A fiasco over a ‘Natural Therapy Clinic’ at Wanganui Hospital was finally resolved satisfactorily – but for the wrong reasons.
The attempted introduction of ‘natural therapy’ to Wanganui Hospital has been yet another appalling demonstration of the failed leadership, governance and management structure of the Whanganui District Health Board.
Whilst clearly recognising all our rights to pursue personal and spiritual health, wellbeing, happiness and pleasure, my view is this: New Zealand hospitals, established with public funds and administered by the Ministry of Health, must follow the principles of evidence-based care.
I have a high level of interest and involvement in things spiritual and religious. I am an ardent advocate of patient and broader human rights and strongly support and respect our indigenous people and the Treaty of Waitangi.
However, and a big however, as a trained scientist, specialist General Surgeon and third term elected member of the Whanganui DHB, I have been appalled at what has unfolded in the attempted introduction of ‘natural therapies’ to our public hospital here.
I think I understand the sentiments that might have driven this initiative. Indeed I also have a degree of sympathy with its proponents, who almost certainly meant well.
The arrogance of thinking within Western medicine that excludes possible benefits of other modalities of healing is not warranted. An environment lacking in empathy and caring is all too common in our public hospitals and also needs to be dealt with. So too, the awful health statistics of our under-privileged population – in which Maori are sadly over-represented.
However, even a cursory examination of what has transpired in this failed process reveals serious and very worrying realities of the state of stewardship of the provision of medical care in New Zealand.
The initiative to establish a ‘Natural Therapy Clinic’ at Wanganui Hospital saw the formal establishment of the service via an early morning blessing at Te Piringa Whanau on Monday 23 July at 7.45am. The service was led by local kaumatua John Maihi and Wanganui Hospital chaplain Rev Graham Juden.
Despite obvious months of planning and detailed preparation, this was announced via a press release of 19 July1, just three days before the formal launch.
This was the first word of this initiative breathed to members of the Whanganui District Health Board. Not a single mention of it was made by the CEO Julie Patterson to her board – not even a hint in her weekly email updates to board members, the last one appearing just days before the launch. For a board that runs on the premise of ‘no surprises’ from its CEO, this is disturbing.
This is especially concerning since the media release in January 2012 suggesting (with the blessing of local obstetric specialists) that Wanganui might soon have no obstetric service was also never formally discussed at a board meeting. This created six months of chaos and anxiety for our community.
Fortunately, like the absurd idea of not providing an acute obstetric service to a city of 45,000 people, the ‘Natural Therapy Clinic’ idea has been terminated.
Interestingly, the scheme was cancelled just days before it was to be presented to the board. The only way I was able to get it to the board table at all was to link the idea of allowing non-accredited ‘practitioners’ loose on our patients with the recent case of alleged sexual abuse of one of our patients by a mental health care assistant in our organisation.
The CEO reported at the time2:
” Almost 12 months ago we received a complaint from a young woman, one of our mental health clients. The complaint alleged that she had been raped by a Health Care Assistant (HCA). The staff member was immediately suspended and the complaint investigated. It was found that the staff member had had inappropriate contact with the woman (texting and meeting her away from the unit) and a strong suspicion that there had been a consensual sexual relationship. The staff member resigned but was informed in writing that the outcome of the investigation was that he would have been dismissed. As this person was part of the unregulated workforce, we had no other levers.”
How much more blatant a lesson does one need to realise the obvious pitfalls of not only allowing, but encouraging, unregulated workers access to our patients?
The ‘paper’ which was finally presented to the board was the usual inept documentation supplied for board members and was lacking in even the rudiments of scientific form or rigour.
The claim that the pilot programme received “overwhelmingly positive feedback from staff”3, is perhaps one of the more obvious areas of deception in all this.
A survey of the 75 staff members who chose to use the service at its pilot stage apparently showed a positive response. However, of course, this is a self-selected group of less than seven percent of hospital staff members who wanted to avail themselves of the service in the first place. The views of the other 93 percent of staff are not canvassed or recorded.
But this is characteristic of DHB doublespeak.
The first media release of 19 July concerned me on a number of levels. The fact that the board had not been consulted was one. Board sets policy; management is tasked with implementing it.
All too often in our fragile district, management has implemented unjustifiable actions and then looked to the board for support after the fact. That support has understandably and correctly for the most part not been forthcoming.
An open-ended field
The second concern was the lack of definition of ‘Natural Therapy’ and the open-ended inclusion of all comers, including traditional Maori healing, Christian prayer, massage, Reiki and meditation training, as treatment modalities.
More recently, and again without prior notification, we learn through the media3 that ‘colour therapy’ was also included in this array.
None of these can seriously or accurately be considered to be therapies any more than a warm bubble bath or hairdressing could be. That does not mean that they necessarily infer harm – of course the latter two do not. Furthermore, it does not mean that hairdressers and bubble bath are not allowed or even encouraged in our hospitals: of course they are. They simply are not therapies. They are nice things and we can choose to use them in or out of hospital if we wish at our own whim.
The provision of Traditional Maori Health is already recognised by our Ministry of Health and appropriately funded and provided outside of hospitals. One could well argue that this is a legitimate part of the history and culture of New Zealand and like the Maori language is worthy of respect and support. I agree. This is a noble sentiment, and one supported by our government, but any serious practitioner of traditional Maori healing would no sooner practise his art in a backroom of Wanganui Hospital then I would perform a laparotomy in the staff canteen.
It is curious that the reported formal line of the organisation as to why the project was shelved was to “avoid confusion and anxiety in the community which we are here to serve”. That confusion, however, has been created by the management team of what is supposed to be a first-world public hospital formally suggesting through one of its most prominent specialists that the likes of ‘colour therapy’, prayer and body rubs might have any serious therapeutic benefit.
Indeed, in a study of some 1200 patients published in the American Heart Journal4 prayer clearly has been tested and shown to have no such effect.
My greatest concern, until recently, was that this project was initiated and sustained by a medical specialist colleague Dr Chris Cresswell, who is a Fellow of the Australasian College of Emergency Medicine (FACEM) and boasts vocational registration with the New Zealand Medical Council.
Code of Ethics
Our own Medical Association of New Zealand code of ethics requires us to “[a]dhere to the scientific basis for medical practice while acknowledging the limits of current knowledge.”5
It is entirely inappropriate for us to use our acquired medical positions and titles to actively promote in a formal way practices that clearly are not evidence based.
The issue is not that these modalities have no value. For individuals they clearly do. It is not that they might do harm; they probably will not. The issue is a gross breach of our commitment to our patients to apply best practice and evidence-based models to their care.
Furthermore, the notion that individuals who are essentially unaccountable and unrecognised by professional bodies and standards should be unleashed on our patients is at best irresponsible. That one of our senior doctors — Dr Cressell — in his professional capacity was using his medical qualifications and status to promote these people and suspect modalities should be a matter for the Medical Council to act on. These are not acceptable treatment options. They might well be nice and comforting and like hand-holding and hairdressing, patients are at liberty to use them at their own behest even in our hospitals. They are not to be formally prescribed by doctors using their medical credentials to promote snake oil. These are not therapies; these are not credentialed practitioners. These are at best warm fuzzies and do not require ‘clinics’ endorsed by our doctors. They have no place in our hospitals any more than homeopathy, devil worship or nail painting does.
I was surprised that the hospital CEO, Clinical Board and Association of Senior Medical Staff supported this poorly conceived idea at the outset. They did. They most certainly did.
Not one of my medical colleagues locally spoke out against this plan. Not one spoke out in support of high-quality, first-world, evidence-based medical care of which we should be unambiguously proud.
Then suddenly, the idea was dropped. I thought some common sense had prevailed.
The real and greatest concern, though, is this. Our CEO and board chair refused in the public section of our board meeting to properly explain why the project was so suddenly stopped in its tracks.
The answer lies not in medical ethics, science, patient concern or professionalism. Astoundingly, it seems, it lies not in a rational, scientific concern for evidence-based practice and a concern for who precisely we allow to have access to our patients. It lies, rather, in religiously based paranoia and bigotry.
A Wizard at the hospital
On 6 September 2012 an advertisement article appeared in the Wanganui River City Press titled ‘Dreams, magic, healing and medicine’6.
This promoted a talk to be given by Dr Cresswell on a number of topics including the ‘Natural Therapy Clinic’ and his proud introduction of it to Wanganui Hospital.
Sadly for Dr Cresswell and the ‘Natural Therapy Clinic’ the article disclosed the fact that Dr Cresswell is an ordained Wizard in the Whanganui School of Witchcraft and Wizardry, a clearly unchristian organisation and the meeting was part of Theosophy Wanganui.
I guess that degree of open mindedness, free spirit and lateral thinking on the part of Dr Creswell is what led him on his natural therapy crusade. I must confess to a degree of admiration, kinship and support for his wide raging interests, but alas, like business and pleasure, some things are best not mixed.
We can deduce it was the wizardry of Dr Cresswell that drove the medical professionals to object to the scheme. Not science, not ethics, not professionalism. Rather, we are told, “it was contrary to their religious beliefs”.
I’ve been told more than once my problem is that I think too much.
That’s probably true, but what has happened is not only mind boggling and sad, but frighteningly revealing on a whole number of levels.
A well-meaning ‘good guy’ doctor probably crossed the bounds of professionalism by formally elevating feel-good modalities to therapies. An ill-informed management team jumped on the bandwagon and Maori health was usurped in an attempt to ooze credibility over other unrelated claptrap practices.
The Health Board members were never consulted and some well-deserved bad press followed. Sadly, the Medical Council of New Zealand and the Ministry of Health provided no guidance and remained silent whilst all this unfolded. Happily, some very influential Wanganui senior doctors killed the project after previously supporting it. Sadly, it seems it was because of their own religious and personal bigotry that a silly idea was ended.
Great result, bad motivation. Very bad motivation.
Vicki Hyde of the NZ Skeptics7 points out:
“It’s rare for public figures to come out against these ‘soft’ services. It´s easier to ignore the ethical and evidential issues associated with claims that these kinds of practices actually help to treat illness or disability beyond exploiting the well-recognised placebo effect.”
It is imperative that as doctors, our first responsibility must be to our patients. Of course, we need to be cognisant of our limitations, humble, not arrogant and open to all the needs of our patients. But we are trusted as a profession and that trust can only be maintained if we adhere to defined standards based on evidence and ongoing re-evaluation and scrutiny. We should not promote, via our medical qualifications, unproven modalities at the level of treatment modalities. But neither can we allow our own specific religious affiliations to affect our professional conduct with respect to our colleagues who might hold different or indeed no religious affinities.
As trained medical practitioners we must boldly uphold the scientific basis of our profession and never be compromised by political correctness or political claptrap and doublespeak.
The supposed saving grace in all of this is that ( we are told) no taxpayer money was spent on this project. My Official Information Act application will shed some light on that. But note, apart from the media releases, the following occurred8:
- A credentialing committee was established, including Dr Cherryl Smith (Co-Director of Te Atawhai o Te Ao), Dr Chris Cresswell, Gilbert Taurua and Runesu Masaisai (WDHB Clinical Therapies Manager).
- Dr Chris Cresswell was to extend his professional development on natural therapy as part of his credentialing requirements as recommended by the clinical board.
- An independent legal opinion was sought which resulted in the WDHB’s insurance company providing approved cover for the pilot.
- Therapists were required to become honorary DHB staff ensuring compliance with all WDHB expectations, policies and procedures.
- Systems were established to obtain confidentiality agreements from all therapists.
- Therapists were required to be police checked.
- Therapists were referee checked and cleared by both steering committee and credentialing committee.
- A memorandum of understanding was developed specific to the therapists collective.
- Informed patient consent expectations and documentation were established.
- The orientation programme for therapists included: WDHB purpose, values and behaviours, fire and emergency evacuation, infection prevention and control, manual handling, patient safety and service quality including complaints, privacy and the code of rights, CPR and smoking cessation.
That appears to be a lot of taxpayer funded work to me.
Some appointed members of the Whanganui DHB tried to excuse this whole debacle by suggesting that this was all just a staff benefit scheme and never intended for patients. They clearly never read their press releases and have been patently out of touch with this important process, or worse, have compromised their own integrity in order to cover for a failing and flailing management.
To add insult to all these injuries, in an attempted justification of the failed project, Julie Patterson made the public comment that “in areas like ‘chronic pain’, Western Medicine has nothing to offer.” Really?
With views like that from high earning health bureaucrats, doctors, nurses, the Medical Council and the Ministry of Health have sure got a lot of work to do.
In the face of all of this nonsense, we cannot and should not remain silent.
1. Whanganui District Health Board Press Release 19th August 2012.
2. Weekly update, CEO Whanganui District Health Board 21st May 2010.
3. Wanganui Chronicle 26th September 2012. Hospital Ditches Natural Therapy, Anne-Marie Emerson.
4. Benson H et al. 2006: Am Heart J. 2006 151(4):934-42.
5. Medical Association of New Zealand Code of Ethics. www.nzma.org.nz/sites/all/files/CodeOfEthics.pdf
6. River City Press Sept 6th 2012 Dreams, magic, healing and medicine.
7. NZ Skeptics press release 24th August 2012,www.scoop.co.nz/stories/AK1208/S00554/consumer-wins-bent-spoon-again.htm
8. Wanganui District Health Board Meeting 28th September 2012 Item 10.2.
Clive Solomon is a Consultant General Surgeon, elected member of the Whanganui DHB (third term) and a Wanganui District Councillor. [Editor’s note: Organisations referred to in this article differ in their preferred spelling of Wanganui or Whanganui.]