MINISTERIAL INQUIRY AND LAW CHANGE IN WAKE OF GISBORNE CERVICAL CANCER CASE

"I am very concerned at the new findings of under-reporting of cervical smear abnormalities by a Gisborne pathologist. This case has been very trying and difficult for the women concerned and these results will only put more stress on those involved," Health Minister Wyatt Creech said today.

"My thoughts and concerns go out to those women and families involved. I repeat my earlier advice for any woman waiting for the results of their retests to take up the HFA offer of a free smear - if they haven't already.

"A full Ministerial Inquiry will immediately be set up to investigate the issues relating to the under-reporting identified in Gisborne," Mr Creech said.

The Inquiry team is expected to include a legal expert, a pathologist and a consumer representative. Details will be finalised shortly. The Terms of Reference are attached.

"The retesting of smears is a key part of the Health Funding Authority's investigation into the testing by Gisborne pathologist Dr Bottrill. This retesting has revealed a concerning level of under-reporting of high grade abnormalities.

"The Ministerial Inquiry will establish what led to the under-reporting, satisfy itself whether this was an isolated case and ensure all measures are in place to reduce any risks of a repeat of this Gisborne experience in future," Mr Creech said.

"At the time of the original revelations of misreporting of smears earlier this year, I asked for a full report on whether the law as currently written provided full protection to patients.

"Following this work the Ministry of Health set up a working party looking at competence of medical practitioners and it recommends a number of changes to legislation

"There have in fact been a significant number of changes that were designed to address issues related to patient safety and doctor competence since this particular pathologist ceased practice three years ago, including major law changes and changes in practice within pathology.

"The 1996 changes to the legislation provide patient safeguards against incompetent doctors, but a gap has been identified for cases before 1996.

The proposed law changes will beef up the existing law and will:

· improve reporting to relevant agencies of risks to members of the public arising from incompetence by a medical practitioner;
· require doctors to co-operate in competence reviews;
· close gaps in powers of suspension and mandatory conditions on the practice of medicine;
· allow access to other patient records if audit or follow-up is necessary, when a doctor's incompetence raises implications for safety of all similar patients.
· encourage reporting to the Medical Council by Medical Practitioners when they believe another practitioner is incompetent and hence poses a risk to the public.

"The working party's recommendations will be consulted on formally with the health profession and consumer groups before the legislation is developed.

"I have instructed the Ministry of Health to get the consultation completed as quickly as possible. I want it dealt with with urgency.

"I have again asked the HFA both to ensure that all that is practical to do is being done to ensure that women have the certainty they need about their tests and to ensure that appropriate support and follow up is in place."

ENDS

For further information please contact Anna Hughes (04) 4719 819 or (025) 477 987
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Inquiry Terms of Reference

(a) Identify the factors that led to the under-reporting of abnormalities of cervical smears in Gisborne.

(b) Satisfy itself that this was an isolated case and not evidence of a systemic issue for the National Cervical Screening Programme.

(c) Identify changes already made to legislation, to laboratory or other processes, or to professional practices to address the risks of underreporting of abnormalities of cervical smears.

(d) Identify further changes agreed to either by the Government or professional organisations that will further address any risks of underreporting of abnormalities of cervical smears.

(e) Thoroughly investigate the circumstances to make sure all relevant proposals that could ameliorate any risks of underreporting of abnormalities of cervical smears are covered by (b) or (c) above and whether further changes are needed.

(f) Comment on any other issue the inquiry team believes to be of particular relevance.

(g) Make recommendations, after considering the purposes of the Health and Disability Services Act 1993, as to any future action the Government or its agencies should consider taking.

Planned Law change to strengthen the provisions relating to incompetence include:

· Encouraging medical practitioner to report to the Medical Council a medical colleague whom he or she has reason to believe is not competent to practise medicine. Currently there is a legal requirement to notify the Council only in the case of fitness to practise through some mental or physical condition.

· Requiring a Complaints Assessment Committee or a Competence Review Committee to report to the Council when it believes that other patients or members of the public may have been put at risk.

· Requiring the Health and Disability Commissioner to notify the Director-General of Health of possible systemic risks to the public, or to classes of doctors, patients, with a copy to the Medical Council.

· Requiring that the Council be notified of complaints, proceedings, medical errors, and dismissals relating to medical practitioners.

· Deeming a failure of a doctor to co-operate in a competence review to be deficient practice.

· Allowing the Council to place suspension or mandatory conditions on practice where there is reasonable grounds to believe a doctor poses a risk to the public.

· Empowering the Director-General of Health, where there is an issue of public safety, to access patient information, with appropriate safeguards around its use. The justification is that it is the patient that is at risk, and if that is the case, the public health system bears the consequences along with the patient.