Roman Hasil and the Whanganui DHB - Health and Disability ...

More documents

Recommendations

Info

Health and Disability Commissioner INTRODUCTION On 9 March 2007, I initiated an inquiry into the standard of care provided by Dr Roman Hasil at Wanganui Hospital, the steps taken by the Whanganui District Health Board (the DHB) to ensure that Dr Hasil was competent to practise, and the measures put in place to supervise, monitor and audit his work. The inquiry was prompted by a complaint to my Office, information provided by the DHB, and community concern about failed tubal ligation procedures undertaken by Dr Hasil. On 24 April 2007, the inquiry was extended to include the steps taken by Dr A to ensure that Dr Hasil was competent to practise. This report examines the quality of care provided by Dr Hasil, and in particular to Patients A and B on whom he performed an unsuccessful laparoscopic sterilisation procedure, and Patient C, whose ovaries and Fallopian tubes he surgically removed. However, it is primarily about the adequacy of the steps taken by the DHB to identify and respond to concerns about his competence and fitness to practise. The terms of reference for the inquiry are set out in Appendix 1, and the investigation process is detailed in Appendix 2. I am hopeful that this report will provide guidance to hospitals and other providers on how to respond to similar situations. INFORMATION GATHERED WANGANUI HOSPITAL, OBSTETRIC AND GYNAECOLOGY SERVICES Whanganui DHB is the fourth smallest DHB in New Zealand and serves a population of about 63,000. Wanganui Hospital is the base hospital and provides secondary services to the population. The DHB’s management is led by the Chief Executive Officer (the CEO). The CEO is responsible for three divisions — planning and funding, corporate, and provider divisions. There is a general manager, public hospital and health services, and there are four clinical services, each headed by a service manager, and a clinical director. Each clinical director carries a clinical and administrative workload. An organisation chart and a list of the key personnel are attached as Appendix 3 and 4 respectively. In 2005, Dr A was the Clinical Director of Surgical and Support Services and head of the department. He also had a clinical workload as an obstetrician and gynaecologist. 1 The management of the Department of Obstetrics and Gynaecology was split — the obstetric service was managed by the Service Manager, Community and Rural Services (Service Manager B), and the gynaecology service was managed by the Service Manager, Surgical and Support Services (Service Manager A). 1 Dr A resigned from this position with effect from 4 September 2006. Dr D is currently the Clinical Director, Surgical and Support Services. 8 February 2008
Opinion 07HDC03504 The department had funding for about 3.4 full-time equivalent consultant positions, but had not been staffed to this level for some time. Immediately prior to the employment of Dr Hasil, the consultant obstetricians and gynaecologists were Dr A, Dr B and a third consultant. They comprised a total of approximately 2.3 full-time equivalents. 2 Dr A and Dr B also worked in private practice in Wellington and Palmerston North respectively. As a general rule, Dr A had outpatient clinics on Tuesday to Friday, and theatre on two days. He worked in private practice on Mondays. Dr B had colposcopy outpatient clinics on Monday mornings, theatre on Monday afternoons, and outpatient clinics on Tuesday mornings. Dr B was on call on Mondays and on every fourth weekend, which included Friday, Saturday and Sunday. The third consultant shared the rosters until his retirement in late 2005. There were no registrars in the department because the hospital was not accredited by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) as a training post, owing to its size. Since 2000, the DHB had been actively looking for consultant obstetricians and gynaecologists to join the department. Over the years of trying to fill the vacant consultant post, it did not receive one expression of interest from within New Zealand. As the recruitment efforts were fruitless, clinical staffing levels remained a challenge. The shortage of clinical staff placed considerable pressure on the department. The vacant position had been filled briefly by various locums, but it became increasingly difficult as the third consultant moved towards retirement in late 2005. Dr A said that he worked a 1 in 2 on-call roster for about four years. He addressed the Board on two separate occasions about the difficulties in recruiting staff. The DHB’s Medical Advisor, Dr C, said that recruiting a specialist in obstetrics and gynaecology to Wanganui Hospital was an ongoing problem for Dr A because of the oncall roster. Dr C stated that the DHB assisted as best it could, but ultimately the responsibility was Dr A’s. The assistance consisted of support from the Service Manager who was actively involved in the recruitment process, and, more generally, from management, which provided financial resources so that short-term locums could bolster the system until a doctor could be found on a more permanent basis. When it became apparent that it would not be able to find a doctor with the appropriate qualifications to fill the consultant post, the DHB started to look for an alternative — a medical officer in obstetrics and gynaecology. 3 2 This comprised the third consultant as 0.8 full-time equivalent, 1 in 4 on call; Dr B as 0.5 full-time equivalents, 1 in 4 on call; and Dr A as 1.0 full-time equivalent, 1 in 2 on call. 3 A medical officer is a doctor who is not part of a vocational training programme and is not employed as a specialist. February 2008 9
Page 1: Dr Roman Hasil and Whanganui Distri
Page 4 and 5: ISBN 978-0-473-13288-0 Health and D
Page 6 and 7: Health and Disability Commissioner
Page 62 and 63:
Health and Disability Commissioner
Page 64 and 65:
Page 66 and 67:
Page 68 and 69:
Page 70 and 71:
Page 72 and 73:
Page 74 and 75:
Page 76 and 77:
Page 78 and 79:
Page 80 and 81:
Page 82 and 83:
Page 84 and 85:
Page 86 and 87:
Page 88 and 89:
Page 90 and 91:
Page 92 and 93:
Page 94 and 95:
Page 96 and 97:
Page 98 and 99:
Page 100 and 101:
Page 102 and 103:
Page 104 and 105:
Page 106 and 107:
Page 108 and 109:
Page 110 and 111:
Page 112 and 113:
Page 114 and 115:
Page 116 and 117:
Page 118 and 119:
Page 120 and 121:
Page 122 and 123:
Page 124 and 125:
Page 126 and 127:
Page 128 and 129:
Page 130 and 131:
Page 132 and 133:
Page 134 and 135:
Page 136 and 137:
Page 138 and 139:
Page 140 and 141:
Page 142 and 143:
Page 144 and 145:
Page 146 and 147:
Page 148 and 149:
Page 150 and 151:
Page 152 and 153:
Page 154 and 155:
Page 156 and 157:
Page 158 and 159:
Page 160 and 161:
Page 162 and 163:
Page 164 and 165:
Page 166 and 167:
Page 168 and 169:
Page 171:
show all

Roman Hasil and the Whanganui DHB - Health and Disability ...

Create successful ePaper yourself

Delete template?

Save as template?