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Doctor tells college to stop Voice push

Carmel Sparke A DOCTOR has accused the Australasian College for Emergency Medicine of straying beyond its remit by supporting the Voice to Parliament campaign .
Clinical Associate Professor Stephen Macdonald says the college ’ s position paper on the Voice “ contains grand assertions ” that it will improve Aboriginal and Torres Strait Islander health outcomes .
But the Perth emergency physician and section editor for the Emergency Medicine Australasia journal said the college ’ s claims were speculation .
“ There is currently insufficient detail about how the Voice would operate and whether it will achieve the outcomes its proponents intend ,” he wrote in his editorial last month .
He urged the college to avoid the “ politically contentious issue ” and focus on its core business of clinical emergency medicine , saying it was not qualified to comment on constitutional law or the complex drivers of poor Indigenous health outcomes .
The college ’ s position paper endorsing the Voice proposal , released in May , said it would deliver “ profound ” benefits to Aboriginal and Torres Strait Islander peoples ’ health and wellbeing .
Other colleges , including the RACGP , have also issued public support for a ‘ Yes ’ vote in the upcoming referendum .
Dr Clare Skinner , president of the Australasian College for Emergency Medicine ( ACEM ), said it advocated on many political issues and was “ proud ” to be a supporter of the Voice .
“ These issues include ED overcrowding , access block , workforce pressures
Clinical Associate Professor Stephen Macdonald .
and equity in health outcomes for Aboriginal and Torres Strait Islander peoples ,” she said .
But Professor Macdonald said , while the college ’ s aims were laudable , it was important to distinguish between the Voice and constitutional recognition of Australia ’ s Aboriginal heritage .
“ The ACEM position statement conflates these issues and contains grand assertions about how the Voice will combat racism in healthcare and improve outcomes for Aboriginal and
Torres Strait Islander people ,” he wrote .
He said doctors were currently grappling with an increasing workload and that senior clinicians were reducing their hours or quitting altogether .
“ ACEM ’ s objectives , according to its own constitution , are to promote the science and practice of emergency medicine , as well as set standards for professional practice and deliver training for the next generation of emergency physicians ,” he said .
“ Our credibility is closely linked to operating within our areas of expertise .”
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In a dramatic appearance before the hearings , Dr Teo accepted much of this assessment .
He accepted that the postoperative MRI scan showed that all of the enhancing part of the tumour in the tectum posterior midbrain was resected along with a margin around that .
He also agreed that he had gone across the midline of the brain , saying this was because the enhancing portion of the tumour had crossed the midline .
“ I clearly went across the midline to take out the tumour . And I didn ’ t respect the midline of the tumour . That doesn ’ t mean I didn ’ t respect the midline of the brainstem .”
He added : “ I take full responsibility for the fact that it was my hand , my technique , my doing , that she didn ’ t wake up .
“ And whether it ’ s because I crossed a midline , whether it ’ s a limited and posterior thalamus , whether there was functional tissue within the enhancing portion , I don ’ t know .
“ But that ’ s not the point . The point is I made an error , a surgical error , and I went too far , and
I ’ ve damaged this lady . I ’ m not disputing that .”
Dr Teo subsequently denied that his evidence was misleading because he failed to acknowledge that he had , in fact , reviewed the postoperative MRI scans ( which clearly showed he had crossed the midline ) the day after the surgery .
The aftermath
Following Dr Teo ’ s surgery ,
Patient A was transferred to ICU and was unresponsive to any stimuli .
She remained an inpatient there for about three weeks .
Her condition did not improve , and arrangements were made by her husband for transfer to Fiona Stanley Hospital back in Perth .
She remained in a substantially unconscious state until her death five months later on 5 April the following year .
The committee savaged Dr Teo ’ s medical care .
“ His answers in both his written material and his oral evidence , while disclosing a willingness to examine and take responsibility for bad outcomes , demonstrated a lack of nuanced appreciation of the vulnerability of his patients and likely flaws in their consent or patient autonomy ,” it concluded .
“ Of greater significance is his lack of reflection on his judgement in offering surgery without supporting statistical data or peer support , which in his own experience , may or may not be proved to have been in
‘ Surgeons should not offer surgery that is futile and high risk just because the patient ‘ willingly ’ consented .’
error in 10 years ’ time .
“ While the practitioner
expresses sorrow and takes responsibility for bad surgical outcomes , he does not express any remorse for offering surgery to Patient A or Patient B .
“ This lack of insight into his judgement causes us concern .”
The committee described patients A and B as “ vulnerable
women facing the prospect of death ”.
“ Their understandable wish to extend their life expectancy placed a great responsibility on the practitioner — whose referees note that he is a gifted surgeon of renowned international standing — to ensure that each patient truly understood the magnitude of the risk she would undertake in having surgery but , more significantly , to refuse surgery in circumstances where the risks outweighed benefits .”
Under the conditions placed on Dr Teo , a neurosurgeon approved by the HCCC with at least 15 years ’ experience in the specialty must give written statements supporting him “ when proposing and before performing any recurrent malignant intracranial tumour and brainstem tumour surgical procedures ”.
The statement must say the other neurosurgeon is satisfied that Dr Teo has explained all material risks to the patient and the procedure is backed by peer-reviewed evidence .
Dr Teo has said he will no longer practise in Australia and plans to work in China .
PBS Information : Authority required ( STREAMLINED ). Asthma . This product is not PBS listed for Maintenance and Reliever Therapy . Criteria Apply . Refer to PBS for full authority information .
Please review Product Information before prescribing . Product Information can be accessed by calling Chiesi Australia Medical Information on 1800 943 587 or scanning the QR code .
References : 1 . Pharmaceutical Benefits Scheme ( PBS ). Available at : www . pbs . gov . au . 2 . Approved Fostair Product Information . 3 . Paggiaro P et al . BMC Pulmonary Med 2016 ; 16:180 . Chiesi Australia Pty Ltd , Hawthorn East , VIC . 3123 . Tel : + 61 3 9077 4486 ; Email : medicalaffairs . au @ chiesi . com ; Website : www . chiesi . com . au . Copyright © Chiesi 2023 . All rights reserved . Date of preparation : Jan 2023 . AU-FOS-2200025 . CHIE00042j .