Scott Lynda: General Debates 
Scott Lynda: General Debates 
[Volume:614;Page:10380] 
Dr LYNDA SCOTT (National—Kaikoura) 
: 
 In August Mr Ian Breeze a general surgeon from Tauranga was found guilty of professional misconduct on three charges regarding his care of Lionel Crowley who died of multi-organ failure following bowel surgery and the Health and Disability Commissioner has received six complaints about cases whereby patients have died. The director of proceedings urged the tribunal to find Mr Breeze guilty of disgraceful conduct. Doctors found guilty of disgraceful conduct in a professional respect are at risk of having their name removed from the Register of Medical Practitioners. 
If that had happened I would not need to be telling members about this case today. But it did not happen and the Medical Practitioners Disciplinary Tribunal chose to find Mr Breeze guilty of a lower charge of professional misconduct. The director of proceedings pointed to Mr Breeze’s serious shortcomings established in this case and suggested that public safety considerations warranted the imposition of conditions on Mr Breeze’s ability to practise medicine. The tribunal however resolved that in this instance Mr Breeze should be fined. The decision was based primarily on the ground that: “As far as the tribunal is aware the events focused upon in this case are a one-off series of events.” 
The first question is why the tribunal did not know about all the issues surrounding the competence of this doctor. Mr Breeze had name suppression until found guilty. We now have a case before the High Court testing the validity of name suppression in such cases. One of the reasons is that this story is one of incompetence and cover-up. Today I do not want to focus on a doctor who to quote the Medical Practitioners Disciplinary Tribunal “has now convinced himself about certain events which do not accord with the recollection of more reliable and objective witnesses and who continues to justify his failure to personally assess and monitor his patients’ condition by attempting to shield himself behind others.”; instead I want to concentrate on the system that allows this to happen. 
It is a doctor’s ethical and moral responsibility to report a colleague who he or she feels is unwell or incompetent. I am a doctor and I know that is our responsibility. But as the 2003 Commonwealth Fund International Health Policy Survey of hospital chief executives and physicians showed support for reporting and addressing preventable medical errors was lower in New Zealand at 64 percent compared with the UK at 89 percent the USA at 86 percent Canada at 80 percent and Australia at 76 percent. This is because doctors do not know what to do. Time and again as I have investigated this case doctors told me they had talked about it but just did not know what to do. Although patients and their families now have an extremely clear line of reporting—that is a written complaint to the hospital’s complaint system and then a complaint to the Health and Disability Commissioner—doctors and other health professionals who are concerned about a colleague’s ability still feel uncertain. Even the Minister of Health got it wrong in the House today. One does not report to the Health and Disability Commissioner but to the New Zealand Medical Council. The message is clear: it is a doctor’s responsibility to report. Then the Medical Council will undertake competency review. Doctors should not fear competency review as this is not disciplinary action but a way to improve practice. 
In 1994 a doctor at Tauranga Hospital documented 13 cases in which Mr Breeze had serious complications. In 1995 a surgical review was undertaken I think by Mr John Simpson. Mr Breeze spent 1 day in Auckland but then returned to practising independently and this is when the trouble began again. If the public look at the Medical Council of New Zealand’s website they will see that no restriction on Mr Breeze’s practice is listed. But on 16 December 1999—the day before Mr Crowley’s operation—Mrs Mackey had been taken to theatre for removal of a cancerous polyp in the lower colon. It subsequently turned out that Mr Breeze had missed the tumour and months later a second operation had to be performed. There was a recurrence at the stoma site and the Accident Compensation Corporation accepted this as medical error. Mrs Mackey died of her secondary cancer a fairly short time later. 
On 6 December 2000 Mr Barry Baker was operated on for bowel cancer. A hemicolectomy was performed at Norfolk Hospital. Three days after surgery he complained of pain and distension in his stomach and was transferred to Tauranga Hospital’s intensive care unit. He went back to surgery where an ileostomy was performed. Four days later a third operation was required. On 28 December he showed signs of multi-organ failure and he died on 31 December. There is conflicting evidence about whether he had a perforated ulcer or a stomach rupture but there was no coroner’s inquest into his death. When the cause of death is uncertain in someone who has had three operations in 1 month I would have thought that would be mandatory.