RPA Hospital Doctors Receive Apologies After "Unreasonable" Misconduct Probe

NSW Health has issued apologies to three senior doctors at Royal Prince Alfred Hospital (RPA) following a two-year confidential investigation that the NSW Ombudsman determined was unreasonable and unfair. This outcome highlights ongoing issues within key departments at the hospital.

Background Investigations

The Sydney Local Health District's largest hospital was subjected to an NSW Ombudsman investigation after allegations of doctor misconduct and patient harm surfaced, leading to claims of bullying and the persecution of whistleblowers. Internal documents obtained by the ABC indicate that NSW Health has conducted at least two inquiries into clinical safety at RPA's Structural Heart Program and three cultural investigations within the cardiology unit since 2020. A NSW Health spokesperson stated that RPA maintains a "long-established culture of clinical excellence and patient-centred care."

Structural Heart Program Concerns

The Structural Heart Program, established in 2009, offers alternatives to open-heart surgery, specifically TAVI procedures. While recognized for cardiac research advancements, the program has experienced internal conflicts and multiple investigations.

A confidential 2023 NSW Health review described the program as "high quality" but noted "discernable mistrust" among clinical teams and issues with its multidisciplinary team structure, leading to "significant patient safety concern."

The report included 37 recommendations, including an urgent investigation into "missing" clinical outcomes data, which rendered RPA an "outlier nationally" and "dysfunctional." The report stated that these issues had been raised repeatedly without action. NSW Health reported that "most critical" recommendations have been implemented, with remaining items in progress, and that patient outcomes in 2024 align with or exceed benchmarks.

Doctors' Allegations and Subsequent Inquiry

Following the 2023 report, six doctors wrote to NSW Health Minister Ryan Park, alleging the review failed to investigate what they described as "serious injuries and preventable deaths" within the TAVI program, including "avoidable deaths, catastrophic bleeding, threatened limbs, retroperitoneal hematomas and false aneurysms." Another senior surgeon independently supported these concerns.

These letters prompted a Clinical Excellence Commission investigation, which recommended that all patients be reviewed by a multidisciplinary team before TAVI procedures and that "escalation pathways" for incidents be improved. The action plan also suggested that only emergency cases proceed without a multidisciplinary team review and a new policy for "managing disagreements." NSW Health stated that two independent reviews did not identify significant clinical issues with patient care but led to changes in governance, data integrity, and clinical pathways.

Misconduct Investigation and Ombudsman's Findings

Soon after the doctors' letters were sent, bullying complaints were filed against three doctors who had raised concerns: cardiologist Ian Wilcox, vascular surgeon Raffi Qasabian, and head of department Steven Dubenec. NSW Health hired law firm Workdynamic to investigate.

In December 2023, the doctors were informed they were under investigation for misconduct but were not provided with details of the allegations despite repeated requests over three months. The doctors then complained to the ombudsman, alleging retaliation for whistleblowing. In December, the ombudsman found that while fears of retaliation were "understandable," they were not supported by evidence.

However, the ombudsman ruled that Workdynamic's failure to notify the doctors of allegations over eight months was "unreasonable," created a "lack of fairness," and caused "undue stress." The ombudsman recommended apologies.

Outcome and Cultural Issues

NSW Health issued apologies to the doctors in December and January. Chris Carr, NSW Health executive legal director, apologized for the delay in providing allegations and stated that "after careful consideration" and "given the significant passage of time," the bullying investigation would be discontinued. He added that NSW Health would consider "other strategies to deal with workplace cultural issues."

Professor Wilcox publicly criticized NSW Health, alleging a "culture of cover-up" and persecution of whistleblowers. Dr. Qasabian and Dr. Dubenec declined to comment. A NSW Health spokesperson denied that investigations were commenced in reprisal, citing the ombudsman's findings. The discontinuation of Workdynamic's investigation was not broadly communicated within RPA Hospital.

The Workdynamic probe was the third investigation into cultural dysfunction within RPA's cardiology unit since 2020. Interviews with doctors revealed differing perspectives, with some supporting Professor Wilcox's claims of discouraged open discussion about patient complications, while others attributed divisions to Professor Wilcox. Professor Wilcox, who agreed to communication skills training, asserted that his concerns relate solely to patient care. NSW Health defended RPA's culture by citing an internal survey where 76% of cardiology staff reported being treated with respect, 70% felt culturally safe, and 80% found personal accomplishment in their jobs.