Health Minister Rachel Stephen-Smith said the vetted locum was hired to cover gaps in the roster due to the dispute with surgeons. Photo: Ian Bushnell.
Health Minister Rachel Stephen-Smith is again locking horns with Canberra Hospital’s outgoing head of orthopedics Professor Paul Smith, who has claimed patients were harmed when the hospital engaged a locum who was not up to scratch.
In a letter last week to the Minister, Professor Smith, who has quit rather than work under a new system of pooled surgeons, alleged that three patients the locum operated on had suffered adverse outcomes, requiring further surgery.
Canberra Health Services is now reviewing those three cases.
Professor Smith said the locum was hired to work on the front line without his department’s knowledge, but when his work was observed, the locum was moved to a less risky area, only for hospital management to overrule this decision and return him to front-line surgery.
“Tragically for the patients concerned, this serves as a learning exercise for you as ACT Health Minister, your CEO and your management team, who seem to labour under the impression that a warm body in a position equals quality of care,” Professor Smith concluded in his letter.
“Incredibly, there are logical reasons why locum surgeons are locums. Think about it, this is yet another consequence of the managerialism and alienation of the clinical group championed by the ACT Health Minister, and promulgated by ACT Health Management.”
Ms Stephen-Smith said the locum had been hired to cover gaps created by the hospital’s dispute with visiting orthopedic surgeons upset at contracts moving away from fee-for-service and pooled surgery arrangements run by the operations centre.
She said the locum was credentialled and appropriately vetted with all due diligence, but because the orthopedic surgeons were not talking to the hospital executive due to their dispute over surgery management, they were not consulted as would usually be the case.
Canberra Health Services Deputy CEO Janet Zagari said the three cases raised in Professor Smith’s letter were now being reviewed.
She said orthopedics had looked at other cases, but these were the only ones of concern. Her understanding was that this was the only locum to perform surgery in the hospital.
“We’re always concerned by issues that are raised in relation to patient safety outcomes, so we’ll review those as quickly and thoroughly as possible to understand whether there is an issue of concern there,” she said.
Ms Zagari said complications did occur in some surgical cases.
“We need to be able to investigate thoroughly to understand what’s behind any issues that may arise,” she said.
Ms Zagari said there was no evidence of substandard care, but “given that concerns have been raised, we always go through a thorough investigation process to satisfy ourselves that care that’s been provided is of an appropriate standard”.
Canberra Hospital is trying to find $27 million in savings, including how visiting medical officers are paid. Photo: Michelle Kroll.
Ms Rachel Stephen-Smith said CHS would not be bringing in any more locums because the surgeons had agreed to ensure all work was covered while talks continued.
She said that of the four orthopedic surgeons who had resigned, including Professor Smith, one or two were reconsidering their positions.
As part of making $27 million worth of savings, CHS is reviewing the way visiting medical officers are paid, from fee for service to fee per session.
Ms Stephen-Smith said that of the 200 VMOs, 70 were on fee-for-service contracts, and these would be extended for six months if they were due to expire within the next six months.
She said this was so talks could occur in a “structured way that takes account of the need of both the service and the individual”.
“But the reality is that ultimately we do need to move towards contracting arrangements that are better aligned with those in other jurisdictions,” Ms Stephen-Smith said.
She rejected claims Canberra Hospital wanted to freeze out senior doctors who spoke out or that they feared retribution.
“I know that senior clinicians are very good at raising their voices when they have concerns, and I’m always willing to and happy to meet with people who do have concerns,” she said.
“I don’t have a view that there’s any retribution for people who are senior who speak out, and indeed, we often see senior clinicians speaking out on things that are important to them.
“The doors of the CEO and deputy CEO are always open to them to have a productive conversation if they are concerned about something that they are seeing, or indeed, if they have ideas about how we can improve the efficiency and the operation of Canberra Hospital and Canberra Health Services more broadly.”
Ms Stephen-Smith said she always knew the proposed changes would be contentious and some clinicians would be unhappy about moving towards a pooled waiting list for elective surgery and planned care.
She said this meant public patients on a public list would not get to choose their surgeon, but it did mean they would be seen in order of priority.
“It will always be those specialist clinicians who are identifying the urgency, triaging matters in terms of people’s category of urgency, but then it’s really important that people are being seen in turn in terms of how long they have waited, so longest wait being seen first.
“That hasn’t always been the case in the way that our specialist teams have operated.”
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