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

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Health and Disability Commissioner respect”. It was clearly difficult for the DHB to continue to provide a safe and sustainable obstetric and gynaecology service during this period. Supervision arrangements Dr Hasil’s job description indicated that he would assist the specialists and work under the supervision of Dr A. The DHB has a supervision and performance review policy. 12 The DHB developed a detailed supervision and induction plan for Dr Hasil. This plan, together with the relevant policies, are attached as Appendices 5 and 6. There was also a supervision agreement with the Medical Council. The Council required Dr Hasil to work under regulatory supervision for at least two years, which included three-monthly supervision reports to the Council. Dr Hasil was to be supervised by the consultants in the department on an ad hoc basis, as and when required. Dr A would provide supervision for 24 hours per week. 13 Supervision after hours would be available in the first instance via telephone through the Head of Department (ie, Dr A) or other consultants. In short, Dr Hasil was to be directly supervised or supervised on site during normal working hours. The supervision was largely informal. This meant that assistance was available on site if required. Such an arrangement was premised on the basis that other consultants in the department, in particular Dr A, were on site while Dr Hasil was on duty for 24 hours per week. It did not mean that the consultants directly observed Dr Hasil’s practice. Such an arrangement would have been patently impracticable in this environment. After hours, Dr Hasil was to be indirectly supervised. This means that a consultant was available by phone. It was also anticipated that Dr Hasil would attend relevant departmental and monthly peer review meetings. Dr A was required to review and report to the Medical Council on Dr Hasil’s performance at three-monthly intervals. This was also to be reviewed in writing every six months on the basis of the standard performance review policy. I have received differing accounts of the nature and scope of the supervision that was in fact provided to Dr Hasil. I set out below the perspectives of Dr Hasil, Dr A and other staff as well as a summary of the relevant documentation, in particular, the supervision reports to the Medical Council and meeting minutes. Dr Hasil’s perspective Dr Hasil did not recall participating in the supervision and induction plan, but said that he commenced work as a medical officer on Wednesday 3 August. Dr Hasil said that initially he was working in clinic and that he then did one or two days of theatre, and that Dr A oversaw him in the performance of a couple of major cases in theatre, but that Dr A did not review his sterilisation procedures. Dr Hasil said that Dr A sat with him one day for a gynaecological clinic because he did not know about the paperwork. 12 The Performance Review Policy is referred to in Dr Hasil’s offer of employment. However, the Commissioner’s Office has not been provided with a copy of it. 13 I assume that the 24 hours of on-site supervision from Dr A each week reflected the hours he worked on site at Wanganui Hospital each week. 20 February 2008
Opinion 07HDC03504 Dr Hasil said he was treated by the hospital as an obstetrician and gynaecologist despite being “supposedly employed at registrar level”. Dr Hasil said that he had tried to work very hard for Wanganui Hospital, and had taken on the extra responsibility, including doing more on-call work because otherwise there would have been no care offered to patients. He said that generally no one knew who was on call, especially the nursing staff, and this made things difficult for all staff. To find out if he was on call, he had to ask. He had no social life in Wanganui, and very little collegial support. Dr Hasil said that Dr B was absent for much of 2006 and, when he was there, he showed no interest in him. Dr Hasil felt that very little supervision had been provided to him and that he had been asked to do increasingly complicated procedures, as generally only he and Dr A took the greater workload. He said that as the obstetric department disintegrated, there was very little consultant support. Dr Hasil believed that the stress of having to work in such conditions, effectively unsupervised, had contributed to the deterioration in his health and ability to cope. He said that the DHB “did nothing to assist … in coping with the enormous load that it was expecting from him, until it was too late”. Dr Hasil said that although his role was to assist the specialists and to work under the direction of the appropriate specialist, in reality, this did not occur. Instead he had been required to “perform” tasks and onsite supervision had been negligible, particularly during parts of 2006 when Dr A was the only obstetrician and gynaecologist available. Dr Hasil recalls that the department meetings were held every Monday and that usually he and the midwives attended. Dr A was there every second week at the start of Dr Hasil’s period of employment. Dr Hasil said that he got on well with Dr A and was able to discuss patients with him when he was available. Dr Hasil’s lawyer acknowledged that “while Dr A did talk with him about concerns that had been raised, these were not serious medical or competence issues but rather advice to Dr Hasil to adjust his practice to be more sensitive to the New Zealand culture”. Dr Hasil said that the supervision reports to the Medical Council were done infrequently and did not follow any concerted supervision plan. He did not receive any feedback to suggest that there were concerns at the time the supervision reports were completed. 14 At one time Dr A told him that he was “over-performing” as he tried to decrease the waiting lists, and advised him that Whanganui DHB did not have sufficient funding to support this. Dr Hasil was “very shocked to be criticised for over-performing”. Dr Hasil was not aware of any performance monitoring or auditing of his work by Whanganui DHB. 14 The Medical Council’s booklet Guidance for doctors working in supervised practice and their supervisors (August 2004) states that supervisors’ responsibilities include providing supervision reports when asked to do so (para 47) and that the doctor working in supervised practice should take responsibility for setting up an appointment schedule with the supervisor (para 26). February 2008 21
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