Hospitals failed to monitor surgeon's work says report

Health and Disability Commissioner Ron Paterson has found Tauranga Hospital and the city's Norfolk Community Hospital did not respond promptly enough to concerns raised about surgeon Ian Breeze.

The commissioner's report, released today, has implications for all hospitals in New Zealand.

Mr Breeze was the centre of controversy in 2003 when he was linked to several patient deaths.

The Medical Practitioners Disciplinary Tribunal found him guilty of professional misconduct and imposed fines and costs totalling more than $50,000 for bungling an operation.

After auditing his bowel surgery, the Medical Council put Mr Breeze on a retraining programme. He resumed duties at Tauranga Hospital early last year, under clinical direction and on severely restricted duties.

Mr Paterson has since completed a two-part inquiry into the quality of care by Mr Breeze to a number of patients he operated on over the past few years.

The first part of the investigation was finished last December, when the commissioner found the surgeon breached the Code of Health and Disability Services Consumers' Rights in four of seven cases.

Mr Breeze reviewed his practice and apologised to the four patients.

The other half of the inquiry looked at whether Tauranga Hospital and two private hospitals in the city - Norfolk and Southern Cross - took adequate steps to respond to concerns and to ensure that he was competent to practise surgery.

Tauranga and Norfolk were ruled to be at fault; Southern Cross was not.

The commissioner recommended the two hospitals review their policies and procedures.

Mr Paterson said a hospital (public or private) had an obligation to maintain and monitor the competence of health practitioners to protect patients. Concerns must be dealt with promptly and hospitals should consult with relevant registration authorities. They should also co-ordinate their actions with other hospitals.

"Patient safety must be the paramount consideration," he said.

"Although employees are entitled to be treated fairly, hospitals cannot allow patient safety to be jeopardised while employees and their lawyers squabble about their legal rights."

Mr Paterson said the interests of patients and clinicians would be better served if competence issues were dealt with "firmly and fairly in the workplace, before they escalate, before patients [and the clinician's reputation] are harmed, and before external agencies become involved".

The report (see link below) says:

* Registration authorities need to undertake competence reviews as speedily as possible.

* Privacy concerns should not prevent hospitals from sharing information about a practitioner's competence.

* The Health Practitioners Competence Assurance Act 2003 has some gaps relating to the sharing of information between registration authorities and private hospitals.

BOP District Health Board chief executive Ron Dunham said the board accepted the majority of the commissioner's findings but would raise some issues privately with him.

Tauranga woman Shirley Crowley, whose quest for answers about the death of her husband triggered the investigations, said yesterday she had been told nothing of the commissioner's report or its contents. Lionel Crowley, 65, died in December 1999 as the result of massive infection caused by a botched bowel operation.

The rulings

* Tauranga Hospital, including the Bay of Plenty District Health Board and its predecessors, failed to fulfil its obligations.

* It did not have in place a system to monitor Mr Breeze's practice effectively between July 1,1996, and December 1999 and failed to reassess earlier concerns about his practice.

* It did not respond in a decisive and timely manner to the serious concerns raised about Mr Breeze's practice in December 1999.

* Norfolk Community Hospital did not take adequate steps to respond to escalating concerns about Mr Breeze's competence.