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"Toxic, incompetent" SA Health rejects call to limit suspension of doctors


SA Health has quietly rejected one of the key findings of a comprehensive review into the suspension of doctors – a report ordered by Health Minister Jack Snelling after a disastrous case which led to a multi-million-dollar payout to a wrongly accused surgeon.

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The revelation comes as one of the state’s most experienced lawyers working in medical litigation described SA Health as a chaotic, toxic, incompetent and “anti-doctor” department which uses the suspension of practitioners as a “weapon”.

The review was ordered in 2013 after the State Government agreed to pay John Knight – an internationally renowned cardiothoracic surgeon – $4.3 million for loss of income, defamation, injurious falsehood and legal costs.

In October 2009, then health minister John Hill told parliament that Knight, then the Director of the Cardiac and Thoracic Surgical Unit at the Flinders Medical Centre, had been suspended in connection with a patient’s death.

Knight spent two years on suspension in relation to the case, eventually being vindicated in a comprehensive fashion – first by a Coroner’s inquiry, and then by the State Government agreeing to a massive compensation pay-out.

In March 2010, State Coroner Mark Johns found that neither Knight nor his surgical team was at fault in the death of Vera Allan, 81, who had died after complications from open heart surgery in November 2008.

The huge cost of the bungled suspension and public aspersions cast on Knight’s reputation led to experienced public servant Warren McCann being brought in by Health Minister Snelling to review SA Health’s procedures in relation to the suspension of doctors.

The McCann review, which still sits on SA Health’s website, made numerous recommendations, including limiting initial periods of suspension to six weeks, which the department promised would be incorporated into “formal policies”. The report finds that  suspension should be a last resort and only used as a safety measure to protect patients – not as a punishment.

However, if SA Health has implemented any of the recommendations, it’s not prepared to reveal which ones.

They’re (SA Health) both incompetent and pretty much anti-doctor – the combination of those two things makes the situation quite difficult.

Under questioning from InDaily, the department revealed that it had rejected McCann’s key finding about the length of suspensions.

“The time taken to complete an investigation depends on a range of factors, including the complexity of the case and the nature of the allegations and as a result, we assess each investigation on a case by case basis,” a spokesperson said.

On the other recommendations in the nearly 60-page report, SA Health refused to detail its position, despite repeated questions from InDaily.

“As with any review we considered the guidelines proposed by the McCann review, of which a number were already part of the SA Health HR manual,” a spokesperson said. “We update our HR manuals regularly and during this process we consider recommendations from all relevant reviews, including the McCann review.”

SA Health’s approach doesn’t surprise Adelaide lawyer Nick Iles, who represented John Knight during his long suspension from practice.

Iles, who has represented many Adelaide doctors through his work with medical indemnity provider, Medical Insurance Group Australia, is scathing of SA Health’s use of indefinite suspension.

“The suspension weapon is used all the time but, really, in hamfisted ways,” Iles told InDaily.

“I’m working for a doctor who has effectively been under suspension for two years, is drawing a full salary and is sitting at home.

“I think they hope the doctor will get so bored and disillusioned that they will resign and find a position elsewhere.”

Iles said SA Health, which he described as “toxic”, used suspension because the agency didn’t appear to have effective mechanisms for resolving HR and clinical issues.

“Suspension is used as a method of shelving the problem. They almost use it to laughable degrees.

“They’re both incompetent and pretty much anti-doctor – the combination of those two things makes things quite difficult.”

Snelling did not respond to InDaily when asked about Iles’ comments.

The issue is topical because in early December last year, another well-respected South Australian medical specialist was suspended by SA Health.

Professor John Horowitz, head of cardiology at the Queen Elizabeth Hospital and an outspoken critic of the Government’s “Transforming Health” process, remains on suspension more than two months later.

He still doesn’t know the full details of the complaints against him, although he has been told it is related to allegations of bullying.

Under the recommendations of the McCann review, a suspended doctor should be fully informed about the allegations at the point of suspension, if the allegation relates to a practitioner’s clinical work. Non-clinical issues should be dealt with according to the department’s HR manual, the review says.

The McCann review recommended that before a health practitioner is suspended “he/she should first be afforded procedural fairness by being put on notice as to the intent to suspend, restrict or place conditions, reasons therefore and given the opportunity to respond”.

According to Horowitz, this did not happen in his case: he was neither given the details of the allegations, nor given an opportunity to respond.

The review goes on to recommend that no suspension be for more than six weeks. If the investigation requires more time, then approval should be sought for additional four week blocks of time.

The department insists that the McCann review is not relevant to Horowitz’s case, because the allegations he is facing are “non-clinical” in nature.

But regardless of whether the case is clinical or non-clinical, McCann makes recommendations about procedural fairness which appear relevant to all disciplinary issues.

“It is government policy is to be a model litigant which includes open disclosure,” the review says. “In addition to ensuring that there are valid reasons for suspension, restriction or placing conditions on the Health Practitioner, the CEO is responsible for ensuring that the principles of natural justice and procedural fairness are adhered to in the processes leading up to the decision.”

When asked by InDaily about the McCann review’s recommendations on suspension, SA Health said: “As with any review, we consider any proposal or idea to ensure we have the best policies and practices in place. The time taken to complete an investigation depends on a range of factors, including the complexity of the case and the nature of the allegations and as a result, we assess each investigation on a case by case basis.”

When pressed, the department said: “The recommendations for timeframes of suspensions were not accepted as we continue to assess each investigation on a case by case basis.”

Lawyer Nick Isles said: “They’re (SA Health) both incompetent and pretty much anti-doctor – the combination of those two things makes the situation quite difficult”.

John Knight quietly retired from his private practice at Ashford Hospital about 18 months ago to run cattle in the far north-west of the state – a long-standing hobby.

John Horowitz, unable to attend to patients or lead his team at the Queen Elizabeth Hospital, continues to wait.

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