Dr Trevor Mudge, AMA Vice-President, with Jon Faine, Radio 3LO

As we said yesterday, at one stage, a nurse from the Alfred under contract to the Grand Prix Corporation was ordered by the Deputy Medical Director of the race, a Dr Temme, to change the patient's medical history so that in effect the record stated that even though the doctors had declared Mr Beveridge to be dead he wasn't dead until he arrived at the Alfred. It almost means you can't die under those rules. Under the Grand Prix Corporation's rules you can't die at Albert Park. You can only die once you're removed from the race site.

And as I asked John Harnden yesterday, is that because you just don't want to have to stop the race in the event that someone's killed in a collision? He denied that yesterday.

But there are aspects of the ethics of the doctor's practises that seemed to me to require further scrutiny.

Trevor Mudge, from the AMA, good morning to you.

MUDGE: Good morning, Jon.

FAINE: And you're involved in the deliberations on ethical standards for the AMA. Is that correct?

MUDGE: I chair the AMA's Ethics Committee, yes.

FAINE: I've sent you five pages of the relevant extracts from the Coroner's findings surrounding, in particular, those events that I've just described. The alteration of medical records on a particular doctor's instruction what do you make of that? Is that proper behaviour?

MUDGE: No, I don't think it is proper behaviour. Of course, it makes no different to the clinical outcome in this unfortunate case. But it does remain an example of a very important principle that doctors around the world are very concerned about, and that is the interference with the clinical independence of the medical staff, medical and nursing, by the third-party payer to whom they are contracted.

That's been our argument against managed care and the power that the health funds in Australia have been given by the previous Labor Government by virtue of contracts between doctors and funds. It's terribly important that doctors retain the ability to fulfil their ethical obligation to consider the patient as paramount in the contract and to resist the pressure from third parties, be they governments or big business, to conform to what the third party would like to see by way of medical treatment.

FAINE: Doctors have a sworn obligation to do what's best for the patient. What happens when they are also under contract to somebody for quite different priorities, usually commercial, and they're therefore finding themselves torn between the two? Is this an illustration of exactly what can go wrong?

MUDGE: Yes, it's a pretty good illustration of exactly what can go wrong. It's not confined to business, of course, it's governments as well. Around the world, for example, there are a number of countries in which doctors are required to bend the truth, if you like, by governments.

Governments, well, even in this country, are not happy about doctors, say, in charge of an accident and emergency department in a public hospital, whistle-blowing and saying that conditions here aren't good enough for our patients. Because the doctors are employed by the government they are often reluctant to speak out, where really they should be speaking out on behalf of patients. So we are very concerned about the importance of the doctor/patient relationship. The AMA often goes on about that, but it's important not to us, but to us as patients and to the population at large.

FAINE: If somebody's done the wrong thing ethically here, have they also done the wrong thing under the law, and if so, what should be done and by whom?

MUDGE: Responsibility for regulation of ethical behaviour by doctors lies with the Medical Boards in each state. Now, I mean, this is this particular instance, as I said, looks very unfortunate. It's not, however, something that's altered the clinical outcome. I think, really, what it should be doing is sounding an alarm bell for Australians to start to look at the importance of their doctor's independence. If your doctor's employed by a third party, then your doctor is under pressure not to give you the sort of advice that is necessarily in your best interests. Doctors have to resist that pressure.

FAINE: Do you propose to do anything about it?

MUDGE: We propose to continue to make representations to governments and to publicise in this sort of circumstance, and others, the very grave dangers for society of having medical decisions impacted upon by the concerns of third party payers.

FAINE: So here we have Dr Temme, the junior medical officer for the Grand Prix, instructing a nurse to change a patient's records so that what has happened is recorded as having not happened, but no one's going to do anything about it.

MUDGE: The Medical Board has responsibility to do something about it. The Medical Board feels that that is behaviour that ought not to be countenanced. I mean, I think that on an ethical level it's certainly behaviour that should not occur, but who is the villain in this piece, the doctor or the $10 billion industry of Formula One racing?

FAINE: Well, doctors should be able to say to the industry, 'Well, you mightn't like me to do things that way but I have obligations that are of a greater order than your commercial needs', but I'm concerned that it's nobody's job here to do anything about it. I mean, I presume the Medical Board don't initiate these sorts of inquiries off their own bat. It usually comes from somebody else, and it would seem that the Coroner's going to make some findings of fact here and then nothing's going to happen.

MUDGE: The Coroner often refers matters to the Medical Board and the Coroner would have to decide in this matter whether he wished the Medical Board to take action. I mean, around the world there are far more significant instances of interference by third parties, as I said, including governments. If you look at South Africa, South Africa has a major problem with AIDS. Something like 20 per cent of its population are HIV positive. South Africa doesn't have the funds to provide anti-HIV drugs for its population, and so its doctors have been told by no less than Thabo Mbeki that actually AIDS has nothing to do with the HIV virus. In other words, distorting the scientific truth to fit a political end.

Now, that's another example of interference with due process by third parties. Who is the villain there?

FAINE: Thank you for your time this morning.

MUDGE: You're very welcome.

Ends