DHBs must support overseas doctors

DISTRICT health boards have an obligation to take reasonable steps to ensure overseastrained clinical staff are fit for jobs in New Zealand hospitals, the Health and Disability commissioner says.

Associate commissioner Cordelia Thomas issued the warning in the wake of a recent case considered by the commissioner which involved an overseastrained doctor working in the Waikato.

‘‘International medical graduates provide a valuable resource within our health system. However, they need to be supported to assist them to perform well in a New Zealand context,’’ Dr Thomas said.

Her caution is timely for many District Health Boards — such as the Southern DHB — which has been looking overseas to fill nursing and junior doctor positions created by the implementation of new safe staffing rosters.

This year the SDHB has hired 15 new junior doctors from Britain, and also advertised nursing vacancies overseas.

However, in recent months it has identified similar issues to Dr Thomas concerning overseastrained doctors.

In its recently issued serious adverse events report, the SDHB recorded four adverse events caused by overseastrained doctors — compression of a spinal disc, failed neck surgery, inadequate spinal decompression, and a drain being placed incorrectly and causing a bleed.

The SDHB — which would not say if the same doctor was involved in all four events — said after its inquiries in to the four cases it had introduced new policies to assess the competency of surgeons and the way referee checks were carried out.

It also revised its orientation and induction plan for new surgeons, and pledged to provide adequate supervision and reinstate weekly clinical meetings to assist new surgeons.

Those measures would be likely to find favour with Dr Thomas, who said matters such as communication skills and a clinician’s manner could be heavily influenced by cultural experiences and expectations.

‘‘These issues may be compounded by inadequate assessment, orientation and super vision, a lack of social and professional support, and differences in training experiences.’’

While it was the Medical Council’s role to ensure doctors registered in New Zealand were competent and fit to practise, that did not detract from a DHB’s obligation to have robust recruitment practices and adequate supervision in place.

‘‘If a DHB or other employer has or should have reason to believe a doctor may pose a risk of harm to patients, it has a duty to respond immediately to minimise the risks,’’ Dr Thomas said.

In the Waikato DHB case the commissioner made a number of recommendations in relation to improving the DHB’s recruitment, supervision, performance management, and complaints management processes.

‘‘However, responsibility does not rest solely on employers,’’ Dr Thomas said.

‘‘The NZ Medical Association Code of Ethics provides that doctors have an obligation to draw the attention of relevant bodies to inadequate or unsafe services.