Friday, August 24, 2007

Bleeding Hearts in Private Hospitals

Obviously things were more complicated that they have been portrayed, and there is not enough information in the public domain to understand what was happening.

No doubt Craig Jurisevic was qualified to be an independent cardiothoracic surgeon. He had passed his exams and gained his fellowship. That does not automatically qualify him for accreditation to any particular private hospital.

Clearly Ross and Knight did not approve of his entry into private practise (at whichever hospital they worked at). Whether their reasons were financial, altruistic, or otherwise I do not know.

Perhaps they were asked their opinion by the Hospital's accreditation committee and they gave it honestly. Perhaps they actively tried to block his accreditation by portraying Jurisevic dishonestly. Perhaps what they did or did not say didn't matter, and the hospital itself would have made an independent decision about Jurisevic's accreditation based on other factors.

In any case, the ACCC saw the outcome and Ross and Knight's actions as stifling competition. That's why they prosecuted and succeeded.

Nevertheless, in a small, saturated or mature market, qualities such as overseas experience may be desirable. And if, in effect, the ACCC is saying that private hospitals must approve accreditation to everyone who applies (without regard to their other qualities, or lack thereof), then this is a big deal.

Let us say, for example, that Surgeon X has a reputation for poor results, or creating staff conflict, but is an otherwise qualified surgeon in his specialty. Do other surgeons in his specialty have the right to prevent his appointment in order to maintain quality or harmony at that private hospital? (NOTE: I am not implying anything about Craig Jurisevic here)

Does the hospital have a right to refuse accreditation on these "soft" criteria?

Would things have been different if Knight and Ross had threatened to withdraw services if Jurisevic were appointed, rather than saying that he was not qualified? The hospital has a reputation to protect, and not appointing a singular new surgeon in order to keep the business of two other surgeons would be merely a commercial decision.

Maybe the hospital felt that it had enough CT surgeons, and would not accredit another one unless they were "outstanding"?

Perhaps things are skewed because cardiac surgeons are a service profession (unlike most other specialties), and there are only a limited number of hospitals with coronary pump facilities. Maybe if your career is under the thumb of a cardiologist it makes you do weird things.

I'm sure Craig is a smart man, and has plenty of options to further his career. The ACCC's action was presumably to benefit Adelaide residents by maximising their access to cardiac surgical services. It was all about what Ross and Knight did, and little or nothing to do with Craig Jurisevic or his personal interests.

As for overseas or post-fellowship experience being desirable - there would be no issue if Craig's appointment to a public hospital were declined due to Ross and Knight's actions. A public hospital has every right to set it's standards as high as it likes before appointing another surgeon. As far as I am aware, a public hospital is not involved in a commercial marketplace, and therefore the ACCC and the Trade Practices Act has no jurisdiction.

But the rules for a Private Hospital are different - Craig Jurisevic did not miss out on a job, he missed out on a right to enter a competitive market for surgical services at that hospital. I wonder if the ACCC's win means that private hospitals will be compelled to maximise competition within their own walls. We might start sueing each other over whether our names appear more prominently around the hospital, as it may stifle business and competition. What a world.


Anonymous said...

Why no response to posts that highlight the fact that CJ was more than qualified and competent??

Sheepish said...

Hi Anon - I assume you are the same Anon from the post ACCC Strikes Again on this topic.

I don't claim to know CJ personally or professionally, so I can't really comment on his qualifications. My observations didn't relate to how skilled or competent he is, and I assume that he is appropriately trained to the level of an FRACS(CT). They were about the issues around the ACCC's actions and private hospital accreditation.

By the way, if you comment again it would be nice if you gave yourself a nickname or logged in to Blogger - it's a bit weird replying to "Anonymous".

Honest Doc said...

Dear Sheepish,
I am not the Anon from other posts referred to. This is my first time on this site. I have recently developed an interest in the case as I have worked in SA all my life, and I , and most other docs in the public and private hospital system know of the past behaviours of the two surgeons charged by the ACCC. The finding is of no surprise as these "Old Adelaide" exclusive practices have destroyed many a young medico in Adelaide.
Lets see what the Medical Board, our independent aribiter of professional conduct, has to sy about the actions of Messrs. Ross and Knight!

Anonymous said...

Hi to all- I have read enough peoples opinions and views of those who support Knight and Ross or try to make it seem that they were doing nothing wrong. I do personally and profesionally know Dr Craig Jurisevic, and in the past have worked under Dr Knight as a theatre nurse. Let me say that there are clear and distinct differences between these two individuals. While they are both immensly tallented and educated surgeons, the motivation behind Knights and Ross' actions were not in the interests of patients who might in future require the services of Dr Jurisevic. In my time working with Dr Knight, It was clear that money was a large motivator for him, while he is an excellent surgeon, and his patients are always the priority, money comes in at a very close second. This is not the case with Dr Jurisevic, while he may be earning a significant salary, and may be launching civil action as reported in the Australian, he has every right to do so. These men have attempted to tarnish this surgeons reputation in a decietful and pathetic manner, even making him believe that he was not qualified to work as a CT consultant surgeon. To Dr Knight and Ross, what you did was intentional, Dr Knight has at various times been very callous and decietful individual to get his way, and obviously has not changed since I have worked with him. While I do not directly work under Dr Jurisevic, I have assisted him in Surgery many times and saw first handedly what an experienced and caring individual he is. Money is not a motivator for him, nor is the position or titles. His main and only motivator is knowing that he is saving or greatly improving the life of another human being.

Anonymous said...

Dr. Jurisevic is war criminal. Little patetic and sick person.

Marty said...

oh you are silly aren't you? Work on your spelling first and then get back to me.
CJ is an intelligent driven individual and a highly competent doctor. Mr Ross and Mr Knight are are also wonderfully competent doctors. But they should have known better. Petty petty petty from 2 senior surgeons who should have behaved better. They both have long histories of bratty spoiled baby acts and this is nothing more. Greed can be a horrible thing and these two have let it take them over. Nothing like an advance rebuffed to tick a man off.