesque NSW town and its local doctors.
Allegations that Reeves is guilty of mutilating and abusing hundreds of patients have left Bega’s GPs baffled and angry on several fronts. They struggle to make sense of reports that 550 complaints have been made to an unofficial complaints body, when the Health Care Complaints Commission received just two regarding the time Reeves worked locally. They’re mystified as to how Bega has become the epicentre of a media storm, when Reeves was actually based 40km south at Pambula, did relatively little work at Bega District Hospital and only worked in the region for about 14 months of his 29-year career. And while they referred patients to Reeves, GPs who spoke to Australian
Doctor had no sense of a medical disaster brewing and are indignant that an accusatory finger has been pointed at them.
Lay press coverage has been ripe with accusations of ‘doctors protecting doctors’and suggestions that medicos must have known of Reeves’alleged abuses and botched surgery; suggestions fuelled by a Bega MP’s claim in State Parliament that local medicos had dubbed him ‘Chopper Reeves’ and a State Government push to protect whistleblower doctors.
“This wall of silence crap irritates me,” says one local GP, who does not wish to be named. “Why would a GP refer to someone who is incompetent in a small town? I was learning about this on the news, like everyone else. I was stunned. I had no complaints [about Reeves] at all.
“We, as doctors, are as shocked as the community.”
The GP is devastated that lay press coverage has “tarnished the name of [Bega’s] good, hardworking GPs”.
“Patients might think I knew about this guy,” he says. “My reputation is impeccable here and this is just a shocker. If I’d known his restrictions [Reeves was banned from obstetrics], I wouldn’t have referred to him at all.”
The town is desperately short of doctors and the Reeves controversy will have a “catastrophic” impact on recruitment, the GP says.
“If I was a GP obstetrician and had a choice of 10 places, why would I come down here?” he says.
He’s similarly fearful of the impact on his own career prospects. “If I was trying to get a job in Sydney now, they’d think I was colluding with [Reeves].”
Since Reeves made headlines, two patients have come to the GP with complaints about botched surgery. He struggles to understand why they did not raise their complaints with him earlier.
“One lady has been going through this for years and not telling me,” he says. “They [patients] didn’t tell their local GPs, but behind the scenes they were actively complaining. I don’t get it.”
But even if he had been made aware earlier, those isolated cases would not necessarily have raised his suspicion of Reeves.
“I’ve seen similar complications in [work by] other surgeons,” he says. “If you see one complication, it’s just part of the puzzle.”
Reeves was banned from obstetrics after a 1997 investigation by the NSW Medical Board’s Professional Standards Committee into nine of 14 obstetric complaints.
“His treatment of one patient led to her death. In another case the death of a baby occurred. The life of another patient was endangered,” a Medical Tribunal summary of the Professional Standards Committee findings says.
The tribunal deregistered Reeves in 2004 for breaching the obstetrics ban, after it found he lied his way into a position with the Southern Area Health Service as a VMO obstetrician and gynaecologist (see box, below). While he attended about 40 obstetric patients at Pambula and Bega district hospitals, Reeves’ deregistration was not due to local complaints about his obstetrics work.
“There is no charge leveled at the practitioner that in rendering obstetrical services in breach of the PSC order that he demonstrated any lack of skill or lack of care in the practice of medicine,” the tribunal’s report of proceedings says.
“There was no suggestion that any of his patients were disadvantaged by his attentions and there was certainly no evidence of any outcomes related to the lack of skill or lack of competence.
“A number of practitioners wrote highly impressive letters laudatory of the practitioner’s skills.”
At the time of Australian
Doctor going to press, Reeves was the subject of a NSW police strike force investigation and a Sydney law firm was preparing 24 cases against the state’s health department and medical board.
Ms Lorraine Long, head of unofficial complaints body the Medical Error Action Group, has received 550 complaints about the doctor, spanning much of his career. She has described the case as the “worst medical disaster in Australia”. And the lay press has detailed a string of civil cases that have been brought successfully against Reeves.
BEGA GP Dr Ernest Gault did not know Reeves, but says doctors who worked closely with him described him as “a very competent surgeon”. The solo GP, who has worked in Bega for 33 years, referred patients to Reeves and never had any sense of problems, which makes him sceptical about the huge numbers of patients alleged to have been injured or abused.
“The theatre sisters and doctors assisting haven’t been involved at all in any complaint, which would immediately make you suspicious the thing was blown up out of proportion,” says Dr Gault, who is surprised lay press coverage has been so condemning.
“You’d think he [Reeves] would have a good case for taking action against the papers,” he says.
Bega GP anaesthetist Dr Duncan MacKinnon says lay press coverage has given only one side of the Reeves story and not reflected its true complexity.
“We only have half the facts and there are hundreds of women who have been managed by him with good outcomes,” he says.
But some women may have genuine and serious grievances about Reeves’ treatment and these cases must be taken very seriously, he says. He particularly feels for women who made complaints after 2004, which were not investigated because Reeves had been deregistered.
“[That] is really wrong, because those ladies didn’t get closure,” he says.
But having worked with Reeves 8-9 times, providing anaesthetics for out-of-hours emergency procedures, Dr MacKinnon suspects that the deregistered doctors’ personality has fuelled some of the complaints, rather than them all being about his work.
The NSW Medical Board’s Professional Standards Committee found Reeves to have “personality and relations problems and depression that detrimentally affects his mental capacity to practise medicine,” according to a report of the tribunal proceedings that saw Reeves deregistered in July 2004. The report suggests a “narcissistic personality disorder” may explain his “arrogant contempt for the authority of the PSC and the Medical Board”.
Dr MacKinnon says Reeves’personality disturbed nurses at PambulaDistrictHospital, but workforce pressures meant Reeves helped to make the hospital viable.
“I know nursing staff down there were uncomfortable and there was pressure put on them to keep quiet because they didn’t want to lose him,”Dr MacKinnon says. “He kept their [Pambula’s] operating facilities open, basically, doing a list a week, which gave them enough to keep it going.
“Workforce shortages are a big issue. We’re really struggling with our GP obstetricians.”
Dr MacKinnon says Reeves’ behaviour also made doctors working with him feel ill at ease. They found it odd that Reeves would stroke patients’ hands and try to reassure them, saying, “You’ll be fine, you’ll be fine”, during stressful emergency situations while the anaesthetist was trying to concentrate.
“There was nothing specifically wrong with it — it’s just not what we would do,” he says, remembering that one doctor regularly asked Reeves to leave the room.
“The rest of us used to put the patient off to sleep as quickly as we could so he’d stop.”
Dr MacKinnon says Reeves did this so publicly that he clearly had no sense others considered it inappropriate.
“He probably thought it would commend him as a caring, compassionate doctor,” he says.
Dr MacKinnon says he referred about 20 patients to Reeves, actively monitoring feedback as he did when referring to any unknown specialist. Patients reported that Reeves was “wonderful”, but in 2003 two patients came to him “very distressed”.
“I encouraged them and facilitated them going to the Health Care Complaints Commission,” he says. “I stopped referring patients then because I was concerned.”
Dr MacKinnon says while the two patients felt “violated”, their account of what had happened did not suggest Reeves had done anything wrong.
“It was just his manner. It wasn’t anything you could put your finger on,” he says.
It is unclear whether the complaints reached the HCCC, because it reports only one complaint about Reeves in 2003, in regard to a patient death during surgery that was performed by a registrar, with Reeves as a consultant. It found “no grounds for investigation”. However, in November 2002, the HCCC received a complaint about Reeves conducting an inappropriate internal examination and breast examination at his private practice in Pambula, which was referred to the Medical Board.
Since stories about Reeves started appearing in the lay press, another two patients have come to Dr MacKinnon with complaints about Reeves’behaviour.
“I’ve seen six other people who’ve said, ‘I feel really sorry for Dr Reeves because he was really lovely’,” he says.
Many lay press reports have suggested Reeves acted with malicious intent, publishing one patient’s allegation that Reeves whispered, “I’m going to take your clitoris, too”, before conducting a simple vulvectomy, with the removal of the labia and clitoris, on a patient who had grade three vulval intraepithelial neoplasia.
A NSW District Court judge found Reeves grossly negligent and described the surgery as “appalling” (see box, page 14). While Reeves denied negligence, he put no evidence forward. Because it was a civil rather than criminal case, the plaintiff and specialists who gave expert opinions were not cross-examined. The patient’s allegation of a whispered threat is not mentioned in the transcript of proceedings.
While Dr MacKinnon is at pains to point out that he is not defending Reeves, he hopes he is not being persecuted because “he’s a bit odd”.
“With Graeme, I’m sure a lot of it is going to fall into the grey behaviour that isn’t strikingly wrong but is not right,”he says.
“If his intention was to take advantage of people, he deserves what he gets. If it wasn’t, then this is really sad. Those people who feel abused — that’s a terrible thing —and his personality disorder doesn’t lessen their grievance. But if there wasn’t that abusive intent in what he was doing then [this situation] is very sad.”
COURT
’
S DAMNING
VERDICT
ON
REEVES
“Gross genital mutilation” is how a NSW District Court judge described the results of a simple surgery that Graeme Reeves performed on Mrs Carolyn Dewaegeneire in July 2002, in which her labia minora, labia majora and clitoris were excised.
A transcript of the civil case, in which Reeves denied negligence, reveals that Mrs Dewaegeneire had grade three vulval intraepithelial neoplasia with no evidence of invasion.
“[Reeves] diagnosed her problem as being ‘localised VIN on the left labia minora extending to the majora’,” the court transcript says.
Dr Chris Dalrymple, a gynaecological oncologist, gave evidence that such surgery “was performed 30 years ago for this disease but has fallen from favour because of the large amount of normal skin removed and the significant deformity left following surgery”.
“The appropriate treatment for this patient would be to have performed wide local excision of the left anterior vulva with the preservation of the clitoris followed by regular monitoring to ensure the disease did not arise elsewhere.”
Dr Dalrymple said the disease is so rare that “the average gynaecologist would see it rarely in a lifetime of practice” and it was routine to seek a second opinion on the histopathology because of potential disagreement between pathologists.
He said the disease has “a significant recurrence rate of up to 50% depending on the type of treatment and other causative factors, including smoking”.
Another expert witness, gynaecological oncologist Dr Margaret Davy, said about 10% of cases led to invasive cancer.
Dr Davy said Reeves did not adequately address the issue of informed consent or consider the plaintiff’s future sexual and social activities, and that the patient should have been offered a second opinion.
Before undertaking the surgery, Reeves wrote to Mrs Dewaegeneire’s Bega GP, Dr Patricia Salisbury, saying the patient “has developed extensive in situ cancer of the vulva” and recommending a simple vulvectomy.
Reeves wrote that it would be a simple procedure, which would not debilitate Mrs Dewaegeneire greatly, and that he had explained the procedure to her.
The court heard that, after the surgery, Mrs Dewaegeneire was shocked that her labia minora, labia majora and clitoris had been excised. The judge accepted evidence that she had experienced “very significant physical and emotional consequences of the surgery”.
Mrs Dewaegeneire felt no prospect of having another relationship due to her “sexual mutilation”. The surgery altered her urine flow so that it was difficult to pass urine without soiling her clothes.
It says Mrs Dewaegeneire “tried to submerge her problems, to use her words, so she could cope”.
Two years later, after reading a newspaper story about Reeves being deregistered, she became “aware that something terribly wrong was done” and became outraged about the surgery.
VMO WORK BUILT ON LIES
Defiance and deceptiveness were the key traits Graeme Reeves exhibited while securing work as a VMO obstetrician and gynaecologist with the Southern Area Health Service, which led to him working at Bega and Pambula district hospitals from April 2002.
How he came to get the job — despite a previous order that he cease obstetric work — is spelled out in the Medical Tribunal report of the proceedings that later led to his deregistration in mid-2004.
While the SAHS has come under fire for not checking Reeves’ credentials, the tribunal report highlights how manipulative Reeves was in his selective provision of information about himself.
Reeves’ application for work as a consultant supporting resident GP obstetricians included a letter the NSW Medical Board had sent him in relation to his endogenous depression and its potential impact on his registration. The letter did not refer to the earlier decision by the board’s Professional Standards Committee that he cease practising obstetrics.
While Reeves failed to disclose this ban and the serious patient mismanagement that led to it, he lied more directly in his resume, falsely claiming to have VMO appointments at HornsbyKuringaiDistrictHospital and the SydneyAdventistHospital.
“It is patent that he was prepared to take whatever steps he deemed expedient to place himself in a position whereby he could resume practice as an obstetrician,” the report of tribunal proceedings says. “These steps included barefaced lies and calculated deceptions to provide false or misleading information, which he knew would affect his application.”
The lies continued when Reeves phoned the Medical Board to report that he had been given the specialist gynaecologist job. He said he’d explained during his interview, and later to seven local GP obstetricians, that he would not be doing obstetric work and that his indemnity only covered gynaecology.
“Clearly he had attracted some obstetric patients who were referred to him by practitioners because he was holding himself out to be an obstetrician, albeit … his evidence that he refused to treat patients who arrived at his surgery seeking obstetric services,” the report says.
The Medical Board became aware Reeves was practising obstetrics in November 2002 and wrote asking him to provide details of his employment. Reeves responded with a letter that “comprised a litany of lies and deceptive statements”.
Reeves said he had not performed any elective obstetric services, in keeping with the conditions of his registration and that he had “no intention” of practising obstetrics again. On the day Reeves wrote that letter he performed obstetric surgery.
Despite another letter from the board saying he was breaching the Professional Standards Committee order, Reeves “flagrantly defied” the order and continued to do obstetrics work.
The tribunal report says he attended 38 obstetric patients at local hospitals between 10 May 2002 and 9 January 2003.
Reeves used workforce shortages to justify breaching the order, saying he assisted during elective and emergency caesarean sections only when he was required in order for safe staffing requirements to be met. In his letter to the tribunal he explained that one local doctor had acute pancreatitis, so he replaced him on the roster “as there is no other practitioner able to do so”. He argued that he was obliged, under the Medical Practitioners Act, to treat patients when no other doctor was available. The tribunal report says Reeves did not understand that his legal obligation to provide emergency obstetric services did not include rostered work.
“It was the thrust of the practitioner’s case that he felt the need to involve himself in the management of obstetric patients at Bega and Pambula as if he did not become so involved this would have caused them harm, in particular the ‘caesar’ patients at the Bega and Pambula hosptials,” the report says.
“He was concerned that on occasions there was no cover to do caesarean sections at the Bega Hospital in which the labour ward had to be closed and patients transported [more than 200km] by road to either Moruya or Canberra.”
While giving evidence to the tribunal, Reeves said he “breached the [PSC] order in circumstances where I felt physically and mentally well and in respect of services/procedures in which I was technically competent and experienced.
“Unfortunately, I have been told by officers of the [medical] board that they don’t care about the area, the problems with health down there, and it wasn’t my responsibility to care about them either. I am in total disagreement with that attitude. I am sorry, but I sincerely believe that I should be concerned about the people of the BegaValley and the level of their health care. That primarily was my motivation. I arrived there doing gynaecology. I found that the obstetric services were poor and the outcomes were atrocious and that complications were occurring unnecessarily. I felt obliged to act in the patients’ best interest.”
Reeves’ employment was terminated in mid 2003.
NEXT WEEK
The lay media have described them as an independent health watchdog, but who are the Medical Error Action Group?
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