ABC’s Australian Story on Monday 25 June told the harrowing yet inspiring story of how one brave woman “ Toni Hoffman, a senior nurse in charge of the intensive care unit at the Bundaberg Base Hospital in Queensland “ blew the whistle, at great cost and risk to herself, on a major official cover-up of a surgeon’s alleged systematic malpractice over a period of two years; malpractice that allegedly took the lives of nearly ninety patients who had put their trust in the competence and integrity of this large regional public hospital.
As I watched this heartbreakingly powerful Australian Story, I saw clear parallels with Andrew Wilkie’s experience in the Office of National Assessments when he saw that the Australian government, unchallenged by his agency’s management, was presenting phoney pro-war intelligence about Iraqi WMD as the truth: and also with my own experience of trying to generate an honest government investigation of who in the Australian border protection bureaucracy knew what, when they knew it, and what they did or failed to do about it, in the case of the sinking of the asylum-seeker boat SIEV X in Australia’s border protection zone, drowning 353 people.
Thanks to Hive
In all three cases, it appears clear that powerful bureaucratic managers’ instinct for their agency’s welfare prevailed over any considerations of proper professional and public-interest ethics, and that ‘shoot the messenger’ was the automatic response strategy.
Toni Hoffman’s is a rare case where the personal ethics, courage and persistence of a relatively junior whistleblower won through at the end, with the Queensland government’s decision (taken only under intense public pressure after the story became widely known) to set up a proper judicial process for ascertaining the truth about Dr Patel’s work “ an independent Royal Commission, which is now working on the case.
Her story exemplifies the familiar adage: if one does not speak out against evil acts, one becomes complicit in them. And yet, how hard it can be to speak out and live with the personal consequences.
The story can be summarised thus. Over a two-year period, Hoffman and fellow nurses and anaesthetists saw repeated examples of what they thought were serious defects in Patel’s modus operandi as a surgeon, resulting in increasing numbers of avoidable patient deaths. Hoffman “ apparently on her own, for the support of her colleagues, while sincere, was mostly in private “ formally requested the hospital to conduct independent audits of his work. For a long time, nothing happened. Hospital management “ happy at the enhanced income and activity statistics that Dr Patel’s enthusiasm to undertake surgical procedures was bringing to the hospital “ was not disposed to heed her pleas. According to the ABC program, officers from the Ethical Standards Branch (presumably a State government public service watchdog agency) also warned hospital staff that they could face jail if they passed on any information about the matter to their unions.
Understand here that a hospital chain of command is as rigidly stratified and hierarchical as in any of Australia’s armed services “ for a nurse, even a senior nurse like Hoffman, to question a surgeon’s professional judgement must have required enormous courage of her. It is akin to an ordinary seaman on board a naval ship complaining about the professional judgement of that ship’s officers. It is no wonder that when it came to the crunch of making formal complaints (as distinct from tearoom gossip), Hoffman was for a long time desperately alone in acting on her conviction that more and more patients were needlessly dying under this surgeon, even as he received a management award for Employee of the Month.
Finally she went outside her chain of command. She told her story to an Opposition National Party MP, who raised the issue in Queensland State Parliament under privilege. Initially, it seems from media reports cited in the ABC program, the government closed ranks behind the hospital and denied the anonymous and unproven allegations.
Hoffman was suspected in the hospital of being the source of the story. She was then subjected to the usual charges of irresponsibility and disloyalty to her colleagues, and warnings of likely dismissal.
But she still persisted, taking the story to a journalist. It only took him minutes to check out Dr Jayant Patel’s name on Google, and thereby to discover a whole publicly documented history of previous lethal malpractice in a Portland, Oregon, USA hospital, resulting in his dismissal. And yet this same doctor was subsequently recruited to work as a surgeon at Bundaberg Base Hospital.
Even after the story finally reached a public tipping point, there were still vain efforts to limit the damage. The doctor was allegedly given a free air ticket and encouraged to leave the country as quickly as possible. This suggests that there were still bureaucrats in the system who hoped that, by his convenient disappearance, the whole story might be hosed down and systemic accountability evaded.
Whatever the Royal Commission now finds, and whether Dr Patel returns to face trial or not, Hoffman’s personal courage has clearly been vindicated and honoured. But it was at an enormous cost to her, and here I can write with some knowledge. Her faith in her honourable calling as a nurse in public hospitals must have been severely shaken. She faced that awful question that Wilkie and I and others in public service have faced “what do you do when you realise that a public organisation to which you have devoted your professional life and given your best, is fallible and “ it would seem on the public information about the case so far “ deeply flawed from the top down? And how lonely and exposed do you become, when you try to expose this?
The Royal Commission now exists only because of this one brave woman’s actions sustained under pressure over a long period. And perhaps, sadly, only because the public became so fired up over the fact of the doctor being foreign and recruited from abroad.
To me, it is irrelevant that Dr Patel is foreign: the system accountability issues that the Bundaberg Base Hospital and the Queensland public health system now face would be the same if he were an Australian citizen and had obtained his surgical qualifications in Australia. Why were there no proper due diligence checks made at the time of his recruitment? And why, when Hoffman began to question his record of practice in Bundaberg, was management so manifestly deaf to her concerns?
These, I believe, are the issues that most matter: not just the issue of resort to foreign-trained doctors in a public health system always chronically short of staff doctors. Though many will have an interest in framing the story in that way, one hopes that the Royal Commission’s terms of reference will allow the wider issues of public accountability and duty of care to patients to be thoroughly addressed.
These Australian stories “ Bundaberg, Wilkie, SIEV X – all raise questions about the integrity of our public institutions. In this case, ironically, they involve a State Labor government: and it took a Coalition opposition MP, and a News Limited journalist, to give a public-spirited whistleblower the support she needed to make her cry for truth heard by the nation. Otherwise, she might have been just another anonymous person, broken on the wheel of powerful organisations’ ability to cover up and deny their professional failures.
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