The Medical Council of NSW has taken what has been described as an unprecedented decision to impose severe conditions on the practice of Royal Prince Alfred cardiothoracic surgeon Michael Byrom according to an article in The Australian by Natasha Robinson. The conditions mean that Byrom is restricted to performing only the simplest of procedures, is unable to supervise medical students and must submit to extensive supervision and training in the areas of technical skills, clinical judgment, intra-operative decision making and communication.
The decision comes after four years of regular clinical mishap, eight post-surgical deaths, several complaints by peers in the cardiothoracic department at RPA, and the commissioning of independent reports (which found that Byrom did not meet the standard reasonably expected of a cardiothoracic surgeon of an equivalent level of training and experience).
Byrom had been suspended from clinical practice by his department and RPA management three times since 2016 when the first of the post-surgical deaths occurred only to be promptly returned to unsupervised practice.
Until the Medical Council decision both executive management at RPA and the government watchdog AHPRA and its investigative arm in NSW (the Health Care Complaints Commission), refused to accept that Byrom’s conduct “place(d) the public at risk of harm by practising the profession in a way that constitutes a significant departure from acceptable standards.” and referred the matter back to RPA for management.
Whilst the restrictions on Byrom are a significant and unprecedented step, the investigation has exposed the abject failure or refusal of RPA clinical governance to deal with the apparent and emerging, persistent risk that Byrom posed to public safety; and the inability of government watchdogs to regulate the delivery of government health care for the citizens of NSW.
There are now claims that RPA executive and clinical governance were negligent in the management of complaints against Byrom, allowing him to return to unrestricted practice when there were real and substantial concerns about his competency, and failing or refusing to mandatorily report to the Australian Health Practitioner Regulation Agency when complaints about his conduct and clinical failings warranted it. Of perhaps more concern are allegations that those surgeons who spoke out against the Byrom were subjected to “systemic harassment, bullying and intimidation… to the extent that they felt so helpless in pursuing public safety concerns that they were left with no alternative other than to resign.”
Also emerging from the Byrom fiasco is the apparent inability or refusal of the HCCC to undertake an appropriate investigation, twice referring surgeon led complaints back to the ineffective and reluctant RPA management, maintaining that the threshold for disciplinary action had not been met.