A HISTORY OF THE MEDICAL COUNCIL OF NEW ZEALAND Compiled by Richard Sainsbury B 1 ABOUT THE AUTHOR Richard Sainsbury is Emeritus Professor of Geriatric Medicine University of Otago, Christchurch. He was an elected member of the Medical Council of New Zealand from 2009 to 2015. He has an interest in the portrayal of ageing and older people in literature. 2 ACKNOWLEDGEMENTS Thanks are due to a large number of people for their help in preparing this book. Georgina Jones’s account of her time on Council formed a very sound basis for the present book, and she has been extensively quoted. Former Chairs of Council Tony Baird, Robin Briant, and John Adams gave generously of their time in providing historical detail and reflections on the issues Council faced during their respective tenures. Bill Brabazon, a former Council member, provided interesting detail about the 1970s. Ian St George provided important insights derived from his long association with the Medical Council, particularly about the development of Cole’s Medical practice in New Zealand and the development of continuing professional development strategy. John Buchanan provided valuable information about the Brych affair and proofread that chapter to ensure accuracy. Dr Joanna MacDonald’s article in Medical Council News provided the basis for the section on the work of the Health Committee. John Nacey and Steven Lillis are to be thanked for their thoughtful and detailed contributions to the education and New Zealand Registration Examination sections 3 respectively. Heather Thomson contributed to the section on lay membership and the development of cultural policy. Lynne Urquhart, Joan Crawford, Peter Searle, Susan Yorke, and David Dunbar made useful contributions about recent Council work. David Dunbar provided vital information about the Health Practitioners Competence Assurance Act 2003 and historical details about staff members. Viv Coppins and Marissa O’Leary provided excellent secretarial support for an author with well-known inadequacies in this area! An editorial subcommittee of Joy Quigley, Mr Andrew Connolly, George Symmes, and Philip Pigou guided the progress of the book with wise counsel and encouragement. Andrew Connolly provided the main substance of the epilogue. I particularly want to acknowledge George Symmes for his friendship, expertise, and wise advice, which has enabled this book to come to fruition. 4 When the Council became a corporate body, an official seal was needed. Professor Cecil Lewis, the inaugural Dean of the Auckland School of Medicine, provided four possible designs. These were accepted in 1967 when Council celebrated the centenary of medical registration in New Zealand. The Council logo still embodies much of his original design, which he delivered to Ms Georgina Jones, the Council’s Chief Executive, with a note saying that he had completed it at 1.30am and he wished he had more time to pursue this hobby! 5 CONTENTS INTRODUCTION 8 PART 1: LEGISLATION GOVERNING MEDICAL REGISTRATION IN NEW ZEALAND 13 Chapter 1: Before 1914 14 Medical Practitioners Act 1867 15 Medical Practitioners Registration Act 1869 19 Medical Practitioners Registration Act 1905 20 Medical Act 1908 21 Chapter 2: 1914–1923 23 Medical Practitioners Act 1914 24 Council activities under the 1914 Act 26 1918–1923 32 The First World War 40 James Sands Elliott 41 Col. William Henry Parkes 41 Chapter 3: 1924–1949 44 Medical Practitioners Amendment Act 1924 45 The 1924 Act and discipline 47 Council activities under the 1924 Act 47 Finance Act 1932–33 49 Overseas-trained doctors 1936 50 Unusual cases 50 Political neutrality 51 The Second World War 52 After the Second World War 55 Chapter 4: 1950–1967 59 Medical Practitioners Act 1950 60 Council activities under the 1950 Act 63 Chapter 5: 1968–1994 67 Medical Practitioners Act 1968 68 Council activities under the 1968 Act 72 1990 80 1991 84 6 Chapter 6: 1995–2003 91 Medical Practitioners Act 1995 92 Council activities under the 1995 Act 96 1999 97 2000 97 2001 98 2002 98 2003 99 Chapter 7: 2003–2015 101 Health Practitioners Competence Assurance Act 2003 102 Council activities since the Health Practitioners Competence Assurance Act 2003 104 2004 104 2005 105 2007 106 2008 107 2009 107 2010 108 2011 110 2012 111 2013 112 PART 2: MAJOR REPORTS AND CASES OF PARTICULAR INFLUENCE ON COUNCIL 114 Chapter 8: Major reports 115 The Cartwright Inquiry 116 Health and Disability Commissioner Act 1994 119 The Gisborne Cervical Smear Inquiry 121 The Cull Report 123 The Council for Healthcare Regulatory Excellence (CHRE) Report 124 Chapter 9: Some notable cases involving doctors 127 Vlastimil (Milan) Brych 128 Dr Kolathur Variath Sreekantan Unni 132 Dr Morgan Francis Fahey 133 Dr Roman Hasil 135 Dr Rhys Michael Cullen 137 The Medical Council and the Privy Council 138 7 PART 3: COUNCIL BUSINESS AND OFFICERS 140 Chapter 10: Core business – registration and examination 141 Chapter 11: Finance 152 Chapter 12: The Health Committee 157 Council’s Health Committee 159 Chapter 13: Cole’s Medical practice in New Zealand and position statements 162 Chapter 14: The Medical Council and medical education 165 The Renwick Report 168 Oversight of prevocational training 173 Chapter 15: Lay members of the Medical Council 175 Chapter 16: Council leaders 179 Doctors who have chaired the Medical Council of New Zealand 180 Secretaries/Registrars/Chief Executive Officers of the Medical Council of New Zealand 199 Ken Hindes 200 Georgina Jones 202 Sue Ineson 204 Philip Pigou 205 David Dunbar 206 Medical advisers 207 Chapter 17: On shaky ground – the Council relocates in 2013 209 Chapter 18: The Medical Council centenary dinner 213 Epilogue: A vision for the future – the Medical Council into its second 100 years 217 8 INTRODUCTION 9 The Medical Council of New Zealand has five main functions, which are to: • set and promote standards that doctors must meet before and after they are admitted to the register • maintain a register of those doctors who meet the standards – only registered doctors with a current practising certificate are allowed to work as doctors • take appropriate action where a doctor’s fitness or competence to practise has been called into question • ensure high standards of education for those training to be a doctor, including hospital internship placements and new vocational scopes of practice • recognise, accredit and set programmes to develop the competence of doctors. Why is regulation of professional groups such as doctors necessary? The short answer is that, while the majority are honourable people providing a competent often excellent service, there is the potential for harm. The public need to be protected from the small minority of doctors who are unqualified, incompetent, unwell, dishonest, or unprincipled. There has always been a tension between the profession, who have wanted a high degree of autonomy, and the governments of the day, who have a paramount interest in public safety. In addition, people have become more educated and articulate about medical matters and are more inclined to challenge the doctor than was the case at the beginning of the twentieth century. This book has been published to celebrate the centenary of the Medical Council of New Zealand (Council) in 2015. There might be 10 some debate about the choice of March 1915 as the origin of the Council given the existence of the first Medical Practitioners Act 1867. This Act was repealed in 1869 and replaced by the Medical Practitioners Registration Act 1869. In turn, that Act was amended to form the Medical Practitioners Registration Act 1905. It was, however, the Medical Practitioners Act 1914 that removed the Medical Council/Board from the authority of the Registrar-General to that of the Director-General of Health. This was the forerunner to the structures that have shaped Council to the present day. This Act came into effect on 1 March 1915 and interestingly was entitled ‘An Act to make better provision for the registration and control of Medical Practitioners’ (emphasis added). A further five Acts and their revisions have guided the Council in the subsequent hundred years, including the Finance Act 1932–33. The current Act under which the Council operates is the Health Practitioners Competence Assurance Act 2003. The principal purpose of this Act is to protect the health and safety of the public by providing for ways to ensure that all health practitioners are competent and fit to practise their profession. There are 16 regulatory bodies, including the Medical Council, that operate under the Health Practitioners Competence Assurance Act 2003. Part 1 of this book outlines the various Acts that have guided the Council and some of the issues that other Councils of their day have dealt with under these Acts. The Council has also been affected by other legislation, particularly the Health and Disability Commissioner Act 1994. There have also been a number of inquiries and reports, notably the Cartwright 11 Inquiry1 and the Cull Report2 in New Zealand and Learning from Bristol: The Report of the Public Inquiry into Children’s Heart Surgery at the Bristol Royal Infirmary 1984–1995 in the United Kingdom, which have influenced Council strategy and policy. Some high-profile cases of bad or unqualified doctors both in New Zealand and overseas have also driven the demand for the reform of medical regulation and the need for the Council to continually review its policies. Major reports and cases of particular influence on the Council are the subject of Part 2. Part 3 describes the Council’s core business, some of the personalities who have chaired Council, and other hard-working and able members of the staff. There have been so many that it is impossible to pay appropriate tribute to them all. Council’s three main committees – Audit, Education, and Health – are also discussed in Part 3 along with the development of continuing professional development and regular practice review together with the development of guidelines and position statements and Cole’s Medical practice in New Zealand.