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

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Health and Disability Commissioner unable to sleep and had consumed a bottle of wine because of personal issues largely associated with his domestic situation. Dr Hasil explained that this incident followed a very unsatisfactory and stressful series of phone calls from his wife in Australia. In addition, he had found out that he had failed his Fellowship examination. Dr Hasil acknowledged that he was on call. He had decided that if he was required to attend to patients that night, he would request a transfer to Palmerston North Hospital. However, he had not discussed this decision with medical colleagues or informed management. Dr Hasil on leave On 9 October 2006, Dr Hasil was given a final written warning to remain indefinitely on his personal record. The DHB placed Dr Hasil on leave while he obtained professional counselling and medical help, including an assessment by an occupational health physician. The physician considered that, overall, Dr Hasil did not have a serious alcohol problem and could return to work at the end of a two-week leave period provided that an adequate system of support could be provided. This would include consultation with his general practitioner and Employee Assistance Programme counselling. The DHB stated that Dr Hasil should be aware that, if he failed to comply with the conditions outlined, there would be an investigation and the outcome might be dismissal. Dr Hasil remained on leave for five months to complete his rehabilitation and return to work programme. Dr Hasil returned to work on 12 February 2007, initially for a twoweek period under direct supervision at MidCentral DHB. On 23 February 2007, he did not turn up for work and was suspended that day pending investigation into the failed sterilisations (discussed below). He eventually resigned from Whanganui DHB on 5 March 2007. In response to this investigation, Dr Hasil said that instead of Whanganui DHB offering him assistance, he received a written warning. He said that the DHB did not seem to take into account that he had been working extraordinary hours, trying to make up for the level of staffing at the hospital at that time. Dr Hasil stated that looking at that episode, there were signs that he needed help but the DHB did not offer assistance. He said that in October 2006 he had failed his Fellowship examination for the fourth time, and the impact of this, the stress of the workload, and the lack of consultant availability at Wanganui Hospital were all relevant to the deterioration in his health. Dr A’s concerns Dr A acknowledged that he was aware of concerns regarding Dr Hasil’s manner and judgement, and addressed these with him, but had no reason to doubt his technical competence until after he went on leave in October 2006. After Dr Hasil was placed on leave, the DHB faced a critical shortage of obstetricians and gynaecologists, with significant gaps from 15 October onwards. Dr B was the only obstetrician and gynaecologist who remained at the department and he was part-time. The DHB took steps to secure the services of locums, and had agreements with MidCentral, Taranaki and Capital and Coast DHBs, for all high-risk women to be transferred at an early stage, and for all women requiring semi-urgent Caesarean sections to be transferred by ambulance or helicopter as appropriate. Dr A agreed to provide 40 February 2008
Opinion 07HDC03504 locum cover during Dr Hasil’s unexpected absence, and became concerned about a number of cases he dealt with (over a period of only a few days). On 26 October 2006, Dr A notified the DHB that he was reluctant to agree to provide off-site supervision and that he considered that Dr Hasil’s practice was currently unsafe. He advised that Dr Hasil “had not made any attempt to fulfil the [supervision] arrangements put in place. This together with the events of the last week or two make me feel his practice is currently unsafe and that any supervision would need to be onsite, if indeed he is deemed well enough to practise.” Dr A noted the events of concern. First, he cancelled two elective cases which Dr Hasil had inappropriately booked for theatre: a 152cm tall woman who weighed 157kg and had been booked for an elective total abdominal hysterectomy, and a woman with a complete vault prolapse who had been booked for an anterior bladder repair. He also saw as emergencies three women who had been treated by Dr Hasil. Dr A thought the matters should have been raised with the Medical Council. Dr A subsequently stated that around the time of the alcohol incident in early October 2006 he became aware of two further clinical cases of concern other than those that are the subject of this inquiry. They both involved complications as a result of surgery for the evacuation of uterus for miscarriage. One involved the perforation of a uterus during an evacuation procedure, and the second arose from Dr Hasil having torn the vaginal wall during an evacuation procedure. Dr A said that the cases indicated to him that something was “seriously wrong” and that they would have been cause for “grave concern”, but that they were brought to his attention at the time Dr Hasil was placed on leave. Dr B’s concerns Dr B recalls that he had had some disquiet about Dr Hasil’s judgement in terms of case selection long before the sterilisation failures came to light. On at least one occasion, he had discussed with Dr A Dr Hasil’s management of an older woman with postmenopausal bleeding. Dr Hasil had planned to undertake a vaginal hysterectomy on this woman. No diagnosis had been noted in the clinical records, and both Dr A and Dr B felt the management was inappropriate because the patient should have been investigated properly in order to establish a cause of the bleeding. Dr B said that if the patient had an underlying malignancy, a vaginal hysterectomy would have been inappropriate. When Dr A resigned in September 2006, Dr B was not prepared to supervise Dr Hasil (other than in an emergency situation when he was available). He was contacted again about providing supervision as part of Dr Hasil’s return to work programme. On 28 November 2006, Dr B telephoned the Medical Council and said that he was not willing to provide any on-site support for Dr Hasil as he had some reservations about his clinical competence and judgement. He said that he worked part-time in Wanganui, and would only be able to provide assistance in emergency situations. Dr B advised that Dr Hasil needed to work with close on-site supervision and teaching. Dr B commented: “I discussed the potential consequences of being a supervisor with MPS [the Medical Protection Society] and various other colleagues and really it is not a job that attracts a huge amount of kudos and it’s a job that potentially can get one February 2008 41
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