10 October 2015
by Prof. Paddy Dewan

The real victims of bullying in health care are the patients

Paediatric surgeon Professor Paddy Dewan has been hounded by the Australian Medical Board since 2006 over a patient procedure that had no negative outcomes — and has now finally been dropped. Here he relates the saga of three boys which he says is just the tip of the iceberg when it comes to disregard for families and good governance.

Bullying in health care has received a lot of media attention lately, but not the sort of attention the subject really needs. The real victims of the inappropriate workplace behaviour in healthcare are the patients.

In recent years, I have dealt with three boys who have a similar problem; each of the families have had to tolerate behaviour towards them that would not withstand public scrutiny; each boy has had a problem with severe constipation; and two of the boys are old enough to have a major problem with soiling despite medication.

Michael – not his real name – was treated by a paediatrician and physiotherapists for a number of years until he was referred for a surgical opinion. Investigation showed him to have a very long and dilated terminal part of the colon and a megarectum. Despite going to theatre to have the “rocks” removed, he continued to have severe constipation, as might be expected from his anatomy on xray and examination. He looked six months pregnant, but there were no fetal movements. Please excuse the clumsy analogy.

An attempt was made to admit the boy to a small private hospital in which there had previously been an uneventful procedure for a teenage boy who had had life-changing surgery that involved the removal of the dilated part of the sigmoid colon and upper rectum. The hospital refused to admit the boy. So an attempt was made to have the boy admitted to a regional hospital where more major surgery is conducted on adults. That hospital also refused.

The family chose to travel to another country. After returning to Australia, the media became involved and travel to that developing country is now out of the question, possibly because of the intervention of the Australian regulator.

Another boy, a younger boy, presented with severe constipation and severe pain when having a bowel motion and in his abdomen. Despite maximal medical management, nothing changed. Surgery was recommended but hospitals in both Melbourne and Geelong refused to allow the surgery to occur in their hospital. The family, therefore, sought a second and third opinion.

The second opinion surgeon disputed the role of the surgery. The third reported me to the medical board for being “a danger to the Australian public”.

A fourth surgeon made tentative arrangements for the operation, as I would have performed it, but then involved two other surgeons, one of whom was in charge of the service (who stated he did not believe in the diagnosis of “megarectum”) and the other who chose to operate.

But, only the sigmoid colon was removed (note this point), despite lengthy emails from me to the surgeons (to which there was no reply) indicating that international research disputes the role of the removal of the sigmoid alone — for a child with a megarectum, some of the rectum has to be removed. Yes, surgery is common sense applied with a knife.

Guess what? The operation failed to solve the problem. Nevertheless, the argument then focussed on there being an alternative diagnosis — particularly fructose intolerance (which had not been investigated before the operation. Wait for it …. the boy then had an operation to remove all of his rectum through an operation via his anus.

Again, I sent an email to the surgeon to raise concern about the possibility of there being part of the bowel between the old and the new operation that would have a poor blood supply. Your guessed it. No reply to my email was received. And surprise, surprise, the boy developed infection and had rectal bleeding after the second operation.

And in the meantime the family had been put through hell to eventually get a surgical outcome that would have occurred in one operation had there been the combination of collaboration and the right to patients having access to the surgeon of their choice.

The next boy is where the unbelievable really kicks in. An older boy who was struggling with faecal incontinence — he shat his pants every day! Vulgar expression, but necessary to highlight the degree of difficulty for this boy. His family had come looking for a solution, which resulted in embarking on further investigating his anatomy and going through the many non-operative strategies in the management of severe constipation. It was clear that he had a megarectum that required surgery.

Because the family could not afford to go overseas and no institution allows access for me to perform this surgery (see bystander phenomenon) in Australia, the boy was referred to the surgeon who operated on the second of the two boys above.

That boy had already had failure to cure his problem from removal of the sigmoid colon. Despite me again emailing to highlight the international evidence that that operation doesn’t work for megarectum, a fellow surgeon at the same hospital responded that the research does not support that operation. The outcome of the last boy? The operation didn’t work.

Then, the story gets really silly. The family claimed the operating surgeon had told them he had told his secretary to delete emails from me, but after the first operation the discussion seemed to be in line with an email I have shared with the family. When a complaint was made to the hospital about the regard to patient communication, the executive supported the right of the surgeon to ignore the communication.

The above saga of three boys is just the tip of the iceberg of disregard for families and good governance that is highlighted by the recent events of Jayant Patel, James Peters, the bullying at the Monash Hospital and the targeting of a surgeon in Townville. There are many more stories about patients I could also share. Several seem to have decisions made about their care based on who gave what other opinion.

I have been bullied for complaining about bullying; I have been bullied for complaining about a lack of good governance. Until health care bullying stops and good governance starts I won’t stop complaining.