Self-regulation 'in danger of failing'

By FIONA BARBER

A former chairman of the Medical Council has conceded that doctor self-regulation in such a small medical specialist community as New Zealand's is at risk of failing.

During cross-examination at the Gisborne cancer inquiry, Dr Ken Thomson agreed that "internal morality" was in jeopardy when there were so few cytopathologists.

He was responding to British medical journal articles by a New Zealand academic that looked at the issue of self-regulation following the 1988 Cartwright inquiry into cervical cancer treatment at National Women's Hospital.

A lawyer acting for affected women, Stuart Grieve, QC, said if problems arose such as the one in Gisborne, it was likely most cytopathologists would be involved in one way or another.

Dr Thomson said the same could be said for a number of specialities in New Zealand.

When asked by Mr Grieve whether he accepted that problems could arise over criticisms of colleagues, Dr Thomson replied: "I would hope that most doctors would rise above the temptation to be too supportive when there is incompetence of any sort demonstrated."

In his written evidence, Dr Thomson said there had been nothing before the council to suggest the Gisborne case was anything other than a very unfortunate episode involving one patient.

"At no stage was any evidence submitted to the council that suggested there was a pattern of inappropriate reporting."

Mr Grieve also asked council president Dr Tony Baird about his attitude to the forwarding of a letter to Gisborne pathologist Dr Michael Bottrill's lawyers.

The letter, sent by Mr Grieve, warned health agencies about the potential of more women being affected by under-reporting of cervical smears in Gisborne.

He asked whether it was appropriate for one of those bodies to pass on the letter rather than acting upon it.

But inquiry head Ailsa Duffy, QC, ruled that the question traversed the issue of natural justice rather than medical matters.

One of Dr Bottrill's lawyers, Jenny Gibson, told the inquiry there might have been several reasons for sending on the letter, including the issue of name suppression.

Both Dr Bottrill and the woman who brought a civil case against him had suppression at the time.

Ms Duffy then asked who had sent the letter.

"The Royal College of Pathologists," replied Mr Grieve.

Another Medical Council witness, former registrar Georgina Jones, said there were still no formal means of dealing with public health issues arising out of individual cases.

"This particular case [the Gisborne situation] has raised it dramatically."

She said the matter was being worked on. In the meantime informal methods were being used. These included a "look-back" programme in one case, and in another persuading a doctor to retire "forthwith."

The Association of Community Laboratories also began giving its evidence yesterday, expressing surprise that Dr Bottrill's laboratory had not been Telarc-accredited.

It was only when the association had received other inquiry evidence that it became apparent the laboratory did not comply.