Dialogue: Let the hospital get on with its real job

The Green Lane heart library issue must be addressed, but it is equally important that disruption to patients is minimised, says PAUL HUTCHISON*.

In light of the 1988 Cartwright Inquiry and the 1996 Health and Disability Services code of consumer rights, it is a huge concern that in recent times human hearts were removed for research and teaching purposes at Green Lane Hospital without informed consent of the relatives.

It is also of huge concern that elective cardiac surgery has been temporarily cancelled to give hard-pressed staff at Green Lane time to address the large number of inquiries by distraught relatives.

Our health services have been disrupted by continuous restructuring and major inquiries over the past 15 years. The National Women's Hospital Cartwright Inquiry, while necessary, was associated with a profound dysfunction of services and staff recruitment at that hospital for many years afterwards. That must not happen at Green Lane.

It is vital that clinical services at the National Children's cardiac unit are not impaired as the problems associated with the heart library are addressed.

Green Lane has publicly apologised to the relatives and expressed deep regret for distress caused. It has also set up a line of communication to the public and mechanisms to allow return of body parts when requested.

Since Britain's Liverpool body parts outcry one year ago, Green Lane has also:

* Formed a steering group, which includes parents and iwi, to ensure the collection was managed appropriately and hearts were not being kept against relatives' wishes.

* Sought advice to complete a revised informed consent form that is as comprehensive as possible.

* Established mechanisms to ensure that body parts from outside hospitals would have informed consent.

A review of the 1964 Tissue Act has also been suggested. This is necessary.

No legislation deals comprehensively with autopsy and the retention of human organs and tissue. Rather, there is a group of acts - the Coroners Act, the Human Tissue Act and the code of rights under the Health and Disability Services Consumer Rights Act.

Susan Watson may be technically correct when she said, in a Dialogue column, that the removal of body parts without consent of relatives had been in breach of the legislation since 1964. But the 1964 law is not clear in many respects and does not mention informed consent directly. Large areas of present practice are not covered.

The Royal College of Pathologists has developed position statements on retaining tissue from autopsy and from the living. But these have no legal force.

The Auckland District Health Board is investigating the heart library and will report to the Minister of Health. Hopefully most of the major concerns will be addressed soon.

The board should be open and rigorous, and show the public that the mechanisms put in place on informed consent are as thorough as possible. Provided this is done well, a formal public inquiry would be counterproductive.

Today's improved results for those facing cardiac surgery are testimony to the commitment and expertise of staff working at Green Lane through the years.

In the 1970s, between 25 per cent and 30 per cent of those facing major cardiac surgery would die. Now, the rate is 3 to 4 per cent. The heart collection has been a key to improving techniques.

The challenge is to address loopholes and establish quality control mechanisms and a culture that insists on informed consent being thorough.

Many people, including at least 1000 Maori, live with donated body parts. The sensitivities surrounding transplant surgery, and retaining and storing body tissue, vary in our multicultural society.

Every day many organs, including gall bladders, ovaries and appendices, are sent for pathological analysis. Normally they are cremated after a set period. Histological (microscopic) tissue specimens are kept for 20 years or more.

Most New Zealanders would not be aware that informed consent is not explicitly given for this purpose when signing informed consent for an operation.

New technologies are becoming increasingly significant and can have key medico-legal implications. DNA technology can detect at-risk children from the tissue of their mother's breast biopsy. On the other hand, the same tissue could be used in a criminal investigation.

Rapid technological advances mean that legislation should be based on broad principles rather than being too prescriptive. Otherwise, the legislation will become obsolete.

Informed consent in the modern world is complex and needs constant revision. It is vital that new high standards emerge as part of medical culture and that district health boards have audit mechanisms to ensure they are complied with.

The Government should also review the laws on body parts and tissue so they are relevant to new technologies.

Everything possible must be done to redress those affected by the omissions at Green Lane. But it is also vital that the teams at the hospital can carry out their first-class cardiac surgery with minimal disruption to those in need of it.

* Dr Paul Hutchison is the National Party's associate health spokesman.