The former independent health service, Djerriwarrh Health Services, in Bacchus Marsh, Victoria provided a range of medical services, including maternity care on the fringes of Melbourne, in a semi rural setting. Over a five year period to 2013 with substantial population growth, maternity activity peaked at over 1,000 births, a steep increase in a relatively short period of time.
In March 2015, the Victorian Health Department was notified by the public body commissioned to register maternal deaths, of a cluster of perinatal deaths at Djerriwarrh Health Services. The Health Department commenced an independent review by a senior obstetrician, Prof Euan Wallace, now Secretary of the Department of Health. That review precipitated a number of actions and led to a more dramatic reform of quality and safety activities in the Victorian health system.
Arising from these reviews was also consideration by the Medical Board of Australia (MBA) of the actions and responsibilities of the then Consultant Director of Medical Services, a person of some regard and reputation (Dr G).
The MBA took action against Dr G, and other practitioners, under the Health Practitioner Regulation National Law (Victoria) 2009 in relation to allegations of professional misconduct, unprofessional conduct and/or unsatisfactory professional performance.
In essence, the allegations were that:
- Dr G accepted and continued in a position as a medical director in circumstances where Dr G knew, or ought to have known that Dr G could not adequately fulfil the requirements of the position to ensure the safe delivery of clinical services.
- Dr G accepted and continued in the role of medical director without requiring a clear and documented statement of expected professional obligations and duties.
- There were deficiencies in Dr G’s performance in ensuring safe delivery of clinical services. (These related to performance reviews of doctors, record keeping, credentialing and scope of practice and addressing identified risks).
Whilst it was acknowledged that the pressures placed on Djerriwarrh Health Services and its staff to perform in a time of substantial growth in demand for health services, particularly maternity services in the area, nonetheless the Tribunal noted that expectations for someone in the role of medical director still required high standards of care and performance.
In late 2011, Dr G accepted a role as Consultant DMS on a part time basis anticipating four on site day visits per year. The MBA submitted that whilst it was not assumed that Dr G had responsibilities of a full time medical director, the role did contain inherent responsibilities of the title “Medical Director”. The Tribunal considered a number of allegations in relation to the performance and responsibility of Dr G:
Allegation 1
The Tribunal was satisfied that Allegation 1 was proven that Dr G’s performance and/or conduct was below and/or substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience, in that Dr G accepted and continued in the position of the Consultant Director of Medical Services in circumstances where she knew or ought to have known that the requirements of that position could not be adequately fulfilled so as to ensure the safe delivery of clinical services.
It is inherent in the conclusions of the Tribunal that, notwithstanding that Dr G may have accepted a role which did not provide enough time or resources to enable Dr G to carry out all of the inherent tasks of the position, the Tribunal concluded that there are nonetheless essential elements of such a role which were not performed or performed adequately.
Allegation 2
It was alleged that Dr G accepted and continued in the role of Consultant DMS without requiring a clear and documented statement of her expected professional obligations and duties.
It was accepted that Dr G was engaged under an unusual arrangement, not typical of the functions of a DMS. Nonetheless, it was alleged that Dr G accepted the role without clear and documented statements of professional expectations, obligations and duties. The Tribunal accepted that the allegation was proven.
Allegation 3
It was alleged that Dr G’s performance and/or conduct was below the standard reasonably expected in that Dr G failed to adequately ensure the safe delivery of clinical services by –
- Undertaking adequate and appropriate performance reviews of medical staff.
- Ensuring medical staff documentation was correct and appropriate.
- Ensuring that all medical staff were appropriate credentialled and working within the limits of their defined scope of practice.
- Failing to follow up on whether the health service had addressed the extreme risks identified with respect to medical staffing in the Obstetric Unit.
The Tribunal accepted these allegations as proven.
The Tribunal, having found all of the allegations proven, ultimately made orders under the Health Practitioner Regulation National Law (Victoria) 2009 that:
- Dr G is formally reprimanded.
- The medical registration of Dr G is cancelled.
- Dr G is disqualified from applying for re-registration of medical registration for a period of ten years.
The sad history of Djerriwarrh Health Services, which was subsequently subsumed within the larger metropolitan Western Health service, has involved consideration of the professional conduct of a number of individuals. It is some time since these events and many careers have been affected.
What are the lessons for medical practitioners, particularly medical administrators?
To some extent the decision in relation to Dr G related to the specific facts of this particular case. However, there are some generalisations that can be drawn from these events.
- Acceptance of a role as a medical administrator with implicit responsibilities for oversight of the quality and safety of health care cannot be overlooked and must be met.
- If the contractual allowances for the role do not match the responsibilities of the role, then a medical administrator should be wary in accepting such a position.
- Having accepted such a role, the inherent responsibilities for safety and quality will need to be addressed because of the standards expected in such a role and the inherent responsibilities for performance and conduct implicit in being a registered health practitioner. Taking on the role of a DMS, however titled or however described, still implies these minimum standards.
This case serves as a warning for all medical administrators of the broad obligations of registered health practitioners involved in roles of health care oversight and administration.
How we can help
For further information and what it will mean for your organisation, please contact Michael Gorton AM or another member of our expert Health Law team.
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