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.

This Dr. Death issue is a serious one. For a Doctor to be permitted to cause so much destruction and despair, whilst being complained about, shows a failure in our complaint handling systems that is such that we should all be alarmed!.

The problem with this matter, our politicians, our hospitals, our railways, our airports, our Government etc., is the same one. The complaint handling systems are set up, directly or indirectly, to protect the reputation and position of the Government and in doing so they also protect those that are failing in their duty of care. The bullies always seem to be able to do what they want regardless of the harm that they do and when the victim complains (or retaliates) - the victim gets vilified, ostrasized, and victimised and blamed and nobody cares - For some reason big bullies have more rights. Sound familiar? It is played out in schools and in society all the time. Criminals also have all the rights.

It is important for the Government that the Government is consistant in relation to the handling of bullies and complaints so as not to set a precedent that might mean that they might be made to answer and held accountable. We should be alarmed as there is only one way to go when incompetance and misconduct is rife and is covered up and that is backwards.

This problem is exacerbated by the deliberate misinformation that the political arm did not know about the problem. It all has that familiar ring of those poignant letters from the Gulags where prisoners blamed all their problems on the bureaucrats and pursued their respective cases in the false hope that, "if only Stalin knew what was going on". The cruel historical truth was that Stalin authorised every individual sentence. And the cruel truth of the "Bundaberg Massacre" was that the Beattie Government knew exactly what was going on and made the cynical calculation that they could get away with it due to the size of their majority and the low visibility of the rural minority, Beattie's Kulaks.

Make no mistake, if Beattie is still there after the next election, the urban South East will have squandered any right to govern the rest of Queensland.

How many post-mortems are done in the State for non-coronial deaths. Once it was very common in hospitals as an audit and a training tool. They are rare in the extreme in private and uncommon now in the public system...cost too much.The public also don't like them because they hurt.
It also kept doctors informed. We learnt from mistakes. There are also Death and Complication Meetings. Were these in Bundaberg?
By the way, there are specialists other than surgeons.

Dr Death, aka J Patel of Oregon USA went out of his way to operate whenever he got the chance ! He organised a surgeon's party to race off to a train derailment to 'rescue' victims, Armed,so we are told, with a voracious appetite for operating well in excess of his capabilities. Anecdotal evidence by Tony Hoffman, he forgot to include an Anathetist - infering, Patel was going to 'gungho' hack, butcher and maim innocent victims.Fortunate for all, called off at the 11th hour due to lack of response from his colleagues, and the speedy response of Queensland Ambulance service.But for the Grace of God..how many more of his patients would have succumbed to his surgical malafeasance.
Despite Tony Morris's assertions JP stand trail, I very much doubt he will ! Dying on the Operating table is not a criminal offence.Evidence from patients attesting his negligence is hear-say, Dr Fitzgerald Q.H's advocate could not find any case that warranted investigations. The initial 87 deaths attributed to Jayar Patel was a figment of hesteria. Mr Morris QC, was swept away with. That a Royal Commission could be so blatantly side-tracked by the Media, is a lesson of 'trail by media'.
His Honour, Tony Fitzgerald must be rocking in his chambers, to find his protege..T.M got it sooo wrong. His style in Court was demeaning, and aggressive.
I watched the Fitzgerald's Trial of Gerry Ballino, and Terry Lewis, and I can vouch his demeanour of IMPARTIALITY. He never took sides. He was there to hear the evidence and the truth.
The Qld Police service will come back empty handed, and all the HYPE Beatie's grandstanding will count for nought in the US. His case is worthless, and circumstantial, and I guess in saner moments, he will reflect the $5,000,000 investment in the RC will see us 'smart state' of the Art, smitten, looking stupid and finally ending up with EGG-ON_YOUR_FACE mister Premier.