"It seems that despite paediatric cardiac surgery being such a multi-disciplinary effort, if things go wrong, the surgeon cops it." - Dr R B Mee, Surgical Director, Center for Pediatric and Congenital Heart Diseases, The Cleveland Clinic Foundation, USA
Phillip Knightley, "The doctor is out": an account of the case published in The Independent Monthly.
Brian Martin, Background to publishing of "Putting a surgeon under": responses of individuals to a draft of John Wright's article.
John Wright, Looking Back - A Personal Analysis of Whistleblowing, December 2005
This article is located on
Brian Martin's website on suppression of dissent
in the section on Documents
In 1963 I was appointed to the full-time surgical staff of a major Sydney university teaching-hospital group. In December 1986, I was dismissed from a very senior post because of "lack of confidence" of colleagues. I rejected a compromise appointment from the hospitals. I had judged that to be demeaning, and offering no solution to serious conflicts over my years of service.
Although my original appointment was as a general cardio-thoracic surgeon, in the last eight months of my appointment I had been made director of a new paediatric cardiac surgical unit, at The Prince of Wales Hospital, Randwick. [Note: Dr Beveridge said, in response to a draft of this article, that so far as he can recall I was never given this title. In a letter of 17 December 1985, W. G. Lawrence, Chief Executive Officer of The Prince Henry and Prince of Wales Hospitals, wrote to my solicitor, Mr P. J. Wood, that "Professor Wright has been formally appointed Director of the Paediatric Cardiothoracic Surgery Unit by the Board of Directors" (emphasis is mine)].
In my prior service, in which I had been director of the general cardio-thoracic surgical departments of both hospitals, I had been located primarily at The Prince Henry Hospital, Little Bay, Sydney.
Legal challenge of my dismissal discovered that, as I was contracted to the hospitals, I could have been dismissed at any time, with or without a reason being given or available. I had no recourse in law.
To find work to replace that which I had done for most of my professional life, seemed impossible at the age of 57 years. Fortunately, my surgical background had been of sufficient breadth that I was able to take up consultancy work in many specialty areas, though I did not practice clinical surgery after 1986.
I was trained as a general surgeon, and had spent years as a registrar and senior registrar in other major teaching hospitals. I had been private tutor to medical students in three residential colleges of the University of Sydney, covering the whole spectrum of surgical education. Throughout the time I was employed as a cardio-thoracic surgeon, I taught and examined senior students in all surgical fields, for more than twenty years. I had also been involved in the management of intensive care wards which admitted patients with all varieties of trauma and major illness.
As I begin to tell the story of this change in circumstances, some questions beg answers:
Why wait ten years to tell the story?
A distinguished journalist did tell some of the story in 1990, showing some of the salient features, but not saying enough to run the hazard of defamation claims. [Phillip Knightley, "The Doctor is out," The Independent Monthly, Vol. 1, No. 11, June 1990, pp. 16-17.] Initially, my sensation of revulsion was overpowering as I tried to understand how and why the events had culminated in my loss of reputation and work. I realised that claims suggesting my incompetence had to be studied in great detail. So I needed time to get to know, by a process of patient and diligent analysis of the circumstances of the events, just where I had erred, where it seemed I had not erred, and how they balanced up.
Why publish the information now?
Because I have reached a point in my life when, if ever, the full story (as I know it) should be told, and I have time to do so. By now, the story holds together very well, particularly because of a broader appreciation of events since Phillip Knightley's short article in 1990. Moreover, time has shown me that such a story as mine reveals the various shapes of human behaviour, whether within the medical profession, any other profession, or elsewhere. That is valuable to know. Besides, I believe that the events which I will describe are unique within the medical profession in this country, at least, uncovering the presence and the power of themes of "dominance" behaviour between medical groups.
Many of the initial sensations of my experience reminded me of the Dreyfuss affair. Motivations were complex and sometimes obscure. Fear of defamation responses inhibited my exposure of many unpleasant details which were always obvious and undeniable. Clearly, I had provoked antagonism, and got a response which was surprising in its violence. No doubt, I remained uncompromising and rigid to my own original and ultimate disadvantage. The result was inevitable, but I didn't know that until it was too late.
Oversimplified, in the final analysis I paid a large professional and personal penalty. I had no room to manoeuvre. I was able to draw upon a large and continuing involvement with all aspects of clinical surgery. When forced to reconstruct my professional life, I could do so in a manner which I had never expected to need.
Chairman: Sir H. Dickinson; later Lady S. Street
Chief Executive Officer: J. Delaney (deceased 1983); later W. Lawrence
Deputy CEO: D. Crofts
Director. Medical Administration: P. Brennan, later T. Smyth
After several early years with involvement in all branches of surgery in a major hospital, learning, practicing and teaching it, I became captivated in the late 1950's by the fairly recent advent of surgery carried out within the chest, particularly as it involved the heart and great blood vessels. Specially, I was fascinated by the application of this sort of surgery to children.
Having then spent a couple of training years devoted to that specialty in Australia, I travelled to England and the USA for additional experience in some of the finest surgical centres in the world.
At the end of 1963, I was offered a full-time specialist post at The Prince Henry Hospital, Little Bay, Sydney, where a brand new surgical department had been established in about 1960, to serve the newly established second medical school in Sydney, at The University of New South Wales, Kensington. I was to work with Associate Professor Bruce Johnston to develop, specifically, the division of cardio-thoracic surgery.
I approached the appointment with great enthusiasm, even though they were such early days that it was a matter of hard slogging to develop such a new enterprise in the face of what was initially low patronage and the slow learning experience for all members of the various clinical teams.
An additional and inevitable problem was that we were not particularly welcomed by long-established departments of surgery in the older teaching hospitals around town, but collaboration and amicability did prevail. Johnston and I, as well as most other members of The Prince Henry Hospital group, were conscious of the initially decrepit state of the hospital, although our operating rooms had been upgraded at around that time. We were also disadvantaged by the fact that The Prince Henry Hospital was located on the edge of Botany Bay, remote from the city. An old infectious diseases isolation hospital, adjacent to an oil refinery, a large jail and an even larger cemetery, was not an ideal location for an up and coming specialty like ours. We needed a much more central metropolitan location, such as our linked sister institution, The Prince of Wales Hospital, which was being refurbished at Randwick, much closer to the central metropolitan zone where a larger population of patients lived.
Tragically, in May 1968 while operating, Bruce Johnston suffered a stroke from which he never completely recovered. I was asked by the head of the surgical department would I take over the running of the division of cardio-thoracic surgery. I agreed to do that and tried to capitalise upon the remark-able pioneering work which Johnston had carried out alone before my arrival five years earlier, and which we had done together during those five years.
Very soon, there was a takeover suggested by the late Harry Windsor, the senior and respected chief of cardio-thoracic surgery at The St. Vincent's Hospital, Sydney. But I rejected that suggestion with the penalty of a less cordial relationship with Windsor later.
As time passed, talented specialists were appointed to various components of our cardio-thoracic enterprise, and I had great support from Professor John Ludbrook, head of all branches of surgery, Professor Ralph Blacket, head of all branches of medicine, and Professor John Beveridge, head of paediatrics. Beveridge was headquartered at The Prince of Wales Hospital, but had beds also at The Prince Henry Hospital. Cardio-thoracic surgery was the only major surgical enterprise which was not contained within the structure of or plans for his department, largely because of the singular expense of cardio-thoracic work, and the early resolution that such work would be located predominantly, if not only and always, whether for children or adults, at The Prince Henry Hospital at Little Bay.
Not long after my arrival in the hospital group, Beveridge demonstrated his friendship and canvassed the issue of my collaborating in a plan to relocate, as soon as possible, children's cardio-thoracic surgical activities at The Prince of Wales Hospital, even if only notionally to begin. In principle, I was in agreement. But there were serious established precedents of demarcation between the two hospitals which would have to be overcome, as well as the economic, political and staffing aspects.
By the early 1970's we were providing, at The Prince Henry Hospital, a large number of surgical activities with a good standard of care. There was a huge level of cooperation from all areas with which we collaborated in the hospital group, even though our isolated and, in places, obsolete physical circumstances involved a great deal of sacrifice and personal inconvenience. Naturally, I took every opportunity to emphasise our difficult circumstances to administrators who were prepared to listen.
Being by now of associate professorial rank, and head of our surgical division, I believed that the administration would be receptive to the advice which I gave with increasing vigour and frequency. Nonetheless, precedents and practicalities did not facilitate negotiation. It seemed that the original planning to locate the cardio-thoracic service way out near La Perouse, had been set in stone. And no specialty allocated originally to the more favour-able Prince of Wales Hospital site, was prepared to move over and let us find a place there.
However, our department slowly flourished, progressively taking a higher place in the surgical environment of Sydney and rapidly gaining the respect of those who were our friendly "competitors", particularly those at The Royal Alexandra Hospital for Children, then at Camperdown, a component of The University of Sydney teaching hospital group. Of course, I envied that hospital for having its cardiac surgical division firmly located within, and having access to, all the resources of a comprehensive children's hospital.
The head of anaesthesia in the two hospitals was Dr George Davidson, primarily located at The Prince of Wales Hospital. At The Prince Henry Hospital, Dr Tom Torda was the local anaesthetist in charge. Both were experienced and of high reputation, but neither had a substantial background in cardio-thoracic surgery and, particularly, little in open heart surgery. Nonetheless, Torda brought energy and enthusiasm in his cooperation with our surgical enterprise, and we were grateful to have such effective help.
Our relationship with the Department of Anaesthesia (later re-titled "Department of Anaesthesia and Intensive Care") was composed of many strands but was, ultimately, complicated by a souring of personal and professional relationships which proved incurable.
In the early 1970's, a very serious area of conflict about authority arose between my department (and me, of course),and the department of anaesthesia at The Prince Henry Hospital. As always, small but simple things are likely to provoke major changes, here for the worse. At a surgical seminar in about 1972, witnessed by most of the surgical staff of both of our hospitals and a mass of medical students, my junior surgical trainees presented data on a large number patients who had undergone surgical treatment in our department in the previous three years. The results were prepared according to the abnormalities for which patients had undergone operations, the nature of the operations performed, the events which occurred after operation and the complications which had been encountered, including death. I was not aware of the detailed material which was to be presented, because I regarded these seminars as an opportunity for more junior staff to exercise their data-research skills and presentation without interference.
As chance had it, my department was entertaining a visiting surgical dignitary at the time, in the person of Dr Eoin Aberdeen. Aberdeen was a distinguished paediatric cardiac consultant from London, and I'd had the privilege of working with him in North America years before, and of being visiting professor to his surgical unit at the Great Ormond Street Hospital for Sick Children, London, in the late 1960's.
At the end of the presentations, as a courtesy the chairman of the seminar asked Aberdeen, who was in the audience and intently interested in the surgical results which had been reviewed, to open the discussion.
With typical meticulous care, Aberdeen recalled several of the demonstration slides, and analysed the case results in such a way as to demonstrate that more than one-half of all morbidity and mortality which was experienced in our division, lay in errors of anaesthetic and ventilator/respiratory care, both in the operating room and in the recovery ward later. He suggested that all anaesthetic management protocols should be reviewed, even though he acknowledged that there had been some improvement in overall results in the later part of the patient-population studied. But he attributed that improvement to the take-over of most of the ventilatory management of sick patients by the increasingly experienced nursing staff in the recovery ward.
Aberdeen had picked out a developing danger zone - the demarcation between responsibilities properly taken by surgical and nursing staff, and those which fell within the normal responsibility of anaesthetic staff. He fanned the flames of a developing conflict about responsibility and prerogative, as I had previously detected and feared. A somewhat precarious relationship between my unit and the anaesthetists (specifically Davidson and Torda) thereafter became much worse.
Differences of opinion about management and questions of authority were all exacerbated by the pressures of fitting an ever-enlarging number of patients into a restricted number of post-operative beds. And children, who required very special and protracted post-operative care after heart operations, were, therefore, generally and increasingly looked upon with disfavour at The Prince Henry Hospital. Even so the nursing staff were remarkable in their selfless dedication to that type of our work.
Without any idea, either then or now, of how it might have occurred, rumours and hearsay, inevitable in all large institutions and certainly in hospitals, began to involve me. They escalated during the 1970's, and involved unfounded suggestions that I was homosexual, or otherwise systematically promiscuous, or mad. Some parts of the bureaucracy "hated" me, and others exercised a "vendetta". Relationships with anaesthetists were not helped by my insistence that the operation of heart lung machines (for open heart surgery) was ideally performed by a technician of high standard who was dedicated to nothing else. Some anaesthetists believed that that job should be done by them, with a technician assisting them, and that the anaesthetist should tender an account.
Additionally, I saw no need for remunerative post-operative clinics proposed to be established and operated by anaesthetists, when surgeons and others already had that as one of their basic duties, in any event.
During the 1970's, our anaesthetists floated the ambition to create an autonomous full department of anaesthesia and intensive care, headed by a full professorial appointment. The director of our department of surgery (Murnaghan) and I opposed that idea, but the department of anaesthesia did, indeed, have a changed title later, the addition of "intensive care" having profound strategic implications in "dominance" issues.
Like many surgeons, I believed that I was, whether I liked it or not, the "captain of the ship". The buck stops with the surgeon. All surgical complications ultimately reflect upon the surgeon and are referred to him, regardless of how they might arise. For that reason, I had always expected to have a margin of authority when there was a difference of opinion between that of the surgeon, and any other involved party. Of course, my attitude sometimes promoted friction with anaesthetists who had different views, even though (as my own history later showed) I had to provide a continuity of care for anybody on whom I had operated, and I obviously knew more about what I had actually done inside a patient's body, for better or worse, than any other person.
I knew that there was a campaign conducted by various anaesthetic groups around the world, in English speaking countries, at least, to increase the authority of anaesthetists in post-operative and other intensive care areas (as "intensivists"), an attitude which brought much alarm from some surgical groups.
In 1982, the president of The Australian Society of Anaesthetists expressed concerns about their status within medicine and the community at large, emphasising the need for publicity to augment the professional image of anaesthetists generally.
In 1984, the American Board of Thoracic Surgery published its recognition of the importance of ensuring that surgeons of various specialties should incorporate post-operative and intensive care management as a crucial part of their training programs for young surgeons. Clearly, that Board was anxious that trainee surgeons should not give up their involvement in areas which were likely to be taken over by anaesthetists and intensivists.
In 1988, the American College of Surgeons pointed out that special training in "critical care" was now being undertaken by non-surgeons, so diminishing the training spectrum of young surgeons in these matters. Hence, young surgeons (and particularly cardiothoracic surgeons) who would not always have access to specialist assistance later in their careers, needed such training to be able to manage critical care for themselves in less than ideal circumstances.
I never believed that there was exclusivity or total autonomy appropriate to any particular medical management group, in any respect. Cooperation, collaboration and consultation were essential to manage complex surgical activities. But experience had shown me that surgeons were much more likely to experience substantial or sole blame for a complication, and, therefore, needed to protect themselves, and their patients, by relentless vigilance and dedication to detail, particularly after operations. Not for one moment did I feel any sense of priority or superiority in regard to avoiding errors, and it must be said that any surgeon who would embark upon critical surgical procedures on sick patients, has to assume a humbling and depressing responsibility in the face of complications which, sooner or later, all surgeons experience.
Along with the professional matters which I have described, I ran a permanent campaign of agitation for improvement in the physical aspects of our Prince Henry activities, but always with a parallel insistence that, sooner than later, The Prince Henry Hospital should be entirely refurbished, or replaced for all demanding clinical activities. If it were not to be refurbished and rebuilt, (there was little logic to that argument, because the hospital was in such a remote location and so run-down), then The Prince of Wales Hospital, Randwick, (which was already partially rebuilt ) should be enlarged and extended to incorporate The Prince Henry Hospital components from Little Bay. (That has now finally happened.)Not only would that allow an overall improvement in all facilities, but it would also allow the integration of paediatric cardiothoracic surgical activities within the general paediatric hospital which had also been rebuilt at Randwick and where, ultimately, paediatric heart patients should be accommodated.
While I understood that administrators must be sounding boards for so many requests, all of which have to be sifted, evaluated and prioritised, it seemed to me that the least which was required was a thorough senior examination of our department, and its various areas of activity, at various times of the day, night or weekend, in order to see, at first hand, the conditions under which our patients were treated and what facilities the treating people had to work with and to offer our patients. That didn't seem much to ask but it was, to my continuing knowledge, impossible to get. I can recall no occasion when any such inspection was carried out. I rely for that belief also on the testimony of my surgical colleagues, junior staff, and nurses.
Plans were frequently drawn up for extensive refurbishments, The chairman of the "Health Commission" recommended a multi-story redevelopment on The Prince Henry site in the 1970's, and Dr Michael DeBakey, who visited our unit in 1973, recommended the same. But nothing substantial was done.
On at least one occasion, later acknowledged by him, Beveridge phoned me very late at night after attending a hospital function. He wanted me to know that, such was the hatred expressed to him by senior hospital management on that occasion, he (Beveridge) would have to sacrifice me if ever the situation arose when he had to choose between supporting me in my ambitions, and promoting his own department's ambitions. [Note: Beveridge, in response to a draft of this article, says that it would be in keeping with his approach to support the dismissal of a member of staff if that person's performance was sufficiently bad and continued employment jeopardised the hospital's overall functioning. That comment seems irrelevant to the context in which he originally gave me "warning".]
He said he felt such a "turd". Beveridge was to repeat that later, particularly when thanking me for operating on him for his own urgent heart condition, and recalling his late-night confessions. [In response to a draft of this article, Beveridge stated that he has never used the word "turd" about any human being, especially himself (sic). Our memories differ on this point. He also found some aspects to be amusing.]
In 1980, things came to an explosive head. After yet another attempt to interest the hospital administration in a reconsideration of the transfer of our enterprise to The Prince of Wales Hospital, a rejection again came to my desk. I was advised by the Acting Chief Executive Officer (David Crofts) that "my Boards of Directors..... believe that it is not practicable to accede to your request that the theatres be located on The Prince of Wales site. Nevertheless, there will always be a most important need to ensure that the treatment available to children at The Prince Henry Hospital is of the highest possible standard".
I turned the matter over in my mind for the next week or so. I finally responded to Crofts by saying that the attitude of the Boards of Directors was inexplicable. I pointed out that there had been no senior administrative examination of our facilities in more than ten years and that I believed that the Boards had acted on ill-informed advice. I went on to say that the question of standards of treatment for children was of particular importance and that I believed that our facilities were "sub-standard".
I finalised my letter to the Acting Chief Executive Officer by saying that "I find the decision to deliberately perpetuate inferior standards quite unacceptable. Our shortcomings cannot be defended or concealed."
It took one week for me to get a direct response from the Chairman of the Hospital Boards of The Prince Henry, The Prince of Wales and The Eastern Suburbs Hospitals, Sir Harold Dickinson. With a copy to my immediate superior, Murnaghan, Dickinson's letter of 2 September 1980 stated:
I must say that I find your characterisation of the Boards' decision not only wrong, but needlessly offensive. It completely misinterprets the Boards' decision.
I am especially concerned that you find the decision "quite unacceptable". While this remains your attitude, the appropriate course would be for you to resign.
My response was to advise Dickinson that resignation would be the least appropriate option which I could consider. I suggested that he should seek a well informed outside opinion before an irrevocable step were taken by his Boards. Needless to say, that brief exchange probably sealed my fate for all time with that institution. Nonetheless, I felt that that was the price to pay for persuading the administrative group that they were deliberately ignoring, for no good reason, their responsibility to provide proper care for our patients within a department which, by that stage, was recognised quite clearly as "the flagship of the hospital group" (to use an expression coined by a senior executive officer).
On 10 January 1983, deeply concerned about unexplained complications during otherwise uneventful surgical procedures, I wrote to Dr Dennis Kerr, one of the younger staff anaesthetists at The Prince Henry Hospital. I had just finished a conversation with the parents of a child who, a couple of weeks earlier, had died without explanation at the end of a simple operation. I had to tell them that, despite an exhaustive autopsy and detailed examination of the case notes, I could offer them no clear or satisfactory explanation for their son's death. Fortunately, they had accepted a "just one of those things" conclusion.
My letter to Kerr said, "For some time it has been apparent that our attitudes to patient management have been at substantial variance. In so far as this is inimical to the interests of good patient care, I believe that our regular operating arrangements should not continue. I regret this decision because I respect you and your professionalism."
The first response was from Murnaghan who was very annoyed that I had written without consulting him and blamed me for provoking poor relationships with the anaesthetists. Within a couple of days, Murnaghan advised me that the anaesthetists had now complicated the matter further by suddenly accusing me of professional incompetence. As Murnaghan remarked, the matter had now got quite out of hand and I was informed that the Chairman of the Hospital Boards, Dickinson, was infuriated by my conduct.
The late John Delaney, Chief Executive Officer, was about to depart on leave. He asked would I, as a favour to him, withdraw my letter to Kerr. Out of respect for Delaney, I agreed to do that, but only so long as there should be no delay in a proper and total evaluation of general problems which existed between the Department of Anaesthesia and us. Delaney undertook to promote that investigation urgently, and he indicated that while he was on leave (he had apparently been ill for some time), David Crofts would act as his deputy and would be advised of Delaney's undertaking. I also told Delaney that, while I would agree to withdraw my letter to Kerr, it would be best if Kerr and I did not work together until all matters had been investigated.
On 21 February 1983, I attended a meeting at The Prince of Wales Hospital with Crofts, Dickinson and the Director of Medical Administration (Dr Peter Brennan, a one time student of mine). Dickinson appeared to be very annoyed. He blamed me for any conflicts and stated that my "procedure" had been incorrect from the beginning. He refused my request that minutes should be kept but suggested that a committee would need to resolve the whole issue. I told him that I believed the attitude of the anaesthetists, after my letter to Kerr, had been dangerously orchestrated. I did not know by whom.
On 11 March 1983, I was invited to meet Murnaghan and Blacket (Professors of Surgery and Medicine, respectively) at The Prince of Wales Hospital. Having just arrived, we were immediately joined by Dickinson, Crofts and Brennan from a side-room. I felt that I had been ambushed. I was instructed to either take leave or be stood down for one month while Dickinson and the Boards investigated the anaesthetists' accusations of my incompetence. There was no mention of an investigation of my complaints, or the reasons for them. (Several years later, Dickinson wrote that my dismissal had been contemplated at that time. But I hadn't been told that and no reasons were given by him.)
On 25 March 1983, Brennan advised me that the Medical Practices Committee would conduct an inquiry into the allocation of anaesthetic services to me, and I was to prepare documentation which would compare my surgical results with those of my two surgical colleagues at that time. A junior administrative officer had been asked to collate the data for presentation to the investigating Committee. I made precautionary contact with a solicitor and the Public Medical Officers' Association of which I was a member.
The analysis of results of surgical operations carried out by me and my two colleagues vindicated me from any charge of incompetence or poor results. It also vindicated my two surgical colleagues, who were not being investigated.
When the Medical Practices Committee finally collected all the data which they had requested, from both the anaesthetists and from my department, no formal report surfaced. Blacket later informally told me that "no shred of incompetence" had been found in me by that investigation. I was later advised by the administration that my "competence had never been an issue" in the investigation, and that the whole enquiry had been directed toward the general issue of creating "harmony" (presumably between some anaesthetists and me).
Nonetheless, we agreed that, until things "settled down", it would be best to avoid highly complicated paediatric surgical procedures where tensions often ran high. Under those circumstances, I agreed to accept the services of Kerr, as well as all other anaesthetists who normally worked with me. Thus, a period of relative calm was established, and it continued for quite a long time.
On 8 April 1983, I again met Dickinson. He still seemed angry with me. He said that, should paediatric heart surgery ever be transferred to The Prince of Wales Hospital, I was not likely to be involved in it because he had been advised by the anaesthetists that they would not cooperate with me at The Prince of Wales Hospital. He was not prepared to acknowledge that the Committee's enquiry had confirmed my competence, or discuss it.
Murnaghan soon asked me would I keep him posted of any and all problems that I may encounter later as a result of anaesthetic procedures, but he did not acknowledge my communications to him later, and I am unaware of what steps he took about them.
I had soon resumed my normal operating program and relationships seemed somewhat easier between me and the anaesthetists, but I had a continuing deep disquiet about Dickinson's attitude towards me, and the fact that the Committee of enquiry had apparently drawn no firm conclusion and had given me no formal clearance of charges of incompetence by the anaesthetists. It was a most unsatisfactory way for me to resume work, amid an atmosphere of variable but continuing tension, lack of resolution of various matters and, above all, because I realised that I needed to clear my name of unresolved serious imputations.
Hence, on 27 April 1983, I contacted an old acquaintance, Dr Max Diment, who had once been a Health Commissioner in New South Wales. He advised me to keep a low profile and a dossier of everything which occurred. He arranged for me to meet the Secretary of the Department of Health, Mr Bernard McKay, and I did so on 8 August 1983. (Sadly, Max Diment did not survive a heart operation in May 1983.)
McKay heard me out and I had no further contact with him.
On 26 August 1983, Dickinson invited me, personally and privately, to meet with him at The Prince of Wales Hospital. He wanted no notes kept and we met alone. Immediately following the meeting, however, I made notes before leaving the hospital premises. I contacted my solicitor shortly after, on the same day. We formulated a letter of response to the conversation I had with Dickinson.
My immediate recollections of the meeting with Dickinson were that he had received a call from McKay asking him to sort my problems out as soon as possible. Dickinson hoped that I would give up the idea of moving paediatric heart surgery to The Prince of Wales Hospital because the anaesthetists were against me. Nonetheless, he and the Boards were grateful for my contributions over the years and I should feel secure in that fact.
We parted on first name terms.
There was a remarkable improvement in relationships between me, Murnaghan, the anaesthetists and the administration in general, from that day onward, although I sensed continuing underlying currents of resentment.
One month after meeting Dickinson, I wrote to him (on 29 September 1983) to summarise my understanding of our conversation. Six weeks later, he wrote back (14 November 1983) saying that he disagreed with most that I had written and that he resented my writing to him at all because he had spoken to me privately, without Board approval or knowledge. [Nearly six years later (26 July 1989) Dickinson testified that he had retired in December 1983 but he recalled that there was a prospect of my being dismissed early in 1983.] Thus, Dickinson's interpretation of our meeting was entirely different from mine and which I recorded immediately in my notes.
It was always of some comfort to me during those troubled times, that my junior colleague, Dr David Newman, who had shared the paediatric cardiac surgery with me, and who had been trained only by me in my department from his earliest registrar days, had a surgical operating record exactly similar to mine, when analysed by the enquiry of 1983. Nonetheless, anaesthetists had never questioned his competence.
On 27 February 1984, I wrote to Lawrence, a new Chief Executive Officer, seeking a comprehensive administrative examination of what had occurred in 1983, because I didn't wish to remain in a situation of damaged reputation. I told Lawrence that the whole conflict had been a permanent stain on our corporate record, and it should be cleared up as soon as possible.
By that time, Beveridge had returned from overseas leave during most of 1983, and he renewed his attitude of warm friendship but conditional support (see earlier). He immediately allocated two of his most senior paediatric registrars to help with the paediatric cardiac patients. There was an immediate and unprecedented surge of comfort and confidence in all of our procedures. Nonetheless, the anaesthetists were still unforgiving, threatening to block any move of me and paediatric heart surgery to The Prince of Wales Hospital, even to the point of threatening resignation. They finally agreed to collaborate only if they were "so directed" (by whom, I wasn't told).
With Beveridge back home and putting his shoulder to the wheel in such a definite fashion, and with his being on very cordial terms with Lawrence, I was confident that the worst opposition from the anaesthetists could be ridden-out. By mid-1984, Beveridge had generated very close collaboration with me and I was frequently invited to dinner, golf and sailing. We even had a couple of trips (at my unit's expense) to the South Pacific islands where we studied children with heart problems. I needed the comfort of Beveridge's support, and he needed my assistance, to keep the paediatric heart surgery unit active, with a view to its re-establishment at The Prince of Wales Hospital.
Beveridge seemed very concerned that he should continue to act as a children's heart specialist which, by all usual definitions, he was not. One of his reasons was that transfer of the cardiac activity to The Prince of Wales Hospital required his personal involvement. It was the only remaining section of his department to which a dedicated specialist had not been appointed at that time. He wished to retain control of the transition.
During late 1984 and the whole of 1985, our surgical activities were rewarded by excellent results, even in the most complex cases. There was an increasing cohesion between all of those concerned with the enterprise and there was an obviously more comfortable relationship in the operating rooms between me and the anaesthetists. There were fewer complications and a fair level of esprit between us all, largely contributed by the excellent trainee paediatric cardiologists whom Beveridge had placed at my disposal. They were not under my control, however, but while we were located at The Prince Henry Hospital, under circumstances where I had been in charge for nearly twenty years, there was no administrative difficulty for me . It was against that, finally, happier background that the hospital Boards resolved on 3 June 1985 that the transfer of paediatric heart surgery to The Prince of Wales Hospital should occur and that I would head up the new department with a working party to get things going. It didn't last long.
According to Associate Professor Toby Bowring, who testified one year later, Davidson, the overall head of the Department of Anaesthesia, approached Bowring and then Lawrence, in mid-1985, to indicate that the anaesthetists would not support my moving to The Prince of Wales Hospital, on the grounds of my incompetence. Although Lawrence was later to deny that, and it is not clear who knew of Davidson's continuing obstruction, it made my transfer farcical. Of course, I knew nothing of it for one year.
To facilitate the transfer from The Prince Henry Hospital to The Prince of Wales Hospital, Matthew Crawford, a young anaesthetist lately returned from overseas study, was appointed by Davidson to head up The Prince of Wales anaesthetic team and to manage the transition from the "borrowed" anaesthetists, who had previously worked with me at The Prince Henry Hospital, until Crawford was comfortable to take over personally the whole enterprise at The Prince of Wales Hospital.
I was advised by Davidson and Vonwiller that Crawford had high credentials from one of the finest hospitals in North America (The Mayo Clinic of Rochester, Minnesota), and that his training had placed "special emphasis" on cardiac anaesthesia. From that, he appeared to be the ideal anaesthetic person to be dedicated to relocating the enterprise.
By September 1985, I felt that we could proceed with our first major (open heart) procedure at The Prince of Wales Hospital. By then, I had re-established myself personally and almost exclusively at The Prince of Wales Hospital in the Department of Paediatrics where I had an office (next door to Bowring), and a secretary whom I had brought over from The Prince Henry Hospital. The door of my office was labelled "Director of Paediatric Cardiac Surgery" [see Note in the second paragraph]. I was prepared to be patient and meticulous in everything I did, exclusively for the success of that new unit.
Nonetheless, I sensed that there was an undercurrent of resistance which far exceeded that which I had expected from those who may not have particularly welcomed any new department and its extra work. I was not to know at that stage that I was on borrowed time, according to what I later learned from Bowring's testimony.
The junior paediatric staff appointed to the surgical activity were less experienced than their predecessors, though very willing and generally capable. We were all learning fast. The same applied to the intensive care area and the operating room. But there were subliminal factors which, after many years of experience, led me to become apprehensive. I sensed I was involved in a sort of cold war with few reliable allies but no clearly-evident opponent , even allowing for the past history of the matter of relocation. Above all, I was apprehensive because there was no junior paediatric staff allocated to my personal requirements, and all paediatric resident staff involved were directly responsible only to Beveridge, or indirectly to Beveridge, via Crawford.
Note: The insecurity which I felt clearly reflected Beveridge's perception, only stated three years later (31 July 1989) that, although I did become the Director of the Paediatric Cardiac Surgical Unit, "there is no formal position as Director. It was and is simply a title: there is no such position". I could understand nothing of those semantics. Again, as with Bowring's statement of Davidson's opposition to my going to The Prince of Wales Hospital, I was also the last to know that the position to which I was appointed by the Boards of the hospitals, simply did not exist, in Beveridge's estimation.
During the first half of 1986, my sense of insecurity and lack of control of the situation, escalated at an alarming rate. Beveridge's posture appeared neutral or enigmatic. Crawford's posture became more difficult to define. Odd complications occurred all over again and management protocols were altered without consultation with me. Fundamental authority for all steps taken in the post-operative period, lay with Beveridge and Crawford. Resident staff acted as filters through which treatment suggestions of mine reached Beveridge. Of course, I was loath to suspend the enterprise so early after its institution. By virtually living in the hospital through those months, I was able to out-guess or abort some of the post-operative management problems which were encountered. I persisted in hope rather than belief that the "learning-curve" would soon reach its top. (Had I known then what I learned shortly after, I would never have begun the enterprise.)
There was a cooling of personal relations between Beveridge and me, even extending to our families. There was a series of minor and, later, major confrontations with him about patient care. In April 1986, I confronted him about what I regarded as his improper interference with research funds which I administered. Beveridge had privately requested the hospital administration to amalgamate those funds with a fund administered only by him. When I accidentally learned of this, I requested the administration to reverse that amalgamation.
In the same month, Crawford advised me that he was increasingly troubled by his lack of specialised cardiac knowledge.
In about May 1986, Beveridge had confidential discussions with members of my technical staff, concerning their perception of my surgical competence. A month later, Beveridge announced, out of the blue, that he had had private discussions with Dr Chang and Dr Farnsworth of The St. Vincent's Hospital, Sydney, concerning their possible interest in joining the paediatric surgical staff at The Prince of Wales Hospital. In the same month, the Chief Paediatric Resident informed me that Beveridge did not believe that I needed a specific resident or registrar allocation. Shortly after, Beveridge, Smyth and others in administration cancelled an arrangement for the media to interview me (only) concerning the development of the new paediatric cardiac unit at The Prince of Wales Hospital.
At 2:30 pm on 27 June 1986, I went to Lawrence's office to tell him that the paediatric cardiac surgical unit was operating unsatisfactorily for several reasons and that I no longer had confidence that we could deliver a satisfactory product to our patients. I advised him that a poor set of arrangements had, indeed, failed. There were swift responses in several areas, all unknown to me at that time.
On 9 July 1986, Beveridge again approached Chang and Farnsworth of The St. Vincent's Hospital, seeking their interest in appointments as visiting surgeons at The Prince of Wales Hospital. (Farnsworth apparently expressed interest, but Chang never participated personally in operations at The Prince of Wales hospital. Five years later, Chang was killed in a street shooting.) After meeting Farnsworth and Chang, he advised Lawrence, CEO, that he (Beveridge) had lost confidence in me. Notwithstanding that, he shortly after implored me to operate, urgently, on a sick child. My surgical judgment was to delay that operation, pending an intensive course of antibiotics for a couple of days, which would make surgical intervention much safer. Beveridge seemed angry that the ultimate decision concerning the timing of surgery, was held by me.
On the same day Beveridge approached Crawford. He had discussions with Davidson. All then decided, collectively, to suspend their cooperation with me.
I was not to know of these various activities until the next morning, or later.
Early on 10 July 1986, Beveridge conferred with Lawrence, Smyth (Chief Medical Officer), Crawford, Torda (I presume that Davidson was unavailable for some reason) and Currie (Paediatric Surgical Registrar). Again, I knew nothing of that conference until later.
Later on the morning of 10 July 1986, Beveridge came to my office, unannounced. He told me that Crawford and Currie were unwilling to work with me. I phoned Crawford to have his version of the matter. He said that he found the surgical results disappointing and his wife complained that he was never home. He finally announced that he saw no hope of success for the surgical unit because there were "too many people with old scores to settle" with me.
On the afternoon of that day, Lawrence called me to meet him. He handed me a letter setting out that I was to be suspended pending an enquiry into these matters. It was anonymous to the extent that it referred to the concerns of "a number of clinicians", and the "Department of Anaesthetics" being unwilling to provide routine anaesthetic services. I responded by saying that, as he well knew from my discussion with him on 27 June 1986, I believed that "services for paediatric cardiac surgery at The Prince of Wales hospital were not adequate for its competent performance".
Put into context, there was no doubt that my surgical career at those hospitals had come to a close at that point. My fate had been predetermined. I well understood that Beveridge and Crawford were disturbed.
When I analysed the whole of my surgical experience at The Prince of Wales Children's' Hospital, throughout this difficult teething period, with a variety of patients of quite remarkable complexity, we had lost seven patients, from all causes, out of a total of 70 operations. But of those seven, three occurred before operation started (reflecting a precarious condition) but were temporarily salvaged by operation. Three deaths occurred after the operation, all in the intensive care ward where I had little or no control of management. One (only) died during the operation itself. That child had uncorrectable cardiac defects which had not been discovered before operation.
On 13 July 1986, Beveridge came to my home, unannounced. He brought a piece of cake and some flowers for my wife. As he left the house he said, "....I have been Judas". [Note: Beveridge, in response to a draft of this article, notes that he exercised his responsibility as a clinical director of paediatrics to recommend that my operating privileges be withdrawn due to what were perceived by him and others as less than satisfactory results of some of my operations. He says that he was surprised that prior to the meeting of the Medical Practices Committee, there was no survey undertaken by the Chief Executive Officer of surgical results correlated with diagnoses, procedures, outcomes and complications.]
The last card had been played. My guesses had been close to the truth. I told him that I would contest the matter as long as I could; I did not wish him ever to speak on my behalf or to me again about any aspect of this matter. I wished no indiscriminate pre-emptive broadcasting. The lines had been drawn.
Lawrence's action had placed me in a remarkable position. The Boards took pains to vindicate him later. I had been suspended from a prestigious position in a major teaching hospital. When I enquired of the hospital about the identities of those who were making charges and what those charges were, no details were originally available. I was told that I could "probably guess who and what they were" (Smyth). I therefore took legal action for a reversal of my suspension pending a proper enquiry with full particulars. They were slow to come.
At a preliminary hearing, counsel for the hospitals pronounced spectacular and damaging accusations by the hospital, based on "safety" factors. As a result, permanent indiscriminate damage was done to me and the media had their destructive day.
It took six weeks for particulars of the accusations to reach me. I responded to 29 claims (sic) of surgical deficiency in 8 months of work. Seven "clinicians" who "lacked confidence" had been invited by the hospital to testify about their reasons for such a lack. They were Beveridge, Crawford, Torda, Bowring, Currie, Duffy and Vonwiller. Four of those seven had only an oblique connection with my work. Most of those relied heavily on hearsay and second-hand information stemming, according to their testimony, from Crawford and/or Currie.
Davidson gave no written testimony although he had apparently been much involved in preceding affairs. Only two of the seven (Beveridge and Crawford) had had any close connection with the surgical enterprise throughout its history. Neither had specialist cardiac qualifications. The depth of their paediatric cardiac experience will be mentioned later.
Crawford seemed to have been the prime mover and author in the preparation of documentation. His qualifications were stated by him as including, at the Mayo Clinic, "special emphasis placed on cardiovascular (and neurosurgical) anaesthesia" (my parentheses). He wrote as an expert. His personal and professional criticisms of me were ferocious, patronising and obfuscating. (In a later response to a draft of this article, he rationalised and circumstantiated his position by more extreme, far-reaching and retrospective pejoratives. Crawford's assessments appear to have overlooked two fundamentals. Firstly, Bowring's letter to the Medical Practices Committee indicated that the anaesthetists would not support me once I arrived at The Prince of Wales Hospital. Secondly, as Dr Mee later wrote, "despite paediatric cardiac surgery being a multi-disciplinary effort, if things go wrong, the surgeon cops it". Thus, I had no supportive team, either before or after I was appointed as director of the surgical unit at The Prince of Wales Hospital. Crawford was meant to be part of that team.)
Beveridge justified his opinions and authority in management on having had "particular interest"..."close association"..."a share in management"... "others providing information."
Currie (a rotating paediatric general registrar who had been available to me intermittently for two months) said that his testimony was not spontaneous but solicited. He wished it to be strictly confidential. He found no fault in the group of operations which he understood well and with which he had assisted but, in the more complicated cases, he was not able to make any comment at all. He believed that I should have had an expert trainee to assist me.
Bowring's testimony included no personal accusation of substance. He quoted views of Vonwiller, Crawford, Davidson and Currie, second-hand. Bowring stated in his report dated 18 July 1986 that "about one year ago, the Director of Theatres, Dr George Davidson, spoke to me as Chairman, Department of Paediatric Surgery, indicating that the members of his staff were no longer prepared to give anaesthetics for Professor Wright's operations". (This was at a stage when I was operating only at The Prince Henry Hospital. There had been no criticism of the excellent surgical results occurring at that time.)
Bowring wrote that Davidson accused me of professional incompetence and Davidson's "Department 's grievance had been taken up directly with the Chief Executive Officer" (Lawrence), and "later he (Davidson) informed me of a revised arrangement whereby anaesthetic services will be provided for Professor Wright's operations which prevailed until the transfer to Prince of Wales".
Thus, one year before my suspension, and before my appointment by the Boards as Director of the Paediatric Cardiac Surgical Unit at The Prince of Wales Hospital, Davidson (speaking for the Department of Anaesthesia but having witnessed no operation by me in 25 years) had advised the Chief Executive Officer that I was incompetent.
Lawrence was later to deny, on 7 November 1986 at the Medical Practices Committee interview, that he had ever been approached by Davidson in this way.
According to Bowring's evidence, therefore, I was invited to head the new Department of Paediatric Cardiac Surgery, and I was formally appointed to that post, many months after Davidson had announced to the Chief Executive Officer (and therefore to the Boards) that he would withdraw anaesthetic services once I arrived at The Prince of Wales Hospital. Lawrence's statement to me on 7 November 1986 at the Medical Practices Committee interview, and Bowring's report to that committee, 18 July 1986, were in direct conflict.
Vonwiller, who described himself as the Director of Anaesthesia and Intensive Care at The Prince of Wales Hospital (located only there), indicated his very peripheral contact with our surgical activities. His understanding of specific issues seemed to be poor. He appeared to be largely influenced in his comments by what Crawford had told him. (Increasingly distressed, he phoned me on two occasions (in 1987 and 1988) to say that he regretted his being used in the "numbers game" and was disgusted with himself and others. He would not say by whom he was influenced. He did say it was a matter of "one in, all in".) Note: in 1992, Vonwiller died from a brain tumour.
Torda (Head of the Department of Anaesthesia and Intensive Care, replacing Davidson by this time) said he had witnessed no operation performed by me in at least three years. My records show that he had given one anaesthetic for me in each of the three years, 1979,1981 and 1983. He had no first-hand knowledge of any patient in question. He gave Vonwiller's views, (already largely second-hand) in his comments. He apparently formed an opinion based on that evidence.
Duffy (Director of the Children's Intensive Care Ward) quoted Currie as a major source of information and then made a comparison of the surgical results which we had accomplished, with The Royal Children's Hospital Melbourne whose experience exceeded ours many times. (His comments should be seen in the light of the report of the surgeon in charge at The Royal Children's Hospital (Dr R B Mee) who attended the Medical Practices Committee inquiry.)
I pondered Crawford's background, in particular. Davidson and Vonwiller had told me that they regarded his experience in paediatric anaesthesia highly. Crawford described himself to the Medical Practices Committee as having placed "special emphasis on cardiovascular and neurosurgical anaesthesia" while at the Mayo Clinic for 27 months. Smyth, in papers prepared for the Medical Practices Committee, described Crawford's "specialised training" in cardiovascular anaesthesia. Vonwiller had advised the Committee and me that Crawford had "extensive experience in paediatric anaesthesia, cardiac anaesthesia and intensive care".
On 4 September 1986, the secretarial staff in the Fellowships Office of the Mayo Clinic and Foundation advised me that Crawford's involvements, as an anaesthetist in training, in 1982-84, during a 27 month period, had been as follows:
Research (laboratory only): 9 months
Orthopaedic: 5 months
General surgical: 4 months
Neurosurgical: 3 months
Cardiovascular (adults): 3 months
Critical care (adult and non-cardiac): 3 months
Although there was no mention of "paediatric" or "paediatric cardiac" involvement in that record, Crawford responded to a draft of this article by saying that he had been involved in a research project involving the ventilation of neonates, that he would not infrequently have to "deal with children whose procedures were finishing late in the day" and that he "came in contact, on a regular basis, with children who had undergone cardiac surgery". He said that his "main aim at The Mayo was to gain neurosurgical anaesthesia experience....."
[In a long letter in response to a draft of this article, Crawford presented various numbers purporting to show that my replacement by another surgeon had led to much improvement in results. He did not reply to an offer to publish his letter, or parts of it. His letter seemed to absolve all, but me, of any responsibility for results. His statistics lacked significance due to low numbers and rates of performance. His classifications were unconventional or ambiguous. Implications that better results were seen soon after my departure, could not be taken seriously. A cogent comparison would have taken months or years of matched cases, by which time great "institutional" and personal learning must also have occurred to improve results.]
In due course, I attended the Medical Practices Committee enquiry on 7 November 1986, with Dr Boyd Leigh. Although not a cardiac expert, Dr Leigh knew a great deal about all branches of surgery, and I valued his assessment of the enquiry.
The Committee officially consisted of three lay members of the Board and two senior medical staff (Professor Dwyer, Head of Medicine and Professor Murnaghan, Head of Surgery).
The Committee had invited a non-voting appointee, to interpret and comment upon surgical matters. That was Dr Roger Mee, nominated by The Royal Australasian College of Surgeons at the request of the hospital. He was Paediatric Cardiac Surgeon in Charge at The Royal Melbourne Children's Hospital, with a very large experience.
On 7 November 1986, however, Professor Dwyer was not present and no reason was given for his absence. Professor Murnaghan announced towards the end of the interview, that he was actually present as "himself" rather than as Director of Surgery. I supposed that meant that he had declined voting capacity. If so, the only members of the Committee present on that day who were to make decisions, were the three lay Board members.
The Committee Chairman (John Gerathy, solicitor), stated that they were not examining my competence but the question of my "operating privileges".
Dr Mee was the only expert person present, apart from me. I totally rejected any inference of surgical fault, at the outset. During the interview, I reiterated much of the history of the development of the new surgical unit, and the multiple administrative difficulties which I had encountered. I pointed out to Lawrence, who was part of the Committee, that I would not have been induced to begin the service at The Prince of Wales Hospital had I been aware that the anaesthetists had indicated a lack of support for me a year earlier, before I, unwittingly, transferred to the new hospital.
At the end of the interview, it was clear that Dr Mee, the expert referee, had already had several discussions on other occasions with the Committee and with those giving testimony to the Committee. He summarised his views by saying that he was critical of my handling of one case of the whole experience, but he did that only with hindsight and emphasised that it was a very complex operation. He expressed criticism of other accusing individuals and procedures, and finally suggested that I was possibly being "gunned for" by somebody seeking a reason to sack me.
Separately, Dr Leigh later wrote his recollections. He gained the impression that my surgical performance had passed muster according to Dr Mee, but that some of my critics lacked experience and balance, some of them relying only on hearsay and presumptions. Dr Leigh concluded that the basic problem seemed to him to be "a conflict of personalities". He had warned the Committee that it should "not take clashes of personalities and will, as evidences of incompetence".
During the following month, I had a couple of conversations with Mee, in Melbourne, to see if he could hasten his final report to the hospital. He continued to hold the same views as he had expressed at the meeting. Remarkably, he had gained the impression that Beveridge was a paediatric cardiology specialist, rather than a general paediatrician. Mee had apparently advised the Chairman of the Committee (Gerathy) of his views, pointing out there was no evidence of my incompetence and recommending that the issue should not be pursued further for fear that I be rendered "unemployable" by a campaign which apparently set out to "get Wright".
Gerathy led him to believe that he was considering negotiation with me. Dr Mee had reservations about the workability of any compromise arrangement.
Indeed, the hospital did make to me, with my solicitor, a "without prejudice" offer of a sinecure on full wages for three years, if I was prepared to "go quietly". I chose not to. Some consider that a serious commercial and practical mistake.
On 19 December 1986, at 8:00 am, the hospital Boards accepted the Committee's recommendation that Lawrence had been justified in suspending my operating on 10 July 1986, and that there was incontrovertible evidence that Beveridge and others no longer had confidence in me, so that my continued association with paediatric cardiac surgery could not continue.
Lawrence then contacted Mee in Melbourne asking for a written report on the Boards' decision. Mee responded at 2:12 pm, by facsimile transmission. He mentioned technical inaccuracies in only two of my cases, both complex problems. He reiterated what he had said at the Committee hearing, that there was lack of experience and expertise in other areas. He regarded no complication of my surgery as unusual or remarkable. He said that I had been working under less than ideal conditions. He was not able to say that any lack of confidence was justified or that I was alone responsible for it.
My legal advisers recommended that I seek reinstatement and compensation. On 25 June 1987, the Supreme Court considered the matter.
On 4 September 1987 the Court determined that, as I was under contract to the hospitals, that contract could be terminated at any time with or without a reason. Mee's very favourable report was not influential in the judgment because the Boards' decision to dismiss me had been taken prior to Mee's written evidence. (Note: The Court was not aware of the extent of Crawford's experience in paediatric anaesthesia, either before or during his attachment at The Mayo Clinic.) The hospital needed to get the job done and exercised considerations of expediency in administration. The judgment acknowledged that the form of surgery involved was at the frontiers of difficulty and peril and had some of the character of experiment and adventure. The Court did not believe that the hospital had made any judgment on my general competence. The situation was that "someone had to go or the work had to be left undone". I had no interest in prolonging Court work by appeal. A small financial compensation was offered and accepted, and I proceeded with my consultancy work throughout the next ten years.
Had I known that the issue could be determined in a quasi-judicial fashion, merely on the grounds of "contract", I doubt that I would have proceeded to Court, at all.
Some time later, Dr Mee wrote me a sympathetic and encouraging letter, saying how concerned he had been about some elements of the inquiry. He said that my colleagues elsewhere would wish me to return to and continue in my work. In a practical sense, however, I knew that was impossible.
My old conflict with anaesthetists about demarcation of responsibilities and being "captain of the ship" was an issue of "medical dominance", the basis of this history. It continues to affect others.
According to Bowring's and Beveridge's comments, my appointment to The Prince of Wales Hospital as Director of Paediatric Cardiac Surgery, was not bona fide and I was bound to fail.
Again, if one accepts Bowring's testimony, it seems inexcusable that so many levels of administration would not have brought to my attention anything they knew of the entrenched hostility of Davidson and some of his department.
Beveridge characterised his own role as "Judas".
Great support came from family, friends, patients, parents of treated children, Dr Leigh in particular, and the publication by Phillip Knightley of a short article in a monthly magazine, summarising the essential elements of the matter. Knightley's article, of course, was severely hedged to avoid defamation claims. It was never challenged and the hospital did not respond to his repeated contact for comment.
Two State politicians exercised an effective interest in having Mee's report included, officially, within a New South Wales Department of Health file. Although the present State Minister for Health is aware of what occurred, he has not provided help.
My medical defence carrier paid my legal costs and gave helpful support at all stages.
Little or no assistance came from hospital or other medical colleagues, with a few notable exceptions. The Royal Australasian College of Surgeons had an initial interest in my predicament, but soon ceased to acknowledge my communications.
The Sydney Cardiothoracic Surgical Group, and the Medical Staff Association of my hospitals expressed no interest. The State Ombudsman's office would not become involved. My approach to the Courts turned out to be futile from the beginning. I suspect that the hospitals' legal advisers were confident of their position on "contract" at all times.
One issue, which concerned me a great deal in the final analysis, was that a copy of Dr Mee's expert report should be acknowledged to exist by the Health Department head office. That evaluation was a summary of my "professional clearance" in the whole ugly set of criticisms of my work.
But as late as 17 May 1988, an advice from the Health Department failed to acknowledge the existence of Mee's report. In fact, it took until 19 November 1991, and multiple approaches by members of parliament, on my account, before such an acknowledgment was made.
Dr. Roger Mee's (Royal Melbourne Children's Hospital) report of 19 December 1986 was supportive of my professional record at The Prince of Wales Children's Hospital, but it was highly critical of the Hospital's performance. I was, therefore, anxious that a copy of Mee's report should be included in the Health Department's file, and acknowledged so.
8 January 1990: Phillip Smiles, State Member for Mosman, my local Member, wrote to Chris Crawford, Executive Officer to the Minister for Health, enclosing a copy of Mee's report and noting that it had not been included in the Department's records of the matter. (I had no response to that letter from Mr. Smiles).
3 July 1991: As Shadow Minister for Health Services, Dr. Refshauge wrote to me, following my request of him, also, for assistance, that "it is vital for you to get a copy of Dr. Mee's report". (I already had a copy, of course, from the Court, but I had not been able to obtain an acknowledgment of the report's existence, from the Health Department).
12 December 1991: My Local Member of Parliament, Mr. Smiles, advised me that Minister for Health and Administrative Services' "senior staff" had advised him that Dr. Mee's report was now included in the Health Department's files, and appropriately indexed.
19 December 1991: Mr. R.A. Phillips, Minister for Health Services Management, personally advised Mr. Smiles, and Dr. Refshauge as Shadow Minister, that Dr. Mee's report was now contained in a Departmental file,
5 February 1995: I wrote to Dr. Refshauge, now Deputy Premier and Minister for Health, asking that he might review the issue of "clearing my name", bearing in mind Dr. Mee's report.
3 April 1995: I wrote to Dr. Refshauge again, reminding him of my letter of 5 February 1995, of which I had had no acknowledgment.
22 May 1995: I phoned Dr. Refshauge's office to ask his secretary to remind Dr. Refshauge of my letters of 5 February 1995 and 3 April 1995. She advised me that my earlier communications (which were accompanied by copies of Dr. Mee's report) could not be located. At her request, I faxed further copies.
2 August 1995: At his request, I met the Minister in his office. Dr. Refshauge indicated that Dr. Mee's report, and previous correspondence from me, still could not be found in the Departmental or his office files.
7 August 1995: At Dr. Refshauge's request, I sent by registered mail, to Dr. Refshauge personally, a further copy of Dr. Mee's report.
22 September 1995: I phoned Dr. Refshauge's office at 9.15 a.m. and at 4 p.m., seeking to speak to his private secretary [Staff names have been omitted on request from Dr Refshaughe's office], in order to ask that she might draw the matter to Dr. Refshauge's attention. She was unavailable on both occasions and did not respond to my calls.
5 October 1995: Having phoned again Dr Refshaughe's private secretary, another member of his staff assured me of total privacy if I sent Dr. Refshauge a personal fax message. I did so, expressing my distress that my registered letter to Dr. Refshauge of 7 August 1995 had had no response.
9 October 1995: Because the papers could again not be found, Dr. Refshauge's private secretary phoned to advise me that the Minister would send his personal driver to collect the Mee report and other documents, from my home. The arrangement was that Dr. Refshauge's driver would personally hand the documents to Dr. Refshauge, and to no other person.
10 October 1995 (7.30 p.m.): The driver for Dr. Refshauge attended my home and collected the documents.
10 October 1995: A memorandum from the Minister's Office, signed by both his secretary and his driver, confirmed collection of the documents, and promised confirmation of their being hand-delivered by his driver to Dr. Refshauge.
11 October 1995: Phone messages came separately from Dr Refshaughe's private secretary and driver in confirmation of the memorandum of 10 October 1995.
20 November 1995 (11.45 a.m.): The Minister phoned me at home to confirm that he had now seen Dr. Mee's report and the associated Hospital documents. He advised that the Director-General of his Department had been asked to ensure that the documents remained safe and that they should be regarded as definitive documents in my file within the Department.
He indicated that he would consider ways and means of mitigating some of the damage done to my reputation, and that he would keep me informed. He was disinclined to "rake over the coals" of the matter, for my sake.
He said that he knew that Mee's written report had not been in the possession of the Boards of Directors of the Eastern Sydney Area Health Service, at the time that a dismissal decision was made by the Boards on 19 December 1986.
Last revised 19 January 1998
Since this article was published in June 1998, there have been no further responses from those concerned, noting that Murnaghan, Beveridge and Davidson died in late 1999. It is clear now that it was Davidson, having no knowledge of the surgery, who covertly orchestrated the conflicts of 1983 and 1986, and conspired with Beveridge [calling himself 'Judas'] to procure my dismissal. Moreover, Davidson intimidated Murnaghan to the extent that he, too, concealed their plans from me and encouraged my transfer to paediatrics in full knowledge of my own and my department's secretly planned destruction. Beveridge continued to falsely present himself as a cardiologist until long after my dismissal. As he confessed on many occasions, but later denied, his motives were at all times commercial and political. There has still been no replacement surgeon appointed at The Prince of Wales Hospital since I left. Regular surgical activity there is confined to a weekly visit from another hospital. That surgeon prefers not to operate in the paediatric theatres. Thus, as a direct and immediate result of my signalling dangerous practices, the surgical department which I founded was destroyed. No good has come from that action. Much has been lost for all time.
After retiring from consultant and medico-legal practice in 1998 and being freed from risks of further damage to my reputation and practice by negative publicity, I set out to further explore my position with the Department of Health, NSW.
In February 1999, I contacted Deputy Director-General Robert McGregor about the security of departmental documents related to my past circumstances. (I had read of a weekend "break-in" at the department.) I was assured that no documents had been taken but no file of mine had been found in the department. A later phone call advised that the file was discovered at the Area Health Service and contained a copy of Dr Mee's report.
In May 1999, after five phone calls, I was sent an edited copy of the file which contained amongst other documents my letter to a newspaper, critical of health matters, dated 16 April 1979. I sent McGregor a copy of the then current published manuscript of hospital matters, to be also kept on the department's file.
In June 1999, McGregor wrote to assure me that my request had been adopted. He later phoned me to say that my manuscript had not actually "reached" him. I sent him another copy. He said I would now be afforded a file number for all future departmental reference.
In October 1999, I met with McGregor to discuss my wishes for some form of professional salvage. He described the events of 1986 as being "impossible these days" and asked me "who I knew" to call on for independent support. Accordingly, I provided him with the names of seven eminent people (six of them medical colleagues) who were agreeable to report to him. There was no response for four months.
In February 2000, McGregor promised to contact those persons and by June 2000 he had received responses from them.
In July 2000, I again met with McGregor who offered to discuss matters with a past Chairman of the NSW Health Commission who had testified for me. In October 2000, after my further letters, he again promised to do that. I have no evidence of such contact.
In September 2000, frustrated by departmental inertia and the failure of all attempts to advance my position, I was advised to seek the support of Mr Alan Jones of Radio 2UE who proved sympathetic and extremely attentive. At his suggestion, I wrote directly to Health Minister Craig Knowles. (On my behalf, Alan Jones corresponded with the Minister on dozens of occasions since then and continued such support until February 2003.)
In April 2001, I met the Minister for ten minutes as a result of Alan Jones' intervention. He promised his attention to my concerns but without undertakings otherwise.
In July 2001, I again wrote to McGregor seeking his response to the receipt of testimonials from my referees fourteen months earlier.
In August 2001, he responded that he would approach the chief executive officers of the major metropolitan teaching hospitals seeking their views on my "engagement within the public hospital system".
In February 2002, after six unproductive calls to McGregor and his staff throughout December 2001 and January 2002, I was advised that letters to the CEOs had not been sent until December 2001 and there had been no responses yet.
In March 2002, I reminded McGregor that it was three years since his involvement began, one year since I had met the Minister, five months since his (McGregor's) letters to the hospitals and one month since my last letter to him. I again sought his response. He replied that he had reminded the hospital executives to respond to his requests.
In April 2002, McGregor sent copies of those responses, all of which stated that they would welcome my application for hospital appointments as they arose. All believed that I was seeking active clinical positions, which was an entirely incorrect interpretation of my wishes for emeritus consultant appointments where I had been employed. Hence, those approaches were inappropriate and inevitably futile.
In June 2002, McGregor cancelled an arranged appointment and indicated he could not assist me further.
In July 2002, as a result of continuing correspondence from Alan Jones, the Minister again arranged an appointment with me. He advised that he would ask the NSW Medical Board to assess the whole situation and provide him with an objective evaluation of the events of 1986.
Between July and December 2002, Alan Jones and I wrote to the Minister on dozens of occasions. In addition, the Premier advised that an approach to him had been referred to the Minister. My local State MP, Clover Moore, also wrote to ask the Minister's position. There was no response.
On 19 December 2002, The Registrar of the NSW Medical Board wrote to me to obtain documentation of the 1986 matter and to arrange that we meet. I sent him copies of all relevant material immediately by courier.
By the end of January 2003, I had no responses to a letter and a phone call to the Medical Board or to a letter and two phone calls to the Minister's chief of staff, Paul Levins, seeking his assistance with expediting the matter.
On February 4 2003, the Registrar of the NSW Medical Board phoned to say that he would be responding to me by letter on the next day. The letter confirmed that my registration status was of good standing with the Board, enabling me to undertake whatever medical work I chose. (That status had never been in doubt.)
It was also pointed out that the Board had "no charter to examine matters such as those outlined in the documentation (I had) provided to the Board". (The Registrar had consulted the President of the Board, a cardiothoracic surgeon who was already familiar with the documented matters.)
At 6.30 PM on 5 February 2003, Levins phoned to ask had I received the Registrar's letter. He then asked what it was that I expected. I faxed him a memo I had handed to the Minister on 7 July 2002, which set out options for the Minister's consideration. None required more than a simple administrative decision. There was no response.
On February 18 2003, Alan Jones' secretary phoned me to say that the Minister could "go no further" with assisting me and had informed Alan Jones similarly in a private conversation. It seems that I was to have no ministerial response excepting via Alan Jones. (State elections were scheduled for March 2003.)
Later that day, I wrote to the Director General of The Cabinet Office, Roger Wilkins, who had previously responded to a letter to the Premier, seeking his further advice. There was no response.
I also wrote to Alan Jones to thank him unreservedly for his prodigious help during more than two years. My admiration for and gratitude to him are uniquely deserved.
On March 7 2003, I wrote to Ms Deborah Green, CEO of the South East Sydney Area Health Service, which encompasses the two hospitals where I had worked for 25 years, seeking appointments as honorary consultant to the departments of surgery and paediatrics of those hospitals. That step would be entirely safe, worthwhile and effective for me and costless to the health service.
On April 9 2003, Ms Green wrote that as I had not "retired" from active practice at the hospitals and as I had not been "invited" to consult at the hospitals, I was ineligible for an emeritus consultant appointment.