2004 for New Zealanders: Ron Paterson

Ron Paterson

Ron Paterson pauses for a long time at the question. Standout cases can be almost too hard to revisit. Inevitably, the Health and Disability Commissioner gets a skewed and often disheartening view of the health system. "You're seeing the worst part of it. There are a number of human tragedies where you wonder how a family can cope."

Generally, he prefers not to talk in detail about last year's tragedies. But the case of a Gisborne family whose adult son was injured in a work accident does stand out. Their complaint was about the muck-up that occurred in their son's transfer to another hospital. "It was a rare case where the family sent me a card saying that the report had brought tears to their eyes and it meant a lot to them to know that their son's experience meant that future patients and whanau wouldn't have to go through the same experience," Paterson says.

Such appreciation is rare because the commissioner is mostly in the unpopular position of making decisions amid conflicting demands. "It's probably a feature of the job that you're not going to please everyone. We still encounter a lot of disappointment from patients." Yes, it is stressful dealing with people who "whether out of their grief or their anger, or fear when under investigation, behave in some pretty difficult ways".

But Paterson is pleased about what he considers to be a marked improvement in how the public and the providers are accepting the system for dealing with medical complaints. "I'm encountering less and less hostility around the sector. There's certainly been a change in the medical profession, where there's been the most resistance."

This year was the 10th since the Health and Disability Commissioner Act came into force, an anniversary marked with a national conference in March. Paterson also spoke at National Women's, the place where - following the 1987-1988 cervical screening inquiry - the need for his office was born.

Word of New Zealand's system - an independent commissioner for investigations and ACC for compensation - spread internationally last year. In January, Paterson addressed the Shipman inquiry, which aimed to implement new safeguards in British healthcare following GP Harold Shipman's convictions for murdering 15 patients.

"The emphasis is on learning not lynching," Paterson told the inquiry. He also talked of the breadth of the commissioner's role: to look at both individual practitioners and the systems they operate under, "potentially to find management in breach of their legal duties under the Code of Health and Disability Services Consumers' Rights".

In March, just such a "systems problem" - unacceptable waiting times in our hospital emergency departments - prompted Paterson to voice concerns. "At times very skilled and dedicated staff are still struggling with hopeless overload and some fairly poorly co-ordinated systems."

He says that resolving such problems isn't always about more money, but acknowledges greater investment in computerised patient records and the ordering of tests could vastly improve the safety of healthcare.

In October, his views on "trial by media" again saw him in the crossfire - initially from the medical profession for saying there should never be name suppression in disciplinary cases and that providers breaching the code of patient rights should be named. But he got it in the neck from the other side too, when he said individual doctors shouldn't be named until the process was complete. A Herald editorial at the time reminded him he was there to serve the public, not the profession. Paterson, not rattled, welcomed the media's input as "an important antidote to complacency".

He has been in the job for five years and if reappointed, will undoubtedly be in the crossfire again. "I'm interested in ways we can use the trends from the complaints - in what we see occurring across the country - to speak out."