Intended for healthcare professionals

Rapid response to:

News

Surgeon sentenced to seven years in jail for patient deaths

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3646 (Published 06 July 2010) Cite this as: BMJ 2010;341:c3646

Rapid Response:

The Patel case and its consequences for health workforce governance in Australia

Bob Burton [1] reports on one reason that 1 July 2010 was a historic
day in Australian health workforce governance. Jayant Patel, former head
of surgery at the Bundaberg hospital in Queensland, was sentenced to seven
years in gaol following a guilty verdict on three counts of manslaughter
and one of grievous bodily harm. This was the very same day that a new
national agency commenced operation across Australia. Some ascribed its
creation to the regulatory failure the Patel case demonstrated.

The Australian Health Practitioner Regulation Agency (AHPRA)
constitutes a new national approach to health workforce governance.
Following an inquiry by the Productivity Commission (an independent
government agency) into Australia's health workforce in 2006 [2] the Prime
Minister and heads of state and territory governments decided to adopt a
national approach to health professional regulation. This single
organisation replaces an array of bodies across the country. We now have
legislation in each of our states and territories that rests authority in
the national body. This will now overcome some procedural issues within a
single country that also present challenges across national borders. [3]

AHPRA's structure brings together health professions under the one
body. Ten professions are included - chiropractic, dental, medical,
nursing and midwifery, optometry, osteopathy, pharmacy, physiotherapy,
podiatry, and psychology. On 1 July 2012, the next tranche of professions
(Aboriginal and Torres Strait Islander health practitioners, Chinese
medicine practitioners, medical radiation practitioners, and occupational
therapists) is set to join the new national structure.

AHPRA brings together the responsibility for two distinct elements of
regulation: registration and accreditation. Registration focuses on the
expectations and obligations of individual practitioners, and
accreditation focuses on the educational requirements of each profession.
For each profession there is a single board (e.g. Medical Board of
Australia), which has responsibility for both these elements, but all 10
boards operate under standard AHPRA measures. [4]

Australia has opted for a streamlined, centralised model of health
profession regulation that is distinctive on the international scene. The
United Kingdom comparatively has nine regulatory bodies that operate under
separate legislation. These govern 30 professions with a separate Council
for Healthcare Regulatory Excellence having oversight of the system. In
New Zealand profession specific bodies operate as responsible authorities
under a single piece of legislation. In the United States of America and
Canada the bulk of regulation is managed at a state/provincial level. In
establishing AHPRA Australia has made significant progress in
reformulating arrangements governing accreditation and registration of its
health workforce. [5] But what led to this reform?

The circumstances that led to the conviction of Jayant Patel provide
a tangible demonstration of the implications of regulatory failure. The
reliance of the Australian health system on doctors educated outside of
Australia was not news. [6] However, a journalist using a simple Google
search to uncover the fact that a rogue practitioner did not disclose
previous disciplinary actions from the United States certainly was. [7]

General media coverage [8] and specialist commentators [9] have
explicitly linked the establishment of the new scheme with the incidents
in Bundaberg. The Queensland Health Minister and Premier reportedly went
further. They claimed that the new national regulatory system was
introduced because of the lessons learnt and that this, together with
additional changes at state level, has drastically curtailed the
likelihood of a recurrence. [10]

There is certainly a precedent for crises delivering change in the
regulatory circumstances of health workforce governance. In the UK the
cases of Harold Shipman (the general practitioner convicted in 2000 of the
murder of 15 patients) and of the Bristol Infirmary (high death rate of
paediatrics cardiac patients) highlighted regulatory problems and that led
to substantive reform. [11&12] In Australia, events at Bundaberg have
similarly been described as the "catalyst for long overdue reform." [13]

But do these linkages provide only an expedient but incomplete
explanation? It is more likely that the brave new world of health
workforce governance under AHPRA comes in response to a complex web of
problems and challenges beyond the experience now synonymous with Patel
and Bundaberg. This is the subject of our ongoing research; exploring the
ways in which this particular regulatory development has been shaped by a
myriad of individual events and crises, various agendas, deliberative
policies, and other factors requiring further exploration and explanation.

References

[1] Burton B. Surgeon sentenced to seven years in jail for patient
deaths.BMJ. 2010;341:c3646.

[2] Productivity Commission. Australia's health workforce. Canberra:
Commonwealth of Australia; 2006.

[3] Dyer C, Tuffs A. Cross border regulation of doctors. BMJ.
2010;340:c3502.

[4] Walton, M. Australian Health Practitioner Regulation Agency:
national law [Internet]. Presented at HealthGov meeting, Sydney, 2010 Sep
[cited 2010 Oct 10]. Available from:
http://sydney.edu.au/health_sciences/healthgov/conference_papers/AHPRA%2...

[5] Palmer G, Short S. Health care and public policy: an Australian
analysis. 4th ed. Melbourne: Palgrave Macmillan; 2010.

[6] Hawthorne L, Birrell B. Doctor shortages and their impact on the
quality of medical care in Australia. People and Place. 2002;10(3):55-67.

[7] Thomas H. Dissecting death. The Sunday Mail. 2010 Jul 4;53.

[8] Barrett R. National accreditation the latest 'Patel reform'. The
Australian. 2010 Jul 3-4;10.

[9] Walton M. How the Patel case has changed the world of health care
for ever. 2010 Jul 5 [cited 2010 Oct 10]. In: Crikey [Internet].
Melbourne: Private Media Pty Ltd. Available from:
http://www.crikey.com.au/2010/07/05/how-the-jayant-patel-case-has-changed-
the-world-of-health-care-for-ever/

[10] Marszalek J. Patel-type saga unlikely to occur: govt. The Sydney
Morning Herald [Internet]. 2010 Jun 30 [cited 2010 Oct 10] Available from:
http://news.smh.com.au/breaking-news-national/pateltype-saga-unlikely-to-
occur-govt-20100630-zkeb.html

[11] Allsop J. Regaining trust in medicine: professional and state
strategies. Current Sociology. 2006;54(4):621-36.

[12] Salter B. Medical regulation: new politics and old power
structures. Politics. 2002;22(2):59-67.

[13] Harvey K, Faunce T. A critical analysis of overseas-trained
doctor (otd) factors in the Bundaberg Base Hospital Surgical Inquiry. Law
in Context. 2005;23(2):73-91.

Competing interests: No competing interests

04 November 2010
Fiona J. Pacey
PhD student
Prof Stephanie D. Short, and Dr Kirsten Harley
Faculty of Health Sciences, University of Sydney