Gisborne Hospital Report - Health and Disability Commissioner

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Gisborne Hospital 1999 – 2000 Operating Theatre Protocols anaesthetic machine. The Charge Anaesthetic Technician orders anaesthetic equipment. 2.16 There were at the relevant time six anaesthetic technicians at Gisborne Hospital. Of these, three were fully registered, and two of the others were in the process of training when Dr Lucas arrived. 2.17 Dr Lucas had not worked with anaesthetic technicians before coming to Gisborne. He did not know what their role was and who they were answerable to administratively. He thought that they came somewhere below a nurse. An anaesthetic technician stated: 2.18 Dr Lucas stated: “Dr Lucas said he was used to working alone. I got the feeling that he didn’t like technicians doing anything. In fact he wanted the technician out of the room.” “I queried whether they are answerable to the nurses because on occasion when I asked the chief technician for a certain item or piece of equipment, like for example, the famous straps [theatre table restraints] the chief technician said that she would have to take that [request] to the charge nurse. The theatre technician’s role job status and training status was never clearly defined to me by anyone. I got the sense that they were not as trained as nurses and that they were assigned to help the anaesthetists. I observed anaesthetic technicians did errands in theatre.” 2.19 There was some confusion about who the technicians in theatre reported to with different accounts given to the investigation team of the reporting lines. This was evidenced by the confusion amongst technicians and other theatre staff about who was responsible for the technicians’ performance appraisals. THL advised that the anaesthetic technicians report to the Theatre Manager, who is responsible for their appraisals, but during anaesthesia the technicians are responsible to the anaesthetists. Dr Lucas’ orientation to theatre 2.20 The Human Resources Department co-ordinates the induction programme, which is now run monthly. Each department is responsible for inducting new members of staff to that department. 2.21 Dr Lucas described his orientation as follows: “When I arrived at Gisborne Hospital I was anxious to start my job. I was concerned that it took about a week for me to be taken through the orientation process in the hospital. I thought that this process could have been completed in a day because all I needed were some lab coats, a pager, a cell phone, to have my picture taken and arrangements made for salary payments.” 71
Gisborne Hospital 1999 – 2000 Operating Theatre Protocols 2.22 Dr Lucas’ orientation programme was co-ordinated by the Charge Anaesthetic Technician. The Charge Anaesthetic Technician described Dr Lucas’ orientation to theatre as follows: “On his first day he was shown all the equipment and what was available. Dr Lucas asked about the role of the anaesthetic technicians. It was explained to him that he would always have an assistant in every general anaesthetic case. [The Charge Anaesthetic Technician] explained that anaesthetic technicians were not the equivalent of nurse anaesthetists. Dr Lucas said that nurse anaesthetists do most of the work and have an overseer anaesthetist. Dr Lucas was happy that someone would be allocated to him, specifically for anaesthetics and not to be shared with the surgical side.” 2.23 The Head of Department (Anaesthesia) advised that he: “spent a lot of hours going over pre-operative assessments, the lists, his core responsibilities and duties with Dr Lucas as part of [his] induction. I tried to make him feel at home. I spent time with him socially, inviting him to my home. Dr Lucas spent the whole day with the senior anaesthetic technician who showed him around the hospital, including ICU. His role in the department was explained to him and the complementary role of staff.” 2.24 Dr Lucas advised that he was not aware of any theatre protocols while he was at Gisborne Hospital and he was not invited to read any theatre protocols. Dr Lucas advised that usually protocols come in a binder that is about four inches thick and he was not sure in fairness whether he would have sat down and thumbed through the theatre protocol if it had been presented to him. THL stated that staff clearly recall that Dr Lucas was either given the orientation manual prior to his arrival or upon arrival. 2.25 Dr Lucas advised he was given a small Department of Anaesthesia protocol binder but this mainly consisted of history and physical requirements. He was not given the orientation manual, relating specifically to THL’s processes and procedures, provided to new junior doctors at Gisborne Hospital. 2.26 Dr Lucas stated in his telephone interview: “No-one from Tairawhiti Healthcare ever discussed with me what was expected of me in the anaesthesia room. I was shown the anaesthetic equipment by the Head of Department (Anaesthesia). The machine was one I was familiar with, as were the anaesthetic agents.” 2.27 Dr Lucas did not receive any formal induction in terms of Maori culture and protocols. THL said the Group Manager (Hospital) referred Dr Lucas to the Maori Health Manager and also advised him to look at the Code. Dr Lucas informed me that he did know about the Maori Health Manager and sought his advice and help about Maori patients on at least two occasions. Dr Lucas said he enjoyed the enrichment of Maori culture: “I made a point of going to the 72
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GISBORNE HOSPITAL 1999 - 2000 A rep
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Table of Contents Page Executive Su
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1. BACKGROUND EXECUTIVE SUMMARY 1.1
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3. THE ENVIRONMENT 3.1 My investiga
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pathologist, staff shortages and pr
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Gisborne Hospital 1999 - 2000 Intro
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Gisborne Hospital 1999 - 2000 Patie
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RECOMMENDATIONS Quality Assurance S
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Gisborne Hospital 1999 - 2000 Recom
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Gisborne Hospital 1999 - 2000 Recom
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APPENDIX NZNO LETTER TO MINISTER OF
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11. The anaesthetist had a practice
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THE ANONYMOUS LETTER The anonymous
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GLOSSARY ABBREVIATIONS A&E A,T&R AQ
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Gisborne Hospital Report - Health and Disability Commissioner

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