One-stop health complaints shop

Wanted: a system for hearing medical complaints that gives faster results and can be easily understood. Medical reporter MARTIN JOHNSTON looks at a new review.

Patients who complain about their medical care often feel baffled by a system which frequently ignores them, a review has found.

The Government last year appointed lawyer Helen Cull, QC, to review the complex system for reporting and investigating complaints about doctors, nurses and other health workers.

Her 121-page report, published yesterday, recommends sweeping changes.

What led to the review?


The tidal wave of complaints by Northland women against gynaecologist Dr Graham Parry.

They were triggered by publicity about his mismanagement of Colleen Poutsma's cervical cancer.

He was later struck off the medical register and fined after he was found guilty of disgraceful conduct over his failure at first to pick up her condition, and his mis-handling of her case. He has appealed.

As more and more women came forward complaining about his work, it was revealed that there was a long history of authorities investigating him but there had been little co-ordination between them.

Since the Parry case was uncovered mid-way through the Gisborne cervical cancer inquiry, which also centred on a doctor's incompetence, the Government was faced with demands from lawyers, patients, and members of Parliament for a similar investigation in Northland.

The Northland Review was announced. Health Minister Annette King was repeatedly pressed for a Gisborne-style inquiry, but said it was not warranted.

What was Helen Cull asked to do?


She was asked to review the legislation covering the Health and Disability Commissioner, the Medical Council, the Medical Practitioners Disciplinary Tribunal and the ACC medical misadventure unit.

She was also urged to interview patients.

What are the main problems of the present system?


It is cumbersome, confusing and slow for patients and health workers, the report says.

Up to 14 agencies could be involved in handling one complaint: the employer, ACC, the Health and Disability Commissioner, the commissioner's director of proceedings, the Medical Practitioners Disciplinary Tribunal, the Medical Council, a complaints-assessment committee of the council, the Medical Defence Union, the College of General Practitioners, a coroner, the police, a mortality review committee, the courts, and the Complaints Review Tribunal.

Other problems include:

* Lack of co-ordination between the various agencies and a failure to share information that might lead to repeat offenders being picked up.

* Inadequate funding for the commissioner's office to handle all the complaints it receives quickly enough.

* Delays in the investigation of complaints and in receiving payments from ACC in the case of medical misadventure.

* Restrictions on taking medical cases to the Complaints Review Tribunal.

Are patients listened to when they make a complaint?


No was the answer given to Helen Cull.

"If a consumer rang the management or complaints mechanism of the hospital and used the expression 'concern' rather than complaint the hospital did not record it as a complaint nor deal with it accordingly."

Another major theme in her interviews with patients was their feeling they were patronised, disbelieved or treated dismissively by hospitals, doctors or other health-service providers.

One patient reported being told by hospital management and a clinician that "she should be grateful she was alive and there were no clinical problems with her management." This contradicted advice the woman received from another hospital's specialists.

How serious are the delays?


One example is the case of a complaint against a Wellington midwife after the death of a baby.

It was dragged through the system for nearly four years and involved the commissioner, her director of proceedings, ACC, the Nursing Council, the Complaints Review Tribunal and the High Court.

The average time for the Health and Disability Commissioner's office to take a complaint through to resolution is 18 months to two years.

Medical Council complaints committees took 49 weeks on average to reach a determination from 1996, but this has been cut significantly this year.

It takes three years on average to get a case through the Medical Practitioners Disciplinary Tribunal - including court appeals.

ACC takes 42 weeks on average to process medical misadventure claims if they are accepted and 46 weeks if they are declined.

What is the main recommendation of the Cull report?


Although it makes a number of proposals for short-term changes, the key suggestion for a long-term solution is that the commissioner's office be beefed up to become a "one-stop shop" for complainants.

Helen Cull wants it to be alone among health authorities in being responsible for investigating complaints, or taking other action such as setting up mediation.

It would even take over ACC's role of deciding whether there has been a medical error or mishap.

She wants a disciplinary tribunal or court set up to judge complaints against all health workers. Appeals would be to the High Court.

Complaints against doctors are now heard by the Medical Practitioners Disciplinary Tribunal; those against nurses by the Nursing Council. Many other branches of healthcare have similar arrangements.

Under the Cull proposal, the tribunal would be headed by a district court judge, with equal numbers of trained lay people and members of the profession of the health worker under investigation.

That would mean doctors would lose their current majority on the medical tribunal, something the Medical Association has already vowed to oppose.

Its chairwoman, Dr Pippa MacKay, has also spoken out against having a single tribunal.

She thinks these changes would make it difficult for doctors to be judged against the standards for their profession.

Should patients' rights to claim damages change?


Helen Cull is critical of the fact that ACC claimants can wait up to 15 months for compensation after a medical failure.

She recommends giving the disciplinary tribunal or court - and until it is set up, the Medical Practitioners Disciplinary Tribunal - the same powers to award damages as the Complaints Review Tribunal.

It can award damages of up to $200,000 but the Health and Disability Commissioner's office has taken only two cases to it.

Only one of them resulted in an award of damages. The sum was $20,469.

Does the report call for better monitoring of health workers who are subject to complaints?


Yes. It recommends the creation of a national database in the commissioner's office for recording accepted claims or proven complaints against health workers. It would also record their workplaces.

This would operate as a red-flag system to highlight any developing patterns of failure by health workers or facilities.

The report notes that until recently there has been little or no information shared between ACC, the commissioner's office, and the Medical Council.

During her review, Helen Cull reports, she looked at a number of cases in which, prior to any disciplinary charges, a pattern of repeated ACC medical mishap claims had emerged but was not identified or acted on.

The lack of a centralised information system "impedes a timely identification of a practitioner whose practice is below acceptable standards."

When can health workers be suspended?


There is no power now to suspend doctors prior to a disciplinary charge being laid and during an investigation, even if a potential public risk has been identified.

The report recommends giving the Medical Council power to temporarily suspend or place conditions on a doctor's practice when the public is at risk.

In line with changes already mooted, the report also recommends that health workers should have to report their colleagues if they suspect incompetence.

At present, doctors have to report colleagues only if they believe the person is unfit due to a mental or physical condition.

What happens overseas?


Similar one-stop shops for health complaints have attracted interest in Britain and Australia.

Britain has set up the National Clinical Assessment Authority, which Helen Cull says is "the focus of the Government's co-ordinated approach to better protection for patients and better support for doctors."

What has been the New Zealand Government's response to the Cull report?


Mrs King agreed with the need to streamline the health complaints process. She made the report a public discussion document and called for submissions from health workers and consumer groups by May 4.

She also noted that some of the Cull report's recommendations reflected proposals already being considered.