eMJA: The Bundaberg hospital scandal: the need for reform in Queensland and beyond

Paul D Fitzgerald

General Practitioner, Suite 303, 83 Mount Street, North Sydney, NSW 2060. docfitzATihug.com.au

To the Editor: It is heartening to see a positive professional response to clinical quality systems in the wake of Bundaberg. However, these are secondary responses, and overlook the primary, preventive solution.

Clinical monitoring systems presuppose that some damage is done before a problem becomes apparent. Hospitals already have mechanisms to examine clinical competence, and their appointments credentialing and privileging procedures.

The Queensland Health Systems Review Final Report (the Forster report)1 comments repeatedly on the apparent failure of these procedures in the Patel case at Bundaberg Hospital:

It appears that the process of checking credentials did not involve the College of Surgeons and no written clinical privileges appeared to have been granted on appointment. (p 169)

The report draws specific attention to special purpose registration for areas of need, pointing out the inherent conflict of interest:

As an employer under pressure to fill medical vacancies, Queensland Health faces a conflict of interesting making . . . determinations of area of need to allow special purpose registration of overseas trained doctors. (p 175)

It adds that these doctors are not subject to the same requirements as locally trained doctors, and recommends:

No overseas trained doctor should commence employment in a senior position intended to be filled by a specialist before . . . [assessment via the established Australian Medical Council / Specialist College pathway]. (p 174)

Furthermore, deemed specialists should participate in the usual clinical performance management processes applicable to all doctors. (p 175) And, finally:

. . . local clinical leaders and managers have a conflict between credentialing someone about whom they are uncertain and having no one to deliver the service. It appears that these issues may have been relevant at Bundaberg. (p 176)

More recently, the Queensland Public Hospitals Commission of Inquiry report (the Davies report)2 confirms a practice of appointing overseas trained doctors as senior medical officers in specialist roles in hospitals in designated areas of need. Such appointments in Bundaberg, Hervey Bay, Townsville and Charters Towers not only bypassed procedures for recognition as a “deemed specialist”, but were also not considered by hospital credentialing and privileging committees. The Davies report states that, in some hospitals, these committees did not exist.

It may be premature for the proponents of clinical quality systems to dance on the ashes of Bundaberg. These recent reports outline a chain of existing systems problems including the Medical Board, the Department of Health, successive Health Ministers and Cabinets, and appointments, credentialing, privileging and complaints procedures in a sample of Queensland public hospitals.

According to the Davies report (section 6.173), around half of the doctors in Queensland public hospitals were appointed under area-of-need arrangements by 2002. How are other states balancing the politically sensitive area of need registration with long-standing appointments, credentialing and privileging procedures?