Are criminal charges apt for medical mishaps?

Have you been sued yet?
I say if rather than when, because the stats indicate that the majority of doctors will be sued at least once in our working lives, and our recent story on the issue received many personal and sympathetic responses.
A usually diligent lot who primarily have the interests of patients at heart, doctors take perceived failures, whether real or not, much to heart.
Which probably explains my reaction when I hear of doctors undergoing criminal charges for a medical procedure gone wrong – not the Patel serial error-type story – but the one-off event where there’s no suggestion of a pattern of offending.
The reason for my focus on doctors and the law is the charging of prominent Queensland gynaecologist, Dr Bruce Ward, yesterday with the manslaughter of a 30 year old woman who died in hospital in 2002 just days after a radical hysterectomy for cervical cancer.
Mother-of-two Ms Nadia Cvitic reportedly collapsed three days after surgery and subsequently died of multi-organ failure. The inquest, which ended 18 months ago, found a pelvic drain had pierced a vein, which went unidentified by Dr Ward who began treatment for a suspected pulmonary embolus. The vein was repaired by a second surgeon who found over a litre of old blood in her abdomen.
As in all such cases, there are no true winners. Ms Cvitic’s dead and the $175,000 out-of-court settlement to the family won’t bring her back. For his part, Dr Ward must have spent a rotten five years and now he’s on bail, about to begin a probably lengthy criminal manslaughter trial with the prospect of subsequent incarceration. Even if he gets off, his practice is probably ruined.
None of this is to say that such deaths shouldn’t be vigorously investigated or that I have a view as to whether he was negligent or not.
But after seeing an Australian Story program where a drunken youth confessed to killing another chap with an unprovoked punch but walked out of court with an unblemished record after acquittal of manslaughter, I’m just not sure there shouldn’t be at least some distinction in the way these two quite different types of cases are death with.
There are other jurisdictions, such as Medical Boards or civil actions, to deal with doctors involved in a single medical tragedy. And if a doctor loses their licence to practice, there’s little likelihood of them harming anyone else.

Stop drip-feed funding for BEACH

Many readers have come to the defence of BEACH, the only independent source of data on GP consults, since my blog on Monday about the federal government’s dragging the chain on funding.
For instance, Andrew (yes it’s the blogosphere and first names and pseudonyms are de rigeur) wrote that the government’s lack of commitment to general practice research is one reason all our bright stars of General Practice research are either working overseas or in salaried tenured positions.
As Andrew says, the government has left BEACH hanging on several occasions, and it’s true that as a journalist I’ve written almost this very same story for several years.
So to keep readers up to date, here’s exactly where things stand as of today.
Funding for BEACH comes via the Australian Institute of Health and Welfare (AIHW) and is assured for the 07/08 year, albeit belatedly.
But given the long lead time for projects such as BEACH surveys, the key question is what happens next, ie will I be writing the same story again next year or will the small group who work on BEACH be able to get on with what they do best?
As it happens, the funding stream for BEACH is a bit convoluted, with the Department of Health and Ageing contracting with AIHW, which in turn gives a share to BEACH via the University of Sydney’s School of Public Health.
According to the school’s head, Professor Glenn Salkeld, an options paper for funding is being prepared by the University in conjunction with AIHW re funding beyond 2008.
“The BEACH survey is terribly important for public health. The data derived from the BEACH survey is crucial for good public health policy and in every sense funding BEACH is a bargain for government”, says Professor Salkeld, who’s hoping for funding agreement by year’s end.
By the sound of it, the ball’s in DoHA’s court.
Let’s hope they do the right thing.

Short ED wait poor measure of hospital health

Although I work close to the now infamous Royal North Shore Hospital, I’ve never advised a patient to vomit so they’d get past triage, as other local GPs admit to in today’s Australian. However, I do routinely recommend patients not “be too stoic” at the triage desk, so the extent of their discomfort is obvious.
As well, I often wait until the patient has left the surgery before ringing the admitting officer to avoid the grilling designed to make me change my mind about the patient’s need for hospital assessment. And more than once, I’ve resorted to asking a particularly resistant admitting officer what they’d do if we were talking about their mother or father.
But although last week’s case of an unfortunate woman delivering a live fetus in the toilet at the hospital has created thousands of column inches and a war of words between politicians, over-stretched hospitals are not just a North Shore Hospital problem, or limited to NSW.
So in some ways, the federal government’s new plan to fix the hospital crisis by forcing states to appoint hospital boards is appealing. So far, it smacks a bit of “policy on the run” and a return to the past, but any move to put the needs of patients before bureaucrats and their financial targets deserves serious consideration.
However, serious questions emerge. For a start, the health system is not just about hospitals, and it’s not clear the proposed move would address the current disconnect between primary and secondary care. Intuitively, the plan also risks severing established and useful networks between hospitals, and between hospital and community based services.
As well, the plan is being sold not as a federal, but a local, takeover of hospitals, with “local people grabbing power”, according to a federal source quoted in the Australian, which makes this local doctor nervous.
Understandably, local communities don’t take a big picture view of the health system, but are concerned about what’s available in their own patch.
As doctors and voters, we need to watch this one closely, and remind ourselves and our elected representatives that there’s more to an efficient and caring health system than a short wait in the ED.