Van Geene case reveals unwieldy medical complaints system

Maybe there isn't a better way of processing complaints against doctors than fitness-to-practise hearings at the Medical Council, but for the sake of patients and the medical profession, it is to be hoped one will be found.

The latest finding from the committee in the case of Dr Peter van Geene highlights many of the shortcomings of a system that is unwieldy and slow, and invariably leaves both sides in a case coming away feeling as though they have lost.

The gynaecologist faced 15 charges arising from complaints made by four patients who suffered severe postoperative complications after he performed hysterectomies on them between 2009-2011.

The charges related to poor professional performance, rather than the more serious charge that exists of professional misconduct. The committee found him guilty of two counts of poor professional performance for failing to communicate with a patient and failing to obtain proper consent, but he was cleared on the more serious counts relating to clinical competency.

No comfort

The guilty counts related to one patient only, so for the other three women this judgment holds little or no comfort.

All four have had to wait years for the case to come to public hearing, and one of them, who waived her right to anonymity, Helen Cruise, has had to deal with the strain of being in the public spotlight.

There is some succour for Cruise following the committee’s verdict that Van Geene communicated with her inappropriately and failed to review her case before operating on her. However, the medical history that followed that surgery, including severe pain and depression, was not considered attributable to his actions.

Split

In many cases, the task of proving an alleged medical failing “beyond all reasonable doubt”, which is the standard of proof required, is too arduous to return a guilty verdict. Even in this case, it appears the committee was split when returning a guilty verdict on two counts.

The findings against Van Geene are on the lighter end of the spectrum, and so it is likely that any sanctions, should the council decide to impose them, will also be relatively light. Should this prove to be the case, any eventual sanction imposed will be far outweighed by the stress of the process, the delay involved and the harsh impact of publicity.

All of which raises the question of whether it is fair to drag anyone through such an arduous process to deliver, eventually, a mere slap on the wrist? Van Geene, who told the inquiry he is no longer practising, filed for bankruptcy in the English courts last year.

The council is tightly constricted in the findings it can make in relation to poor professional performance as a result of recent court judgments. Any alleged failures have to be serious and, preferably, multiple. Arguably, the law needs to be changed to allow for a more graduated scale of sanctions.

Two-tier

This case also raises questions about the two-tier nature of the Irish health system.

Van Geene was working at a private hospital in Kilkenny but was also treating public patients funded by the National Treatment Purchase Fund.

He never met Cruise or other NTPF patients before operating on them, a less than ideal situation that was rightly criticised by expert witnesses. The effect of this assembly line approach, as his lawyer pointed out, was to turn doctors into “technicians”.