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

Health and Disability Commissioner
supervision, performance management, incident reporting, complaint management and
credentialling, together with traditional audits of morbidity and mortality within
specialties. A hospital is responsible for ensuring that staff are aware of these systems,
adequately trained and supported to comply with them.
Whanganui DHB had a number of policies and processes for quality assurance or
improvement, such as incident reporting, credentialling, mortality and morbidity review,
complaints management, audit, performance appraisal and supervision. Overall, the
policies and processes look reasonably sound, at least on paper. But many staff were not
aware of the policies, and they were routinely circumvented — for example, in relation
to audit processes, incident reporting, supervision and performance management. There
was a significant gap between the rhetoric and the reality on the ground. The gaps were
especially evident in the areas identified below.
Employment of Dr Hasil
A DHB has a duty to exercise reasonable care and skill when employing staff. This
involves establishing clear and appropriate recruitment processes and supporting staff to
comply with them. In my view, Whanganui DHB failed to fulfil its responsibilities as an
employer in the following respects.
Dr Hasil was offered a position as a medical officer at the DHB following a review of his
CV, a brief reference report from an obstetrician and gynaecologist who had worked
with him for a short period more than six years ago, and another report from a
paediatrician who had more recent experience of his obstetric practice. Dr Hasil was
interviewed by telephone, then credentialled under urgency. Credentialling 62 is part of a
risk management system designed primarily to protect patients.
There were obvious shortcomings in the employment of Dr Hasil, as highlighted earlier
in this report. My expert advisor commented that while the credentialling processes were
appropriate as part of an employment exercise, the references should have been
checked. 63 The fact that the written references were old and, in the main, not from
obstetricians, should have been queried.
As noted, the DHB’s policies and processes were reasonably sound and consistent with
those of some other DHBs. What happened when employing Dr Hasil was a departure
from usual practice. The reference checking was undertaken by a recruitment agency.
Such agencies have a commercial interest in “placing” the candidate. The agency’s
process was less than reliable. Dr A accepted Dr Hasil on face value and failed to make
any independent enquiries regarding his suitability and background.
62 Credentialling is defined as a process used to define specific clinical responsibilities (scope of
practice) of health professionals on the basis of their training, qualifications, experience, and current
practice, within an organisational context. The context includes the facilities and support services
available in the service the organisation is funded to provide. Credentialling is part of a wider
organisational quality and risk management system designed primarily to protect the patient. Ministry
of Health, Toward Clinical Excellence — A framework for the credentialling of senior medical officers
in New Zealand (March 2001) 1.1.
63 See Appendix 10, Independent Advice to Commissioner
80 February 2008