Weekend Herald

‘ I’m a builder’s ap­pren­tice’

The fake medical stu­dent at the head of the op­er­at­ing ta­ble

- Ni­cholas Jones ex­clu­sive Health · Medicine · Wellington, New Zealand · University of Otago · Surgery · John Tait · Otago Region

A man used his flat­mate’s se­cu­rity card to get into a Welling­ton Hos­pi­tal op­er­at­ing the­atre and watch a three­hour car­diac by­pass surgery.

The breach was only dis­cov­ered af­ter he was asked about his medical stud­ies and he replied: “I’m a builder’s ap­pren­tice.”

The Week­end Her­ald has ob­tained the find­ings of an in­ves­ti­ga­tion into the ex­tra­or­di­nary se­cu­rity and pri­vacy breach, in which a medical stu­dent gave scrubs, di­rec­tions and en­try card to her flat­mate, who ob­served the surgery on Au­gust 25.

Cap­i­tal & Coast DHB says the fact no for­mal pro­ce­dure was in place to check stu­dents’ ID cards when they entered the­atres left an “un­ac­cept­able gap”, which was ex­ploited by an “enor­mous be­trayal of trust”.

“Our sys­tems have failed the pa­tient and their fam­ily in this case,” chief medical of­fi­cer John Tait said.

“This was a clear breach of the code of con­duct that stu­dents sign when start­ing a place­ment.”

How­ever, the Univer­sity of Otago, which is yet to com­plete its own in­ves­ti­ga­tion, says its stu­dent has “ex­plained that they be­lieved they had fol­lowed ap­pro­pri­ate process to ar­range at­ten­dance at the pro­ce­dure for a third party who as­pired to study medicine”.

The stu­dent was in the fi­nal year of a six- year de­gree, and had com­pleted a six- week place­ment at Welling­ton Re­gional Hos­pi­tal’s in­ten­sive care unit. She was “well re­garded as an en­thu­si­as­tic, hard­work­ing stu­dent and gained the trust of the medical staff ”, stated the DHB’s re­port, re­leased un­der the Of­fi­cial In­for­ma­tion Act.

Trainee in­terns of­ten ob­serve car­diac elec­tive surg­eries, with pa­tient per­mis­sion, and the stu­dent in ques­tion did so in June.

In Au­gust, she mes­saged a car­dio­tho­racic reg­is­trar who helped or­gani se it, ask­ing, “I have an as­pir­ing car­dio­tho­racic sur­geon called [ name redacted] who would be very keen to see a case. Let me know if that would be pos­si­ble.”

The stu­dent used an IT sys­tem to look up a surgery, which the DHB says was a breach as it wasn’t for the per­for­mance of her du­ties, and fol­lowed up with the reg­is­trar, “just re­gard­ing my friend com­ing to see some cases we were won­der­ing if Tues­day works”.

“Tues­day would work well,” the doc­tor replied. “I’ll be around so they can call me around 7.30- 8am and we can work some­thing out.”

That morn­ing, Au­gust 25, the builder’s ap­pren­tice texted the reg­is­trar, and was told to meet at the the­atre. He entered the hos­pi­tal through a con­nect­ing door to the Otago School of Medicine, dressed in scrubs, over­shoes and a hat, and used the stu­dent’s swipe card to get into the the­atre area.

The reg­is­trar in­tro­duced him to an­other doc­tor as a medical stu­dent, the re­port stated. The pa­tient, who had con­sented to a medical stu­dent be­ing present, was in the­atre, but it’s un­clear if at that point they were se­dated, or un­con­scious.

A stu­dent would usu­ally be in­tro­duced and their name writ­ten on a white board, but staff said they couldn’t re­mem­ber if this hap­pened.

The man, in mask and gog­gles, stood at the head of the bed for about 3.5 hours. The anaes­thetist showed him where to stand and dis­cussed the op­er­a­tion.

“The ob­server never in­ter­acted or touched [ the pa­tient] at any point. The ob­server knew how to move round the op­er­at­ing the­atre to avoid equip­ment and the ster­ile field [ an area kept free of micro­organ­isms to pro­tect against in­fec­tion],” the DHB re­port stated.

“The­atre staff com­mented that: ‘ It felt like the ob­server had been coached on how to be­have in the­atre.”’

Be­tween 12.20 and 12.40pm the sur­geon left the the­atre, and the car­dio- tho­racic reg­is­trar who had ex­changed the text mes­sages com­pleted su­tur­ing of the chest wall. They asked the ob­server about his plans af­ter grad­u­a­tion, and if his su­tur­ing skills were any good.

“Not very good,” he replied. “When’s your fi­nal exam, where are you next year?” the doc­tor asked, ac­cord­ing to the re­port.

“I’m not a medical stu­dent,” he said. “I’m hop­ing to start in three years’ time. I’m a builder’s ap­pren­tice.”

The man gave his thanks and left. The reg­is­trar, af­ter call­ing the sur­geon to re­lay the news, sent the ob­server a text: “I didn’t re­alise that you aren’t a medical stu­dent! Maybe best not to tell any­one that you came in to­day. We would usu­ally fol­low a bit of a dif­fer­ent process for peo­ple who aren’t medical stu­dents!”

He apol­o­gised: “I thought [ the medical stu­dent] may have men­tioned it” and promised to keep what he’d wit­nessed to him­self.

Among those alerted were the DHB’s chief ex­ec­u­tive and the univer­sity’s Pro Vice- Chan­cel­lor. The Pri­vacy Com­mis­sioner was told, and the po­lice con­tacted. They de­clined to take any ac­tion.

Just af­ter 2pm, the medical stu­dent was reached by phone.

“[ She] said the ob­server was a house­mate who wanted to see an op­er­a­tion,” the DHB re­port stated. “[ She] de­scribed feel­ing up­set and felt sick.”

The re­port made rec­om­men­da­tions in­clud­ing for a for­mal process to check medical stu­dents’ iden­ti­ties on the­atre en­try, since ac­tioned, and for Otago to re­view in­for­ma­tion and train­ing. Re­view­ers didn’t in­ter­view the medical stu­dent or builder’s ap­pren­tice.

“We re­ally don’t know what was go­ing on in the minds of ei­ther the medical stu­dent or the ob­server. They may be ques­tions that the univer­sity can answer,” Tait said.

“The stu­dent did ac­cess in­for­ma­tion from our sys­tems, which i s against code of con­duct. The giv­ing of a se­cu­rity card is also against any code of con­duct.”

All staff had as­sumed the man was a medical stu­dent, Tait said, and the reg­is­trar’s text mes­sage was to try to “en­sure that this per­son didn’t go telling [ his] mates what he saw at the op­er­a­tion”.

Asked if he was dis­ap­pointed po­lice didn’t take ac­tion, he said: “Their view, and prob­a­bly very cor­rectly, was it was our pro­cesses which had al­lowed this to hap­pen, rather than the per­son be­ing there un­der false pre­tences”. ( When the Week­end Her­ald broke the story last month Tait said false pre­tences were used).

He again apol­o­gised to the pa­tient, who had con­sented to a medical stu­dent ob­serv­ing the op­er­a­tion, and their fam­ily.

The stu­dent is cur­rently un­able to un­der­take clin­i­cal place­ments, and the univer­sity and Medical Coun­cil are con­sid­er­ing what fur­ther ac­tion might be taken.

A Univer­sity of Otago spokesper­son said it agreed with the DHB rec­om­men­da­tions, and is work­ing to “elim­i­nate the pos­si­bil­ity of any fu­ture in­ci­dent of this kind”. Its own in­ves­ti­ga­tion is on­go­ing, and fo­cuses on the stu­dent’s ex­pla­na­tion that they be­lieved ap­pro­pri­ate process was fol­lowed.

Tait, who has been a con­sul­tant ob­ste­tri­cian and gy­nae­col­o­gist in Welling­ton since 1986 and chairs the Health Quality & Safety Com­mis­sion, said he had never heard of such a case.

“We have had unau­tho­rised peo­ple in hos­pi­tals, but not in the­atre.”

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 ??  ?? Chief medical of­fi­cer Dr John Tait says the pa­tient was “failed” by a gap in the DHB’s pro­ce­dures.
Chief medical of­fi­cer Dr John Tait says the pa­tient was “failed” by a gap in the DHB’s pro­ce­dures.

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