Monday, April 07, 2008

Your regulators will protect you -- again

Crooked and incompetent German doctor allowed to practice in Australia for years -- despite complaints and at great cost to the community

One of Australia's most senior trauma surgeons faces the sack for incompetence and a possible criminal investigation for billing for operations that never occurred. The stellar career of Thomas Kossmann, the head of the nation's busiest and most prestigious trauma unit at The Alfred hospital in Melbourne is in tatters after a three-month investigation by an expert panel into his surgical and administrative practices. The panel's damning findings are contained in a confidential report obtained by The Australian.

The scandal once again raises serious questions about the ability of medical authorities to properly assess doctors before allowing them to work in this country. The panel reports that more attention needs to be paid nationally to how specialist doctors are credentialled to practise in the public health system.

The key findings against Professor Kossmann are that he performed unnecessary surgery and undertook surgery he was incapable of doing. The panel found he invoiced Victoria's Transport Accident Commission, the WorkCover Authority and Medicare Australia for operations that were not performed, surgery he did not carry out and surgery that was unnecessary. The panel found that in his billing he used multiple Medicare item numbers that are mutually exclusive and used item numbers not in the spirit of funding agreements. They found he did not have the required expertise to practise or teach spinal and pelvic surgery - something he was routinely doing at The Alfred. He was found to have misrepresented his surgical experience on his curriculum vitae by overstating his level of experience and training in the area of orthopaedic surgery. And he was found to have performed surgery that had not been performed in Australia or overseas before and which was flawed in its conception and harmful in its effect.

The expert panel's final assessment of Professor Kossmann is scathing. In relation to his invoicing habits, it concluded: "The professor failed to perceive a problem, almost to a level where he seemed to have no concept of what constituted a moral approach to patient billing." The panel recommends that the TAC - Victoria's publicly funded traffic accident compensation system - Medicare Australia and the WorkCover Authority conduct audits of Professor Kossmann's entire billing history.

He told the panel his billing practices were no different to those of his colleagues. He said that because the TAC had never questioned his billing, he assumed he was billing appropriately.

The panel was also critical of Professor Kossmann's clinical performance. It called his surgical practices and decision-making inappropriate, unnecessary and beyond the accepted norm. "The nature of these practices and decision-making was beyond any level of acceptable behaviour and standard of care, and was flawed in its conception and harmful in its effect," the report states. It dismisses Professor Kossmann's defence that if such an audit were conducted of other surgeons a comparable rate of incidents would be found. Professor Kossmann argued to the panel that the cases where he was found to have exercised wrong clinical judgment reflected differences of medical opinion. The panel disagreed.

The investigation was established by Bayside Health, which runs The Alfred hospital, after four surgeons lodged complaints against Professor Kossmann last August. Respected Victorian child orthopedic specialist Bob Dickens led the panel. The other members were Brisbane orthopedic surgeon John Tuffley and Sydney orthopedic surgeon Stephen Ruff. The panel examined 24 cases raised by the four doctors in their complaints against Professor Kossmann. In all but seven of the cases, the panel substantiated the complaints. It randomly reviewed a further 31 of Professor Kossmann's cases and, of these, found three where there were significant concerns about his clinical and/or administrative practices.

During the investigation, Professor Kossmann was interviewed by the panel members - two of whom are examiners in orthopedics for the Royal Australasian College of Surgeons - to test his understanding of basic science. He failed dismally. "All panel members are of the opinion that if an orthopedic candidate in his/her final exam had given the answers which the professor had given, they would have seriously considered failing that candidate," the report states.

It is understood the hospital has sent the final report to Professor Kossmann. He has two weeks to respond. Professor Kossmann has taken legal action in the Victorian Supreme Court against the hospital following its suspension of him on full pay last November after adverse preliminary findings were made against him in a draft report.


Qld. police union backs police fraud

And no attempt is being made to find the offenders

THE police union has openly encouraged its members to keep faking random breath tests to meet "impossible" targets. At the same time efforts to track down police faking the tests have been scrapped because the police service does not have the resources despite an official investigation into the practice. The Courier-Mail last year revealed officers had been manipulating RBT machines to generate fake tests as they struggled with impossibly high targets.

The practice has probably skewed drink-driving statistics for years, hiding the size of the problem, and led police and the Crime and Misconduct Commission to set up an investigation. However, after uncovering "deficiencies" in police records and questioning some data, the investigation was wrapped up due to lack of resources even as some regions upped their targets.

Writing in the March Police Union Journal, northern region representative Mick Barnes suggested increases of up to "tens of thousands" of tests would further strain operational police, possibly leading to more "rubbery" figures. "Ask a traffic officer that's (sic) been around for a while and you'll find the best way to reduce the likelihood of drink-driving in our community is to sit off the pubs again," he wrote. "This was the tried and tested method when operational police had the time to proactively police instead of running between jobs. In the meantime keep exercising those thumbs," he said, referring to the method of placing a thumb over the machine's air intake to generate a false reading.

Police Commissioner Bob Atkinson recently offered regional assistant commissioners "flexibility" to adjust targets as police grappled to find the most effective testing strategy. "We need to find what the right amount of random breath testing is," Mr Atkinson said. "We haven't got that right yet and it may be that that varies from place to place." He admitted police did not have the resources to fully investigate the fake tests but denied the practice was widespread. "No one to my knowledge has put up their hand and admitted they fudged the tests," he said. "To conduct an extensive investigation into each RBT return . . . would tie up a huge amount of resources for a long period of time."

A police source said the internal investigation was destined to fail because of a lack of resources, but officers had stopped faking tests for a while after being exposed. Mr Atkinson said some regional assistant commissioners were reducing test quotas because the previous target of one breath test per licensed driver was "too onerous". The South Eastern Region cut its target to 85 per cent of licensed drivers, while Metropolitan South and parts of the Southern Region cut the target to 90 per cent.


Another Australian police force with high ethical standards (NOT)

There are so many crooks that they are "too many" to prosecute, apparently. So they all get off scot-free!

HUNDREDS of police officers across South Australia caught using their work computers to illegally copy movie DVDs will escape prosecution. The activity - strictly banned under federal copyright laws - was detected during an audit conducted by the information technology branch of SA Police. Senior police, including Commissioner Mal Hyde, have been briefed on the extent of the problem.

An internal email to police management said the audit had "identified a number of instances where commercial DVD movies have been copied to the hard-drives of police computers which potentially had been burnt to blank DVDs". "This practice is potentially a breach of copyright and misuse of SAPOL equipment," it said. "Branch managers are requested to take measures to ensure this practice must not occur and to remind members (officers) of the policies relating to the use of SAPOL computer equipment."

Police sources have told The Advertiser an official investigation, which could lead to criminal charges, will not be conducted because of the large number of police officers involved in copying DVDs. Mr Hyde's spokeswoman, Roberta Heather, confirmed his senior executive group had been briefed on the results of the computer audit. "A recommendation was made that identified work areas should remind members of the need to comply with SAPOL's policy in regard to the appropriate use of work systems and legislative requirements," she said. Ms Heather said police computer systems regularly were audited "and appropriate action is taken where any breach of legislation or policy is detected".

The Australian Federation Against Copyright Theft said it would write to Mr Hyde to seek an explanation. Under federal laws, severe penalties can be imposed on video piracy. Penalties include fines of up to $60,500 for individuals and up to $302,500 for corporations for each individual infringement, and up to five years' imprisonment.


Moronic body of psychologists doubts that it upsets a kid to see animosity between his or her parents

Feminists at work, no doubt

Child custody determinations in scores of Family Court decisions could be challenged following a ruling debunking parental alienation syndrome, a controversial diagnosis of the effects on a child when one parent denigrates the other. The Psychologists Board of Queensland last month disciplined prominent Brisbane clinical psychologist William Wrigley, saying he had acted unprofessionally in giving evidence about parental alienation syndrome to the court. An investigation found that Dr Wrigley's evidence three years ago, which had led to a mother losing custody of her two children, constituted "professional conduct that demonstrates incompetence or a lack of adequate knowledge, skill, judgment or care".

The Australian understands that Dr Wrigley has identified the syndrome as a factor in other cases to the Family Court. So have psychologists and psychiatrists throughout Australia. The syndrome was diagnosed in 1985 by US clinical psychiatrist Richard Gardner, an advocate of a father's right to custody, even in cases where he had been accused of abuse. He argued that some parents who criticise other parents or step-parents in front of children were guilty of psychological abuse. Dr Gardner's theories remain highly controversial among psychiatrists, psychologists and therapists, who claim they are simplistic or erroneous.

The complaint was lodged by the Brisbane mother who lost custody of her two children in 2005 when Family Court judge Neil Buckley determined, acknowledging the evidence of Dr Wrigley, that she had affected the children with the syndrome. Justice Buckley said Dr Wrigley's reports provided a "comprehensive and balanced assessment" of all relevant issues. "It has to be said that in terms of objectivity, professionalism, fairness and balance, his reports are in stark contrast to those provided by (other professionals)," he said.

The board advised Dr Wrigley on March 3 of its unanimous decision that he had "acted in a way that constituted unsatisfactory conduct" for "referring to an unrecognised syndrome in his reports". "It was inappropriate for the registrant (Dr Wrigley) to either diagnose the children or state there was a likelihood the children could develop parental alienation syndrome, as it is not a recognised syndrome," it said. "To diagnose a patient as suffering from or demonstrating a potential to develop an unrecognised syndrome is contrary to the code of ethics." However, the board advised that details of the disciplinary action not be recorded on the public register because it was "not within the public interest". The board told The Australian it was precluded by law from commenting on the disciplinary action taken against Dr Wrigley.

Family Court Chief Justice Diana Bryant last year posted on the family law court website a "fact sheet" about the syndrome, which said the malady was used in evidence, but warned that it was not accepted as "a psychiatric disease". Chief Justice Bryant's notice cited several cases "where PAS has been rejected or not accepted as a concept". The cited cases, with names excluded, included the controversial matter for which Dr Wrigley was disciplined by the psychologists board.


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