NEWS 7
Obstetrics director ‘ will never practise again ’
Tribunal says poor working conditions do not excuse substandard care .
NEWSPIX
Heather Saxena
THE director of obstetrics at Bacchus Marsh Hospital , where 21 perinatal deaths occurred , will never practise again after being banned from reapplying for registration for 12 years .
The case against Dr Surinder Parhar was about the extent of individual responsibility in a healthcare service “ where systemic dysfunction is adversely affecting patient outcomes ”, according to the Victorian Civil and Administrative Tribunal .
But last month , it concluded that “ poor working conditions do not excuse substandard clinical practice ”.
A cluster of deaths at the hospital , 50km from Melbourne , led to a high-profile Victorian Government investigation , which found seven deaths between 2013 and 2014 were avoidable .
More preventable deaths were subsequently uncovered , going back to at least 2008 .
By 2018 , AHPRA had received 101 complaints relating to 43 doctors and nurses at the hospital , leading to six cautions and 10 referrals to the tribunal .
This included the manager of maternity services and the director of nursing , who were subsequently struck off for 10 years .
Dr Parhar , now aged 74 , went before the tribunal this July , accused of “ wide-ranging ” clinical failings , including a failure to initiate a clinical review after each death .
A recurrent issue at the hospital was a failure to properly understand fetal surveillance by cardiotocography , which was not resolved despite junior doctors ’ poor Fetal Surveillance Education Program results .
The tribunal heard that , in addition to not encouraging junior doctors to up their cardiotocography skills , Dr Parhar ’ s own Fetal Surveillance Education Program results in 2012 and 2015 were equivalent to a “ novice ” practitioner .
His manner with patients was also criticised after apparently telling one mother that her baby ’ s perinatal death was “ one of those things ” and another that “ these things just happen ”.
However , lawyers for Dr Parhar — who graduated from Monash University in 1972 — said he “ was doing his best in a situation that was getting worse and worse ”.
They pointed out he was the only Australian-educated doctor in the maternity unit , supervising four IMG junior doctors .
There were also issues with workload . Between 2006 and 2013 , the number of births at Bacchus Marsh Hospital had almost doubled , but no extra staff were hired by hospital management , the tribunal heard .
The lawyers added that Dr Parhar was made director of obstetrics in 2008 , but he was not told the job carried any more
responsibilities beyond those of a fulltime staff specialist .
“ The title of director of obstetrics and gynaecology was given to him without consultation , and he did not understand or realise that it carried additional duties , responsibilities or advantages .
“ Dr Parhar also says that he understood his duties and responsibilities in substance remained the same as was the
His lawyers said Dr Parhar was doing his best in a situation that was getting worse and worse . case when he was a VMO at the hospital and that he had no specified function in relation to staff training .”
Despite accusing him of professional misconduct , the Medical Board of Australia said it was unnecessary to impose conditions on Dr Parhar , saying he had given an undertaking never to practise again . But the tribunal would not accept this . Instead , it decided the official sanction would be a ban on reapplying for registration for 12 years , as a deterrent to other doctors .
“ For Dr Parhar , this will make no practical difference , although it may bear a greater sting ,” said the judgement handed down at the start of November .
“ But it sends a clear message to those who may still expect to have years of medical practice before them that , if they engage in similar conduct , their time as a doctor is likely to end well before their planned retirement .”
It said , “ like others , Dr Parhar was working in difficult conditions … an almost doubling in the number of births at Bacchus Marsh Hospital , no corresponding increase in staff and a substantial workload .
“ But poor working conditions do not excuse substandard clinical practice .
“ What we saw here was a blindness to his personal responsibility , a failure to recognise that he had professional obligations that were not being met — as the senior clinician in the unit , as the supervisor of four international medical graduates and as a medical practitioner .”
His failure to investigate possible systematic causes behind the perinatal deaths “ was a disservice not only to patient safety but also to the junior doctors ”, the judgement said .
It concluded : “ We consider it important that there also be a clear message about individual responsibility here for those who may have similar leadership roles to Dr Parhar in healthcare settings , now or in the future , or who may simply be registered medical practitioners working in healthcare settings where systemic failures are adversely affecting patient outcomes .”
Dr Surinder Parhar ’ s lawyers said the number of births at the hospital had doubled but no extra staff were hired .
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