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How we're fixing what went wrong at St Vincent's

Toby Hall - Sydney Morning Herald
August 2016

The past six months have been some of the most testing in St Vincent's Hospital's 160-year history.

With a doctor's off-protocol prescription of chemotherapy to a group of head and neck cancer patients, we failed to meet the high standards we set ourselves.

Of course, such difficulty pales in comparison to the distress experienced by patients and families: it has delivered an extra and unnecessary source of anxiety and uncertainty.

To those patients and families, we cannot apologise enough. We say again publicly: we are deeply and sincerely sorry for letting you down.

It's an apology we share with the broader public, who have high expectations of the hospitals that care for them and their loved ones.

Now that NSW Health's final report into this matter has been released, it's necessary to reiterate where we went wrong, and what we have done to fix the problem to ensure it does not happen again.

Let's start at the beginning: the public statements we made at the time were made with the best of intentions, using the information we had on hand. But clearly, as the final report has concluded, the processes we followed in managing this issue failed. We made mistakes and the statements we released turned out to be inaccurate.

But it's important to remember that at no stage did the hospital set out to deceive.

I raised this matter with the head of the inquiry and asked if he had any evidence to suggest hospital staff had intentionally misled the public. He said he had no such evidence.

It is true that we failed to appreciate the seriousness of the situation; we didn't recognise the gravity of what had occurred - nor understand the distress it would cause patients - and this coloured our responses throughout.

For example, early questions about the doctor's dosage practice should have led to a formal examination.

In the department where the problem occurred, we had a culture of acceptance, rather than a culture of challenge, with junior staff accepting the doctor's dosage practices and senior staff not being made aware of it.

When we detected the problem, our inquiries should have been more comprehensive and completed more quickly.   

Early on we made the decision not to contact patients until we had all the information so as not to cause unnecessary distress, but we now recognise this was a mistake. We should have communicated with our patients earlier.

We fully accept the criticisms of the hospital. Those of us in senior positions - at the hospital and within the broader St Vincent's Health organisation - take responsibility for what has gone on.

We also take responsibility for putting things right so that something like this never happens again.

To that end, over the past three months - since NSW Health's interim report was published - we have implemented the recommendations that relate to the hospital's operations.

We have followed up with patients and reviewed and changed our processes.

We have redoubled our efforts at improving workplace culture, fostering a spirit of challenge and inquiry when it comes to clinical decisions.

We have put in place a world-standard cancer electronic medical record and prescribing system that updates new dosage protocols.

Under such a system, if any clinician wants to prescribe medication outside the guidelines they must submit their request for peer review and explain their reasoning. There are regular clinical audits to ensure this is occurring.

Cancer patients at St Vincent's are now overseen by a multi-disciplinary team as per the inquiry's statewide recommendations.

The hospital's process of implementation has been independently supervised by Professor Robert Thomas, chief advisor on cancer to the Victorian government and one of Australia's most respected cancer surgeons.

Professor Thomas' guidance has helped the hospital immeasurably. As difficult as this process has been, I believe we come out of it stronger as a result.

There is no question that this is just the beginning of a long-term effort by the hospital to make amends for a distressing episode in our history and restore public confidence and trust.

But we do so in the knowledge there is a deep well of public goodwill towards St Vincent's.

It's now up to us to prove that that goodwill is not misplaced. We won't let you down.