Questions Raised Over Skin Clinics

Newcastle Herald

Monday July 25, 2005

GREG RAY SPECIAL REPORT

THE SURGEONSOME doctors at Hunter skin cancer clinics may be doing more harm than good, according to a senior Newcastle specialist.

Plastic surgeon Dr Chris Howe, a former director of the Hunter Melanoma Unit, asserts that some of the staff of clinics in the Hunter are not well enough trained to recognise potentially fatal cancers. He also says some of the GPs at the clinics are attempting procedures well above their levels of ability, often without access to adequate patient histories.

Dr Howe has made a list of 50 patients whom he alleges received substandard or dangerously inappropriate care at the clinics.

The list, which he plans to submit to the NSW Health Department, includes:

? A man with an "obvious melanoma" which was wrongly identified by a clinic doctor as a harmless seborrheic keratosis (a benign, warty lesion). The patient delayed treatment and died.

"A properly trained person would have known these keratoses seldom occur singly," Dr Howe said.

? A man with myeloid leukaemia who was given a major skin graft by a skin cancer clinic doctor who was unaware of the man's underlying condition.

"This man had no immune system to speak of and the attempted skin graft was a significant contributing factor in his death," Dr Howe said.

? A woman who was left with a "huge hole" in her abdomen following an attempted "full thickness skin graft".

"The GP didn't appear to know enough about grafting to realise that a full-thickness graft would not be successful. The flesh died and the patient faced a very big and expensive repair job in a public hospital," Dr Howe said.

? A man on blood-thinning medication who was subjected to surgery at a skin cancer clinic. "Nobody seems to have taken a history from the patient. People on blood-thinning medication have to be dealt with very carefully," Dr Howe said.

Dr Howe said the man survived, but his recovery had involved many weeks of expensive, specialised care.

Dr Howe said he had long been concerned about the clinics, but had been reluctant to make his fears public because he could be accused of attempting to undermine commercial competitors.

But he said so many serious cases of poor or inappropriate treatment had now emerged that he had no choice but to blow the whistle. He had contacted the Health Insurance Commission and was writing a detailed report for other medical authorities, he said.

"Despite not accepting direct referrals from these clinics, I have found myself having to clean up a large number of their problems and I think some kind of investigation is needed to protect the public," Dr Howe said.

Before the advent of the clinics, he said, people with skin cancer used to see their family doctor, who could remove minor cancers, order pathology if needed and refer more difficult or uncertain cases to specialists.

Nowadays, heavy advertising by skin cancer clinics had resulted in many patients bypassing their own doctors and going directly to the clinics.

"The trouble is, the clinics have no access to a patient's records. They don't know what past conditions they've had or what medications they might be on. Unless they take a very careful history they can easily find themselves recommending what might be a poor course of action," he said.

"The second danger seems to be that some of these clinic doctors are attempting quite advanced surgery, such as skin grafting and flaps, that might be beyond their ability or for which their clinics are not properly staffed or equipped. I've got a large amount of troubling evidence that suggests there are some very inappropriate risks being taken at times.

"I haven't been into all the clinics in the Hunter and it might be that some of them are quite well run. Equally, it's clear to me that in some clinics the facilities are not up to standard for what they are trying to do. Some are pushing through 30 or so patients a day and attempting some fairly serious surgery with little or no nursing back-up.

"Obviously it's a very big money-spinner. I'd suggest some clinics might be making $30,000 or $40,000 a week by billing Medicare for consultations and procedures.

"I'm not attacking their right to make money, but I think it's only responsible to ask a few questions."

© 2005 Newcastle Herald

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