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.
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If his intention was to take advantage of people, he deserves what he gets. If it wasn’t, then this is really sad.
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WHEN the lay
press dubbed
deregistered
doctor Graeme
Reeves the
Butcher of Bega
it
cast a dark cloud of stigma
and suspicion over the pic
turesque NSW town and its
local doctors.
Allegations that Reeves is
guilty of mutilating and abus
ing 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 unoffi
cial complaints body, when
the Health Care Complaints
Commission received just two
regarding the time Reeves
worked locally. They
re mys
tified as to how Bega has
become the epicentre of a
media storm, when Reeves
was actually based 40km
south at Pambula, did rela
tively little work at Bega Dis
trict 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
AustralianDoctor
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 Govern
ment push to protect whistle
blower 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 com
plaints [about Reeves] at all.
We, as doctors, are as
shocked as the community.
”
The GP is devastated that
lay press coverage has
tar
nished 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 head
lines, two patients have come
to the GP with complaints
about botched surgery. He
struggles to understand why
they did not raise their com
plaints 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 complain
ing. I don
t get it.
”
But even if he had been
made aware earlier, those iso
lated cases would not neces
sarily have raised his suspi
cion of Reeves.
I
ve seen similar compli
cations 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 inves
tigation by the NSW Medical
Board
s Professional Stan
dards 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 endan
gered,
”
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 Pam
bula and Bega district hospi
tals, Reeves
deregistration
was not due to local com
plaints about his obstetrics
work.
There is no charge leveled
at the practitioner that in ren
dering 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 tri
bunal
s report of proceedings
says.
There was no suggestion
that any of his patients were
disadvantaged by his atten
tions 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 let
ters laudatory of the practi
tioner
s skills.
”
At the time of
AustralianDoctor
going to press, Reeves
was the subject of a NSW
police strike force investiga
tion 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 doc
tors 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 sus
picious 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 griev
ances 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 investi
gated 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
person
ality has fuelled some of the
complaints, rather than them
all being about his work.
The NSW Medical Board
s
Professional Standards Com
mittee 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 pro
ceedings that saw Reeves
deregistered in July 2004. The
report suggests a
narcissistic
personality disorder
”
may
explain his
arrogant con
tempt for the authority of the
PSC and the Medical Board
”
Dr MacKinnon says Reeves
personality disturbed nurses at
Pambula
District
Hospital
, 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 obste
tricians.
”
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 specif
ically 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 refer
ring to any unknown special
ist. 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
vio
lated
”
, 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 reg
istrar, with Reeves as a con
sultant. It found
no grounds
for investigation
”
. However,
in November 2002, the
HCCC received a complaint
about Reeves conducting an
inappropriate internal exami
nation and breast examina
tion 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 neopla
sia.
A NSW District Court judge
found Reeves grossly negligent
and described the surgery as
appalling
”
(see box, page
14). While Reeves denied neg
ligence, he put no evidence for
ward. 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 perse
cuted 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 strik
ingly 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 abu
sive intent in what he was
doing then [this situation] is
very sad.
”
COURT’S DAMNINGVERDICTONREEVES
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 earlie
r 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
Hornsby
Kuringai
District
Hospital
and the
Sydney
Adventist
Hospital
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 t
hat 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 incl
ude 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
Bega
Valley
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 t
o 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?