Nationally Consistent Standards and Assessment for OTDs - Radio Interview Transcript

This time the hospital is Townsville. It's facing criticism for the appointment of a Czech vascular surgeon, Dr Patrick Tosanovski, who's currently involved in a British coronial inquest into the death of one of his patients. According to British press reports, the inquest was told that Dr Tosanovski decided to carry out a second vein graft on the patient, who was a 58-year-old mechanic, and that that decision led to his death.

The hospital and the Queensland Government are defending his appointment, arguing there's no reason why he shouldn't be practising in Queensland. But understandably, it's revived fears about standards and patient safety in the state.

With us this morning is the President of the Federal AMA, Dr Mukesh Haikerwal. Good morning, Mukesh.

DR HAIKERWAL: Good morning, Paul. How are you?

PAUL BARRY: This doctor, Dr Tosanovski, the Scottish court was told that the decision to give the patient a second vein graft was what caused his death and that reasonable professional opinion would not have backed him up in that decision, that it was basically the wrong decision.

Why have we got someone like that working in our health system?

DR HAIKERWAL: If you really want to talk about specific cases, it is obvious that this one is still under the courts in the UK, and I suppose there's no final decision come down on that. And I suppose with cases like these, there's always a difference of opinion.

I think ultimately people end up before coroners or before the medical boards and they need to be allowed for those processes to be finalised.

PAUL BARRY: I'm not suggesting we should convict him, but should we be employing him while that is - while those accusations are hanging over his head, whether he's innocent or guilty?

DR HAIKERWAL: The question is correct. How do we assess people before they come into the system? How do we make sure that when we enter the consulting room or the operating theatre that the people that are looking after us are actually fit for the task. And obviously in the case of Bundaberg, one that was very clearly focused in people's minds, we hoped that would have changed the situation.

PAUL BARRY: That was Jayant Patel.

DR HAIKERWAL: Exactly. Before the end of last year, the Council of Australian Governments hoped to have a single assessment process for all doctors from overseas entering Australian practice. Unfortunately that hasn't actually come to pass.

There's also currently another process underway, also under the COAG umbrella, which is looking at having a single national registration process.

Now, the actual standards need to be set and set high and need to be nationally applicable so it doesn't vary from State to State. Otherwise you get a situation where the very strict guides we have currently get sidestepped.

PAUL BARRY: Why hasn't this happened? I mean, you have been lobbying for it. Why has it not happened that we have - why don't we have a single way of registering these people or approving these people?

DR HAIKERWAL: Well, I mean, there's many pathways which they come through, and different States use different ways to get people into their health system. And I suppose because of the political necessity and the need to have somebody in place, sometimes the rules are bent.

We see, for instance, in Tasmania where they're actually passing Acts of Parliament to allow people that aren't fully registered under various current medical board processes to actually practise, even though they may not be fully registered, and also to practise as specialists. And those sorts of sidesteps of the system are not acceptable.

PAUL BARRY: But we seem to have a problem both ways, don't we? We seem to have a problem that sometimes people like Jayant Patel and this doctor who has an inquiry pending into his, well, something he's done, they get through. On the other hand, you've got places unfilled because the approval process takes so long. Ten months, some doctors are complaining.

DR HAIKERWAL: Well, that's right. I mean, I think we do have to work on it in two ways. One is to make sure the AMC, the Australian Medical Council, processes for processing first degrees is speeded up. And that's also a task for the State medical boards, but also the specialist colleges that check that people are fit for the task to work as independent specialists. They need to be, I suppose, cajoled to work a bit faster and to make sure they do the assessments. But they can't work till they've actually had the approval from the medical boards.

There is a concern that the people that are approaching, that are residents or citizens of Australia, are actually having more difficulty than people that are coming in on temporary visas, for instance, and then working without the same sorts of checks and balances. And it's important we have a very rigorous set of standards, nationally set standards, but they need to be then implemented regionally by each State because to implement it from a distance is really very difficult.

So there's a lot of things that we're pushing for. We also don't want to dilute the level of care, we don't want to dilute the stringency of the standards that we currently impose. We want to make sure that everybody is fit for the task wherever they've trained so that when people walk into the consulting room they know that the doctor they have is fit and competent.

PAUL BARRY: But the root of this is a problem firstly in remote or reasonably remote areas, but also, I think, overall through the whole system, isn't there, there's a shortage of specialists?

DR HAIKERWAL: There is a very significant shortage of doctors across the board, GPs and other specialists, and I think it's important that we do make sure that we have enough training positions.

Now, after many years of procrastination, the Government has actually agreed that there is a shortfall and we are seeing the number of medical students entering medical school increasing dramatically so that by 2010 we'll go up from about 1800 to 3200 doctors being graduated.

But we're not seeing any follow-through from the States in terms of specialist training posts. In order to get the independent GPs or other specialists, we need the specialist posts to be up and running so that they can actually take people and train them beyond the intern positions that are currently allocated.

PAUL BARRY: But your own profession has been criticised in this respect, too, in that the colleges have been accused of not training enough people so they can protect their own income and their own privileges. Do you…?

DR HAIKERWAL: … I hear that often and I think that's a completely false set of criteria. What's actually happening is that the college will train as many as they are asked to train. But in order to do that, they need hospital beds that are open with people in those beds being treated, and being allowed to be treated, otherwise if you have empty beds that aren't having people having operations going through, there's no way that you can actually do any training.

So the colleges will do the training as long as they have the clinical material, if you like, the clinical people that need treatment within the beds that are allowed to be treated, which isn't currently happening.

PAUL BARRY: You want to see the system made national and speeded up. How do you propose that's going to happen?

DR HAIKERWAL: Well, we think we were just about over the line with a driver's licence kind of model, where each State would do a registration process that would be recognised from State to State. Under the current proposal, we would like to see the same high standards apply from State to State, with implementation to be a State level.

There is a concern that the current proposals also bring in all health professionals under one umbrella. That would in many ways dilute the level of medical input into medical assessments, and we think that's wrong. Indeed, it would be in any other professional assessments, because people from other professions wouldn't know the sort of rigour that is required in medicine.

So what we'd like to see is the nationally set standards and an implementation at a State level and to make sure that there are proper ongoing continuing educational requirements that are met so that people are not only fit for the task at the time that they're checked but also continue to be beyond that time.

PAUL BARRY: But isn't that something that you as a body can decide? Can you not just say, this is how it will be? Who do you have to persuade?

DR HAIKERWAL: Well, obviously we have to persuade the people that are responsible for regulation, the State governments and the medical boards.

The current position of our state medical boards is in the balance because of this new set of proposals, with the proposal being a Federal overarching body. But we believe that if you have a Federal body doing all this work in all the professions with one modularised board involving every profession, not only are you diluting that need for each profession to have their own specific professional regulation, you're also causing decisions to be made at a distance from where they're needed. And the timelines will blow out and the oversight that you get from a State level organisation will disappear.

So we need to have locally responsible organisations but we need a nationally set standard. Currently we don't have that standard because each State has been saying we're very happy to have a national standard as long as you adapt ours. And of course, that's something we need to get beyond and agree to a high level national standard.

PAUL BARRY: Sounds like you need some leadership here.

DR HAIKERWAL: We need to - we're trying to give the leadership. We need to have people to actually listen to the reasoning.

PAUL BARRY: OK, thank you very much.

Ends….