Deadly Healthcare

James Dunbar, Prasuna Reddy and Stephen May




Rogue surgeons, overburdened hospitals, medical mismanagement, doctor shortages.

The story of Australia's own "Dr Death", Jayant Patel, is symptomatic of a tidal wave heading towards all modern healthcare systems. In this absorbing book, the authors have ploughed through the mass of public inquiry data, interviewing key figures in the affair to reveal in gripping detail how it happened, who was to blame, and how it can be avoided. Drawing on international cases and experiences, they reveal how institutional weaknesses are able to be exploited by individuals with serious personality problems. Hospitals worldwide are facing increasing pressures from staff shortages and the need to manage financial considerations that impact directly their ability to adequately manage patient care. This is a story relevant and timely for all who are a part of a modern complex healthcare network, from hospital administrators to doctors, nurses, ancillary staff and the patients themselves. The case of Bundaberg Hospital and its infamous "Dr Death" could be happening again right now in your own modern overburdened healthcare system.


About the Author

Professor James Dunbar (MD, FRCPEdin, FRCGP, FRACGP, FFPHM) is the inaugural Director of the Greater Green Triangle University Department of Rural Health, Flinders and Deakin Universities, Australia. In his former post of Medical Director of Borders Primary Care NHS Trust in Scotland, he won the Golden Phoenix Award - the primary award for improvement in health care in the UK.

Professor Prasuna Reddy (PhD, MAPS) is Chair of Rural Mental Health Flinders University, and Director of Research, Greater Green Triangle University Department of Rural Health. She is a practising health and organisational psychologist and also currently Director of Training for Life! Taking Action on Diabetes a joint initiative of the Victorian Government and Diabetes Australia - Victoria.

Stephen May (BSc Hons) originally trained as a psychologist, but left the profession to establish his own publishing company. He has edited an extensive range of scientific and professional texts as well as writing for newspapers on psychological topics. He is currently President of the Australian Publishers Association.

Reviews

A thoroughly enjoyable read. With fascinating detail the authors clearly demonstrate the thin veneer covering all healthcare systems. There are lessons to be learned from this case by all countries. - Sir Graeme Catto, FRCP, FMedSci, FRSE, Immediate past president of the General Medical Council and Professor of Medicine, University of Aberdeen.

This well-researched and racily written account is a cautionary tale about what can happen in the crunch of tight budgets, staff shortages and purblind hospital administrations. The risks of another Patel will increase unless the lessons from this case are well learned. It is an essential and riveting read. - Dr Denis Muller, Visiting Fellow, Centre for Public Policy University of Melbourne and former Associate Editor, The Age, Melbourne.

Drawing on the disciplines of medicine and psychology, this insightful and compelling story examines Patel's personal narrative as well as the political and professional environment which led to the Bundaberg Hospital becoming an accident waiting to happen. - Associate Professor Kerry Petersen, La Trobe University, Melbourne, Australia.

This book should be regularly read by every clinician, hospital executive and above all every health bureaucrat, to remind them of what can occur when standards of quality and safety in patient care are compromised. - Prof Alan Wolff, Director of Medical Services, Wimmera Health Care Group, Horsham, Australia.

A compellingly written story of serious harm. A deep understanding of quality improvement enables the authors to identify systemic failures that enhanced individual failure. They draw on international examples of similar events to demonstrate powerfully how we shouldn't allow these things to happen — but warn we are not learning the lessons. This should be compulsory reading for managers, clinicians and politicians. - Sir John Oldham, National Clinical Lead Quality and Productivity Department of Health, England.  

This meticulous account of the tragic consequences of poor standards at many levels in the Australian medical system is salutary, not only for that country but throughout the world. The ability of Patel to move between three continents after attracting major problems in his surgical care is breathtaking. It is, however, probably not unique. This book deserves to be read as much by medical managers and administrators as doctors. - Professor R Hugh MacDougall, Dean of the Faculty of Medicine and Head of the School of Medicine, University of St Andrews.

The United Kingdom has over recent decades had its own fair share of inquiries into failing services and poorly performing healthcare professionals that have been ‘covered up’ by acts of both omission and commission in the healthcare organisations they have worked in. This book demonstrates why investigators and regulators need to be independent from the organisations and institutions they oversee to avoid complicity with the events they are investigating. Good governance systems can be made to work in different organisational configurations provided that there is appropriate external scrutiny or quality assurance of those systems and, importantly, local ownership of delivering high quality care. - Dr Frances M Elliot, Chief Executive, NHS Quality Improvement Scotland.

James Dunbar, a respected medical educator and leader in healthcare safety quality, with able support from his fellow authors, brings acute observational skills to bear on the infamous ‘Dr Death’ episode that shook the public’s trust in the health system of the State of Queensland and changed the healthcare regulatory environment in Australia. This book is a concise and very readable account of the many underlying issues in the saga that cascaded together with disastrous consequences for patients. It starkly underlines the lessons that must be learned to keep patients safe. - Bruce Barraclough, AO, FRACS, and former President, International Society for Quality in Health Care and of the Royal Australasian College of Surgeons.

This is a gripping treatise on the collision of individual ego, organisational incompetence and political mendacity. The authors have used their considerable experience of medicine and organisations to identify a range of sobering explanations for a series of recent medical disasters. Within the text is a fascinating analysis of psychological factors which, had they been understood and acted upon, might have prevented the unfolding of one of medicine’s greatest scandals. This is a story that illustrates that the road to healthcare hell is paved with good intentions — but also with potholes of bureaucratic and political incompetence. Along with the authors, I was left wondering whether sick health care institutions were capable of real recovery. - Dr Don Coid, BM, FRCPEd, and former Chief Administrative Medical Officer, NHS Tayside, Scotland. 
 


Table of Contents

Acknowledgments 

About the Authors 

CHAPTER 1 Dr Death

CHAPTER 2 ‘Dazed and distressed’

CHAPTER 3 ‘Doctors don’t have germs’ 

CHAPTER 4 ‘He doesn’t bother for others’

CHAPTER 5 A Sad Parade of Management Failures

CHAPTER 6 The Self-Obsessed ‘Super Surgeon’

CHAPTER 7 A Compulsion to Operate

CHAPTER 8 Getting Away With It

CHAPTER 9 A Quality of Care Somewhat Lacking 

CHAPTER 10 Rogue Doctors on the Loose 

CHAPTER 11 It’s All About Outcomes 

CHAPTER 12 Desperately Seeking Surgeons 

CHAPTER 13 Something Starts to Happen

CHAPTER 14 Deadly Healthcare

CHAPTER 15 Burgeoning Bureaucracy

CHAPTER 16 A Matter of Judgment 

CHAPTER 17 The Aftermath

Bibliography 

Index