Dialogue: Just what have I achieved after two years of typing?

After Amanda Garden died at Middlemore Hospital in 1998, her family complained about her care and the way they had been dealt with.

The Health and Disability Commissioner, in response to this complaint, has criticised South Auckland Health for being "lax and insensitive" in its handling of the death of the 21-year-old cancer patient.

Commissioner Ron Paterson said that while Ms Garden's death could not have been prevented, she was not treated with appropriate care and skill.

Authorities should continue to monitor Middlemore's care systems, he said, even though the hospital had made improvements and apologised to the Garden family.

But BILL GARDEN says he has little confidence the health system will mend its ways, even after a scathing report on his daughter's death...

Last week, the Health and Disability Commissioner reported on the death of 21-year-old Amanda Garden at Middlemore Hospital.

When the health care of New Zealanders appeared to be coming apart, commissioner Ron Paterson's conclusion that South Auckland Health had not treated Mandy with appropriate care and skill received front-page coverage.

If people so chose, they could read the brief summary of the tragic experience this young woman was put through. I have held the Herald in my hands many times, but never felt quite as euphoric as I did in that instance.

My euphoria was not long-lived. Reading the article I heard myself ask: "What exactly have I achieved?" It was good to see verification we had got it right - more right, I am sad to say, than I had ever imagined.

And, yes, South Auckland Health had been smacked on the hand, and that was sort of good.

And when they make mistakes in the future, apparently systems are in place and families will no longer have to wait two years for an apology. (The working party must still be out on the content if the piece of paper they have just issued me is anything to go by.) But, in fairness, they were at least saying publicly that they were apologetic.

They were, however, a little ambiguous, talking about weeks when it was months. They said Mandy was anxious to leave the hospital as if that was justification for what they didn't do right. Who has ever heard of anyone not being anxious to leave a hospital?

But the question that keeps haunting me is just what substantial benefit my two years of pounding the keyboards has actually delivered.

I have been kidding myself that pushing this investigation was somehow going to make a difference; that by highlighting Mandy's and our experiences it would somehow begin the journey of making hospital managements take responsibility.

It would assist the process of putting a human face on our health delivery system and help to get rid of the Yes, Minister attitude. And, most importantly, it would give the consumer a voice.

I wanted to attract attention. I wanted to awaken those values that start where the blood vessels meet - that somehow we could get away from the sort of values that begin where the linings of pockets are sewn together.

My intent was to give Mandy's life a sense of purpose - by relating her experience to all and sundry, to make the health providers put in place quality management systems, so that her cruel death would never be repeated.

Then in the next world she would give me a big hug and say, "I am glad you didn't go in with the machete and the hand grenades, Dad. Thanks for using my death in a constructive way, for making it a meaningful experience."

Opening Kidz First for sick children is a wonderful gesture and public relations exercise, and perhaps along the way we can open Familyz First centres for the grieving mothers, fathers, daughters and all the rest of those people who have come out of the woodwork these past few years - people who can't get hearings for tragedies that visit them.

Our evaluation of what is happening around us, our consideration for other people's troubled experiences with life, our sense of responsibility, our empathy cannot be simply an interaction with our inner being somewhere between the One News and Coronation Street, no more than it can be the couple of paragraphs in the morning paper which consumes our minds for the time it takes to butter our toast.

At this moment I feel impotent, I feel frustrated.

This investigation into the circumstances surrounding my daughter's death is absolutely worthless without quality management systems being put in place. Middlemore says they are in place. I have my doubts.

People want more than bland generalities which say absolutely nothing and cannot be verified.

We want to know what these systems are, if they have been monitored, who is monitoring them, how often, and will they be monitored in the future - before the next death?

South Auckland Health's statements appear so general that they could have been driven by knee-jerking.

I also have little confidence in the Government agencies which have been advised of the failings in Mandy's care, and who, I am told, will somehow oversee Middlemore.

Have they the means, or for that matter the will, to support, drive, oversee and implement systems?

They, too, are part of the problem. They have failed to challenge as we, in turn, have failed to demand what is our due. The health system has been undersold by most politicians and most bureaucrats for a decade and more and we, the consumer, have chosen to turn a blind eye.

Now the chickens are coming home to roost.

We go through life believing tragedy is something that happens to somebody else.

We need to each put mechanisms in place to remind ourselves that perhaps the next one in the queue is us. And isn't that an exceptionally good reason to ensure we think seriously where we are at, and then add our voice to the debate?

I can't debate whether Mandy's death from cancer was inevitable. I don't have that knowledge. They say she was likely to die. If they are correct, it would have been selfish beyond comprehension to want her life prolonged.

What I have been unable to accept is the manner of her death, and the terrible suffering that we, her family, saw her endure.

What the investigation identified is that this hospital failed Mandy, failed her mother, failed her father, her partner, her brother.

An analogy is the terrible tragedy of being informed that your child has been run over by a bus. For us, it was like standing watching the bus run over our child. It wasn't really the bus driver's fault; she had been pushed in front of the bus - a freak accident.

But it seems that this bus didn't have very good brakes, the tyres were a bit shoddy and the driver really did need to have taken a little more care, had a little more training before being permitted behind the wheel.

Still, the bus was never going to be able stop in time, so does it really matter? And if the bus company refuses to take responsibility for putting the poorly equipped driver on the road, or for the state of their vehicle, does that matter when there was going to be a victim irrespective?

When you read the commissioner's report, you realise it wasn't just the brakes, the whole bus was suspect. Not only was there no maintenance, there wasn't even a manual.

And there will always be that doubt in our mind about what the outcome might have been had the bus company had well-maintained buses and proficient drivers.