Abandoned for blowing the whistle

MEDICAL MATTERS: Who would be a whistleblower? In one US study, 100 per cent of whistleblowers lost their jobs. Some 80 per cent suffered ill health, while 17 per cent forfeited their homes as a direct consequence of exposing wrongdoing.

The Government's decision last week to abandon the Whistleblowers Act will do nothing to reverse the stark choice facing those who possess evidence of wrongful activity in an organisation. Acting in the public interest, however justified, is not encouraged by society.

From the perspective of the health service, last week's decision is an especially regrettable one. The Leas Cross exposé, while laudably exposed by Prime Time, should have been highlighted from within. Protective legislation would have offered some encouragement to staff in the nursing home to speak out and record evidence of the maltreatment of patients.

Although the decision to kill off the legislation was presumably a collective Cabinet one, it would be interesting to know what contribution was made by the Tánaiste and Minister for Health Mary Harney. Given her forthright comments at the time of the Travers report, accusing health service managers of "systemic maladministration", would it not be logical for her to have strongly backed a Whistleblowers Act?

While both the Ministers for Justice and Education have had recent direct experience of the acts of whistleblowers - in the McBrearty and Caoimhe Martin cases respectively - it is Harney who must deal with a system representing an unstable powder-keg of ongoing potential harm to individual patients. The encouragement of whistle-

blowing would surely have strengthened the image of a can-do, fearless Minister for Health.

But it is not to be, and we are left to reflect on the thankless task of whistleblowing. It is interesting that in the case of Dr Michael Neary and the unnecessary hysterectomies performed by him at Our Lady of Lourdes Hospital, Drogheda, it was two student nurses who first raised concerns about his operative practice.

Student nurses, are, by definition, a transient population who are likely to proceed to further training or employment at St Elsewheres. That it was relative outsiders, and not the many permanent nurses and doctors at the Drogheda unit, who spoke out is a reflection of the immense personal damage that the unprotected whistleblower is likely to suffer.

Witness the major scandal involving heart surgery at Bristol's Royal Infirmary in the early 1990s. Acknowledged as the catalyst that led to a major overhaul of the UK General Medical Council (GMC) and a culture change in medical accountability, a subsequent inquiry revealed a generalised systems failure as well as individual failings. Two cardio-thoracic surgeons at the Bristol unit had mortality rates of over 60 per cent when they performed corrective surgery on infants. It was left to a young anaesthetist, Stephan Bolsin, to draw attention to the appalling figures.

When he wrote to the clinical director expressing his concerns, he was rebuked. With no internal options available to him, he went public. Although Dr Bolsin had acted in a most honourable fashion, he went to practise medicine in the Antipodes because he reportedly found it impossible to secure an appointment in Britain following his actions.

The GMC chairman at the time, Dr Donald Irvine, in his book, The Doctors' Tale: professionalism and public trust, writing about the Bristol inquiry said: "I think the term 'no blame' is actually unhelpful. It can become so easily associated with the abrogation of responsibility. It might be better to seek a 'fair culture' that attributes responsibility appropriately."

A consultant palliative physician in the Western Health Board undoubtedly helped save patients' lives some years ago when she went public about poor medication practices at the Galway Hospice. Although vindicated by a public inquiry, allegations of bullying were subsequently upheld against her.

The Irish Nurses Organisation (INO) published a paper on whistleblowing at its annual delegate meeting in May. It called for all healthcare employees not to be victimised or discriminated against as a result of making a complaint in good faith, even if the complaint is then not poven.

Despite the withdrawal of the Whistleblowers Act, it is still open to the HSE to initiate a whistleblowers charter for healthcare workers. Such a move should be viewed as an essential element of healthcare reform.

Finally, I wish to thank the many readers, colleagues and friends who sent me good wishes during my recent enforced absence. I hope to share some of my experiences as a patient with you in a future issue.

Dr Muiris Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he cannot answer individual queries.