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CORPORATE
MEDICINE WEB SITE Background Every attempt is
made to provide accurate and well written material.
Your contributions, suggestions, additional
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they will be included in revised pages. The intention is
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This is the personal story of my fight to expose NME's practices and force them out of Australia. I had some prior experience in dealing with dysfunctional behaviour and in confronting recalcitrant governments. My battle with NME followed on from earlier concerns and earlier battles. In a sense they reflect a long-standing discomfort with the commercialisation of health care and the exploitation of the vulnerable for profit.
CLICK HERE -- for information about prior experience
Brian Martin, who manages this web site was chairman of the Australian Whistleblowers Association. He has wanted me to put an account of my long and complex battle with Tenet/NME on this web site. This page is an attempt to bring many complex issues and events into focus and simplify them. It starts from my family's personal tragedy in an NME hospital and then goes on to my discovery of the company's practices. I succeeded in having the issues addressed by carefully crafting my correspondence so that I could enlist powerful support. This page describes my attempt to expose the matters in Singapore and then to keep the company out of Australia. A long battle followed in Australia. The company finally sold up and left Australia. The company had commenced defamation actions against me. When these continued after they left Australia I responded by taking the battle to them in the USA. My concerns and warnings that the company would continue with its practices even after criminal convictions were confirmed when it was involved in another scandal in 2002.
The drawn out battle required careful planning and preparation but also flexibility and a willingness to seize the moment when opportunity presented. There were vast quantities of emotive but carefully considered correspondence which enabled me to enlist powerful support. The battle later became one of credibility. My efforts involved destroying theirs by exposing disturbing practices and dishonesty in dealing with authorities. They attempted to attack the messenger and show that I was not objective. I was fortunate to be sufficiently far away from the company to be out of reach of the usual tactics adopted to destroy whistle blowers. I had sufficient credibility among my peers to sustain me. All of these were important considerations and without them I could not have succeeded. I enjoyed a measure of success and others may find the account helpful.
CONTENTS
My first contact with corporate medicine and National Medical Enterprises (NME) occurred in 1988 when my son became ill and died in one of their hospitals in Singapore. Nothing I say here is intended to suggest that the treatment given to my son in Singapore by the specialists who later took over his care was inadequate. I have never questioned their integrity, or their motivation. I would certainly have treated this case very differently and so would the experts I consulted.
At the time I questioned the adequacy of the care provided and my experts opinions were critical. The issues were complex and difficult to resolve. Contrary opinion was presented. When I reached a settlement with the hospital in 1994 I withdrew the allegations I had made about his later treatment by the specialists unconditionally.
The way in which medicine practiced under contract and primarily for profit compromises care was an issue, which I had confronted many times before. I felt very strongly about this but had never been in a position where I possessed enough information to prosecute the issues effectively.
My past experience convinced me that matters like this could not be addressed by arguing abstractly. Arguing from the general to the particular had little impact. Concrete instances, concrete examples and emotional content are required to give the understandings and arguments a human face and social relevance. My son's case gave me an opportunity to address the issues in a practical and focused way. The complexities of the case made it difficult but it was the best I had.
By 1994 when I withdrew my allegations about my son's care there was a vast amount of reliable information from the USA linking Tenet/NME to substandard care. The problems were directly related to the primary focus on profit at the expense of care.
My eldest son was returning to Australia from the United Kingdom in December 1988. He became acutely ill on the flight. A medical group operating under a contract with the airport authorities removed him from his flight in Singapore. A request to go into the public hospital - the Singapore General Hospital was refused. His companion was misinformed and told that foreigners were not eligible. Instead he was admitted to a large private hospital owned by National Medical Enterprises (NME), a US multinational health care corporation. My son's companion, a nurse, phoned me early the next morning. The story she told me suggested Meningococcal disease, one of the most life threatening of diseases, but one which responds dramatically to early treatment. Time is so important that treatment is commenced within minutes of suspecting the diagnosis and without waiting to confirm this with tests. It is one of the major emergencies in medical practice.
I spent four desperate hours trying to contact the doctor looking after my son. He simply refused to return my phone calls or speak to me. I was told that he was busy and would phone me when the results of tests were available. I learned from a colleague that our acting dean had contacts in Singapore. I immediately phoned him and he got someone to look into what was happening. By this time my son was shocked and desperately ill. He was immediately transferred to the intensive care unit where he died 10 days later.
I was held up with passport problems and did not reach Singapore until the early hours of the following morning. When I met the specialists who had now taken over care I found that they were well qualified, motivated and very kind. I had been awake and active for 24 hours. I was extremely anxious and also very angry. They had discounted my diagnosis and that I was correct was only confirmed 48 hours later. The uncommon diseases they were talking about were ones I was unfamiliar with. I felt that I was unable to be objective and would only make it more difficult for the doctors. Once surgical conditions had been excluded I elected to stand back and did not examine the notes or involve myself directly in decisions.
My son's companion told of a very cursory initial assessment. Two doctors operating the contract at the airport had been phoned repeatedly about my son's deteriorating condition during the night yet had failed to attend him. I met with one of these doctors and also with the doctor who had founded the medical group operating at the airport. The conduct and the justifications offered were typical of those I was familiar with in doctors working under contract. I was not impressed.
I felt that action was required but that it would be best if the hospital and the profession in Singapore properly addressed the matter. Before leaving Singapore I spoke to an administrator at the hospital and arranged to send statements to one of the doctors to be used in prosecuting the matter. This I did soon after returning to Australia.
Three months later I made inquiries and learned that the matter had simply been shelved. It was clear that there was little will to address the matter in Singapore. I had confronted bureaucracy and authoritarian governments before. I was therefore careful to write to the Singapore Medical Council and secure a response explaining how the council dealt with misconduct. The letter indicated that the same standards were applied as in Western countries like Australia.
I secured a copy of my son's notes, examined them and obtained expert opinion. While my son had received some antibiotics some time after admission to hospital his shock was not recognised and not treated. The doctors who were advised of them ignored serious and ominous signs. They failed to attend him
After reviewing the notes and reflecting on my experience with the hospital administrators and talking to the doctors I concluded that the hospital and the service at the airport were primarily commercial enterprises. Their prime interest was in getting people admitted to the hospitals and making a profit from their misfortunes. My assessment was that the hospital was organised for profit rather than care and that as a consequence there was a considerable risk to the welfare of seriously ill patients admitted there.
I now lodged a formal complaint against the two doctors from the Singapore Airport Medical Centre with Dr. Kwa, secretary for health and chairman of the medical council. I later learned that Kwa was the brother in law of the Singapore Prime Minister. My complaint was acknowledged and the letter indicated that it had been referred to the Preliminary Procedures Committee who would decide whether the doctors should face charges.
In my covering letter to Dr. Kwa I indicated my concern about the organisation of services at the hospital and the need to address them. I also indicated my view that the doctors working there were unaware of the problems. They had unwittingly identified with a system that boosted their practices and gave them status and authority. Three years later I found that this is exactly what had happened in corporate hospitals across the USA - hospitals organised for profit rather than care. Vast numbers of patients had been misused and mistreated as a result.
When there was a long delay my suspicions were aroused. I noted that my complaint had been acknowledged but this acknowledgment did not extend to the expert reviews, which I had asked them to acknowledge. I suspected a close relationship between the government and the company. Singapore was an important specialist centre for the regions. Many patients were referred from surrounding countries, a profitable business. I suspected that the expert opinions I had supplied were to be ignored.
This is how the South African government would have behaved in similar circumstances and I therefore wrote requesting specific acknowledgments of my expert reports. The reply thanked me for the letter but did not acknowledge the reports. I wrote again enclosing copies of the expert opinions and asking for acknowledgment. There was no response to this or subsequent letters. The bureaucratic wall had been put up. I later found that the hospital's quality assurance committee had carried out an audit of my son's case and that this was submitted to the committee. I obtained a copy in 1991.
By this time I had started talking to people who had dealings with Singapore, with the doctors at the airport and with the hospital. Several people were angry and disgusted by their experiences in dealing with these groups. From these discussions I came to suspect that many of the unethical US practices I had heard of in 1964 were being introduced in Singapore. If my suspicions were correct then patients with trivial complaints were being pulled off planes. They were needlessly admitted to two hospitals owned by NME. Here they were kept for unnecessarily long periods as profits were maximised.
I concluded that kickbacks and other unethical practices to secure patient admissions were very probably occurring. There were also rumours of money laundering and other unethical practices in the region. I had no means of knowing if there was any substance to these but the anger of those I spoke to was persuasive. Most of these practices were later documented in the company's US hospitals but I did not know of this at the time. A doctor in Singapore later made similar allegations in a civil action he took against the hospital in 1993. The hospital denied the allegations but failed to produce any witnesses to back their denial. The matter has never been investigated or prosecuted by Singapore authorities and there is still no proof that these things occurred in Singapore.
Someone in a position to make inquiries started asking some questions on my behalf then backed out warning me to be "very very careful". I had no evidence that any of these practices were occurring and my suspicions were based on telephone conversations.
On 14 June 1990 I wrote to my lawyer in the United Kingdom in regard to another matter. In that letter I stated
"With regard to the other matter in Singapore the situation becomes worse as I speak with people who have had dealings in Singapore, stories of over servicing, passengers removed from aeroplanes without sufficient cause and hospitalised (one doctor known as the "bandit of Singapore"), administration of unneeded expensive treatment and difficulties in getting the authorities to confront issues and act."
By this time I was in communication with a group of lawyers who were extremely helpful to me and provided some friendly advice. I was acutely aware that if I said anything I would be subjected to a libel suit in Singapore - something I dared not risk. This company was extremely credible. If I had voiced my suspicions publicly I would have been discredited as lacking objectivity because of my recent experiences. My own profession in Australia would have regarded the accusations as preposterous. I had to proceed with great care.
My son's luggage had gone on to Brisbane and I did not know whether he was still covered by his travel insurance. The hospital was pressing and I paid their large bill before I left Singapore. On our return from Singapore we discovered that my son's travel insurance covered him for any illness acquired during his recent travels in Europe.
Although the insurance had expired by the time he reached Singapore the prodromal symptoms of his illness had developed while traveling in Europe and covered by the insurance. The incubation period was such that he could only have acquired his infection during the period of insurance. He was clearly covered.
The response from the emergency UK number on the insurance form was heartless and rude. They rejected the claim and refused to send me a claim form. The matter was taken up for me by a local firm, then by a firm of lawyers in Brisbane and finally by a large legal firm in the UK. There were many expenses and medical expert opinions.
I knew that as a foreigner I would have to pay a large sum into court before any legal action could proceed. The insurance company made a number of token offers, which I rejected. It was not until 3 years later in 1991 when I paid money into court and a trial was imminent that the company finally paid up. In the end they paid their own and all my legal expenses, about 50% more than if they had paid at the outset.
I learned that these tactics are so successful that some companies challenge and resist every large claim as a matter of policy. This was my first experience of the harsh reality behind the smilingly benign face of big business.
As a university employee I was not particularly wealthy and dared not risk much expenditure in Singapore. During this time I could not afford to defend even a token defamation action. I was fighting a battle on two fronts and had to be extremely careful.
It is difficult looking back to examine the reasons why I decided to act in Singapore and explain my actions. It is easy to rationalise ones actions and create reasons afterwards. It did not happen all at once. Decisions were made by degrees.
I was certainly angry and disgusted with my profession but I recognised this. I had some years before been part of a group exploring the issues of death and bereavement. I was aware of the psychology and recognised the well-described responses in myself. To any conventional psychologist my response would be interpreted as an exaggerated grief reaction and my suspicions about the hospital as a consequence of that. I was not in a credible position. It is clear from their responses that this is how the doctors, the hospital and its corporate masters saw my actions. The anger and disgust were certainly a motivating factor and I had to balance this by trying to be as objective as I could. The problem was that it allowed me to be labeled by those I was accusing and so discounted.
I have never been particularly enthusiastic about conventional psychological wisdom. I have been influenced by the writings of Frankel who sees personal misfortune as part of the fabric of life. Rather than some terrible event, which one in some way endures and comes to terms with, misfortune can become an opportunity for action and for developing new meanings in life. One is able to use these experiences to re-involve oneself in life and build strength rather than have a hidden weakness. I like to think that this is what I was doing. Certainly I have learned a great deal about the corporate world, about government, about the way all sorts of people behave and about myself.
These two different psychological approaches give totally different and contradictory interpretations. There is of course no correct view and no hard evidence to base either set of explanations on. It is simply a matter of perspective and opinion - and there can be many of those! As the person at the receiving end of opinion I had little choice in the matter and had to learn to live with the label, even if I did not identify with it!
I had to constantly confront the problem of my objectivity. Clearly I was vulnerable to conspiracy theory. I was at risk of "confirmation bias". I was likely to reach adverse conclusions and interpretations on the basis of limited information and I certainly did so. On a number of occasions I jumped to unjustified conclusions. I tried to make a point of recognising this and writing to acknowledge and withdraw unreasonable assertions I had made.
I also had past experience in highly emotive conflict situations. I had learned to deal with people in these situations and evaluate the accounts of mistreatment, which they gave. I had learned to trust my interpretations. The tone of the responses to my inquiries about the hospital revealed genuine anger. I felt certain that with so much smoke there must be a large fire. The subsequent exposure of severely dysfunctional practices across the corporate health care marketplace indicates that my assessments were well founded.
While I was personally satisfied that there were major problems I dared not speak out about it as I would simply have looked ridiculous and discredited myself. I was soon labeled as a "crusader"! I had to walk a very fine line between fact and suggestion, only hinting at what I suspected when the opportunity arose. I did not even discuss it fully with my family. I had no idea whether there was any truth in some of the more bizarre rumours I heard and accepted that these were unreliable and probably not true.
I later realised that my actions posed a serious threat to the company. A number of people had warned me to be careful. Because of the murder of the Australian heart surgeon Dr. Victor Chang (who frequently visited this hospital) soon after NME made moves to enter Australia I adopted the practice of writing out my suspicions whenever we traveled anywhere where I might be at risk. I left these where they would be found should anything happen to me. I said enough to be sure that suspicions would be aroused and that anyone listening would hear. I had no idea whether I was at any risk but decided to be careful. There was a very fine dividing line between losing credibility and self protection. I was even more careful when I learned later that a US hospital administrator had been imprisoned for threatening to kill a witness who spoke out and a whistle blower had died suddenly alone shortly before he was to give evidence in Washington.
I realised that I would be "labeled" and that my objectivity would be repeatedly attacked in the company's dealings with authority. I would not be there to defend myself. This was particularly so when the company entered Australia. I took every opportunity to respond vigorously but carefully to any hint of criticism and to write to authorities pointing to my objectivity whenever my assertions were confirmed. I repeatedly attacked the company for criticising me rather than addressing the information I had supplied.
My last few years in South Africa had been extremely exciting, with intense involvement and conflict. It had also been a time of personal challenge, study, reflection and insight. It is not a reflection on Australia that after this I found Queensland boring. The issues which excited and motivated people seemed trivial and not worth fighting about.
I had spent most of my life doing things because there was a need and had fought for things, which needed to be done. I found myself in an environment where competition for position and for funding was all-important. Activity was directed to personal advancement and to competing with others for position. Assertiveness was highly valued. I had little interest in competing for something which others could do as well as I could. I wanted security for my family and to be doing something satisfying and useful.
I had returned to university because of an interest in teaching but found my perspectives out of step with the local education establishment. The university paid lip service to education but at the time had little real interest in supporting it or in innovation. I had been working in communication theory and my main interest was in the potential which the new media offered for education but there was little interest in this at the time. I found myself driven into research projects for which I had only moderate enthusiasm.
What I had unearthed in Singapore seemed both important and challenging. There were important principles involved and many people's lives were affected by it. Large numbers of tourists traveled in the region and most of them carried medical insurance. This put them at risk. Something needed to be done and no one was competing to take on large establishment structures and recalcitrant governments. I had the sort of background that enabled me to be effective. I was gradually drawn into it. Once involved there was no going back. Had I been sensible I would have backed away. Had I realised what the eventual cost to my family and myself would be I would have done so.
I had a very good idea of the sort of people I was dealing with. If I was to act then I must be seen to be absolutely genuine. I had to generate support and to do so I needed to show emotional integrity. I could not be seen to be manipulative. I had to play it as I felt it and live out the role of anger and grief. I therefore wrote letters exactly as I felt them. I played the role of the aggrieved relative. I then came back, deleted sections and carefully altered others to meet my objectives. Many were reviewed and discussed with a lawyer before they were sent. The words and the emotion were carefully preserved and there was no legal verbiage. I have felt strongly about the way the medical establishment and their legal advisers responded to patient's complaints. I knew what the likely response to some of my letters would be. I made my letters as typical and genuine as I could. The sort of emotionally charged slightly angry letters someone in my position would typically write. At the same time I dug holes for them to fall into when they behaved as I suspected they would. They obliged by doing so putting me in a position where I could seek powerful assistance.
Like most families who are victims of medical misadventure my prime concern was to see that others were protected - that some benefit resulted. My correspondence concentrated on this aspect and repeatedly stressed my concerns for others. I complained about the delays by stressing the continued risks to travelers in the region.
It was difficult to know how to proceed. I considered commencing a court action against the doctors and the hospital, but the most I would have achieved was a settlement probably paid for by my own medical insurance group. The hospital would simply have blamed the doctors. This would not have had any beneficial outcome. The courts were a familiar battleground for corporate businessmen. They were experienced and would employ the best legal teams. I was interested in ethics and integrity rather than legality. The medical council was a venue through which issues like this could be pressed. Singapore operated in the UK tradition and the more legalistic US hospital administration would be in unfamiliar territory.
I wrote carefully constructed reasonable but very concerned letters to Dr. Kwa setting out the issues, complaining about the delays, his failure to respond, and the potential risks. I tried to put him in an increasingly embarrassing position. There were no replies.
Our medical superintendent was at the time president of the Queensland branch of the Australian Medical Association (AMA). I enlisted his aid and in December 1989 I met with Dr. Bryce Philip president of the federal AMA. He was sympathetic and willing to help. I indicated that I would write out a full criticism and send it to him.
I was now faced with the most difficult decision in the whole business. The specialists who had attended my son had been kind and had done their best. I could not address the problem in the hospital without criticising them. I decided that the issues were very important and that I had no choice but to involve them. The gloves had to come off.
I wrote a detailed criticism of every facet of care in an attempt to draw attention to the problems in the organisation of the hospital, but at the same time being careful to show that the doctors had not been malign in any way. I deleted their names from most of the copies. The document was intended to expose the problems in the way the hospital was run as much as support my complaint to the medical council. I sent a copy to the AMA.
I also used it to apply more pressure in Singapore. I sent a copy to the hospital urging them to ensure that my complaints were addressed. I also lodged a complaint against all of the doctors and the hospital with Dr. Kwa, the Secretary for Health. I supported this with my criticism. The hospital responded with a letter of denial and threatened legal action. I wrote an angry response and made threats of my own. The letter was actually carefully written and when it was later used in court to accuse me of blackmail I was able to draw attention to the rest of the letter.
Dr. Kwa did not acknowledge my new complaint. I therefore wrote a short summary in lay terms. I wrote to the Prime Minister of Singapore complaining of Dr. Kwa's failures and enclosed a copy. I wrote to the Foreign Minister, Gareth Evans and asked him for help. I also wrote to the major airlines outlining the potential problems for their passengers and asking them to exert pressure. I attempted to solicit support and pressure from major firms operating in Singapore, asking them to write urging action.
The AMA had not yet acted, as they were very involved in a conference at this time. I therefore wrote a letter to the editor of the Medical Journal of Australia addressing the issues and the risks to visitors. They were willing to publish it but suggested that the AMA take the matter up with Singapore on my behalf first.
The AMA now gave me very strong support. They wrote to the two major airlines urging them to avoid the medical service at the airport and the hospital until the issues had been resolved. They wrote to the Singapore Medical Association and to Dr. Kwa. They indicated that they would publish my letter and also threatened to withdraw facilities for training Singapore doctors in Australia if the matters were not addressed. They wrote to Gareth Evans asking him to lend support.
A doctor from the Department of Foreign Affairs contacted me. She was extremely helpful to me and supportive during the subsequent months. I understand that the matter was taken up with the Singapore government by the high commission in Singapore without any outcome. This was followed by high level action in Canberra.
I now received a profuse apology from Dr. Kwa who had apparently been away and had just returned. He promised that the matter would be attended to.
This was before Keating, before the courting of Asian countries and before globalisation. I wonder if any individual would get this sort of support from government in confronting a foreign power in Asia today.
To my surprise the preliminary procedures committee decided to charge all of the doctors with professional misconduct. They may have felt that they had little choice as they were responding to diplomatic pressure. I was soon in contact with the lawyers acting for the council to prosecute the doctors. There was no mention of the hospital about which I had also complained. I wrote to the lawyers and to Dr. Kwa at the Ministry of health asking about this but it seemed that the medical council had no jurisdiction over the hospital and the ministry would not act.
I found that the address of the doctor who was to chair the Singapore Medical Council's hearing was in the same hospital complex and objected on the basis of a conflict of interest - unsuccessfully. The council had no money to bring in expert witnesses and I became both the complainant and the prosecutor's only expert witness - an impossible position. I paid for another witness and myself to fly to Singapore. I was sent the responses of the various doctors and in my replies made it clear that the specialists had acted in what they felt was the patient's best interests even though I realised that they could not be convicted if this was so. I also understood that subject to the council's approval I would be allowed to have a lawyer to protect me at the hearing. I employed a lawyer and briefed him to be present at the hearing.
The doctor's defence was paid for by their respective medical insurance agencies and a Queen's Council from Australia and South Africa who had considerable experience in medical council proceedings represented the specialists.
I flew to Singapore a few days before the hearing to prepare. The prosecutor was understandably not eager to prosecute the specialists and wanted me to withdraw the charges. He did not think that we would succeed with them. I indicated that it was the hospital with which I was primarily concerned and that I could not show the problems in the hospital if I withdrew the complaint against the specialists. He agreed to this and undertook to give me a fairly free hand in presenting the evidence. At the same time the case was against the specialists and I would not be allowed to deviate too far from this.
One of the problems was that the document I had submitted was the one I had written to stimulate action and I had not realised that it would become the document of complaint. I would be required to go through it and deal with each criticism I had made there. I had taken a pretty broad swipe at all treatment and was now faced with having to defend all of the criticisms and some were certainly open to differences of opinion. Had it been written for the court it would have been tighter and concentrated on essential and critical issues. It did have the advantage that criticism of the hospital was included.
I was apprehensive about the whole process and worried about the objectivity of the Medical Council. At the outset of the hearing the prosecutor applied for me to be represented legally and to be allowed to sit in on the proceedings. Both were refused. I threw a temper tantrum and refused to give evidence but then allowed myself to be persuaded.
I was given a fairly free hand to go through the complaint which I did making the points I wanted to make within the limits imposed by the nature of the proceedings.
The tactic of the defence in cross-examination was to destroy my credibility. The Queens Council had tracked back all my court appearances in South Africa and commenced his attack 30 years earlier. He attempted to label me as racist, accused me of blackmail and then of being manipulative and dishonest quoting from letters. I was able to phone home overnight and get my son to check dates on correspondence. I was able to refute the allegations the next morning. At the time I felt devastated and felt I was doing badly but when I read the transcripts 3 years later I found I had not done too badly. I then had to defend all of the allegations and try to maintain a case against the specialists. It was a pretty stressful exercise and seemed to go on for days.
I was allowed to meet with and have a discussion with the prosecutor over the weekend. He wanted to withdraw the charges against the specialists. I had been extremely reluctant to involve all of these doctors and had only done so when the Singapore government refused to address the issues. I withdrew the charges against the specialists on the Monday morning.
During the proceedings I had been able to table all of the correspondence with Dr. Kwa. The reasons why the specialists had been charged and my ambivalence about this were obvious. I received an apology and was assured that the Singapore Medical Council was quite separate from the Ministry of Health and had not been involved. The proceedings then continued and the two doctors from the Airport Medical Centre were suspended from practice.
In retrospect withdrawing the charges at this early stage was probably a tactical blunder in dealing with the hospital. They later used it to criticise me. I should have returned for reexamination to address and refute a number of points made by the Queens Council before doing so.
The Queens Council with whom I shared school friends arranged for me to meet the specialists, which I did. We discussed the problems in the hospital and the services in Singapore. We agreed to send a joint letter to Dr. Kwa at the Ministry of Health. They also suggested that I meet and discuss this with one of the hospital's senior administrators.
During the proceedings I had received a copy of a review carried out by the hospital's Quality Assurance Committee and submitted in defence. I felt that this was dishonest and I confronted the administrator with this. He refused to discuss it unless I gave an undertaking not to take legal action against the hospital. I had taken advise and refused. I offered the services of our intensivist to help them reorganise their unit and also offered to train some of their staff in our hospital. My offer was refused.
Instead I was subjected to a long lecture about the latest in "Quality Assurance" from the USA. I was by now exhausted. It sounded most impressive and I felt hopelessly out of my depth. It wasn't until I reflected about it later that I realised that I had been subjected to a mishmash of impressive words and that they actually had little concrete meaning. It was my first experience of what I later called "NMEspeak". What was clear was that this administrator actually believed what he was saying. He was caught up in the flow of the words and their associations rather than their concrete meanings. This was the way the company thought. They could justify anything this way.
The Airport Medical Centre lost the contract at the airport. The doctor who had founded the centre was I believe later charged with another misdemeanour and also barred from practicing.
I corresponded with the specialists in regard to the letter to Dr. Kwa but this did not go anywhere and I wrote myself 3 months later. I also wrote and complained about the review conducted by the hospitals Quality Assurance Committee.
My experience is that when there are serious problems in a social system cracks will eventually appear and people will eventually speak out. I needed to be able to show later that I knew what was happening without rendering myself at risk of libel actions. I therefore wrote to the Singapore Medical Council to complain about some aspects of the proceedings, about the hospital and about the Quality Assurance Committee's report. In the letter I stated
"It (the information I obtained) suggested the exploitation of patients and the presence of unscrupulous and criminal activities in some portions of the medical services provided. Even allowing for the fact that many of those I spoke to might have axes to grind, I feel that there cannot be so much smoke without a large fire. Some of the tales were frightening. Many of these related not only to financial matters, medical standards and practices in the hospital but particularly to the conduct of the Airport Medical Centre and its assumed relationship with the hospital. Others related to air ambulance services and practices of referral from surrounding countries."
This was useful to me later. I was able to show conclusively that I suspected these practices long before the same practices were exposed in the USA.
I had sustained a fair amount in expense. Instead of taking action against the doctors convicted I wrote to the Australian Medical Insurance Group who had funded the Airport doctors defence suggesting that they might like to cover my expenses. Instead they attacked my actions. They claimed that their doctors were scapegoats and that such conduct would not raise eyebrows in Australia. We had a brief and fairly heated correspondence. I later had pleasure in sending them some accounts of NME's conduct and asking whether this would raise any eyebrows. This aggressive stance by the profession and insurers is the sort of thing which I believe is unforgivable and drives patients looking for explanations and constructive changes to sue for damages. I had long ago learned that the only thing which changes this sort of behaviour is when those involved get burnt as a result of their actions. I later included their doctors in my court action in order to buffer my action against the company in Singapore. They ended by paying much more.
NME had started negotiating to buy control of Markalinga, a West Australian (WA) company with hospitals in WA and NSW some time early in 1991. I did not learn of this until about Oct 1991. The AMA had earlier written to Richard Eamer the chairman of NME on my behalf urging him to address my complaints about the hospital but he had not replied. The AMA now wrote again suggesting that the failure to respond would compromise their acceptance in Australia. I also wrote to Denis Brown the Singapore administrator who was to take over in Australia suggesting that the hospitals failure to respond to my concerns might count against them. We both received prompt replies.
I felt that Eamer's response to the AMA was dishonest. I clashed with the AMA's new president when he refused to oppose NME's entry to Australia. Instead the AMA tried unsuccessfully to get a member of the AMA on to the board of the new company. I also took the matter up with the West Australian newspaper but they would not publish. I really did not have enough information to justify their doing so. I did not know that in September 1991 the practices about which I was so concerned had become the focus of a major scandal involving NME in Texas. The Sydney Morning Herald published an article in October 1991 but I did not see it.
I was not able to do anything further in Australia at that time but I did not believe that the people who had been running the show in Singapore should be allowed to operate in Australia. I started to put myself in a position where I might be able to challenge these executives suitability. I lodged a complaint of unprofessional conduct against the members of the Quality Assurance committee who had prepared the report on my son's case with the Singapore Medical Council. This was a direct attack on an official hospital committee and the hospitals credibility. I thought that it would not be prosecuted but that I should try. The doctors would be represented by their medical insurers who would not be interested in protecting the hospital and I hoped that they would persuade these doctors to speak out about the hospital, especially when and if they were cross examined.
I felt that sooner or later someone would speak out in Singapore and that the hospital's conduct there would be exposed. The three-year limitation on legal action was to expire in December 1991 but I learned that if I lodged an action I need not serve the papers for a year. The company probably would not know that the case was pending. I felt that the threat of a legal action would back my complaint to the Singapore Medical Council and if they failed to act then I could still bring it into open court. I wanted to keep my options open even if I never proceeded with the action.
I realised that any case against the hospital would be extremely difficult and that I would have to show that their business practices interfered with the care given to patients. I hoped that such evidence would emerge in time and that I could force the hospital to disclose their relationships with doctors. Doctors are responsible for care and an action like this would have been totally new legal ground. I also knew that the doctors from the airport could not successfully defend themselves after the Singapore Medical Council findings. I included them in the action to cover my costs should I be forced to withdraw. The specialists were not included. The papers were quietly lodged shortly before the limitation deadline.
To my surprise the complaint to the Singapore Medical Council was dealt with quite expeditiously and the Preliminary Procedures Committee elected to charge the doctors. Their medical insurance companies initially represented the doctors. I hoped that they would disclose information which would assist my cause. I would get more information about the relationship between the doctors and the company.
There was considerable delay as the doctors appealed the decision of the Preliminary Procedures Committee to the high court. It ruled against them. In their appeal the doctors did give useful information which was embarrassing to the hospital. The hospital now saw the trap. The hospital and its lawyers took over the defence of the doctors from their medical insurers and paid all their expenses. Companies such as Columbia/HCA later adopted the same tactic in the USA when their staff were charged with fraud by the US government.
I was happy to let the matter ride in the hope that more useful information would become available in time. It suited me to keep their Australian operations under the cloud of proceedings in Singapore. This was a double edged sword as they could claim my actions in Australia were directed to supporting my action for damages.
The story from here on becomes even more complex and some of it is told in more detail elsewhere on this www site. This is only an outline and addresses a few matters not mentioned elsewhere.
Colleagues returning from the USA told me of television and press reports exposing misconduct but I did not recognise any names. Unbeknown to me the scientologists had lodged an objection to hospital licenses in New South Wales (NSW). The objection was based on the scandalous conduct that had been exposed in Texas. The NSW Health Department dismissed the complaint after a very cursory investigation.
The new company had been renamed Australian Medical Enterprises or AME. AME won the contract to build the new St. George's hospital in Sydney and applied to NSW Health department for a license.
I did not know of these events or of developments in the USA until Andrew Ollie ran an expose of NME's US conduct in the Four Corners program on ABC TV in October 1992. The Health Department had objected strongly to Ollie's plan to run the program and considered it irresponsible. I watched in disbelief as witnesses and prosecutors described in Texas many of the things I had concluded about the company's operations in Singapore.
I phoned the department the next day and they were angry and indignant that the program had been screened. I followed this with a letter and then later with a complaint and objection. By this time the department had been sent much more information by a US source. This including the proceedings of the damning April 1992 Senate Inquiry entitled "The Profits of Misery".
I obtained material under FOI and also met with NSW health at this time. It was clear that they were now persuaded but they were not in a position to resist a legal challenge to a decision to reject the license.
I tracked down many of those who had given evidence at the inquiry in the USA. I wrote letters and also phoned some of them. I wrote more insightful letters to the various prosecutors in the USA and received very different responses to those initially received by NSW health. I received a stream of material from US sources that I passed on.
The opposition in the NSW parliament took up the matter. My concerns about Singapore featured. In March 1993 the small Medical Observer published a series of articles relating to the problems in Singapore. They were silenced by a defamation action that was never prosecuted. The Sydney Morning Herald published a feature article "Chequebook Hospitals" addressing the entire issue. The NSW director general of health clearly felt he had been mislead. He gave an assurance that he would not grant a license until he was fully satisfied.
The Health Department were aware of the risks of a legal challenge, the costs, and that any witnesses would have to come voluntarily from the USA. The government, which would have to pay for any legal action taken against them, was not supporting them. There was no time limit set in the regulations for making a decision. The Director General simply decided to delay the decision and wait for events in the USA to unfold. This was not a popular decision. There were strong objections.
There was now a clear advantage in pressing the company harder in Singapore and I served the hospital with court papers in December 1992. By now I knew of the contracts which the company in the USA had made with doctors. I felt it was likely that similar contracts would have been signed in Singapore. If so then it might be possible to show that the hospital had intruded into the care of patients. I now pressed ahead with my action against the hospital. The stage of interrogatories and then later disclosure of documents was reached. I wanted and requested disclosure of their contracts with the doctors. If these were similar to those in the USA New South Wales could immediately reject the license application.
The charges against the Quality Assurance committee and my court action placed a large question mark over the company in Singapore. The same Singapore staff were running operations in Australia. NSW Health was demanding disclosures about events in Singapore and at the same time I was asking questions in the interrogatories. The company needed to give totally different sorts of answers in the two situations. They knew that the responses they gave in Singapore would be used to challenge them in Australia. I would also secure their responses in Australia through FOI and could use them in my action. They were in a difficult position.
The St. George hospital enterprise had very strong political, business and medical support. The hospital was badly needed. Soon after his emphatic claim that he would not grant a license until he was fully satisfied the director general was persuaded that he had a conflict of interest. He agreed to delegate his responsibility to Mr. Justice Yeldham, a retired Supreme Court judge. At the time I did not know of Yeldham's clandestine sex life and his vulnerability to improper influence - the reason for his early retirement. Political, legal and business circles were very probably aware. The Independent Commission against Corruption (ICAC) had recently investigated this conduct. The ICAC investigation was abandoned when Yeldham took early retirement.
NSW Health made a submission urging justice Yeldham to delay his decision until more information became available. He decided to press ahead. I was very suspicious and wrote a detailed review of all the material available and an evaluation of its significance. I wrote a criticism of every possible rationalisation that might be used to justify granting a license. This was given to Yeldham.
I now went to the USA where I visited the Pentagon and met with politicians, fraud investigators, doctors, administrators, whistle blowers and lawyers. I collected a large amount of material. I learned that NME was only one of the companies indulging in unethical and illegal practices. The problems were industry wide.
When it received the documents I obtained from the USA NSW Health made a submission to Yeldham advising him to reject the licenses and advising against granting a license with conditions which is what Yeldham planned. They indicated that there was enough information to show that the license should be rejected.
Yeldham pressed ahead amidst escalating exposures in the USA. He granted a license with conditions in September 1993. This was only a week after a Dr. Ng described in court how the staff now working in Australia had attempted to entice him into illegal contracts involving payment for patient referrals. None of the hospital staff gave evidence to deny this. NME had not disclosed this action to NSW Health. Within weeks of Yeldham's decision press reports documenting this were available in Australia but no action was taken.
The West Australian health department had been supplied with copies of all documents. They did not have the power to remove licenses from AME. In March 1993, long before the Yeldham decision they made a submission to their minister outlining the danger that NME posed to Australia and its citizens. They urged government to set in place procedures, which would allow licenses to be removed. The government ignored this advice. The West Australian Newspaper was by now in possession of information. It adopted a fairly hostile approach to AME and consistently sniped away until the company left Australia at the end of 1995.
I demanded disclosure of the contracts between the doctors and the hospital. The hospital refused. I took this to court and won. They appealed the decision to the high court and they won. I now had little chance of winning the case against the hospital. The Airport doctors had meanwhile offered to settle and in late 1993 I went to Singapore to discuss with my lawyer and negotiate this. I had an amicable meeting with the doctors' lawyers and a reasonable sum was negotiated. This covered my legal and other expenses.
I also met with a lawyer from the firm prosecuting the Quality Assurance Committee in the Singapore Medical Council. They were much more committed to this case than they had been in 1991. However they did not think that they would succeed, as they could not prove a motive. I pointed out that the report had been submitted to the Preliminary Procedures Committee by the doctors in their defence and was probably prepared in order to support them. They would not call Dr. Kwa the secretary for defence to give evidence in this regard.
The second medical council hearing was held early in 1994. This time there were expert witnesses for both sides. I gave evidence early and every effort was made by the hospital lawyers to object and limit what I could say. I suspect they had a good idea of what I wanted to say and tried to prevent this. They elected not to cross-examine me. The prosecutor later called the hospital administrator to give evidence and then called me back to clarify some points. This gave me the opportunity to state in court why I had taken the actions and what I knew of the operations of the company - the things I had originally said in the letter to the medical council in August 1991 were now in evidence. The doctors were acquitted.
If I simply withdrew from the court case against the hospital I would have been faced with all of their expenses which were considerable. We now entered into aggressive negotiations. The hospital demanded undertakings, which would have effectively prevented me from taking any steps to supply anyone with information about the company. This I was not prepared to do as I had every intention of securing the Ng court documents in due course and forcing this company out of Australia. I agreed to withdraw all allegations made against the hospital and the specialists in regard to my son's care by them. This was becoming an embarrassment as my actions were being labeled as self-interest.
Dr. Ng's case had gone to appeal and my colleagues in Sydney were very concerned that the St. George Private hospital be built. It was badly needed. It was therefore necessary to contain the company and prevent it from getting a larger foothold, until after the hospital was built, and until the criminal investigations in the USA were resolved.
There was now extensive information available about NME's activities, a $200 million fraud settlement with US insurers. Yeldham had concluded that conditions were necessary to protect Australians from NME's disturbing culture. Despite this the banks, the WA government and the federal government now strongly supported the company. A federal government owned development bank even went into partnership with the company. NME knew it was negotiating a criminal conviction in the USA and seized the window of opportunity before it was convicted to become more established. It rushed to secure a footing in Victoria and Queensland by buying hospitals. The company thought Yeldham's decision would be accepted in these states.
A citizens group "The Friends of Prince Henry" formed to fight attempts to downgrade the St. Henry's hospital had taken up the battle against corporate intrusion into health care and NME in particular. They had also lodged complaints with NSW Health. We corresponded and shared documents. They prepared a publication describing all of NME's practices and circulated it widely. I had no part in this but many of the things which needed to be said and which I dared not say publicly as an individual were set out in this publication. All politicians received a copy. This was an extremely valuable contribution. The Friends of Prince Henry held public meetings and I spoke at one of these.
I had kept all state health departments informed of events and the concerns about Yeldham's decision. Victoria elected to perform its own investigation. I was able to send them all the Yeldham material and also more recent material which challenged the truth of NME's previous claims. I could now advise them in advance of the pending criminal plea and the sum being negotiated. Queensland Health and my colleagues at the Repatriation hospital targeted by NME in Queensland were kept fully informed. The company withdrew from Victoria and Queensland. In June 1994 it pleaded guilty to criminal conduct in the USA and the Australian federal government stepped in to place an embargo on its further expansion in this country.
Since 1993 I had kept the World Medical Association supplied with information about NME. I also supplied additional material to foreign embassies in Australia and to medical associations around the world. It was clearly important that they knew of the potential threat which Tenet/NME and similar companies with international ambitions posed. Tenet/NME was only one example of what was happening. It provided a window into the corporate health care world. They were also told that Australia had restricted NME's operations.
I felt it important to make the problems posed by NME and companies like this more widely known to the medical profession. It would also be helpful in forcing NME out of Australia if people were more widely aware of their conduct. They would be under much greater pressure if the medical profession were hostile. I needed to do so without courting a libel action. I wrote to the library committees of most hospitals in Australia urging them to stock a number of books on corporate health care including Ron Williams's book "Remission Impossible" and Lindorff's "Marketplace Medicine". I enclosed material about Tenet/NME to support my submission. Steps were also taken to ensure those health insurance groups and other bodies, which might fall victim to improper practices, were properly informed about NME's track record, its conviction for fraud and the practices in which it had indulged.
I sent Dr. Kwa a copy of the Four Corners program and other documents, as they became available during 1992-4. I urged him to investigate whether similar practices had occurred in Singapore. He returned the video and early documents claiming that he saw no need to examine them. Perhaps he realised that he was setting himself up and after a while he accepted the documents. I continued to plug away at him with documents and press my concerns that these things had happened in Singapore.
After its guilty plea in the USA NME was forced to sell all of its US specialty hospitals where the fraud had occurred - nearly 75% of its hospitals were sold or incorporated into its general hospital division. It used the funds to buy American Medical International (AMI) and then renamed the company "Tenet Healthcare". It claimed that its new name reflected its integrity and its reformed character. Staff from its international division were appointed to senior positions claiming they were distant from the fraud and therefore clean. They mounted a massive publicity campaign under their new name to restore their image. When they were challenged they attempted to distance themselves by claiming that these practices had been localised to their psychiatric hospitals. These were an "infected appendix" which had been amputated.
When NME took control of Markalinga in 1992 the company was renamed Australian Medical Enterprises or AME. By now I had purchased some AME shares so had access to shareholder material and could attend meetings. I needed to make the company vulnerable to shareholder reaction when the Ng Singapore documents became available. I wanted to force the company to confront the possibility that their Singapore staff had been involved in wrongdoing and respond in writing before they were presented with documents.
I made a few inquiries to identify an Australian member of the board whom I felt could be challenged and might break ranks and create division. I wrote repeatedly to him to express my concern that their Singapore staff may have been involved in similar practices. I subsequently urged him to ensure that the company investigated the conduct of its US directors and staff to be sure that they had not been involved in any similar unsavoury conduct. I received assurances back in regard to their integrity and finally a threat of defamation action from the company's lawyers.
The company's annual general meeting was in October 1994. Prior to this it informed shareholders and the press of the way in which it had amputated its infected appendix. It claimed that the federal government would now lift the embargo on its further expansion. Its senior US staff were coming to the AGM and were to meet the various federal ministers in the days before the AGM. I do not believe that they would have been so confident if they had not received some assurances from government.
By now construction of the new St. George's private hospital had reached a point of no return. The appeal against Dr. Ng's court victory in Singapore had been rejected. I was now in possession of Dr. Ng's statement of evidence and it was damning. While their lawyer had denied the allegations, none of the many staff involved including those now in Australia had given evidence to contest Ng's claims.
Copies of these documents were supplied to the politicians who were to be interviewed by NME. The delegation would probably not have known of this until the meeting. Two of them were named in the documents and a third was indirectly implicated.
I had decided that it was time to actually look at some of these people and make a better assessment. I flew to Perth for the annual general meeting. The federal government had refused to lift the embargo on NME's expansion in Australia and this was now very embarrassing. The US directors looked decidedly shaken and not pleased to see me. The meeting was rushed, particularly the opportunity to ask questions. A plan to expand into China hurriedly replaced the planned expansion in Australia.
After the meeting I was approached by the Australian chairman of the company and I presented him with a copy of Dr. Ng's testimony. I followed this the next day with a hand delivered letter asking him to stand these people aside. I also took the opportunity at the meeting to get a copy of the Ng evidence into circulation among shareholders. The Australian directors also came over and spoke to me.
The chairman responded in writing and refused to stand these people aside. He accused me of lacking objectivity. This was an opportunity to write back and explain just how objective I had been and how accurate.
Copies of the Ng documents now went out to the various states' licensing authorities and I know that there was a meeting with AME directors in Perth. They were also sent to the AMA and it's various branches.
This federation is the powerful representative body of the large corporate health care chains. Its offices are in Washington where it lobbies on their behalf. Michael Focht who was in charge in Singapore at the time of the Ng events was a director. Michael Ford who was one of those accused by Ng was on their Quality Assurance committee.
I sent copies of the Ng documents to the federation expressing my concerns that these people might be unsuitable to hold these positions and asking them to look into the accuracy of the allegations. The documents were not acknowledged. I made repeated requests to do so and sent more copies. I next approached the American Medical Association with the document and my concern at the federation's failure to respond. The AMA took the matter up with the federation but got nowhere.
As part of its settlement the company were required to set in place a compliance program overseen by the justice department. Focht, now COO of Tenet/NME was largely responsible for this so the justice department also received a copy of the Ng documents.
I suspect that these documents put some pressure on the company as they tried to explain why they had not contested the evidence. They were making claims of clean brooms, reform and integrity. They must have found it uncomfortable.
I now received threats of defamation actions from AME, from Dennis Brown their senior administrator and from the hospital in Singapore. All were threatening and demanded retractions and undertakings that would have made it impossible for me to supply information. It was certainly very intimidating.
They had previously written to my university about my conduct. They now threatened to include the university in the defamation actions.
I had since 1991 been very frightened of a defamation action and had been careful of the way I had worded my correspondence. I had so much material that I felt I could defend myself and make it very damaging for them. I was therefore fairly confident that they would only lodge an action when they were absolutely desperate. It would be a last ditch effort. I was both frightened and encouraged by the threats.
I also reflected back on the meeting in Perth and realised that while I had been looking them over they had responded very professionally and had not only looked me over but had been probing in their discussions. They knew that I was coming. A shortish man whom I suspect was an American had been standing near the chairman when we had spoken to me. The chairman had spoken about a defamation action and I realised that I had responded involuntarily and given my fear away. The same man was standing behind the other Australian directors when they were talking to me but without saying anything. He was simply one of the group.
At the airport at 1 am the next morning I looked up and recognised someone watching me from the back of a crowd. It was either Focht or Ford. I deliberately walked over to see who it was and he turned and bolted. There were no other flights leaving at that time. I concluded that they had been carefully sizing me up and had concluded that I would crumble.
I therefore responded politely protesting that I was unaware of any libelous statement and asking for details. Dennis Brown served me with documents. He alleged that I had accused him of bribing Dr. Ng. This was a very liberal interpretation of what I had written. My lawyers considered that I had a defence. If I lay low it would eventually go away. This did not seem an appropriate response to this sort of conduct.
I decided to embarrass them further by pressing the issue. I wrote to Ombudsmen in the states where they worked enclosing documents and asking for advice. I did the same with every legal assistance group I could find asking for assistance. I wrote to the AMA asking them for legal support and enclosing material. A significant section of the Australian legal profession would have known what was happening. The Australian senate was holding an inquiry into whistle blowing in Australia and I made a submission describing their action against me.
I also wrote a careful letter to doctors in all their hospitals. This explained the nature of the court action against me, and my concerns about the Ng documents. I enclosed a copy of the relevant sections of Ng's evidence. I asked them to assist by pressing the company through hospital processes.
The original claim against me was legally deficient and my lawyers now objected to the wording of the claim and tried to force the matter to court. We responded promptly to every step and Brown delayed as hard as he could. Every time he delayed we went back to court to force him to respond. His responses were never adequate and we had to appeal against them again and again. By the time he withdrew his action at the end of 1995 NME had paid over $62,000 in legal expenses for him and this was before they paid my expenses. He had not yet come up with a claim against me, which was acceptable to the court.
Since October 1992 I had kept the Australian Medical Association fully informed with documents and criticisms. I repeatedly chided them and strongly criticised both Bruce Shepherd and Brendan Nelson for their lack of action. In fairness to them they would have been met with a defamation action had they spoken out, as they would have liked.
Senator Herron was a past president of the Queensland branch of the AMA and Bruce Shepherd wrote to him asking him to raise the issues in parliament. He did not do so. I had known Senator Herron before he entered the senate and from then on I included him in my information loop so that he was well supplied with information and documents.
There are serious deficiencies in the Foreign Investment and Review Board legislation and structure which places Australia at risk from foreign criminals. There are also serious deficiencies in state regulations, which were not designed for corporate license applicants and except in Victoria are ineffective against multinationals. I first wrote to the treasurer about this in 1993 and have been prodding state health ministers, their departments, the treasury and politicians about these matters since that time - making a nuisance of myself. The health department in Western Australia had identified the same problems in March 1993 and had advised their minister to address them but no action was taken. I obtained this report under FOI in 1995.
By 1995 Senator Herron was chairman of the Senate Reference Affairs committee, which has wide powers to inquire into a number of issues. When the company commenced a defamation action against me I made a submission to the committee suggesting an inquiry into the practice of corporate medicine, the ability of our regulatory structures to cope and of Tenet/NME's conduct in particular. I understand there was some support for this and that Senator Herron wrote to AME in regard to a proposed inquiry. Had an inquiry been initiated I would have been able to make a full submission and give evidence under parliamentary privilege. When Tenet/NME decided to sell up and go the members of the committee lost interest. Tenet sold not only in Australia but also in the rest of Asia and Europe. All were aware of their conduct and of the action taken in Australia.
Two days after the case in Australia was withdrawn my front door bell rang and I was served with court documents from the hospital in Singapore. Why they should want to do this is difficult to understand unless they were still under pressure from the material I had sent to the USA and needed to show that they were taking action against me to justify their denials. Perhaps it was pure vindictiveness. It was certainly stupid to stimulate me to further action. I was at the time very happy to see the last of the company. Citizens in the USA had been wonderfully supportive in sending me material. I was now stimulated to try to protect US citizens from people like this.
The defamation action related to the information I had sent to medical libraries in Singapore but once again the meaning of the words was being stretched. I had been careful in what I said. This was a very unwelcome lawsuit. Singapore is a very different country to Australia or the USA when it comes to defamation. They are particularly sensitive where foreigners are concerned. My Singapore lawyer did not think that they would prosecute the case or that they could win and advised me not to force the pace. The government had itself introduced legislation to hurry cases along and the company would have to either proceed or drop the case reasonably soon.
I was much more concerned than my lawyer was. When I obtained material under FOI from NSW in 1994 I also received correspondence between the chairman of AME and the minister of health. They were on first name terms. After I had examined the Yeldham material I concluded that the whole process had been corrupt. I wrote a particularly scathing letter to the minister of health accusing him and Yeldham of having corrupted the whole licensing process. I was very critical of Yeldham. I realised that AME would have obtained this letter under FOI. This would not have raised too many eyebrows in Australia but in a conservative country like Singapore this would have been damning. My credibility would be destroyed.
I therefore took the matter very seriously. Some of the medical assistance companies helped and I was able to trace a number of patients who had been taken from their flights and admitted to these hospitals. None were willing to give evidence in Singapore but some gave me statements when I undertook not to call them as witnesses. I contacted people and built up material for a defence.
I needed to hit back at the company in the USA and also generate a situation that would put them in a bad light and suggest to the Singapore court that the action was an attempt to suppress legitimate action on my part. I had to do it in a way, which would make it difficult for them to litigate in the USA, and would also hurt.
Tenet/NME were boasting in their public documents of their integrity and of their ethics committee. This was under the supervision of their new COO, Michael Focht who was in charge in Singapore at the time of the Ng events. Others referred to by Ng, including Brown and Ford now held more senior positions in the USA. I wrote a submission asking the ethics committee to investigate the conduct of these people to determine whether there was substance to Ng's allegations and whether they were suitable people to hold senior positions in a company so strongly committed to ethical conduct.
When this was not acknowledged I prepared a second submission using the FOI material from NSW and referring to the NSW health department's conclusion that the company had been less than frank in its dealings with them. I was able to add additional material, which showed their dealings in a much worse light, including their failure to disclose the Ng action to Australian authorities. I did not challenge the legality of their actions but questioned their integrity and their ethics. Current members of Tenet/NME's new board were implicated.
When this also was not acknowledged I drew it all together into a single shorter document summarising the issues. I also questioning the ethics of their court actions against me and its purpose. I sent this as a final submission and allowed time for them to respond. All mail was registered. When they failed to respond I put it onto the web site.
Senator Herron kindly offered to make a statement in the senate and he did so immediately after a whistle blower report from a committee. He praised my efforts in addressing the problem caused by Tenet/NME in Australia and described their efforts to silence me with litigation. He indicated my complaint to the ethics committee and my continuing concern that people involved in these matters were still responsible for health care decisions in the USA. The full statement was published in the magazine "Healthcover" and a copy is available on this www site.
I presented a paper about Tenet/NME's conduct at a conference in Australia and a full version was published in the proceedings - a publication, which I could supply or refer to. It described NME's business practices in the USA, the consequences and also their behaviour in Australia. It also went onto the web site.
David Weedon the new president of the AMA was a Brisbane colleague and agreed to act as a referee should anyone want to know more about me.
I had now established some credibility so my words were more likely to have an impact. I prepared representative extracts from the Ng documents and the NSW material and also short summaries. I added a copy of the senate statement. I wrote to the American Medical Association and the presidents of all the Medical Association branches in all the US states where Tenet/NME operated giving my referee and asking them to pressure Tenet/NME to address my complaint to their ethics committee. I also wrote to all of the doctors in Tenet/NME hospitals asking them to press the company to address my complaint through their hospital committees. The US department of justice was responsible for overseeing Tenet/NME's compliance program. I wrote to them asking whether Tenet/NME's failure to address legitimate complaints to their ethics committee was a breach of their obligations under the settlement agreement.
I also set up this web site which described the conduct of Tenet/NME in the USA and Australia. It included a modified version of my paper and the text of my final complaint to the ethics committee. I asked visitors to my web site to e-mail Tenet/NME or write to the chairman of Tenet/NME expressing concern and asking them to address my submission.
I have no idea how much impact any of this had but certainly many people who worked for or related to the company were made aware of these events which must have been embarrassing. It would have been difficult for them to discount and discredit me. It was difficult to take a defamation action when I had simply expressed concern and sought support in getting them to investigate matters that clearly raised ethical concerns about the conduct of senior staff. The complaint gave me a lever with which to counter the letter about Yeldham if the case came to court in Singapore.
The case in Singapore now started to move through the early stages. Parkway Holdings now owned the hospital although NME staff were running it for them. I suspected that they had little interest in this case and it was being prosecuted at Tenet/NME's insistence. If it came to court the hospital would get plenty of adverse publicity and Parkway would not benefit. My information was that Parkway had behaved responsibly and I had no reason to suspect them of any of the practices, which had characterised Tenet/NME. I wrote and later phoned the chairman of Parkway. He was obviously in a difficult position, could say little except that he had no control. He indicated that he would see if the hospital would withdraw.
The offer to withdraw when it came made all of the same demands that had been made before and I promptly rejected it. The case then progressed and the hospital gave every indication of prosecuting the action. It reached the stage when disclosure of documents was imminent. I canceled an overseas trip, bought a photocopier and spent 2-3 weeks copying large volumes of correspondence and many documents for my lawyer. I sent these to Singapore.
Towards the end of 1996 the Hon Franca Arena, a member of the NSW parliament used parliamentary privilege to publicly accuse Justice Yeldham of paedophilia and the NSW authorities of a cover up. Justice Yeldham immediately committed suicide. His sad double sex life in the toilets of Sydney's train stations, the protection given him by the police, the knowledge of his conduct by a significant number of people, and his vulnerability to improper influence were splashed across our newspapers. The pieces of the jig saw behind the 1993 decision fell into place. Yeldham's initial draft decision and conditions in 1993 actually had some teeth and seemed a genuine if rather limited attempt to control NME's influence. AME's lawyers when they received a copy dictated changes that rendered these ineffective and protected those involved in the Ng case. Yeldham had meekly included these changes in his final conditions.
I now lodged a complaint about Yeldham's 1993 decision with the Independent Commission against Corruption. This questioned his appointment by people likely to know of his behaviour, and whether he had been influenced. Further information about this is available on this www site. I also wrote again to Tenet/NME's ethics committee asking them to investigate to see if any of their staff had attempted to influence Yeldham.
The case in Singapore was now quickly settled. The hospital withdrew all of its requirements that I make retractions and give undertakings. I happily agreed to make it clear that the hospital was now under new ownership, and that the new owners were not involved in any unsatisfactory practices. My expenses were paid.
NME and Tenet provide a wonderful insight into the way these corporations operate and how they think. There are so many documents available. This company had never accepted that it had done anything wrong. Like others it thought its business practices were appropriate and that it had been victimised. There was a deeply embedded market culture to support this denial. I had asserted repeatedly that it was likely to offend again. The same people still ran the company. The same patterns of thought were evident.
In October 2002 a second massive scandal broke around the company and investigations are still ongoing. This was so flagrant and so bizarre that the press described what happened and what everyone said in great detail. Once again there is a great deal to be learned and pages describing this have now been included on this web site.
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This page written Aug 2003 by
Michael
Wynne
