HEALTH LEGISLATION (MISCELLANEOUS AMENDMENTS) BILL 2020

Second Reading Debate

Ms JODIE HARRISON(Charlestown) (18:32:53):When a patient sees a health practitioner he or she is investing a lot in that practitioner's training, professionalism and ethics. This is especially true if a patient is going to be in surgery, and it is also true of people in regional areas where health care is often less accessible. Emil Gayedformerly Dr Emil Gayedtook advantage of the trust his patients placed in him. He was an obstetrician and a gynaecologist and he had a negative reputation around Taree where he often practised.

The phrase "first, do no harm" is one of the principal ideas at the heart of the practice of medicine. MrGayed failed to live up to that idea time and time again. An investigation byThe Guardianrevealed that Gayed "needlessly removed women's reproductive organs and performed unnecessary surgeries on his patients". Others were left with dangerous, sometimes life-threatening infections and one patient died. Taree woman Rhiannon Tull toldThe Guardian:

I know nurses who work at the hospital and they told me, 'Do not see Gayed,' I was told he's OK if you deliver naturally, but not if you need to have surgery. I was told people come back with infections and complications and heaps of bad things happen. From then on I thought, 'I do not want to encounter that man, ever.' Unfortunately, Rhiannon was not so lucky. When she had her second child, she required an emergency caesarean section. Gayed performed the procedure, but it seems that there were errors throughout every stage of her care. Ms Tull and her child, who suffered liver complications as a result of Gayed's actions that day, are lucky to be alive. A review into this matter was conducted by Gail Furness, SC, who uncovered Gayed's incompetence, the mismanagement of complaints against him and the widespread harm he caused to his patients across decades. The report found:

In most years from 1999 to 2016 there was a complaint or concern raised about Dr Gayeds clinical treatment of a patient. They were expressed by nursing staff, anaesthetists and other medical practitioners as well as, more recently, patients themselves.

The 220-page report went so far as to say that staff became desensitised to Gayed's poor performance. After his actions led to the death of a baby boy in 2006, a review by the hospital and the health district where he practised found that he had no competence in performing even basic obstetric ultrasounds; that he performed multiple operations on patients while demonstrating borderline surgical skills for a senior gynaecologist; that his tissue handling was poor; and that he demonstrated an inappropriate knot-tying technique. Worse still, his infection control was suboptimal, with contamination of sterile equipment and inadequate handwashing exposed. And, in a serious breach of fundamental medical ethics, he also failed to obtain informed consent from his patients.

He resigned from Mona Vale Hospital after he learned that the Northern Sydney-Central Coast Area Health Service was investigating him. He then worked mostly at Manning Base Hospital in Taree, where he was employed as a visiting medical officer on a contractual fee-for-service basis. That he was allowed to continue practising at all is incomprehensible. The system of checks and balances in place to protect patients by ensuring that visiting medical offices are appropriately skilled was not adhered to. Gayed did not undergo regular performance reviews as required and the hospital's incident information management system was also not utilised by other doctors to record any of his mistakes.

Hunter New England Health did not carry out a review of Gayed's clinical privileges, even after it was notified of his suspension by the Northern Sydney-Central Coast Area Health Service. As a result of the Furness report, the cases of 50 women treated by Gayed were referred to the HealthCare Complaints Commission [HCCC] for re-investigation. More than 250 women called dedicated hotlines in 2018 to respond to concerns about him and his practice. Furness wrote, "The health system failed each of these women."

This is not even the first time that a man like Gayed has wreaked havoc on women in our regional hospitals. Roman Hasil, employed as an obstetrician at Lismore Base Hospital in 2001, was struck off in 2012 after his incompetence inflicted a great deal of harm on a number of women and babies. Worse still, his career in Australia came after a disastrous period of practise in New Zealand. Of course, the "Butcher of Bega" Graeme Reeves did irreparable harm to so many before being struck off in 1999 after defying his 1997 NSW Medical Board ban on practising obstetrics. That it took until 2008 for his activities to become publicly known is horrifying.

Each of these cases led to legislative reform that sought to tighten the net and protect patients from the future misconduct of health professionals. In this light, I welcome moves to enact most of the review's recommendations. I note that the Government is waiting on the results of a broader review of the performance program by the Medical Council of New South Wales and will consider its recommendations. I also note the amendments to the Queensland Health Practitioner Regulation National Law Act, enacted in November 2019 by the COAG Health Council, which clarify an employer's obligation to report withdrawal of clinical privileges. This is in the process of being implemented nationally.

The Furness report was handed down in February 2019. In my view, that Gayed was able to operate for so long with such impunity, causing such harm, speaks to broader inequities in our healthcare system when it comes to the treatment of women. In the course of researching for her bookPain and Prejudice, Gabrielle Jackson, who was diagnosed with endometriosis at 23 and has lived for many years with crippling symptoms, found that:

women wait longer for pain medication than men, wait longer to be diagnosed with cancer, are more likely to have their physical symptoms ascribed to mental health issues, are more likely to have their heart disease misdiagnosed or to become disabled after a stroke, and are more likely to suffer illnesses ignored or denied by the medical profession.

Just this year, one of my constituents came to me with serious concerns about the standard of gynaecological care after her concerns about her own health were downplayed or ignored by medical practitioners. Her pain was dismissed as attention seeking. Her request for surgical intervention was denied on patronising grounds. She sought a second opinion from a private gynaecologist and was quickly whisked in for a hysterectomy. The debilitating symptoms of her adenomyosis, which had her screaming in hospital, immediately subsided after the operation. This is an all too common experience.

I am pleased to see that the bill will strengthen the capacity of the HCCC to respond to and to investigate complaints, and will enable it to proactively ensure compliance with orders and recommendations. Granting the HCCC powers of entry, as well as the power to require the production of documents and the giving of answers to questions made in pursuit of ensuring compliance, is a positive step. As an MP who represents a regional area, Iwas pleased to see that the report highlighted the specific issues faced by women in regional areas when seeking medical care. If a hospital is reliant on a sole medical practitioner or a small specialist team, as is often the case in rural and regional areas, local health districts have been advised that external oversight from practitioners in other parts of a district is needed. I acknowledge the bill's amendments to the Public Health Act which allow for regulations to be made that establish a code of conduct for health organisations and increase the penalty for breaching prohibition orders. This is an important element in tightening protections for patients.

I note the bill's efforts to expand the definition of "e-cigarette", which will help to control the sale of those products. I am glad to see that steps are being taken to protect patients in the future. I recognise that surgical complications sometimes arise. I also recognise that when a procedure is undertaken, any number of things can go wrong. However, in Gayed's case there were a series of red flags that were not properly acknowledged and dealt with by health authorities. Even though I realise that little or nothing can be done to make full restitution for the many victims of Gayed's incompetence, my thoughts are with them. I join my colleagues in not opposing the bill.