The many trials of Dr Parry

By MARTIN JOHNSTON

Women's doctor Graham Parry is now quietly trying to restore his medical reputation, damaged by a tidal wave of complaints from former patients.

Those close to the former Whangarei surgeon say he is doing well in supervised practice at Middlemore Hospital. But he won't speak publicly about the dark days when his career was derailed, even though only one case against him - a very serious case - has been upheld. He leaves it to his lawyer, Harry Waalkens, to rage about the "witch hunt".

How could one doctor attract so many complaints - 70 by one MP's reckoning - when only five would lead to disciplinary charges and only one would stand after appeals?

Parry became one of New Zealand's most investigated doctors. Between them, the Medical Council and the Health and Disability Commissioner's office looked at around 50 complaints, resulting in the disciplinary charges. That led to three guilty findings by the Medical Practitioner's Disciplinary Tribunal, but two of the verdicts were not upheld on appeal, leaving only the disgraceful conduct verdict relating to Bay of Islands woman Colleen Poutsma. On the other two charges, the tribunal said he was not guilty.

Even though most of the charges failed, the Parry saga has had lasting effects. Moves to streamline the health complaints system are in train, with the Health and Disability Commissioner's office becoming the main entry point for those with grievances.

Parry could be seen as a victim of unfortunate timing: in the context of the Gisborne cervical cancer inquiry and just a decade after the inquiry into the "unfortunate experiment" in cervical cancer treatment at National Women's Hospital, the public reaction to his alleged medical mistakes involving women turned into alarm.

A corrosive sense of suspicion of the medical establishment had developed. Despite the emphasis on informed consent, some people aren't willing to accept that surgery is inherently risky.

Parry's first steps to becoming a household name came in TV3's 20/20 programmes in September 2000 about his mistreatment of cervical cancer patient Colleen Poutsma - who died, aged 48, the following April - and the complaints of other former patients.

The Herald, too, began investigating Parry and found that ACC had made several findings against him of medical error, which it defines as essentially negligence.

But some uncertainty accompanied those findings. ACC had reported four findings to medical authorities, which then held disciplinary hearings in private. The Medical Council has said it received one referral and two others went to the then Medical Practitioners Disciplinary Committee, but none led to Medical Journal notices, a form of penalty. The fourth referral is unaccounted for.

Four days after the first TV programme, Poutsma was back on screen, heavily sedated and looking deathly, when the Medical Practitioners Disciplinary Tribunal took the unusual step of hearing her evidence early. It feared she might not survive until the hearing in Waitangi the next month.

Her appearance, her emotional testimony read by her husband Jack, and her location - in bed at an Auckland hospice - all contributed to the demonising of Graham Parry.

Her comments only added to this: "The pain and suffering throughout this time has been horrific ... My main concern is to protect other women and to prevent them from having to go through [the same experience]."

The Health and Disability Commissioner's independent prosecutor charged Parry, who qualified as an obstetrician and gynaecologist in 1976, with disgraceful conduct for inadequate care of Poutsma, including failing to perform an internal investigation when she came to him about abnormal vaginal bleeding in August 1997. He admitted his handling of her case was inadequate, but denied it was disgraceful conduct, the most serious professional charge.

The tribunal found Parry guilty, struck him off the medical register and imposed a $15,000 fine plus costs of more than $56,000. On appeal, two courts confirmed the guilty verdict and the ban on practising gynaecology, but reduced the fine to $5000 and allowed him to resume supervised practice in obstetrics and ultrasound. (In Middlemore he performs ultrasound scans on pregnant women.)

One of the appeal judges, Graham Hubble, of the Auckland District Court, noted the influence of the Gisborne cervical cancer inquiry, whose hearings overlapped the period of the Poutsma tribunal hearings.

Hubble said it was clear the public thought that with Parry and cervical cancer cases in Northland "they had on their hands yet another Gisborne-type cervical screening fiasco ... "

"The facts do not support the public's hue and cry. Dr Parry is guilty of disgraceful conduct in relation to one examination with one patient only, Mrs Poutsma."

But that hue and cry had carried at least some weight when the tribunal suspended Parry from practising, ahead of its main hearing in the Poutsma case. It said it was aware of the publicity from Poutsma's complaint and, "in fairness to Dr Parry, it has endeavoured to disregard that publicity".

"But equally, it would be irresponsible of the tribunal to ignore reports of a number of other possible complaints against Dr Parry ... and it is clear that there is now a high level of alarm present in the Northland community as a result of Dr Parry's being permitted to continue his practice."

Parallels with the Gisborne situation had been drawn earlier in the Parry saga. That inquiry, led by lawyer Ailsa Duffy QC, ran from April 10 to September 29, 2000.

Seven days before that inquiry ended, Health Minister Annette King and MP Phillida Bunkle, an Alliance minister in the coalition Government, announced a review, later headed by lawyer Helen Cull QC, of the medical mistakes reporting set-up. It was prompted partly by the Parry complaints.

Bunkle pushed for a Gisborne-style ministerial inquiry in Northland. She was supported by the Greens but rebuffed by King, who was happy to rely on the tribunal's, commissioner's and Medical Council's scrutiny of Parry and considered the expense of a full-scale inquiry unwarranted.

But the calls for an inquiry mounted as the apparent links between Gisborne and Northland grew. As well as the accusations against Parry, it was alleged that a Northland laboratory might have misread some smears from Poutsma and other women.

In the Gisborne cases, the inquiry panel later said the Health Ministry and pathologist Dr Michael Bottrill should share blame for the under-reporting of smears that led to dozens of women developing cervical cancer. Many have since died.

After a review of the Northland women's smears, the Health Ministry last year said it had not found any systemic issues in the region's pathology services that needed further investigation. But, back in 2000, public alarm kept growing as Poutsma and other women related their histories of misread smears and cancer treatment.

Bunkle met Northland women and, with Green and then National support, ambushed Labour members on Parliament's health select committee and set up an inquiry.

"Lynda Scott [National] got into cahoots with Phillida and Sue Kedgley [Green]," said Judy Keall, who was a Labour MP and the committee's chairwoman.

"We were in Dunedin for two days and shouldn't have been making a decision like that ... We weren't in a position to counteract it, like negotiating behind the scenes and getting senior people in the party to talk to them."

Keall said she tried to steer the inquiry terms of reference more on to systemic issues. "I bent over backwards to make sure that natural justice was observed. I was very concerned about the hysteria that was being stirred up by some people in the community."

Waalkens, Parry's lawyer, was livid at the committee's inquiry. "There's never been a select committee inquiry personalised into an individual where there is [already a separate] process for that type of investigation. It's unconstitutional."

Concerned the committee might be biased, he objected to Parliament against Bunkle sitting on the inquiry and also giving evidence.

Her 56-page submission was subtitled "Women who have experienced adverse effects following treatment by Dr Graham Parry". It analysed the cases of 72 women, 70 of whom recorded serious consequences from his treatment.

Keall said Bunkle was reluctant to stand down from the inquiry but eventually went voluntarily. "When we discovered she had been helping people write their submissions we had to challenge her on that ... We did not want to have the committee accused of bias."

After hearing from former patients, organisations and Parry, the committee said his number of ACC medical error findings was high. But it noted difficulty in getting accurate figures on his medical mishaps (rare but severe complications of treatment properly given) and medical errors for the more than 20 years he had been practising.

"There was no clear evidence presented to us to show his rates were significantly higher than internationally accepted best practice. Dr Parry's evidence indicated he was within accepted rates both here and overseas."

The committee said women's complaints were mainly about gynaecology rather than maternity care. "This is in keeping with the numerous letters of support received for Dr Parry, which related in the main to his obstetric practice."

In one of Parry's appeal cases, it was stated that he had received more than 120 unsolicited letters of support.

Sue Kedgley, when asked if the inquiry was justified, said it showed up systemic problems. "The guy was working huge long hours. You can't expect people to work ludicrously, dangerously long hours and then not expect that there will be cases where there are serious problems."

Not everyone is sympathetic to Parry. One complainant, Sharon Pahau, feels the legal system has let her down after the High Court rejected her appeal against a Medical Council complaints assessment committee's decision not to prosecute Parry over the way he handled her cervical cancer.

As well as alleging that Parry failed to pick up her cancer early enough, Pahau, who had surgery and radiotherapy, had smears misread by a Northland laboratory. She said she was prejudiced by not being able to take a lawyer to the committee hearing.

"There should have been a [ministerial] inquiry up here. Fifty to 60 women laid complaints. People said they wanted media attention. That's crap. We wanted an apology; we wanted answers."

Her lawyer, Antonia Fisher, said it was an unfair battle when Parry was represented by a senior lawyer, but most of the women did not have personal representation. "None were in a position to afford it."

Medical Association chairwoman Dr Tricia Briscoe believes media hostility and complaints about doctors are helping to drive them out of practice, overseas or into practising defensively, putting patients through unnecessary tests just so nothing is missed.

"We need to have a more realistic attitude to healthcare and outcomes ... a positive approach, rather than name, blame and shame. It's usually a system problem."

Health and Disability Commissioner Ron Paterson said it was right that Colleen Poutsma went public with her case. The complaints system had handled it slowly and her publicity triggered a review and changes.

But the parliamentary inquiry was unhelpful. And the publicising of other cases was "problematic" because "when you investigate what happened, it will seldom be a case of individual negligence. Many more cases were investigated by the Medical Council or this office that were not upheld ... The part that was irretrievable was the effect on the reputation of an individual."

And despite findings that Parry's clinical practice was acceptable, the impressions still linger. "People gained the impression he is a bad practitioner," Waalkens said. "I still hear comments like: 'This is another Graham Parry'."