I was uncomfortable with Nicholas Gruen’s second piece on the Bundaberg Hospital scandal (“No more Dr Deaths”, 4 July) . I found a little more comfort in his first piece on 6 May, “Learning a Lesson from the Butcher of Bundaberg”.

Compare as a very different take, my article on this week’s New Matilda ( I do believe in cross-fertilisation among our serious national opinion websites):
“A whistleblower at Bundaberg Base Hospital”, NM 29 June 2005

It is interesting how loth people are to comment on this subject. It is morally discomfiting because it is about life and death of our fellow Australians under a public health system that now delivers good or safe outcomes for the rich, and bad or risky outcomes for the poor. I don’t think Gruen sees that as seriously as I do. I have this quaint idea that we all have a right to an equal chance of life when we are in need of medical care.

The “area of need” approach to recruitment of overseas doctors betrays a deeply disturbing reality. It is everywhere now. We are not talking about finding doctors for Woop-Woop Hospital any more. In Canberra now, Canberra Hospital – a teaching hospital that caters to a regional catchment of upwards of 350,000 people – is, I understand, considering listing obstetrics and gynaecology as an area of need requiring foreign doctor recruitment.

Think about it – Australia’s national capital an area of need for women having babies in the public health sector ! So Canberra Hospital cannot recruit locally-trained and certified obstetricians and gynaecologists? Of course it could, if only it paid them enough for work in the public hospital system. There are plenty of experienced O&G doctors with good safety records working in the private system in Canberra for those who can afford them, or sacrifice other needs to afford them . Twenty years ago, those sorts of doctors gave some of their time and expertise working in public hospitals. Why don’t they now ? What has gone wrong ? This is just one example. ( To continue

(Continued) To me this is evidence of serious systems failure, both in economic efficiency and ethical terms. It is wrong that the less well off have more chance of their pregnancies going wrong under less well trained and professionally screened foreign doctors, than the better off.

And how do you rate what surgical failure rate is acceptable? As a doctor said recently on ABC news, how do you rate good drivers? Not simply by their accident rate. And who assesses – Health economists? Accountants ? Experienced fellow doctors and senior nurses? These are very serious questions if we care about the preservation of life in our society. It must not just be about economic efficiency, it must be about professional standards of competence and ethics as properly understood by experienced peers.

Then there is the undeniable smell of systemic cover-up in the Bundaberg story which the ABC TV Australian Story brought out so brilliantly. Why did so many people in government health service close ranks even after it was clear that too many people were dying under this surgeon ? I find that even more terrifying than Patel’s own reported callousness and indifference to patient death. What has gone wrong in our society ? I am not sure that Nicholas Gruen fully sees this dimension of the story. He tends, I think, to sanitise it. He is not the only one.

I don’t see the Bundaberg Hospital story as about politics or economics or management as usual. I think we have to recognise how deeply confronting it is – as the history of SIEV X is. I’m not sure Gruen does see this – I think there is an almost Panglossian complacency of tone here.

Well it's not going to get any better,Doctors are leaving the system in droves due to the threat of litigation and the cost of medical indemnity.

The only response of the Govt.can be to import cheap expertise from 3rd world countries.Get the legal system and insurance companies under control,and you will have better medical services.

So what do we want,more rights,or a health system that works?

Who has the courage to take them on?

We are wanting Champagne Medicine on a Beer Budget.

There is also a systemic climate of non-accountablity and lack of encouragement of feedback loops which would not be tolerated in the airline industry.

We want a QANTAS safety record with no checks and balances, pilots working in unsafe conditions including working hours and supervision and a bureaucracy that is fat, overloaded with paper, not accountable, and dictating affairs at the coal face while never getting out of the office at the pithead.

The medical bureaucrats are by and large the least talented who rise to the top like grease in a grease trap as they cannot make it in the tough world of specialist training schemes. This leads to the least imaginative and most compliant (Yes Men) being the masters at the top of the mine while the experts battle at the coal face underresourced and undermined by the bastards on the top.

Health Ministers come and go like the breeze and are nongs, and good specialists usually find life more pleasant in their own private practices where they can run their run their show efficiently with less paperwork.

A lot of full-time hospital doctors like the hospital life because they are not renowned for their energy and prefer the institutional predictablity than the cut and thrust of the real world...the sheltered workshop mentality. Some can't leave because they are 3rd world slaves stuck on a working visa...mouths shut tight too.

Data source: my own experience of 30 years of specialist medicine.

Neither Nick Gruen nor Tony Kevin appear to have grasped the key issue here. The Forster Inquiry into broader health issues in Qld held public meetings all over the state. The ones in the South East (Logan and Ipswich) were complete no-shows while those in the rest of the state each had 30+ in attendance. There is no health crisis in the urban south east but there is a serious problem in the bush.

So it is not, as Tony has suggested, simply a problem of the economically or socially disadvantaged because country people have limited choice between public and private health. If there is only one Doctor in town then rich and poor alike must use them.

The Forster Inquiry meeting in Cairns was told that there was in the order of 3000 suspicious deaths in country Qld. The documents that suggested that Patels error rate was close to industry norms were prepared by Patel himself. Staff at Bundaberg are of the opinion that record keeping was one of the few fields that he was actually good at "doctoring".

It is worth reflecting that the now 89 deaths at Bundaberg, and a claimed 3 more at Mt Isa, bring the total toll to three times more country Queenslanders than were killed in Vietnam. To paraphrase the old protest song, "and you tell me, over and over and over again, my friend, that you don't believe that urban Australia is waging war on the rural community".

If only it were just Dr Patel. There's another Queensland case, somewhat less publicised, because no-one died, but equally alarming. The Queensland Medical Board attempted to cancel the registration of Helen Tsigounis, claiming she had not satisfactorily completed her Townsville Hospital internship. On Ms Tsigounis' appeal, the Board was directed to extend her internship by a year (see Tsigounis v Medical Board of Queensland, QDC103). This despite an unnerving catalogue of potentially fatal errors and the court's acceptance of psychiatric evidence stating the appelant suffers from a paranoid personality disorder which renders her unable to distinguish correction from attack, and makes her incapable of learning through experience. How many more such cases are coming soon to a hospital near you? For those who wish to be further alarmed, Nicholas Shakespeare's article in June's The Monthly "Oh My God. He's Done It Again" should suffice.