Nursing and doctor organisations have condemned the “naming and shaming” of health professionals as setting dangerous precedent.
Their comments follow the High Court overturning a coroner’s decision to suppress the name of three nurses and a doctor (now deceased) involved in the care of Zachary Gravatt who died of meningococcal disease in Auckland City Hospital in July 2009. Suppression was retained for one doctor involved.
The coroner had found that systems failure during the peak of the swine flu epidemic led to the 22-year-old medical student’s death, whose meningitis was not diagnosed for more than four hours, rather than individual fault. Gravatt’s parents went to the High Court late last year seeking for suppression to be overturned, arguing that it was wrong for health professionals to be almost guaranteed name suppression.
Hilary Graham-Smith, acting professional services manager of the New Zealand Nurses Organisation, said the organisation was “extremely disappointed and disturbed” at the High Court’s decision to name individual health professionals.
“The Coroner found that systems failure led to the tragic death of Zachary Gravatt. If the problem is systemic, the solution should be systemic as well. Naming and shaming individuals is not conducive to positive change.”
“The nursing practice of the three nurses named was never called into question, and even though the High Court judgment makes that clear, it certainly isn’t being reported that way.”
She agreed with the Association of Salaried Medical Specialists and New Zealand Medical Association (NZMA) that the decision set a dangerous precedent.
“NZNO is also surprised to hear that there is a view that a ‘veil of secrecy’ lies over the New Zealand health system. The only secret we would like to have answered to why the family of Zachary Gravatt negotiated a private agreement with the currently practicing doctor to keep his or her name suppressed whilst continuing to push for the release of the nurses’ names,” Graham-Smith says.
Dr Paul Ockelford, chair of the NZMA, said blaming and shaming the healthcare professionals involved was not only a dangerous precedent but would not help improve the care or safety of other patients in the health system.
“The greatest challenge to moving toward a safer health system, according to the Institute of Medicine, is changing the culture from one of blaming individuals for errors, to one in which errors are treated as opportunities to improve the system and prevent harm,” said Ockelford. “This principle is at the heart of the need for open reporting, without fear of blame and retribution, and recognises the importance of this for overall patient safety and quality improvement.”
“The coroner found no blame should be attached to those staff who did their best to care for Zachary. The NZMA believes, therefore, that the ‘shame’ of publicly naming these individuals is completely unwarranted, and ultimately, destructive of the coroner’s statutory purposes.”
Auckland District Health Board chief executive Ailsa Claire said although the board was disappointed at the decision, it had decided not to appeal the High Court’s decision.
“The Court recognised that publishing the names of healthcare workers involved in cases such as this could result in unfair media attention and damage to people’s professional reputations.
“However, the Court determined that a balance must be struck between freedom of expression and transparency and the reputational risks faced by individual medical professionals.
From the outset, the DHB has emphasised that Zachary Gravatt’s case involved a systemic failure (which has since been addressed), rather than fault of individual staff members,” Claire said.
She said the Court also stated that there must be “additional unique factors to justify name suppression in any given case” and “to that end, one doctor has ongoing name suppression”.
Claire also said the DHB would continue to be “forthright” in seeking name suppression for staff when justified, with decisions made on a case-by-case basis.
“The current ruling provides clear guidelines so that we can continue to support and protect our staff members, whilst ensuring that our resources are allocated in a pragmatic way to improve the health of the Auckland population.”
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