Channel 7 Today Tonight (Adelaide)

Dr Rabone and the Medical Board 22 March 2004

This version of the transcript has been edited by Dr Robert N Moles

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In order of appearance

Leigh McCluskey - presenter.
Peter Humphries - solicitor for the alleged victims.
Graham Archer - producer and interviewer.
Professor Ross Kalucy - psychiatrist, Member of the Medical Board.
Tony - alleged victim of Dr Rabone.

Program

Leigh McCluskey

Hello and welcome to the program. Tonight, a special investigation into a public health scandal. The patients accusing a South Australian doctor of infecting at least a dozen of them with potentially fatal hepatitis C. They believe their doctor injected himself with their pain killers and then using the same needle, gave them what was left, infecting them with the virus - a claim he denies. And there has never been an effective government survey to establish just how many patients were affected and may have contracted the virus. Under scrutiny too is the Medical Board which may claim it did what was legally required of it, but still allowed the doctor to continue practicing over many years. Graham Archer has this disturbing investigation.

Peter Humphries

Well, it sounds emotive, but I think it's disgraceful.

Graham Archer:

I say it gets down to how the Board acts in individual cases -

Graham Archer:

Stop them [the camera operators] - or I'll walk out - no no no - stop the cameras.

Graham Archer:

Stop the cameras. This is a story that will make your blood run cold.

Peter Humphries:

It's difficult to imagine that the only patients he infected are the ones we know of.

Graham Archer:

It's not just the betrayal of his patients by a South Australian doctor -

Tony:

It's just unbelievable, I mean, feelings that you get and have, the anger that you get. I even struggle to talk about it now. It gets me that upset.

Graham Archer:

More than that. It's about the Medical Board's subsequent failure to protect the public by repeatedly permitting him to return to treating patients.

That was one of their fundamental duties I would have thought?

Peter Humphries

Yes, certainly, one the Medical Board's primary responsibilities is, of course, to ensure that doctors who practice medicine in South Australia are practicing medicine properly and safely.

Graham Archer:

It's also the failure of successive health ministers - Dean Brown and Lea Stevens. The doctor in question is this man - Dr Stephen Rabone. After many years of silence he's finally admitted carrying the Hepatitis C virus - but denies infecting his unsuspecting patients with the potentially fatal disease. Injecting himself with a portion or all of their pain killing drugs, feeding his long term habit, before giving the rest to them via the same needle.

Peter Humphries

Typically pethidine, morphine or fentanyl, we assume, injected himself - and then used the same syringe on the patients and - what that means is the hepatitis C virus was passed from him to them.

Graham Archer:

I mean, that's just disgraceful isn't it?

Humphries:

It is. I mean, I'm not suggesting that he knew he was hep C positive you understand - but he clearly was - by injecting himself first and his patients second - he was aware of the risk, and he wasn't going to take the risk of catching anything they might be carrying. But, of course, he was passing the hep C virus onto them.

Graham Archer:

Tony was the first patient to make the fateful discovery. He was actually playing a game of Russian roulette and pointing the gun at his patients?

Tony:

Certainly, every thing has been pretty reckless, there's no doubt about that.

Graham Archer:

Lawyer Victor Kudra in the Riverland - and Peter Humphries from Duncan Basheer Hannon - represent the patients. Like Tony who has to live with this life threatening prospect after briefly crossing paths with Dr Rabone at the Barmera Hospital.

Graham Archer:

Was there something - something about that consultation that made you uneasy?

Tony:

When we left I just said I'd never go and see that bloke again - never ever, and I didn't. But unfortunately, it was too late. Once was enough - yes once was enough - yes.

Graham Archer:

Two years later the normally robust builder mysteriously fell ill

Tony:

I struggled a bit with fatigue and aching joints - the other symptoms I started to get, were I got nausea and the night sweats - very much flu like symptoms.

Graham Archer:

After all the standard tests came up negative, over a golf game, his doctor decided to venture further afield.

Graham Archer:

And hep C was one of them?

Tony:

Yes, yes, decided to check for hepatitis A B C and aids and cover off all those areas.

Graham Archer:

The result was like a lightning bolt

Tony:

Yeah the outcome was I was diagnosed with hepatitis C.

Graham Archer:

When you heard that what was your reaction?

Tony:

Well, it was just beyond belief - the really big thing - and caused me the most grief - was to work out how the hell this had happened and how the hell I had got it.

Graham Archer:

But there it was - hepatitis C - incurable - possibly fatal - and completely no clue as to how he could have contracted it. Except, perhaps, that one bizarre encounter with Dr Stephen Rabone and his polluted syringe. And that was when he mentioned it to a doctor friend.

Tony:

I said to him then, I had an unusual feeling about him, which was a bit surreal in the patient doctor line. And that's when we started to follow on that line.

Graham Archer:

Initially, given a life expectancy of just five years, things couldn't get much worse for Tony.

Tony:

Within two minutes in a room - and walk out thinking - what is going to happen in my life? My life has been turned upside down.

Graham Archer:

But it was to get much worse - for everyone, particularly Dr Rabone's other patients.

Graham Archer:

Well, in total, how many that you know of were infected?

Peter Humphries:

About a dozen that are known. But then, of course, he was treating patients in the Barmera hospital for many months, and it's difficult to imagine that the only patients he infected are the ones we know of.

Graham Archer:

Val was one of those. She decided to have tests after a chance discussion with Tony's mum. Like Tony it was years later before she became aware of her condition.

Peter Humphries:

And to her very great surprise, was found to be hepatitis C positive as well, and that was the way it went.

Graham Archer:

Val's health deteriorated as she developed full blown hep C.

Tony:

Really, one of the reasons that I am sitting here today - there's 10 to 15 people included in our group at the moment - and that over a fairly small window. What does concern me, is the time spent elsewhere by that person, and you think to yourself - even in the Riverland - there may be more who don't know.

Graham Archer:

And so began the unravelling of the sordid history of Dr Stephen Rabone - and the emergence of what is of far greater concern.

Graham Archer:

If a doctor is ill, and they go to another doctor, our Act requires that the Board is notified in case it endangers patient safety.

Graham Archer:

This is psychiatrist Professor Ross Kalucy, a current Medical Board member, but at the time - not only it's President - but also an expert on doctors in distress. How long have you been interested in that area?

Graham Archer:

About 18 years, mainly through the Medical Board of South Australia.

Graham Archer:

There are many understandable reasons for doctors to become distressed. Pressure, stress, long hours, isolation in country or solo practices.

Graham Archer:

Sometimes they get so distressed that they misuse medications - drugs. Sometimes they become depressed - sometimes they are ill and don't realise it.

Graham Archer:

It seems the Board's benevolent policy under Professor Kalucy is to first heal the doctor.

Professor Kalucy:

In the old days, if someone came to us with a drug problem, they were off the Register. But people like myself didn't think that was reasonable. So we started a different kind of program which offers a doctor the chance to get well - be rehabilitated - and be productive.

Graham Archer:

Which is fine. But what happens when the doctor becomes a positive threat to public health?

Assoc Professor Walton:

The Medical Board's primary task is public interest. And while these impairment programs that Boards conduct are important to keep doctors practicing, but not at the expense of the public interest.

Graham Archer:

Associate Professor Merrilyn Walton the former NSW Health Care Complaints Commissioner says Boards have an obligation to be more transparent.

Associate Professor Walton:

There is no question that the public interest is paramount. It must override those privacy concerns for the individual doctors.

Graham Archer:

A doctor who is displaying aberrant behaviour may be putting his patients at risk.

Professor Kalucy:

If the doctor is displaying aberrant behaviour it will be picked up like this (clicks fingers).

Graham Archer:

Well what about the case of Dr Stephen Rabone?

Professor Kalucy:

I don't know the case.

Graham Archer:

I think you would.

Professor Kalucy:

No.

Graham Archer:

You were President of the Board when that case went through.

Professor Kalucy:

Don't know.

Graham Archer:

That isn't the case at all as the files show.

Graphic:

Kalucy letter dated 10 November 1989.
Dear Dr Rabone, I refer to your meeting with me on Friday 27th October, 1989. I understand you have visited Gribbles with a view to having the type of urine testing you were undergoing changed to one which did not test for cannabis and certain other narcotic drugs.

Graham Archer:

Well, let me tell you about it

Professor Kalucy:

No, no - you did not say you were going to go into this stuff, you said you wanted to talk about health and stress of doctors.

Graham Archer:

Well this is health and stress of doctors - this is just an example.

Graham Archer:

Admittedly Professor Kalucy is in a tricky spot. Ethically, he can't discuss a case. But here arises a paralysing conflict of interest which only gets worse as the story unfolds.

Associate Professor Walton:

Medical Boards are required by law to put the public interest first. That is their reason for existence. The reason for their existence is not about a club - or letting doctors make decisions about doctors. It is letting doctors make decisions for the public interest not the profession's interest.

Graham Archer:

The Board re-instated him. He went to Barmera, and started injecting himself with his patients' medicine. Now how could the Board allow someone like that to go into a hospital?

Professor Kalucy:

You're not going to mention his name are you?

Graham Archer:

Well it's in the Courts, it's in the newspapers.

Professor Kalucy:

Well, I won't take part in that discussion.

Graham Archer:

And in effect the authorities did the opposite. When the patients' lawyers eventually requested Rabone's Medical Board records the Board and the State Government tenaciously worked to keep the details confidential, claiming it was all really in the public interest.

Graham Archer:

Having got an order from the Magistrates Court that they produce these documents, the Medical Board then appealed to a single judge in the Supreme Court and on from that judge to the Full Court to resist the disclosure of this history.

Graham Archer:

So they tried and they tried, to stop you getting it?

Peter Humphries:

Yes.

Graham Archer:

As did the State Government on behalf of the Barmera Hospital?

Graham Archer:

It was appealed by the Board to the Supreme Court. It was appealed to the Full Bench of the Supreme Court.

Professor Kalucy:

I think we had better stop this.

Graham Archer:

So they acted more like the AMA, than the Medical Board?

Peter Humphries:

That's a fair - a fair comment.

Graham Archer:

But could it also be an attempt to avoid revealing just how much they knew about Dr Rabone. After all, Board President Professor Kalucy was intimate with the case.

Professor Kalucy:

I don't know about it that's what I am trying to say to you.

Leigh McCluskey:

Well, after the break, the devastating diagnosis of hepatitis C for these patients. Now the battle to find out how they became victims.

Graham Archer:

He breached his conditions, and now they were protecting him, they gave him the all clear?

Peter Humphries:

Yes.

Graham Archer:

What do you make of that?

Peter Humphries:

There's no sensible conclusion you can draw to that.

Break

Leigh McCluskey:

With patients testing positive for hepatitis C they began looking for proof of what they suspected was the cause. Now they weren't surprised by Dr Rabone's lack of response, but what they didn't anticipate was the resistance they'd encounter from the Medical Board. Nor did they think the government would be so reluctant to see how many others might have been affected. Graham Archer continues his investigation.

Tony:

For me it's just beyond belief that you would not do everything within your power to try and sort this out.

Graham Archer:

You were President of the Board and it was your Board who refused to give the victim access to his file.

Professor Kalucy:

That's what you are telling me, but I don't know about it, and I'm not talking about an individual.

Graham Archer:

And is it any wonder they wanted to keep a lid on things? As early as 1982 Dr Rabone was exposed as an IV drug abuser. At that time he was practicing in NSW.

Letter dated 13th September 1991, In 1982 he moved to Brunswick Heads and over the next three years his opiate use escalated significantly. He then turned to South Australia in the late 1980's, where his drug abuse continued, raising concerns amongst other doctors.

Graphic:

Kingswood Clinic letter 25 January 1989. I recently asked him (Dr Rabone) to resign from our employment following the unexplained disappearance of several ampoules of narcotic.

Graham Archer:

This, despite his treating doctor claiming he was narcotic free at the time. Rabone was suspended in 1989. But less than 12 months later he applied to be re-instated and the Medical Board obliged - with certain conditions.

Graham Archer:

What were the conditions they set for him?

Peter Humphries:

That he practice under supervision, and that he provide urine samples on a regular basis.

Graham Archer:

Rabone got work in the Riverland including Barmera Hospital between 1990 and mid '91 - under the supervision of a senior doctor.

Peter Humphries:

A Dr Matthews at Barmera - who apart from being the supervisor within the clinic setting - was also, I think, on the Board of the Barmera Hospital.

Graham Archer:

Dr Matthews has since gone to Saudi Arabia. But the Medical Board's records show that Dr Rabone was never a good risk. Early on, he was discovered substituting urine samples.

Graham Archer:

So he was, even though he was under such supervision, he was cheating, more or less from the -

Peter Humphries:

Yes.

Graham Archer:

Right from - or more or less from the start?

Peter Humphries:

Well, certainly not too long after he went to Barmera he was engaging in that practice.

Graham Archer:

So what sort of conclusions do you think the Medical Board should have drawn from the fact that he was sending phoney urine samples?

Peter Humphries:

Well, there's really only one sensible inference isn't there?

Graham Archer:

And the nurses' notes at the hospital tell their own story.

Graphic:

Audio mix of voices overlapping at the end of each quote. My observation of Dr Rabone convinces me he was a chemical substance abuser... I did try to report my fears but was - Valium and Hypnoval have been disappearing in large amounts. It appeared to have 2mls in the syringe, but only 1ml in the syringe when given - I have also been concerned about Dr Rabone's lack of personal hygiene when attending patients. His eyes were glassy, unable to focus and speech slurred. - that Fentanyl was never actually administered to the patient.

Peter Humphries:

There was one entry in the hospital records that he woke a patient, who was sleeping peacefully in the middle of the night, to administer some Pethidine.

Graham Archer:

A painkiller while they are asleep?

Peter Humphries:

Yes, yes.

Graham Archer:

That's absurd isn't it?

Peter Humphries:

Yes.

Graham Archer:

And you could only draw the conclusion that it was actually for him?

Peter Humphries:

Yes.

Graham Archer:

And that appears to be what the nurses thought so too, but complain though they did, nothing happened.

Peter Humphries:

What can be said is that it took complaints over a considerable period of time, for anything to be done by way of a serious response to those complaints.

Graham Archer:

So it appears, initially, their concerns were fobbed off?

Peter Humphries:

Ah, yeah, by someone, yes.

Graham Archer:

In other instances Rabone is accused of substituting saline solution, leaving the patients to endure their pain, while he used their drugs on himself. Again, the Board - and in particular President Kalucy, knew things weren't right, as this letter clearly indicates

Graphic:

Prof Kalucy letter dated May 7th 1991 - Page 1 I heard from Dr Rabone this morning. He reports that he was "busted" at Christmas. Hoarding medications, taking some from surgery and some from the hospital, and frequently thinking of ways to avoid urine tests.

Graham Archer:

Despite this the doctors still wanted to protect him.

Graphic:

Prof Kalucy letter dated May 7th 1991, page - turn to Page 2 It is clear Chris (Dr Matthews) would be willing and indeed, would like Steve to remain in Barmera

Graham Archer:

Eventually the Board decided to act - suspending Dr Rabone - and instigating an investigation. During this stage, Rabone decided to move states - returning to NSW with the intention of practicing.

Peter Humphries:

They could not give Rabone a certificate to practice in NSW, without a certificate of good standing from the South Australian Medical Board.

Graham Archer:

And?

Peter Humphries:

And they provided it.

Graham Archer:

The cost - $10.00. Here's the bill, signed by the Board's long standing registrar, David Wilde.

Graphic:

Certificate of good standing.

Graham Archer:

Even though they were prosecuting him?

Peter Humphries:

Yes.

Graham Archer:

Even though they knew that he'd been suspended in the past - he'd breached his conditions - and now they were prosecuting him - they gave him the all clear?

Peter Humphries:

Yes.

Graham Archer:

What do you make of that?

Peter Humphries:

Oh - there's no sensible conclusion you can draw to that.

Graham Archer:

Ultimately he was prosecuted - and he went to NSW - and the Board gave him a certificate of good standing, even though he was under prosecution. That strikes me as strange?

Professor Kalucy:

I have to know what it was about.

Graham Archer:

It was four years before the patents discovered they had been infected by the hepatitis C virus. But it gets worse than this though. As it turns out he was hep C positive and he infected at least a dozen of his patients.

Professor Kalucy:

I'm not going to talk about individual cases.

Graham Archer:

So begins their constantly thwarted journey to get support from the authorities. Despite it being a critical issue of public health.

Peter Humphries:

Well, I've always thought it was - and I've just been surprised that my view hasn't been - shared by anyone.

Graham Archer:

Nobody?

Peter Humphries:

Well nobody that was in a position to do anything about it.

Graham Archer:

Bear in mind Dr Rabone went on to practice in NSW with minimal restrictions and over a six year period regularly worked in the emergency department of the Sydney hospital where pain killing drugs would have been plentiful, and where his hepatitis C status would have posed a particular risk for injured patients.

Humphries:

I don't know the details of his practice in NSW, but it is certain that he was practising over there for a number of years.

Graham Archer:

So - it's possible that there is an unknown number of infected people in NSW, just as they were in the Riverland in South Australia?

Peter Humphries:

Well, it's entirely possible. Whether they are or not I have no knowledge.

Graham Archer:

And there are records within the NSW Medical Board's file which give entirely the wrong picture. Such as this file note from 1998.

Graphic:

File Review date 7 April 1998. He has been narcotic-free for ten years.

Graham Archer:

Obviously not right. Rabone himself, when approached by the victims' lawyers refused to submit to a blood test, and could not be forced to do so.

Leigh McCluskey

It's an extraordinary story. Well, have the authorities learned anything from this case? How safe can we all now feel?

Tony:

It should be a Stephen King novel, it shouldn't be a real story, this isn't understandable, and the fact it's been able to just fester on.

Break

Leigh McCluskey:

Well with the legal and health system where do the patients go from here? And more importantly, perhaps for the public, have the authorities learned anything to prevent this happening again? Here is Graham Archer.

Tony:

The simple thing to ask was that as common people, if this bloke has a blood test, or is forced to have a blood test, then we'll all know and that's taken 5 years.

Graham Archer:

So eventually though, he fessed up?

Peter Humphries:

Not really. He has admitted now to knowing, since - I think 1997 - that he's hep C positive.

Graham Archer:

He kept this to himself for another five years, prolonging the suffering of his victims. The public scandal in this is that the Health Commission, the previous Minister Dean Brown and the current health minister appear to have failed us too.

Peter Humphries:

Well that's fallen on completely deaf ears on two occasions.

Graham Archer:

Nothing at all from the previous Health Minister?

Peter Humphries:

Yes.

Graham Archer:

To the current health Minister?

Peter Humphries:

Yes.

Graham Archer:

And if patients had asked Professor Kalucy to take action they'd have got an equally staggering response.

Professor Kalucy:

Are you going to go through every case of that doctor whom you're presuming had hepatitis? Well some people do that, it's a huge undertaking, and of the ones that I know of they've never found a case.

Graham Archer:

Well, there's doctor Rabone for starters - if they'd dared to go looking.

Graham Archer:

So who's watching the watchdog?

Peter Humphries:

Well - I don't know - it's not apparent.

Associate Professor Walton:

Well if its' like that Parliament has a problem.

Graham Archer:

And that's just the start. The Crown Solicitor represents both the patient's so-called watchdog - the Medical Board - while at the same time protecting the Barmera Hospital and the Board from the patients' claims. It's check-mate for the innocent.

Tony:

This should be a Stephen King novel, it shouldn't be a real story. And the fact that it's been allowed to fester along for so long is what has been so frustrating for all the people involved.

Graham Archer:

As for the Board's Registrar through all this extraordinary affair - David Wilde -

Associate Professor Walton:

As a registrar, I think he thought his audience was the profession. Those days, I think, are going.

Graham Archer:

Not in Adelaide - just moving across town. Mike Rann has now appointed Wilde to the public watchdog of that other establishment profession - the Legal Practitioners Conduct Board. Meanwhile, who is looking after the patients like Tony and Val?

Tony:

To be best of my knowledge, we haven't been contacted by the Medical Board, the Ministers office, the Health Commission.

Graham Archer:

What about the others in your boat?

Tony:

I'm pretty certain that's the case with everybody.

Graham Archer:

Certainly their lawyers have worked for eight years to get some compensation and action. But its little wonder governments are unwilling to go looking for others who might sue them. As for public health - who is ever going to know?

Tony:

For someone to come forward, and say things have happened, we can't change that, and we are very sorry for it, and here what we've put in place. To me that seems logical, but obviously it is not, so we've had to go down the other track. And we'll just continue to go down the other track.

Leigh McCluskey:

This is quite shocking. Well, former health minister Dean Brown spoke to us today and we will air his response tomorrow. The current health minister Lea Stevens has not responded to our calls.

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