INSIDE ISSUE: President`s Column

Transcription

MARCH 2014 | Issue 37
The newsletter of the New Zealand Society of Anaesthetists
INSIDE ISSUE:
President’s Column
Inaugural PSM largest ever meeting
of anaesthetists in the Pacific
Quality learning and networking at 2014
Combined AACA ASURA Conference
Dr Stephen Shafer talks
to Kim Hill on National Radio
Lifebox takes equipment
and training to Vietnam
The New Zealand Anaesthesia’s newsletter design includes the NZSA’s
logo (safety through knowledge) and the symbol on our constitution.
The Kotuku, a white Heron, represents the physical person, its shadow
represents the spirit. Te Kotuku can be translated as ‘safe’ and Rerenga
Tahi as ‘journey’. The flight and return home of the Kotuku, is likened
to a patient’s experience under anaesthesia.
Can you remember how
good it felt when you
got your first consultant
anaesthetist appointment
in New Zealand? The
sense of relief in my case
lasted for several years.
Unfortunately that relief may
have to be postponed for many of our younger
members and I want to explain why and ask for
your views on how the NZSA can help.
The big issue is that events in Australia have
culminated in a workforce problem and this
will impact heavily on New Zealand. The
NZSA attends all Australian Society of
Anaesthetists (ASA) Board meetings, and
the ASA has a stronger ASMS-type role in
industrial advocacy for their members than
the NZSA. Through our strong links with the
ASA we get to see and hear about issues in
Australia that are not well publicised.
The following is just one example which
illustrates that too many anaesthetists are
being trained in Australia and New Zealand
for the positions available. According to
Richard Grutzner, ASA President, there is
a young FANZCA in Melbourne working as
a barista - not a barrister - as a cafe barista.
Presumably she doesn’t want to leave
Melbourne and right now there are virtually no
consultant jobs available in public or private so
she makes coffee in a cafe. Apparently there
are over 100 young unemployed or underemployed anaesthetists in similar situations in
Sydney; Adelaide has been full for years, and
in Brisbane, Gold Coast, and Perth jobs have
recently started to dry up. The big red centre
is getting full as well and I have seen utterly
dreadful contracts being offered at short
notice to anaesthetists in the smaller rural
centres of New South Wales and Victoria.
In Queensland especially it’s no secret that
the senior staff across all specialties are
close to calling for industrial action due to
deteriorating terrible contracts.
The “Lucky Country” is now not so lucky
for younger Australian ANZCA’s. So
what has changed? Well it’s a perfect
storm of Global Financial Crisis (GFC),
very tight Federal and State budgets (with
no new public hospitals opening and no
new appointments), no expansion in the
private and defense medical sectors,
and most significantly an oversupply of
anaesthetists. Back in the 80’s in Australia,
around 60 consultant anaesthetists would stop
working every year and this made room for 7090 new FANZCA’ s. Supply matched demand
but with a bit left over to cover economic
growth. What has changed is that each
year more than 300 newly minted Australian
FANZCA’s are on the job market but there
are still only 60-80 retiring. This mismatch has
worsened as more older FANZCA’s can stay
on working nowadays without compulsory
retirement at 65. There are many working on
past the age of 75 in Australia.
So why has this oversupply occurred? The
Australian Competition and Consumer
Commission (ACCC) is part of the answer.
The NZ Commerce Commission, which many
private anaesthetists will be familiar with, has
a much stronger Australian equivalent - the
ACCC. The ACCC decided it was “anticompetitive behavior” for ANZCA to restrict
the number of trainees that a hospital could
train and instead encouraged ANZCA to
simply accredit or not accredit a training
hospital. The surgeons took a different
approach and the Royal Australasian College
of Surgeons (RACS) took ACCC to court
and won the right to manage trainee numbers
- at a legal cost thought to be in the 7 figures.
Even though the tenure of the agreement to
control surgical numbers has run out, RACS
continues to be able to limit training positions,
but ANZCA does not.
Australian and New Zealand theatre
managers have chosen not to pay overtime
to a few but instead to employ a much larger
number of registrars on 40-hour weeks in
order to cheaply cover theatre needs. The
result is a huge increase in training registrar
numbers, and with a 6% attrition rate over the
FANZCA training, Australia now has over 300
new FANZCA’s each and every year.
President’s Column Continued…
I am sure the older among you will have had
the joyful experience of attending Australian
anaesthesia conferences and meeting great
flocks of migrating New Zealand anaesthetists
that we trained who come up to chat. One
makes the often rueful comparisons of their
contracts with our own - often the Australian
contract used to include a house, car,
more money, education costs for children
etc. The reason for the happy meeting-up is
that ANZCA in New Zealand trains about 250
registrars over a five-year training programme
graduating 30-50 FANZCA’s annually. The
majority of these graduates for many years have
gone to permanent consultant jobs in Australia,
particularly to Queensland, because New
Zealand has few jobs available for the finishing
New Zealand FANZCA trainees.
So what’s the problem you may ask? Well
the tap is going to be turned off sometime in
the near future. Here’s how it happens. Proud
dad time - my daughter finished her Auckland
MBChB last year - and for a while it looked
like she had no job to go to because the
Australian medical schools quadrupled numbers
a few years back for political gain to “solve”
the Australian doctor shortage. However, no
further provision was made for ongoing training
by making extra House Officer or Registrar
positions.
Many New Zealand medical students relocate
to Australian medical schools because the
courses are shorter, entry fees lower, and
possibly they are easier for fee paying students
to enter. But when faced with a lack of jobs
for graduating Australian citizens the Federal
government instructed all hospitals to employ
Australian citizens preferentially. So in my
daughter’s year 100+ New Zealand MBChB’s
came back home to get a job so that they could
complete medical training and register here.
Fortunately jobs were found for all New Zealand
citizens but - as in Australia - about 10% of her
class who were fee paying overseas students
had no job and no medical registration and a
hard road ahead to repay debt as a result. This is highly relevant for New Zealand
anaesthesia because I think the tap for New
Zealand anaesthetists migrating to Australia will
also be turned off by the Federal Government in
Australia in the near future. The ability of Foreign
Medical Graduates (FMG’s) to register in
Australia can be made to include New Zealand
graduates by the Australian Federal or State
Governments via their regulatory authorities.
The ASA is likely to act on behalf of its members
to lobby to limit “imported” FMG anaesthetists
as will other specialist groups. I can’t say when
this new change will occur just that pressure for
change is building across the Tasman. Page 2 | March 2014
Unfortunately after 10 years ANZCA cannot
now easily challenge ACCC and reverse the
decision on hospital training accreditation
versus Registrar numbers and New Zealand
NC-ANZCA has to be consistent with policy
across Australasia. So in both countries
hospitals will continue to be registered
for training and managers and industrial
circumstances (e.g. NZRDA), will mean the
numbers of registrar training positions cannot
be regulated downwards or managed easily
by ANZCA. At the NZSA AACA conference in Auckland
a few weeks ago Des Gorman of Health
Workforce New Zealand told us at the
Workforce Session that New Zealand now
has the most stable consultant workforce
in the world with less than 2% annual
turnover. Clearly consultants in New Zealand
have stopped going to Australia and you can
see why. Now imagine a situation where over
several years the 50 FANZCA’s annually
graduated in New Zealand could not get a job
in Australia and many were unable to move
their career forward. If there were no new jobs
in New Zealand for New Zealand FANZCA’s,
what might happen? What can we as a
profession do to mitigate a bad outcome for
our younger colleagues?
The answer is not easy as we have a uniquely
New Zealand problem, generated by events in
Australia, and we will have to tailor a uniquely
New Zealand solution and not look to Australia
for a solution. As a first step I am planning to
approach the funder of New Zealand registrar
training positions Des Gorman and Health
Workforce New Zealand to request that in
view of the developing situation that the funder
of registrar positions proactively look at helping
us try to improve the situation. I understand
NC-ANZCA is supportive of looking at
alternatives alongside NZSA.
There are many complex issues to work
through. Issues include the potential
unfairness of registrars working together,
some in training while others are in nontraining posts.
One alternative might be to increase Fellow
jobs so that post-fellowship registrars can
get further experience in particular clinical
areas. This solution is being looked at
particularly in Australia where the VMO
system may limit the number of cases seen
by registrars at times and extra Fellowship
experience can add value to their FANZCA.
At Auckland’s North Shore Hospital we are
keen to look at this as a possible way to
maintain after hours registrar cover without
increasing training positions, or adding
more onerous cover duties for existing
consultants, or diluting after hours consultant
call rosters. I think a knee-jerk response
to just add more consultant positions is not
necessarily the best answer. We will need
innovative thinking and support from New
Zealand’s anaesthesia community to help us
come up with solutions for our current and
future colleagues all rise to the occasion!
2014 Combined AACA ASURA and
inaugural PSM
The NZSA sponsored the very successful
14th Asian Australasian Congress of
Anaesthesiologists, the 4th Australasian
Symposium on Ultrasound and Regional
Anaesthesia and the first Pacific Super
Meeting last month. These events featured
outstanding speakers from around the world,
informative lectures and workshops and
excellent social events.
My sincere congratulations to all the
organisers and in particular I acknowledge
convenors Martin Misur and Neil
MacLennan. In this newsletter you’ll find
reports and photos of these fantastic events.
Your feedback
In the last newsletter we reported to you on
our strategic review and our vision and mission
for the future. The executive is continuing work
in this area but wants to hear from you, our
members, as your views will inform this work.
We want to know if we are on track with what
you expect NZSA to be doing. We will be
coming to members soon with a survey giving
you the opportunity to comment to us on what
you expect of the Society and its direction. So
look out for this survey and we look forward to
your feedback.
Ted Hughes
March 2014
NZSA Representing, Supporting and Promoting NZ Anaesthetists since 1948
March 2014 | Page 3
First Pacific Super Meeting a success
The largest ever meeting of Pacific anaesthetists was held recently in Auckland. The “Pacific Super Meeting”
(PSM) was a great success, with 30 island delegates learning new skills and discussing a range of clinical and
organisational issues.
The meeting was held as a satellite
meeting before the Combined
Asian Australasian Congress of
Anaesthesiologists-ASURA. PSM
delegates stayed on to attend the
Combined AACA-ASURA, taking
the opportunity to attend lectures
and workshops, and network with
anaesthetists from Australia and New
Zealand and from the rest of the world.
The PSM brought together the three
anaesthetic societies in the Pacific region
– the Pacific Society of Anaesthetists
(PSA) which covers the south-western
Pacific, the Micronesia Anaesthetic
Society which covers the North Pacific
and the Society of Anaesthesiologist
of Papua New Guinea, which covers
Papua New Guinea. Between them, the
societies represent anaesthetists in 13
independent Pacific nations.
The PSA usually holds annual meetings,
as does the Papua New Guinea society.
The Micronesia society usually holds
meetings every two years. It has been
difficult to get members of the three
societies together because of the large
distances involved so this was the first
combined meeting of all three societies.
One of the main problems Pacific
anaesthetists struggle with is
professional isolation and problems with
communication. Organiser Dr Wayne
Morriss says while there wasn’t a formal
meeting theme, “Working Together” was
what the meeting was about.
Delegates attended from Fiji, Tonga,
Samoa, Cook Islands, Vanuatu, Solomon
Islands, Kiribati, Federated States of
Micronesia, Marshall Islands, Palau,
Papua New Guinea, and from Timor
Leste at the edge of the Pacific.
The meeting included short interactive
lectures, hands-on workshops, a
seminar on disaster management, a
business meeting of the three Pacific
societies, and sessions devoted to
presentations of exceptional cases that
delegates have encountered themselves
during their practice.
The case presentations were particularly
memorable. Dr Dennis Agapito from
Yap, Micronesia described having to do
a post-mortem examination after one of
his patients died of a very rare infectious
disease, to get a diagnosis. Dr Pauline
Wake from Papua New Guinea described
a thoracotomy to remove a wooden spear
that had been embedded in a man’s
chest for a number of years.
Pacific delegates were given the
opportunity to attend an ASURA basic
ultrasound workshop on the first day of
the AACA meeting which was supported
by the Hugh Spencer Fund. They all
thoroughly enjoyed the opportunity to
have hands on experience performing
ultrasound examinations of nerve block
areas and manipulating needles under
ultrasound guidance.
As well as representatives from twelve
Pacific countries, there were delegates
from Australia, New Zealand and other
countries – people who have lived and
worked in the Pacific in the past.
At the same time, a number of
anaesthetists from Australia and New
Zealand went to Pacific Island countries
to provide cover and allow the local
anaesthetist to attend the PSM.
Our thanks to Debbie Sorenson, CEO
of the Pasifika Medical Association
who organised the dinner evening
There were two social highlights during
the PSM and Combined AACA and
ASURA. On the Thursday night, the
Pasifika Medical Association hosted a
very colourful dinner at the Rendezvous
Hotel, complete with a Pacfic band,
dancing and kava drinking. Particular
thanks go to Debbie Sorenson who
organised this function. On the Sunday
night, PSM delegates joined all the
AACA-ASURA delegates for the Gala
Dinner at the Viaduct Events Centre. The
Pacific delegates showed us all how to
dance – they were the first on the dance
floor and the last to leave!
Jack Puti receives the Gary Phillip award for the
outstanding MMED II candidate for 2012 from Michael
Cooper of ANZCA and Harry Aigeeleng of SAPNG
Organisers of the Pacific Super Meeting: Drs Wayne Morriss,
Maurice Lee, Ted Hughes (NZSA President), Alan Goodey and
Tony Diprose who are also members of the NZSA Overseas
Aid Subcommittee
Peter Kempthorne and Angela Enright,
Past President of WFSA
Page 4 | March 2014
Pacific Super Meeting
Harry Aigeeleng,
SAPNG President
“I would like to sincerely
thank the NZSA, ASA and
ANZCA for sponsoring
the first ever Pacific
Super Meeting. We believe
that this meeting has
achieved its objectives
and it was a worthwhile
experience meeting other
fellow Pacific Island
anaesthetists and other
anaesthetists in the
Australasian region. We
were particularly humbled
by the presence of very
senior colleagues.”
Delegates at the Pacific Super Meeting
SAPNG President, Harry Aigeeleng left,
with delegates at the Pacific dinner
Chris Bowden from Australia
and Sereima Bale of the PSA
Mara Vukivukisera
AARS Chair Rob McDougall with Pacific Meeting delegates
Dina Tuitama, Vika Fatafehi Lemoto and Selesia Fifita
Kenton Biribo President of PSA
and Muralidhar Joshi of the ISA
“Was an outstanding success
and testament to the hard
work of organisers. Course
content was highly relevant
and educational and
stimulated a lot of healthy
discussion. We realized how
similar our challenges are
across the Pacific.”
Kenton Biribo,
Pacific Society of Anaesthetists
Suesue Cargill, Renu Borst of NZSA
and Margaret Blakeley
“I commend the
organisers for conceiving
the idea and for
their tremendous
support for having the
first meeting combining
all three associations,
and for it to continue
through into the future.
The highlight was the
joint business meeting
held by the three societies.”
Mara Vukivukiseru,
Vice President of the Pacific
Society of Anaesthetists
March 2014 | Page 5
Pacific Super Meeting
L’amour Hansell of the Pacific
Society of Anaesthetists
PBLD Training
PBLD Training
“Thank you for a successful
meeting. Despite our
different backgrounds,
I felt we encounter similar
constraints, challenges and
find it easy to understand
and relate to the many
experiences shared.”
L’amour Hansell
Delegates listen to another
interesting presentation
Pacific delegates
Ted Hughes, Margaret Blakeley and Maurice Lee
Angelica and Dennis Agapito
Pacific delegates enjoying dinner at Ted Hughes’ house
“I commend the organizers
for this wonderful idea
of bringing together the
anaesthesiologists from the
region together in one place
to share their experiences
and obstacles in the practice
of our profession. Indeed the
problems we are facing are
very similar and we learned
a lot by hearing from others
how they skillfully dealt
with these difficulties.”
Dennis Agapito,
Micronesia Anaesthesia Society
Attendees at a social function
of the Pacific Super Meeting
Page 6 | March 2014
The buffet meal
AACA ASURA brings top faculty to New Zealand
The combined 2014 AACA and ASURA held in February provided a wide range of high
standard speakers, lectures and workshops for the large number of visiting anaesthetists from
the Asia Pacific region, sponsored by the NZSA.
The 14th Asian Australasian congress
of Anaesthesiologists (AACA) and
the 4th Australasian Symposium of
Ultrasound and Regional Anaesthesia
(ASURA) were held over four days from
February 22-25 at Auckland’s Sky City
Convention Centre.
to relax, meet old friends and colleagues
and form new relationships. A highlight
of the conference was the opening
ceremony which included a traditional
Maori powhiri and official welcome by
the congress convenor and gala dinner
on the Sunday evening.
Delegates from over 20 member
societies of the Asia Pacific region
attended, and it also involved a large
number of Pacific Island delegates
who came early to attend the satellite
inaugural satellite Pacific Super Meeting.
We have received much positive
feedback from both the AACA and
ASURA meetings and we include some
of these in the next few pages of the
magazine, along with photos from the
various events.
This conference was the largest ever
hosted in New Zealand and convenors
acknowledged the great distances both
delegates and speakers and facilitators
travelled to take part.
We congratulate the AACA ASURA
organisers, and in particular coconvenors Neil MacLennan and Martin
Misur and their organising committee:
AACA Scientific Programme Chair,
Simon Mitchell, AACA Scientific
Programme Assistant, Jacqueline
Hannam, ASURA Scientific Programme
Chair, Darcy Price, ASURA Scientific
Programme Committee, Andrew
Cameron, ASURA Handbook Editor,
Craig Birch, Treasurer, Peter Cooke,
AACA PBLD and Workshop Chair, Tim
The main goal of the conference was
to provide opportunities for delegates
to further their education. The full
programme of speakers from specialist
areas, and the wide range of sessions
and workshops on the programme,
combined with the theme of “Discovery,
Understanding and Wisdom” meant the
conference more than achieved its goal.
The challenge
Accepting
the challenge
The Conference Company at the conference
registration and information desk
We are also thankful to our
professional conference organisers
The Conference Company who coordinated the many events occurring
simultaneously, and for the smooth
running of the registration and
information desk to support delegates.
Organisers also thanked the industry
sponsors for their support of the
event. “Hosting international medical
conferences is a challenge financially.
With our large international faculty we
required significant industry support and
fortunately, this has been generous.”
The Platinum sponsors were Baxter,
Edwards and GE and the Gold sponsors
were Merck, Mindray and Siemens.
Convenors noted that the conference
hosted the most impressive line-up of local
and international faculty ever seen in New
Zealand. The internationally recognised
keynote speakers included Professors
Vincent Chan, Lee Fleisher, Admir Hadzic,
Paul Myles, Mark Newman, Warwick Ngan
Kee, Steven Shafer and Ban Tsui.
The social programme attached to the
meetings gave delegates an opportunity
Hall, ASURA PBLD and Workshop
Chair, Chris Nixon, Workshop
Facilitator, Murray Ross, Social Chair,
Karen Smith, NZSA President, Ted
Hughes, NZSA Executive Officer, Renu
Borst and Graphic Designer Murray
Dewhurst from Worksight.
Ted Hughes thanks the organising committee
for the 2014 Combined AACA ASURA
Traditional maori hongi with
WFSA President David Wilkinson
The welcome
March 2014 | Page 7
Combined AACA ASURA Conference
NZSA President Ted Hughes
drums at the Opening Ceremony
Delegates from the Malaysian
Society of Anaesthesiologists
Julian Gore-Booth of WFSA,
Lynaire Kibblewhite and Claire Carpenter
The stand of Platinum
sponsor Edwards
“I was hugely impressed
by the AACA ASURA
meeting. You were
magnificent hosts, I met
some amazing people,
learned a lot and had a
fabulous time.”
Julian Gore-Booth,
CEO, WFSA
Keynote speaker
Paul Myles & Girish Joshi
Japanese delegates
Rob McDougall AARS Chair
at the opening ceremony
Phillippine Society
of Anaesthesiologists
Keynote speaker Warwick Ngan
Kee talks to a delegate
“I think the people who
attended really thought
it was a top quality
meeting and there was
much enthusiasm for the
AARS activities.
The AARS scholars have
been extremely positive
in their praise of the
scientific program, the
social functions and
the general “feel” of the
meeting.”
Rob McDougall,
AARS Chair
Subhashini Premarathe of Sri Lanka, Pavel Janda of
Australia and Dushyanthi Jayasekera of Sri Lanka
Page 8 | March 2014
Keynote speakers Lee Fleisher
and Mark Newman
Keynote speaker Vincent Chan
Neil MacLennan
Co convenor of AACA ASURA
Keynote speaker Amir Hadzic discusses
some equipment at an exhibit
Delegates from the Korean Society
of Anaesthesiologists
David Wilkinson
“(AACA ASURA) was a very
special meeting from my
perspective. I was very grateful
to attend the second day of
the Pacific Meeting and again
everyone was so enthusiastic
and excited about everything
that it was especially uplifting.
The social events were very well
orchestrated and I even enjoyed
the opening ceremony with the
interaction with some very
scary people! ”
David Wilkinson,
President, World Federation of
Societies of Anaesthesiologists
Key speaker Stephen Shafer
Vice Chair of AARS Chan Yew Weng
from Singapore with his daughter
AACA ASURA Gala Night
Song and dance was part of the Gala Night entertainment
Asian delegates at the Gala event
Wayne Morriss and Renu Borst
March 2014 | Page 9
AACA ASURA Gala Night
The cultural performances were enjoyed by all
Congratulations to Korea for winning the
bid to host the 2022 AACA ASURA conference
The Korean stand
NZSA President’s Cocktail Function
Rob McDougall and Ted Hughes
hand over the flag to Jin Liu of
China which is hosting the
2018 AACA Conference.
The NZSA President and Executive Committee hosted Presidents and partners of member
countries, keynote speakers and the organising committee of the AACA ASURA conference in
the spectacular Blue Water Black Magic Gallery of the Auckland Voyager Maritime Museum.
David Wilkinson of WFSA speaks
at the cocktail function
Delegates enjoy a laugh
at the cocktail function
Page 10 | March 2014
The Minister for Pacific
Island Affairs Hon. Peseta Sam
Lotu-Iiga opens the President’s
cocktail function
Neil MacLennan, Ted Hughes, Hon.
Peseta Sam Lotu-Iiga and Debbie Sorenson
Immediate Past President
Rob Carpenter of NZSA speaking at the
cocktail function
Learning at AACA ASURA
ASURA workshop
ASURA workshop
Jennifer Hays, Greg Luck and Bini Macklow
of Platinum sponsor GE Healthcare
Airways workshop
“Thanks for your hospitality
at the AACA ASURA
meeting. It was a great
meeting and I enjoyed the
opportunity to again be
in New Zealand and also
to catch up with so many
colleagues from around the
region. I thought the scientific
program was excellent.”
Lindy Roberts,
ANZCA President
Exhibition by Bronze sponsor Covidien
Exhibition by Platinum sponsor Baxter
Trainee Corner
AACA & ASURA
As already reported, the AACA &
ASURA conference was a highlight
on the NZSA event calendar this
last month. I headed along for the
four days and it was great to see a
sizeable number of trainees also taking
the opportunity to hear from world
experts right here in Auckland. The
Resident Medical Officer MECA allows
registrars to receive reimbursement
for conference expenses one year
after completing their college Primary
Exam. Those in an earlier stage in
their training should not necessarily
disregard conferences. The scientific
sessions are not just for the experts
and registration fees for trainees are
often at a reduced rate so not always
prohibitive. A pleasant surprise for
me too was just how approachable
the invited speakers were and their
willingness to talk with a registrar.
My particular goal at the conference
was to develop my regional anaesthesia
and ultrasound skills. With my limited
experience in anaesthetics I am some
way off producing the kind of images
my consultants seem to effortlessly
generate with the ultrasound. Whilst
a universal standard of training and
assessment of regional techniques
does not yet exist (a session of the
conference was dedicated to this
subject) I was very pleased to see
that the training I have received so far
across three different New Zealand
hospitals reflects best practise as
recommended by experts at the
conference. That is completing a block
“time out”, thorough documentation
noting adequacy of US image, needle
used, drug volumes, amounts used
and any paraesthesia or complications
encountered.
WORKFORCE
A concerning theme we’ve been
hearing over the last 18 months is the
lack of consultant positions for those
coming to the end of their training in
Sydney and Melbourne. Dr Des Gorman
reminded us at the AACA conference
that New Zealand too is heading for
an oversupply of medical professionals
exacerbated by a low turnover of
senior staff and reduced migration to
Australia. We are left with the very real
prospect that there will not be enough
vacancies to match the number of new
ANZCA Fellows in coming years.
The NZSA has only a limited number of
trainee members. The likelihood is that
‘you’, the person reading this, are not
a trainee but a consultant anaesthetist
with an established public and private
practice. Trainees are very well looked
after by ANZCA in terms of educational
and professional development but as
a trainee it can often be difficult to see
past the immediate demands of exams
and navigating the TPS to such issues
as workforce.
I would like to see more trainees
involved with NZSA as I feel we are
the ones that will be most adversely
affected by current workforce patterns.
As someone reading the NZSA
magazine it would be great if you
could talk to your trainees about NZSA
ensure they recognise our role on the
medico-political stage. Membership
for trainees is currently free so please
encourage them to join!
Kate Romeril
ATY1 Northern Training
Scheme
Whangarei
March 2014 | Page 11
Dr Stephen Shafer talks to Kim Hill
~ Radio New Zealand National, Saturday 22 February 2014
Kim Hill: As editor in chief of
a journal called “Anaesthesia
and Analgesia”, possibly
known as ANA, Dr Stephen
Shafer has found himself
leading the charge against
several outrageously dodgy
anaesthesiologists. In fact, his journal holds the
dubious record for the most retractions of any
medical journal articles and studies withdrawn
because they have been found to be faulty.
Dr Shafer is based at Stanford University’s
medical centre and misconduct is what he has
been talking about at the Society of Anaesthetics
Conference in Auckland … Anaesthetists
Conference. How are you?
Dr Shafer: I’m doing well, how you are?
Kim Hill: I’m very well, thank you. I was very
taken by the experience cited at your conference
of the unfortunate woman who was not made
unconscious by the anaesthetic due to the failure
of a drug infusion pump.
Dr Shafer: That’s terrifying.
Kim Hill: The pump was supposed to inject
Propofol into her blood stream but failed to do
the job and so she was wide awake when they
went in, which is everybody’s nightmare. How
often do you think that happens?
Dr Shafer: We have data about how often that
happens and it happens somewhere in the area
of about one in 10,000 anaesthetics. I’ve even
had the experience myself of waking up in the
middle of anaesthesia.
Kim Hill: What were they doing to you when you
woke up?
Dr Shafer: I was a foolish 17 year old kid having
a molar extracted and I remember the experience
of waking up in the middle of the procedure
and feeling them grinding on my jaw and being
astounded that I didn’t feel any pain. I could feel
the grinding but I thought, this is … a dumb 17
year old I thought, this is really cool! And then I
probably moved and they gave me some more
drug and I went back to sleep. But that was the
experience of having awareness but not having
pain. It’s awareness with pain, of course, that
everybody is particularly afraid of.
Kim Hill: That’s what this woman experienced –
it was keyhole surgery to remove a gall bladder
and she was fully conscious.
Dr Shafer: Yes, it’s a terrible outcome. We do
have ways of preventing that both by monitoring
the drugs that are going in and also by monitoring
the brain during anaesthesia.
Kim Hill: Apparently, she wrote a letter
describing her experience, she said. “The first
umbilical incision felt like a huge incision across
my abdomen, the pressure of the probes pushing
around inside my upper abdomen …” She wrote
a letter to an Australian anaesthesia journal and
now that letter is credited with, and I’m quoting
from the New Zealand Herald story here,
credited with triggering an important change
in hospitals – the widespread use of brain
monitoring machines.
Dr Shafer: I think that’s the right response.
Kim Hill: This is specifically Propofol and you’ve
had quite a lot to do with Propofol because you
gave evidence at the trial of Michael Jackson’s
personal Doctor Conrad Murray about that very
thing, did you not.
Dr Shafer: That’s correct, yes.
Kim Hill: Propofol is, it seems, a very dangerous
drug used in the wrong hands.
Dr Shafer: Absolutely. Any of the drugs that
we use to induce unconsciousness have to be
used respecting the fact that when you render a
person unconscious, you render them essentially
unable to defend themselves. So you have to be
there to keep the person alive and be sure that
they’re breathing, they’re getting oxygen and their
blood pressure’s adequate. You have to be there
to do all these things and if you’re not ready to do
that, then you shouldn’t be giving these drugs.
Kim Hill: The main reason why you testified for
the prosecution in the case of Conrad Murray was
because he crucially left the room.
Dr Shafer: I think the main reason I testified was
because I didn’t charge them anything to do it.
Kim Hill: Your colleague, Dr Paul White,
testified for the defence and he charged like
a wounded bull.
Dr Shafer: Yes, he did but I don’t like charging
and making money on the misfortune of others.
But back to your question, the reason that
I felt the case was pretty clear was that he
walked out of the room for 45 minutes while
Michael Jackson was getting Propofol and
certainly no anaesthesiologist would be surprised
that he would then walk back in and discover that
Michael Jackson was dead.
Kim Hill: You don’t think that Michael Jackson
could possibly have given Propofol to himself.
Dr Shafer: He could have but this gets back to
some of the data in the trial. The largest syringe
that was present in the room would have 10cc. If
he self-injected 10cc, that could do it. But you’d
have to wake up and you’d have to be pretty with
the programme to draw it up and inject it. That
seems extremely unlikely and the thing is that
the blood levels were quite high and what we
know about Propofol, I don’t know how technical
you want me to get here, but I will say what we
know about Propofol, it goes away really quickly
because the liver essentially chews up every
molecule that goes through it.
So, if you stay alive even 10 minutes, when
you do stay alive you stop breathing and at
least 10 minutes your liver just chews all the
drug up and the levels are really, really, really
low. Michael Jackson’s levels were really high
suggesting he died during the drug administration
and that’s why the theory that he self‑injected
actually isn’t consistent at all with the evidence.
Kim Hill: How hard was it to explain what was
very technical evidence to the jury for you?
Dr Shafer: I have to thank the jury for it and
initially I was quite anxious and I was talking too
rapidly. The judge told me to slow down, the
stenographer told me to slow down – everybody
said, “Slow down.” Eventually I looked over and
I saw 12 students and I said, “I know how to do
this, I can explain something to students, this is
what I do.” Once I made that mental transition
and just said, “Here’s the students,” I talked
like I would in a classroom which means you
make eye contact with each person, you go from
person to person. If they’re not understanding it,
you slow down. If they nod that they’re getting
it you say, “Okay, this is right pace.” It was
really the jury that guided me in the testimony.
I can’t communicate directly with them but in
their body language, in their expressions and
their note taking let me know if I was getting it
at the right level.
Kim Hill: The interesting thing, and I mentioned
Dr White before – Paul White, a colleague
of yours who was a witness for the defence
– he’s highly regarded in the specialty, he
said he did not think that it was at all obvious
that Conrad Murray was infusing Propofol
into Michael Jackson and said that there
are indications that Propofol is effective in
normalising disturbed sleep and that 25mg of it
had very little effect and so on. He was adamant
that he was right, you’re adamant that you were
right, okay, so, he’s getting paid. Putting that
aside for a moment, there you both are arguing
about what is presumably a scientific fact. How
does that come about?
Dr Shafer: I was very disappointed in Paul’s
testimony.
Kim Hill: He was pretty disappointed in yours.
Did he call you a scumbag?
Dr Shafer: Yes, he did in fact. If you want I’ll
even tell you a funny story about that. I made a
little name tag for myself because I was basically
in the DA’s office after he did that where it just
said “Scumbag”. People thought it was funny
and it was put on as a little joke. Anyway, I
walked out of the building and was followed by
CNN reporters and I was having no interaction
with them. They said, “Dr Shafer, Dr Shafer,”
I said, “No, I can’t talk to you.” Then after they
left I looked down and I’m still wearing the name
tag! Fortunately, none of them picked it up or it
would’ve been on the nightly news, Dr Shafer
walking out with his “Scumbag” name tag.
Kim Hill: Why the difference between your
testimonies, do you think? I don’t think you are
suggesting that Dr White did not mean what he
said, are you?
Dr Shafer: I would rather not weigh in on his
motives.
Kim Hill: Are you still working with him? Is he still
a colleague of yours?
Dr Shafer: No, his testimony caused a level of
estrangement, not just with me but really with
the entire anaesthesia community. There were
multiple calls for our society to investigate him and
look at his testimony and this kind of thing, all of
which he actually blames on me, oddly. I did talk
to him before the trial and I just said, “Paul, you’re
defending Conrad Murray. I mean, have you really
thought this through? Is this really how you want to
be remembered?” He said, “It’ll be fine.”
His assertion was that 2½cc of Propofol caused
a cardiac arrest, that was the only way they could
try to rationalise the blood levels. It doesn’t work
for scientific reasons but I won’t bother you with
that. The point is it’s a ridiculous assertion and
no anaesthesiologist believes that. If you talk to
every anaesthesiologist in the world and say,
“Can 2½cc of Propofol make your heart stop
instantly?” It’s ridiculous, it just can’t happen.
Kim Hill: But Jackson died of acute Propofol
intoxication exacerbated by Benzodiazepine?
Dr Shafer: He died because he stopped
breathing and that’s how anaesthetic drugs
kill you – your heart stops eventually but only
because it runs out of oxygen. These drugs
all depress ventilation, that’s why we are
there and that’s why they look at what the
anaesthesiologist brings with him or her to
the operating room. It’s all kinds of airway
equipment and oxygen and masks and ways
of keeping the air going in and out of the
lungs. That’s really where the rubber hits the
road. That’s really the mechanism of death
from anaesthetic overdose, just like it’s the
mechanism of death from a heroin overdose
or any of these drugs. The heart doesn’t stop
until it runs out of oxygen and it runs out of
oxygen because some period of time earlier
breathing stopped.
Kim Hill: So, why would Jackson have wanted
Propofol? He called it “milk”.
Dr Shafer: I’m sure he craved Propofol.
Kim Hill: To make him unconscious?
Dr Shafer: Propofol makes you unconscious. It
also has euphoric effects. I have had two fairly
recent procedures myself and I can tell you,
waking up from Propofol is very pleasant and,
obviously, I observe this in patients every day. It’s
a nice drug to receive, people wake up, they’re
fairly clear-headed but they’re very relaxed, they
feel calm. These are all positive properties of
Propofol which is why, essentially, it displaced
all of the other intravenous sleep drugs that
we would otherwise use. It’s a delightful drug.
Patients enjoy getting it, they enjoy waking up
from it, they report back to their surgeons that
they had a nice experience with Propofol. Most
patients who get Propofol, when they leave the
hospital say, “This was actually not a bad day at
all.” It brings that kind of experience to it and for
Jackson, who clearly needed chemicals both to
wake up in the morning and then to go to sleep at
night, it was a great choice.
Kim Hill: Jesus, what wasn’t he on?
Kim Hill: They were all prescription drugs as far
as I know.
Dr Shafer: They were all prescription drugs.
Kim Hill: Huge, huge quantity and variety.
Dr Shafer: Right, except for caffeine. I’m sure
he took also an enormous amount of caffeine.
He had a world class sleep disorder, maybe as
disordered a sleep as anybody on the planet, and
he needed world class sleep medicine to help
him through that.
Kim Hill: Do you think that he had that world
class sleep disorder because he was already on
so many meds that they argued with each other?
Dr Shafer: I don’t know the answer to that.
Clearly, once you become dependent on
medication to wake up and to go to sleep, it’s
just really an extension of most people who often
will say, “I can’t get up in the morning without my
cup of coffee.” We all go into routines and we
get dependent on those routines. I’m sure his
routine was essentially a sledgehammer to wake
up and a sledgehammer to go to sleep every
night. Yes, he was in those routines, he became
dependent upon having pharmacological aides
to go to sleep at night. As to the underlying
reasons, it’s combinations of wealth and
celebrity and the very odd and distorted lives
that a lot of people who are very wealthy lead,
people become delusional and they think that
somehow that if they can abuse their bodies,
abuse the drugs, get anything they want and
sometimes go down a very dangerous path.
Kim Hill: He was unlucky enough to find in
Conrad Murray, the man who was gonna give
him what he wanted, and you found in court,
you said, “Seventeen separate and distinct
egregious violations of the standard of care on
the part of Murray.” Your view of that hasn’t
changed with time?
Dr Shafer: Oh, no, not at all. If anything, it’s
actually increased. We pay so much attention in
medicine to informed consent. Patients have to
understand what’s going on, have to agree with
what’s going on. We pay so much attention to
documentation, patients have a right to know
what’s happening to them, families have a
right to know what’s happened to their family
members. And given how much attention, really
every minute of the clinical day is devoted to
things like informed consent and documentation
and respect for the person, respect for their
autonomy and, above all else, do no harm.
Watching how Murray treated Jackson and how
he kept no notes and how he tried to hide what
he was doing from others and, really, I think
Michael Jackson had no clue how Conrad Murray
was placing his life at risk every single night that
he was giving him Propofol.
Kim Hill: I don’t know whether Conrad Murray
has ever said this, but Conrad Murray might say
– and this is beyond the ambit of your expertise,
I’m sure – is that Michael Jackson is gonna get
this stuff from someone and so it may as well be
me and I’m going to try, I might make mistakes
but I’m gonna try and keep him much safer than
he’d be in the back street.
Dr Shafer: I’m sure that’s correct. I’m
sure what you said is in fact exactly part of
the – as sure as I can be given that I’m not
Conrad Murray – that was part of the mind‑set.
But it’s a little bit like saying, “I found this
person with a gun and it was clear they were
gonna shoot themselves so I just went ahead
and shot them.” You’re always responsible
as a doctor for your own behaviour and I’m
sure Conrad Murray was star struck and I’m
sure that Michael Jackson played to his ego
and said, “Dr Murray, you’re the only doctor
that can do this for me,” and I’m sure that
he was manipulated by the star power of
Michael Jackson to give him Propofol. But
he’s responsible for his own actions, you can’t
blame Michael Jackson for the things that he
did as a doctor.
Kim Hill: Incompetence then, I’m reading an
excerpt from an editorial that you yourself wrote
for your journal and it says, “On behalf of the
editorial board of Anaesthesia and Analgesia, I
deeply apologise to those clinicians who were
misled by the fraudulent articles published in
Anaesthesia and Analgesia and to patients
receiving inappropriate treatment as a result.” Did
somebody sue you? Could somebody sue you
for publishing those fraudulent articles?
Dr Shafer: It’s a good question and I’m sure
the answer is, yes. They could say we did
not exercise our diligence. Certainly as all
this misconduct started to arise I checked
with things like corporate liability. There really
is no precedent, at least in the US law and
Anaesthesia and Analgesia is owned by the IARS
– the International Anaesthesia Research Society
– which is a US based non-profit organisation
and there is also Lippincott, Williams and Wilkins
which is also a US company so US laws apply.
There is no precedent in US laws for someone
suing a journal for publishing fraud and the
reason is because we were also misled.
Kim Hill: You may have been misled but, of
course, the conversation then arises about
whether your checks and balances in your
system is in place.
Dr Shafer: Absolutely, and clearly there weren’t.
Clearly the checks and balances were not
in place because we allowed papers to be
published that had we treated them as I treat
papers now, with much greater attention to the
possibility of fraud which when I started in 2006 I
didn’t even think was a possibility. Some famous
cases but always somewhere else, someone
else’s problem.
Kim Hill: I’m not sure to whom you were referring
by that editorial – is that Scott Reuben you were
talking about?
Dr Shafer: I’ve written those words a number
of times.
Kim Hill: The main ones, really, were Joachim
Boldt, there was Yoshitaka Fujii and there was
Scott Reuben, all of whom …
Dr Shafer: They were the three big ones.
Kim Hill: The record breakers, I think,
weren’t they?
Dr Shafer: Yes, those, unfortunately, are people
who were engaged in fraud for decades, clearly
going back to the nineties in all three cases.
Kim Hill: They made up the data.
Dr Shafer: They made up the data.
Kim Hill: Why?
Dr Shafer: That’s beyond my pay grade.
Kim Hill: Scott Reuben, the suggestion is, that
Pfizer was paying him to do these studies and so
he was giving Pfizer what they wanted to hear.
Dr Shafer: I think that’s exactly right. I think in all
of the cases they were giving companies what
they wanted to hear. If I could just comment
on that, what Scott Reuben did is he set up a
non-profit foundation to promote education and to
fund his research. This is actually something that
many investigators did in the nineties and it was
essentially a way of getting around the overhead
that academic departments charge. If you do a
study for a hundred thousand dollars, academic
departments will say, “Gee, half of that’s our
money just because we provide you a secretary
in our office.”
So, he set up a non-profit foundation and he
would do research, the research was funded
by his non-profit foundation, it was not directly
funded by Pfizer or Merck or Wyeth but he said,
“If you like my research, you can support my
foundation.” His foundation, interestingly, the
title of that foundation was “Scott Reuben,” so
they made out cheques to a foundation called
“Scott Reuben” which he then deposited,
presumably, in his own bank account.
Kim Hill: That was clever.
Dr Shafer: Yes, and the reason that I mention
this is that if the company had done the studies
themselves it would’ve been impossible to do the
fraud. When companies do studies, they come
in and they look at every patient’s chart and
they look at every informed consent and they
check every single number against the computer
systems in the hospital. And you can’t make stuff
up if the company does it. But if the investigator
does it, none of those controls exist and these
people just found that they could make up stuff,
the journals didn’t catch it and, presumably, if the
journals didn’t catch it and it was published, they
were home free.
Kim Hill: Don’t the companies have any check of
an investigator that they are funding to make sure
that he or she is on the straight and narrow?
Dr Shafer: The answer is I don’t know. I think
they will now be more careful about that.
Certainly at the time, and this is one of the big
personal changes for me in the last 10 years,
there was a sense 10 years ago that science is
based on trust and academicians were the guys
that wear the white hats, we don’t engage in
fraud. Fraud – that’s the big, bad Pharma and
that’s just not the case at all. There’s crooks
in every profession, there’s cheats in every
profession and it was naïve of us and perhaps
naïve of companies to think for some reason that
academics and academic anaesthesiologists
would be different from anybody else and would
be free of people who would abuse the system.
Kim Hill: One of your colleagues at Stanford,
I don’t know whether this is current,
John Ioannidis, this paper went viral and it’s
called “Why most published research findings are
false”. It can be proven the most claimed research
findings are false. He’s not talking about fraud or
plagiarism or data invention, is he?
Dr Shafer: The answer is by and large, no.
What he’s talking about is the low standards that
journals, including Anaesthesia and Analgesia
but also including science and the New England
Journal of Medicine, that the low standards that
we have had in allowing investigators based upon
not terribly strong evidence to make claims –
claims that certain drugs are efficacious, claims
that certain drugs are safe or claims about basic
biomedical facts, claims about cellular physiology
– that allow people to make claims based upon
evidence that is inadequately strong according to
standards that were set a hundred years ago.
Interestingly, though, Ioannidis did identify in
2006 that if people looking at the stuff called
colloid, it’s like saline except it’s thicker and
it’s what we use in place of saline sometimes
if people need a volume, for example, if they’re
haemorrhaging. He said, “People look at
this colloid stuff, the studies looked a little
dodgy.” In 2006 he contacted Joachim Boldt
to say, “Your studies look a little dodgy to me,”
and Joachim Boldt in some sort of personal
communication reassured him but he mentions
that in a paper in 2006. So, in his efforts to
assess are research findings correct, Ioannidis
actually picked up three years before anyone in
anaesthesia did that there was something wrong
with Boldt’s research.
Kim Hill: Just going back to “Why most
published research findings are false”, is there a
suggestion that standards have dropped or that
in some way the subsequent refusal isn’t coming
quickly enough? What’s happening?
Dr Shafer: I think what’s happening is when the
standards were set 20 years ago there might be
a handful of research papers that would come
in and the notion was, we wouldn’t want to
publish more than, let’s say, if we were looking
at this statistically, one in 20 sounds like a failure
rate we’ve gotta have. We’ll publish 20 papers
knowing that one of them may be wrong and if
you’re only talking about a couple of papers, then
there’s a couple of wrong papers, bad papers
being published so they set this thing called “P
0.05”. What P 0.05 means basically we’re setting
the likelihood that maybe a paper is claiming
something that’s not true, we’re setting it at about
one in 20. That was one thing when there were
only a handful of papers a century ago. Now,
when there are tens of thousands of papers
submitted monthly, and we’re talking about one
in 20, that standard suddenly looks ridiculously
loose because we’re talking about thousands of
papers monthly being published that are probably
not true.
The other part of this that has changed is that
research has become much more complicated
and the statistics of a century ago are no longer
up to the task of analysing modern research
studies. Many journals have not tried to keep up
with statistical methodology. Anaesthesia and
Analgesia in the last few years, in part because
of all this misconduct we’ve dealt with, we’ve
gotten a reputation of being really not very nice
people as far as statistical review because we
ask a lot of our authors. It’s directly related
and, in fact, specifically inspired by the work
of John Ioannidis to try to fix this problem of
the large number of research findings that are
published that are false.
Kim Hill: Have you personally had to ring up
any of these individuals that we’ve mentioned –
Joachim Boldt or Yoshitaka Fiji or Scott Reuben
– and say to them, “We don’t believe you, we’re
going to put a retraction on everything we’ve
published.”?
Dr Shafer: I never spoke with Scott Reuben
after the fraud was publicly announced. I’d
spoken with him prior to that but after it was
announced I’ve never had any communication
with him. I had a lot of communication with
Joachim Boldt between the initial questions that
were raised in 2009/2010 about his paper that
we initially retracted that kind of sparked this
whole tsunami that followed.
Kim Hill: Joachim Boldt’s actions were
described as possibly the biggest medical
research scandal since Andrew Wakefield’s
false MMR/autism claims.
Dr Shafer: The answer is, yes, but with two
caveats on it. Wakefield’s misrepresentations
clearly resulted in vast numbers of children not
getting immunised and probably led to significant
death from that. Boldt’s misrepresentations
certainly did lead to patient injury and very
likely led to patient death. Wakefield went for
one really, high quality misrepresentation with
profound implications. Boldt had a series of
small things. Cumulatively, I think Boldt was
89 retractions and a lot of other things that are
dodgy about review articles where he talks about
other things and he contaminated an enormous
amount of additional literature that used his
findings to draw subsequent findings – something
called meta-analysis. Everything that his research
touched was contaminated by it. In that sense,
yes, it’s huge.
Wakefield picked such a particularly horrific
form of misrepresentation to get people to not
participate in immunisations.
Kim Hill: Feeding on the fears of parents.
Dr Shafer: Absolutely, feeding on the fears of
parents. Unfortunately, even though it’s been
shown now, I believe, for four or five years that
his work is fraudulent, at least in the United
States there is still a very large community of
parents who will not get their kids immunised cos
they haven’t followed the data. They just know
immunisations cause problems with cause and
it’s all based upon fraud.
Kim Hill: So, when you dealt with Joachim Boldt,
what did he say? How was his demeanour?
Dr Shafer: His demeanour, I have to describe
as bizarre. For months he ignored me and I sent
an initial request to him which I always do –
whenever there’s an allegation of fraud I always
go first to the author. About half the time there’s a
pretty innocent explanation so I always start with
the author. He didn’t answer me. I then started
contacting others at his institution and trying to
figure out in Germany he’s in a private medical
clinic – how do I reach them? With every letter I
sent off, I always sent a copy to Boldt. I always
was completely transparent so he knew what I
was doing and he was completely quiet. Months
later, with no response from him, he submits a
new paper to ANA. I got this new submission
and I was shocked. How could he submit me
another paper? I wrote back and I said, “We’re
having an investigation ongoing.” He wrote to me
and said, “You don’t trust me then I’m done with
ANA.” I said, “Well, okay, we can probably agree
with that.”
Then he got increasingly bizarre from there. He
wrote to me saying I’m not communicating with
him at the right email address but that was a
reply to an email I sent him! I said, “How can you
reply to an email I sent you and tell me I sent it
to the wrong email?!” And it got more and more
bizarre and since then he was fired from Klinikum
Ludwigshafen in October, I believe, of 2010 and
I’ve had no communication with him since.
Kim Hill: Was it self-interest or was it
incompetence in his case?
Dr Shafer: It was self-interest and he had
taken his group at Klinikum Ludwigshafen,
they were publishing a manuscript every month
almost and Boldt was at the top of the German
anaesthesia hierarchy. He had been the president
of the DGAI which is the German Anaesthesia
Society, he was considered among the most
influential and academically successful German
anaesthesiologists. It had driven him to the top
and he was flown around by these companies
even though they did not, with one or two very
small exceptions, one or two studies, that’s
all, they did not directly sponsor his research
but they benefitted hugely from his constantly
showing good results for their products and they
flew him all over the world.
I will say, though, that in 2009 when he
published a paper that actually was identified as
the first one being fraudulent, one of the people
who contacted me and said they didn’t believe
it was with the company whose product was
tested. They just said, “We’ve looked at these
data, we don’t believe it. We’ve asked Boldt for
the data, he refuses to give it to us. You might
have a problem here.” That actually came from
the company.
Kim Hill: A report that I read relatively recently
was that almost two years after editors at 18
journals agreed to retract 88 of Joachim Boldt’s
papers, 10% of them had not been retracted.
Dr Shafer: Yes, that’s correct.
Kim Hill: What does that mean and why not?
Dr Shafer: Boldt’s co-authors did contact us.
They contacted every one of the signers of that
letter that you have, the 18 editors came together
and said, “We will retract these papers unless
there’s evidence that these studies are valid
and that there is IRB approval.” The co-authors
wrote to all of us and they threatened to sue us.
People threaten to sue me pretty regularly! They
threatened to sue me personally and they said
that we have no right to retract their papers, this
will harm their careers. Our own interpretation
was that they actually had the liability backwards
– that we could sue them for having harmed the
journal by submitting fraudulent research and
successfully suing us.
On the other hand, we were separated by the
Atlantic Ocean. People in Europe and specifically
some of the German journals were in fact
intimidated by the threat of legal challenge and
chose to not retract the papers because of the
threat of liability.
Kim Hill: So, those papers are still out there
at large.
Dr Shafer: Yes.
Kim Hill: And presumably could be continuing to
do damage to patients.
Dr Shafer: I think so. On the other hand, at least
in the anaesthesia world the name Joachim Boldt
is pretty much identified.
Kim Hill: Mud.
Dr Shafer: Yeah, it doesn’t have a lot of
credibility these days.
Kim Hill: No. Why do you think it is then that
anaesthetics is an area that is so fraudulent?
Dr Shafer: It’s a good question.
Kim Hill: It’s a leading question – do you think it is?
Dr Shafer: The answer is, if you look at the
number of retractions you have to say, yes,
because we have had many retractions. On the
other hand, part of what I do is I spend a lot of
time looking at data and I’m very sensitive to
small numbers. So, we’ve had a lot of retractions
but they’re really based on just three individuals –
Scott Reuben, Joachim Boldt and Yoshitaka Fujii.
Out of a hundred thousand anaesthesiologists,
the fact that three individuals operated for two
decades before they were caught suggests
to me that the vast majority, 99.9999% of
anaesthesiologists do not engage in this kind of
behaviour. I don’t wanna generalise about our
entire profession based upon three crooks.
Kim Hill: Given how long they got away with it,
how would we know?
Dr Shafer: Absolutely. Here’s the thing – they
got away with it and that is really the culpability of
me and my colleagues who are journal editors.
We were not adequately vigilant a decade ago,
two decades ago. We’re better now and we’re
better not because of my efforts but because the
journals all work together. Every one of these
cases involved multiple editors exchanging data,
exchanging files. We worked closely, it’s funny
to think of myself saying I’m leading this effort –
not at all. It’s a whole bunch of editors that are
working in collaboration to clean up our act. I
think that if other specialties in medicine acted
the way that we did where editors got together
and said, “Where are the problems? Where are
the bad apples and what are we gonna do about
it?” There will be a couple of these people
everywhere. I don’t know of another one now
in anaesthesia. There probably is some there
I don’t know about but there’s no big active
investigation which is quite a relief to me in our
specialty. It’s because the journals – we cleaned
up our act, we became more diligent, we
followed up on things, we didn’t just say, “Oh,
it’s somebody else’s problem, we’ll pass it on
to the next editor.”
I think that’s why we caught them and I think
that’s why we have this black eye right now.
I’m not sure that we’re the only ones that have
a small number of people who have been
engaged in fraud for years. We were just
asleep at the switch.
Martin Mizur and other delegates
listen intently to Stephen Shafer
Kim Hill: One of the points about
Yoshitaka Fujii’s data was that they were
described as too perfect and that would be
a red flag. You would think that he would’ve
been clever enough to make them slightly
imperfect, wouldn’t you?
Dr Shafer: Yes. Just to give the listeners a
little insight into the specifics of that – he
did multiple studies where he had several
groups, two or three groups in each study. In
every study, in every group one patient had
a headache as a side effect. You go through
study after study and there’s a study with two
groups, a study with three groups, 25 people,
30 people, 40 people in different groups and
every time one patient has a headache. You
might see that on one study so it’s interesting
that three groups, three headaches. But when
you see that in 30 studies and there are three
groups and there’s 90 different groups and
every time there’s exactly one headache,
you’d say, “There’s a problem here.” That’s
obvious to anybody looking at it and saying,
“That’s just not gonna happen with real data.”
That’s what he did. It is only when some folks
in Germany – Kranke and his colleagues in
Germany in the year 2000 went back and
they looked and they tried to be diplomatically
correct, they said, “His data are incredibly
nice.” But what they really meant to say is
there is no chance that this is real data.
Kim Hill: Very strange, isn’t it?
Dr Shafer: Yes.
Kim Hill: Is it like compulsive gambling for
them, do you think, that they get so far and
then they can’t stop?
Dr Shafer: This is just me speaking from a
personal perspective, not in a professional
perspective. I personally think that it has to
be in part mental illness. I cannot imagine
every morning getting up, looking in the mirror
and wondering if today is the day when my
world is gonna crash round me. Is today the
day that a career built on fraud is going to be
unmasked? If that was the experience of each
of these individuals, their lives were destroyed
when it was finally unmasked. To have gotten
to that point, how could you get up every day.
Kim Hill: Unless they had convinced
themselves that the drugs or the treatment
that they were espousing were in fact good,
they were just gilding the lily.
Dr Shafer: I did think that initially about
Scott Reuben. I thought, maybe he just thought
that he really believed these drugs really
worked and journals were so demanding for all
this evidence, he knew they worked but then
I realised that that’s the reason that I would
commit fraud. That’s the Steve Shafer thing
– I’d be so committed to patient health that I
would commit fraud to do the right thing. No.
What Scott Reuben did was he was getting
money for it, he was getting promotions for
it, he was going on speaking tours, he was
widely acclaimed for his research. It was
ego gratification, money, the usual rewards.
Probably nothing so sophisticated as saying,
“I’m really trying to help patients by lying.”
Kim Hill: Before you became editor of the
journal Anaesthesia and Analgesia, did you
imagine that people in your profession could
do this?
Dr Shafer: No.
Kim Hill: Were you naïve?
Dr Shafer: I was very naïve.
Kim Hill: Did you have a grotesque epiphany
one day at your desk?
Dr Shafer: Yes. The first shock was the literally
weekly drum beat of misconduct. I would start
to see paper after paper and it still is the case
that I deal with a misconduct case every week.
There’s a paragraph in the discussion of a
paper and a reviewer writes back and says,
“I really like the discussion, particularly the
paragraph that’s exactly cut and paste from my
own paper!” I had a look and, sure enough, the
guy had just plagiarised a paragraph.
I started to realise how much low level
misconduct was going on and that was very,
very concerning.
Kim Hill: The low level misconduct would be
plagiarism for, I think you said, for scientific
English, so people cut and paste Wikipedia.
Dr Shafer: Yes, people cutting and pasting
Wikipedia, yes, exactly right. This is low level,
this is the kind of thing where I explain the rules
to the authors who typically don’t understand
the rules and then they apologise and they write
it back and they get it right and sometimes
we even publish those papers because
they fixed it and they get it right and I had a
chance to take them through as the rules.
It was really Scott Reuben who I had talked
with because some of his papers I had
accepted and I had even worked with him
on trying to get the papers crafted exactly
right. On one of the cases, I didn’t like
one of his figures and I had him send me
the spreadsheet because I wanted to get
his paper on a specific issue. He said,
“I’m going out of town,” I said, “Send me
your data,” and I actually put together this
figure in his paper. I did it myself from a
spreadsheet of fabricated data.
Kim Hill: Where are these guys now?
Where’s Scott Reuben and Joachim Boldt
and Yoshitaka Fujii now? Where are they?
Dr Shafer: I don’t keep close tabs on them.
The last I heard of Scott Reuben is he’s lost
his medical licence, he no longer has any
academic associations and he’s suffered
quite personally. I believe that his wife and
family left him and last I heard he’d moved
back in with his parents and lives essentially
out of work.
Joachim Boldt, Germany has a shortage
of anaesthesiologists. He will not lose his
medical licence just last month the German
prosecutor determined that his fraud did not
constitute a criminal act. So, they dismissed
all criminal charges against him. He is
practicing as a private anaesthesiologist.
Kim Hill: Are you suggesting that, as you
said earlier, the German legal system might
be more prone to law suits?
Dr Shafer: It may be more prone to law suits
but I truly think that both in Germany and,
frankly, in the United States as well, we’re
not set up to deal with scientific fraud. Other
types of fraud where there’s a financial
arrangement between two companies and
one company commits fraud, the other
company sues them and there’s all kinds
of things there. But fraud in science,
unfortunately, is not well handled by the
legal system. There are things in place in the
United States, for example, by the United
States Office of Research Integrity, part of
the US government, which has the ability to
look at research fraud but only for things the
US government funds. If the US government
isn’t funding it, they have no say. So, we
aren’t really set up and, again, I thinkit’s the
same notion – science is based on trust but
you would never say banking’s based on
trust! If you said banking’s based on trust
some crook would set up a bank at every
street corner.
That notion that science is based on trust,
we’re getting away from that and we have
to get away from that because there’s no
reason that scientists are any less human
than anybody else and some people will
always abuse the system.
Kim Hill: The price of being editor of the
Journal of Anaesthesiology and Analgesia
is eternal vigilance! Dr Stephen Shafer,
nice to talk to you. Dr Shafer is a professor
of Anaesthesiology, Perioperative and
Pain Medicine at the Stanford University
Medical Centre.
Anaesthesia hits the headlines
Horror stories, celebrities and fraudsters featured in high profile media coverage for
anaesthesia around the time of the recent AACA and ASURA Congress in February.
The horror scenario of being awake during
surgery drew attention on TV One and in
the New Zealand Herald. Professor Paul
Myles explained awareness during surgery
can occur if people have a high resistance
to anaesthetic drugs. He assured his
audience that the risk is much less than it
used to be and the profession is focussed
on getting it right 100 percent of the time.
Another risk that attracted attention is postoperative cognitive decline – a measurable
decline in functions such as perception,
memory and processing speed following
surgery. The ‘Listener’ magazine featured
an interview with Professor Mark Newman
about the higher risk for older people, and
the work anaesthetists do to reduce the risk.
Dr Shafer also talked to Radio New
Zealand’s Kim Hill for 40 minutes about
both the Jackson case and research
fraud. Dr Shafer, as editor of the Journal
of Anaesthesiology and Analgesia, was
involved in exposing three fraudulent
researchers. The interview provided
reassurance for listeners that fraudsters
are being unmasked and the profession is
learning to examine claims from researchers
with more care.
The full script of this interview is on page 12.
You can find the articles by searching the
following websites or using these links:
Prof Newman led a study published in
2001 which showed 40% of patients
who underwent coronary surgery had
measurably reduced cognitive function
five years later. With new strategies and
management the number of incidences was
going down, he said. But at the same time
“we’re charting new territory because we’re
using new devices and doing heart surgery
on people aged up to the young nineties,”
he told the Listener.
Michael Jackson’s death from propofol was
the focus of Dr Steve Shafer’s interviews
on TV3, where he said the care Jackson
got “could not have been worse”. Dr Shafer
drew the audience in with his descriptions
of his experience testifying in the trial of
Jackson’s doctor Conrad Murray. At the
same time, he conveyed a serious message
about the risks of the drug, saying it should
only ever be used in hospitals where there
is appropriate monitoring.
The New Zealand Herald,
February 22, page 3
http://www.nzherald.co.nz/lifestyle/news/
article.cfm?c_id=6&objectid=11207529
Steve Shafer on TV3 News, 6pm
http://www.3news.co.nz/Doctor-warnsabout-Michael-Jackson-killer-propofol/
tabid/423/articleID/333460/Default.aspx
Steve Shafer on The Paul Henry Show, TV3
http://www.3news.co.nz/Dr-Shaferon-the-proper-dosage-of-Propofol/
tabid/1837/articleID/333480/Default.aspx
Steve Shafer on Kim Hill, Radio New
Zealand National
http://www.radionz.co.nz/national/
programmes/saturday/20140222
Radio coverage through the Pacific
Meanwhile Radio New Zealand
International, which broadcasts to the
Pacific, covered the Pacific Super Meeting.
For hundreds of thousands of New
Zealanders, reading, watching or listening
to these stories left them with a greater
appreciation of the crucial role anaesthetists
play in their health care.
AACA ASURA keynote speaker
Paul Myles gained media coverage
Paul Myles on TV1, Breakfast TV
http://tvnz.co.nz/breakfast-news/horrorwaking-up-during-surgery-traumatisedlife-video-5847588
The Listener, 6 March 2014, page 46
http://www.listener.co.nz/?s=anaesthesia
Radio New Zealand International
http://www.radionz.co.nz/international/
pacific-news/236369/’historic’-pacificanaesthetists-meeting-to-provide-helpingtraining
http://www.radionz.co.nz/international/
pacific-news/236373/more-assistance-topacific-emergency-health-workers-required
Badgernet – a new nationwide maternity
information package
Badgernet is an incredibly
powerful tool being introduced
to improve patient care.
The concept with Badgernet is that from
the moment an LMC (Lead Maternity Carer
– usually a midwife) first meets the patient,
record keeping about the pregnancy goes
into a national database and anyone caring
for this woman can access it. This means
all obstetrician, physician, paediatrician, and
other medical staff opinions and plans are
accessible to anyone caring for the patient
who has access to Badgernet.
The reason for introducing Badgernet is that
a lack of information sharing about medical
problems in critically ill obstetric patients has
contributed to poor outcomes and deaths in
women in virtually all enquiries by coroners,
PMMRC (Perinatal and Maternity Mortality
Review Committee), AMOSS (Australasian
Maternity Outcomes Surveillance System)
and SAMM (Severe Acute Maternal
Mobility) studies. The common factor in
many deaths and disasters is that if doctors
knew what had happened previously to the
patient they would not have allowed what
happened to occur.
The result is that Badgernet is going to be
introduced in the next two years and New
Zealand anaesthetists are soon going to be
asked to trial this new maternity information
system. This will mean that we need to have
the same national forms for labour epidurals,
pre-operative assessments of pregnant
patients, and intra-operative anaesthesia
records for caesarean sections and other
maternity procedures. There will need to be
new computers placed in every delivery room
for every delivery suite in New Zealand, and
post-delivery pain rounds will also need to
be computerised. All of this information will
be fed into Badgernet. This promises to be
one of the biggest changes in anaesthesia
record keeping that has ever occurred and
will affect all obstetric and pre-operative
assessment anaesthetists.
The NZSA is keen to support Badgernet
because it promises to benefit patients and
staff looking after them. The NZSA is planning
to hold discussion meetings with obstetric
consultants in the next couple of months.
Outline of Badgernet
The current DHB maternity systems are
a mixture of out-of-support and manual
systems and those that are supported
are not fully integrated or fit for purpose.
Maternity records cannot easily be
collectively viewed either electronically or
in paper form by other service clinicians,
midwives in the community, GPs providing
care, or other clinicians in the region. Relying
on paper records is not feasible for a multidisciplinary model of care as the physical
transportation of clinical records means the
information transfer may be delayed and is
often not available at point of care. A reliable
electronic system for collecting and viewing
information will negate the need for reliance
on paper records and reduce clinical risk.
Over the period November 2011 to
April 2012 a procurement process was
undertaken. In May 2012, a decision was
made to select Clevermed Limited to
provide the national solution. The BadgerNet
Platform is a specialist product from UK
company Clevermed, currently providing
functionality for hospital based primary,
secondary and tertiary maternity services
and neonatal services.
Maternity stakeholders discuss
sharing of maternity information
In August 2013, representatives of the
Maternity Information Systems Programme
met to discuss which pieces of information
gathered through the care provided to a
woman during pregnancy and birth should
be shared and who should have access to
this information.
Represented at the meeting were
consumers, the NZ College of Midwives,
the Royal NZ College of Obstetricians and
Gynaecologists, the Royal NZ College of
GPs, the Paediatric Society of NZ, the
maternity and neonatal clinical reference
groups, the Ministry of Health and district
health boards.
It was agreed:
• information that should be shared would
include that recorded at the time of
registration with the lead maternity carer
(LMC), any significant medical history,
allergies and alerts, past obstetric history,
prescribed medicines, results of blood
tests and scans, information for maternity
facility booking, birth plan, labour and birth
summary, and discharge summary;
• LMCs, GPs, relevant hospital/facility staff
and the woman would have access to this
information; and
• for health professionals and other
health care providers, access will be
controlled using a Role-Based Access
Control (RBAC) model. Typically, this
mechanism determines which health
professionals are able to access the
woman’s maternity information based on
their role and function.
Once the national MCIS is in place, the care
received by a pregnant woman and her baby
may be safer and of higher quality because
health professionals will have timely access
to information about her and her baby’s
clinical/medical and maternity history before
making care decisions.
In time, women will have electronic access
to their maternity information held in the
Maternity View portal, including through
portable device applications.
Clinical Reference Groups
Dr Dave Chamley and Dr Elaine Langton
have provided considerable input into the
Anaesthetic section of the maternity system.
Staged development and
introduction of new system
The new maternity and neonatal clinical
information systems will be implemented
by DHBs at different times. MidCentral,
Whanganui, Counties Manukau, Capital &
Coast and Tairawhiti DHBs will be the first
to introduce the new systems, in 2014.
Women in these DHBs are expected to
be able to see their information online by
2014/15. Women will need to continue
keeping a copy of their records (paper
or electronic) in the meantime. A paper
copy of records will always be provided to
those women who don’t have electronic
access or who choose not to use the
electronic access option.
A view of a baby’s neonatal summary
information will be available in a later phase
of the project.
Women in other DHBs will be able to see
their summary information online as their
DHBs introduce the new system. They will
need to continue keeping a copy (paper or
electronic) of their own maternity notes in
the meantime.
Progress of the Programme
The programme has made considerable
progress to date. Early adopter DHBs are
now preparing for rolling implementation
from the middle of this year. Current work
to support the national programme is
focusing on:
• Finalising version “1.0” of the maternity and
neonatal software for the first DHBs to use
in their respective implementations;
• Consultation of the privacy impact
assessment is nearing completion;
• Completing the contract documentation for
DHBs using the system;
• Developing and testing of the various
national and local DHB technical interfaces
to enable maternity information to flow
across the sector; and
• Engagement with consumers through
a Maternity Consumer Advisory Group
supported by the National Health IT Board
Dr Ted Hughes is now proposing two
workshops with the national programme
manager (John Tolchard) and Clevermed
representatives to discuss the programme
and its impact on Anaesthetists working
in maternity services. Programme staff
would also like to use these workshops to
gather feedback from senior clinical staff.
Workshops will likely take place in Auckland
and Wellington or Christchurch within the
next few months.
BWT Ritchie Scholarships 2013 Announced
There was an unprecedented level
of interest in the BWT Ritchie
Scholarships in 2013, with seven
excellent applications received. Dr
Kerry Gunn, Chair of the selection
panel, said the achievements and
contributions of all the applicants
were impressive. This made the task
of the selection panel, comprising the
Chair of the New Zealand Anaesthesia
Education Committee (NZAEC), the
President of the New Zealand Society
of Anaesthetists (NZSA) and the
Chair of the New Zealand National
Committee of the Australian and New
Zealand College of Anaesthetists
(NZNC ANZCA), extremely difficult.
Three scholarships were awarded,
to Dr James Moore for a fellowship at
Papworth Hospital in Cambridgeshire,
UK; to Dr Kathryn Hagen for a
fellowship at Cork University Hospital
in Ireland, and to Dr Sam Grummitt
for a fellowship at Vancouver General
Hospital in Canada.
Dr James Moore has
worked as a dual
trainee at Wellington
Hospital. He
completed his training
in anaesthesia in
December 2013,
and will complete
his training in intensive care medicine
in June 2014. The nomination from
the ICU Department of Wellington
Hospital notes that Dr Moore has
“outstanding leadership skills and
has performed to a high standard
in his position as Chief Registrar in
Anaesthesia and Intensive Care. He
has drive that is directed to problem
solving and clinical improvement. For
example during the past two years he
has been instrumental in establishing
a Hospital Trauma Committee and
he has driven the development of
a local intravenous iron project to
reduce the need for transfusion. He
has been a member of the Education
Committee of the Medical Council,
and has a long track record with
the St John Ambulance Service. He
has demonstrated an outstanding
level of commitment to his hospital
based specialities, to the medical
profession as a whole and to the wider
community.”
Dr Moore’s major interests include
cardiothoracic anaesthesia and
critical care. Dr Moore notes that
Papworth Hospital is a major heart
and lung hospital providing tertiary
cardiothoracic services to the East
of England, and quaternary services
especially in managing severe heart
failure and pulmonary hypertension
to the rest of the UK. Papworth is
well regarded for transoesophageal
echocardiography, a skill Dr Moore
intends developing and bringing back
to Wellington ICU, which has just
purchased an ultrasound with TOE
capabilities.
Dr Kathryn
Hagen has been
chief resident at
Auckland Hospital
in 2013. In the
nomination form,
Dr Bradfield
comments on Dr
Hagen’s extensive involvement with
the anaesthesia community—both
within the Auckland training region
and at national and international levels.
Dr Hagen has been one of the trainee
representatives on the Auckland
Vocational Trainee Committee, a
trainee representative on the NZ
Society of Anaesthetists Executive
Committee, the Chair of the ANZCA
Trainee Committee, and the Chair of
NZ National Trainee Committee of
ANZCA. Dr Hagen was awarded the
Ray Hader Award for Compassion
from ANZCA. Dr Bradfield also notes
her involvement in their department,
citing her work in assisting in setting
up Auckland as a site in the Canadian
led METS (Measurement of Exercise
Tolerance before Surgery) Study.
Dr Hagen has obtained a research/
regional anaesthesia Fellowship at
Cork University Hospital in Southwest Ireland. Cork University Hospital
is the largest teaching hospital in
Ireland and the only level 1 trauma
centre there. It has more than
1000 inpatient beds and over 40
medical and surgical specialties.
The anaesthesia department is well
regarded as an early adopter of
simulation based teaching and has
developed several simulation tools for
teaching trainees; e.g. Haystack, a
hapto-visual simulator for anaesthesia
procedures. A mandatory requirement
of her fellowship is to develop her own
research project. Dr Hagen feels it
will be particularly useful to see what
level of support and infrastructure is
required to enable someone in a 1
year post to contribute to or develop
meaningful research ideas, as Level 8
at Auckland City Hospital is currently
reviewing its Fellowship programmes
with a view to embed an expectation
of research within its Fellowship
positions.
Dr Sam Grummitt
has trained
predominantly in
the South Island
with a twelve month
post in Taranaki.
His supervisor of
training, Dr Ashley
Padaychee, describes him as “an
outstanding registrar…hardworking,
motivated and the ultimate team
player.” Most recently, Dr Grummitt
has worked as a Perioperative
Medicine Fellow at Christchurch
Hospital. He was the founder and
facilitator of the Journal Club in the
Department of Anaesthesia and has
been involved in teaching junior
anaesthesia staff and anaesthetic
technicians.
Dr Grummitt has a general clinical
fellowship at Vancouver General
Hospital, which is a teaching hospital
affiliated with the University of British
Columbia and home to one of the
largest research institutes in Canada.
His work will focus on major noncardiac surgery, including colorectal,
hepatobiliary, and vascular.
Dr Grummitt is looking forward
to gaining experience in
transoesophageal and transthoracic
echocardiography during his
fellowship and acquiring sufficient
skills to help develop a perioperative
echocardiography service in
Christchurch on his return. As an
avid supporter of free health care for
all, Dr Grummitt is also interested to
explore how a bill-for-service model
affects patient care.
NZAEC congratulates the BWT
Ritchie Scholarship winners for
2013. It wishes all applicants the
best for their fellowships overseas,
and looks forward to their ongoing
contributions to NZ Anaesthesia on
their return.
Applications for the BWT Ritchie
Scholarship 2014 close on October
31. Further information about the
BWT Ritchie Scholarship can be
found on the NZAEC website (http://
www.anaesthesiaeducation.org.nz/).
Six Monthly Report for NZAEC
On August 1st 2013
I started as Regional
Anesthesia Fellow at St
Luke’s-Roosevelt Hospital
in New York City, home
of the New York School
of Regional Anesthesia
(NYSORA). A lot of people thought I
was crazy to take my pregnant wife and
2-year-old son away from our comfortable
life Wellington, to a small apartment in one
of the busiest cities in the world. While
there have been occasions when I might
have agreed with them, we have all had an
amazing experience and have no regrets
about making the move.
St Luke’s-Roosevelt is a private, not-forprofit, teaching hospital in Manhattan.
It is spread across two campuses,
Roosevelt Hospital on W 59th St, which
serves Midtown and the West Side of
Manhattan, and St Luke’s Hospital on W
114th St, which serves West Harlem and
Morningside Heights. Each hospital has
about 500 beds and 12 operating rooms,
and offers a wide range of services to a
wide range of patients.
My typical week involves clinical duties on
Monday, Wednesday and Friday, which
usually means covering an orthopaedic
list at St Luke’s. There is a good variety
of upper and lower limb work, most of
which is done under neuraxial or peripheral
nerve block with sedation. The orthopaedic
surgeons here are very ‘regional friendly’,
and some will specifically request blocks
or perineural catheters to facilitate early
rehabilitation and discharge. I am generally
rostered with my co-fellow, Malikah
Latmore, and either Jeff Gadsden or Admir
Hadzic as our attending anesthesiologist.
Having two fellows in one operating room
seemed redundant to me at first, but we
learn a huge amount by observing and
assisting each other with blocks, and it
means one of us is able to go to another
operating room or the PACU for a block,
while the other stays in the room. Because
of the private hospital model, there is a
focus on getting as many cases done as
Columbus circle subway station
possible, and attendings typically cover
two operating rooms. Lists start early and
often run late, but elective cases are never
cancelled without a strong clinical reason.
It’s not unheard of for an elective gastric
bypass or hysterectomy to start at 9pm
if there have been delays during the day
or the list was overbooked. Despite the
incentive for throughput, theatre turnover
can be slow, so we often bring patients to
our ‘block room’ and have plenty of time for
teaching while getting the patient ready for
surgery.
Tuesdays and Thursdays are non-clinical,
which generally means working on one of
the many research or writing projects that
are on the go at any time. So far I have
been involved in writing textbook chapters
and journal articles, clinical trials involving
liposome-encapsulated bupivacaine, and
evaluating a needle navigation system
that has been incorporated into a new
ultrasound machine. These days are also
used to practice ultrasound scanning (and
occasionally nerve blocks) on each other,
discuss techniques and keep up to date
with recent literature. So far I have been
able to attend the NYSORA symposium
here in NY, and the ASA annual meeting
in San Francisco. There are a number of
meetings coming up in 2014 including
ASRA, NWAC and NYSORA Latin America
which will give me opportunities to instruct
at workshops and present some of the
research we have been working on.
It has been fascinating to gain some insight
into the US healthcare system, particularly
at a time when it is undergoing considerable
change. I had anticipated that a hospital
in the most expensive healthcare system
in the world would have an abundance
of staff and the latest equipment, but
instead I find myself struggling to get
used to working without an anaesthetic
assistant, and longing for the TCI pumps
and advanced airway equipment that was
so readily available back home. The recent
introduction of “Obamacare” has been
met with some scepticism and a fear of
dwindling incomes, while the expanding
Celebrating Halloween at the 69th
Street Party
role of nurse anaesthetists also has some
of my colleagues fearing for their future job
prospects.
One of the big benefits of this fellowship
has been the lack of after-hours work
– I only work one night a month and no
weekends, leaving plenty of time for
exploring the city with my wife and son (age
2 ½). We have visited numerous parks,
museums and tourist attractions, wandered
various neighbourhoods, and eaten a lot of
good food. Other highlights include going to
a Broadway show, an NBA game, and a live
taping of The Daily Show. The changing of
the seasons and the general enthusiasm for
celebrating holidays (especially Halloween
and Thanksgiving) has been a lot of fun,
although the winter has been particularly
cold and pushing a stroller through the
snow has been difficult at times. The recent
arrival of our second child brings with it a
new set of challenges for the second half
of the fellowship, but also ensures that
our time in New York will be particularly
memorable.
I would like to thank the NZAEC for
their generous support in the form of the
BWT Ritchie Scholarship, and also the
Department of Anaesthesia at Wellington
Hospital for giving me time off to undertake
this fellowship. I am planning to return to
Wellington in August 2014 to resume my
consultant position, and look forward to
sharing the knowledge and skills that I have
learned during my time away.
Dr Matt Levine
Regional Anesthesia Fellow
St Luke’s-Roosevelt Hospital
New York, NY
Roosevelt Hospital
From the Archives ~ Forty Years Ago!
In 1974, there were the usual four issues of
Newsletter but the first did not appear until July.
Late publication was due to a delayed changeover
in NZSA Headquarters from Wellington to Dunedin. In
his editorial, the new Editor, Mack Holmes, apologised
for this, but asked (as so many editors need to do) for
contributions from the members! Jim Clayton was now
President of the Society, and he too, added his apologies
for the late delivery. Issues he raised in the Presidential
Message included problems with the Specialist Register
and with payment for anaesthetics given for children’s dental
treatment. He also noted the continuing shortage of specialist
anaesthetists. Other Society officers were Bruce (Spotty) Cook
-- Vice President, Trevor Dobbinson -- Secretary-Treasurer,
and Humphrey Rainey -- Business Editor.
halothane and nitrous oxide. Would we eventually move to
total intravenous anaesthesia?
The major article by Ron Trubuhovich was on Drug
Overdoses which covered principally tricyclic
antidepressants, glutethimide, paracetamol and
aminophylline. This was based on experience in Auckland
Hospital’s Critical Care Unit and had been presented at
the Wairakei Meeting of the Society in July 1973. This was
followed by Mack Holmes who wrote Whither the Volatile
Agents? This dealt with toxic effects of numerous agents
used over the years and queried the continuing use of
The Historical Section highlighted a 1941 paper on
Pentothal Sodium Anaesthesia by Dr Grace Stanley. This
was the first paper on thiopentone in the N Z Medical
Journal and the first N Z anaesthesia paper by a female
author. Dr Stanley was the mainstay of anaesthesia at
Palmerston North Hospital during World War 2.
Dr John Ritchie was congratulated on being awarded the
Orton Medal of the Faculty of Anaesthetists, RACS. Over
the years, he had made many modifications to anaesthetic
machines to make them simpler and safer.
Correspondence included notice of the Centennial of the
Otago Medical School (February 1975), the Sixth World
Congress of Anaesthesiologists, Halothane Jaundice,
and a list of available audio-digest tapes. Society News
included reports from Auckland and Otago. There was
a section of Faculty of Anaesthetists’ news, and Mack
Holmes presented An Arrange-ment to Allow Volume Preset Ventilation with Simple Apparatus.
Basil Hutchinson,
Life Member.
New Zealand Anaesthesia Visiting Lecturers 2014
The New Zealand Anaesthesia (NZA)
Visiting Lectureship programme,
under the auspices of the New
Zealand Anaesthesia Education
Committee (NZAEC), has now been
running for five years. During this
time eleven visiting lecturers have
presented their topics of interest to
anaesthesia departments in regional
centres.
Dr Graham Roper, Chair of NZAEC,
notes that the tradition of stimulating
and thought provoking presentations
will continue in 2014, with the
awarding of three NZA Visiting
Lectureships to:
Dr Jane Torrie,
a specialist
anaesthetist at
Auckland City
Hospital and a
senior clinical
lecturer and
Director of
Simulation Centre for Patient Safety
at the Department of Anaesthesiology
at Auckland University.
Simulation and integrating simulation
techniques into the quality/safety
arm of institutions is a specialist area
for Dr Torrie. She also frequently
runs workshops on other topics
of interest, particularly in the
area of team work. Dr Bradfield
who nominated Dr Torrie said
that “She is very well respected
in our department for her work
in emergency management of
anaesthetic crisis, simulation, and
team work. I have heard her talk
many times on these topics and know
she will be able to put together a very
interesting informative and hopefully
practice-changing presentation.”
Dr Colin
Marsland,
a specialist
anaesthetist
at Wellington
Hospital, who
will present
on emergency
transtracheal
ventilation and bronchoscopic airway
management, both research topics
for him.
Dr Snelling who nominated Dr
Marsland noted that the “paper
he presented to our education
session was very well received and
generated a lot of discussion about
management in this area.”
Dr Nav Sidhu,
a consultant
anaesthetist at
North Shore
Hospital in
Auckland, whose
topic is “CICO
and the Surgical
Airway: a personal account”, which
uses a case report to highlight
issues and discuss the evidence
surrounding emergency airway
management with a particular focus
on cricothyroidotomies.
Dr Warmington wrote in his
nomination that “the talk was very
thought-provoking, making one
review one’s own practice and
caused an immense amount of
invaluable department discussion on
a very scary subject.”
Nominations for NZA Visiting
Lectureships close on September 30
each year. Further information about
the NZA Visiting Lectureship can be
found on the NZAEC website: http://
www.anaesthesiaeducation.org.nz/
Lifebox takes equipment and training to Vietnam
Links between colleagues can bridge
continents and save lives, and Lifebox
Foundation is thrilled to be part of a
collaboration that is doing just that. The
commitment between NZSA and the
Vietnam Society of Anesthesiologists to
distribute Lifebox equipment and training
will support a long-term improvement
in the safety and quality of surgery and
anaesthesia.
In October last year, the latest cohort
of NZSA members visited Vietnam. The
trip was coordinated by Maurice Lee
(North Shore) who was joined by Emma
Patrick (New Plymouth), Indu Kapoor
(Wellington), John Hyndman and David
Murchison (both Christchurch) and
Tomas Goscinski (Gisborne). They aimed
to provide train-the-trainers teaching
for anaesthetists in Hanoi, including an
introduction to the concept of Lifebox and
approaches to adult education. The group
also distributed oximeters and training
to hospitals in Đak Lak province in the
Central Highlands region.
“It was a truly magical moment to be able
to hand over the Lifebox from NZSA,”
Tomas Goscinski recalled, of the group’s
visit to a hospital that previously had no
oximeters. “The Anaesthetic Technician
had been up the night before giving a
general anaesthetic with only NIBP for
monitoring.”
Follow-up of donated equipment is an
integral part of the Lifebox distribution
model, and the NZSA team was able to
visit hospitals in provinces such as Lào
Cai and Nghe An which had received
oximeters previously. The oximeters
inspected were working well, were well
cared for and rarely idle. More oximeters
are still required to meet the need,
however, and to quote Emma Patrick, “the
next time you are thinking of joining in a
“fun” run (is there such a thing?), a cake
bake or other fundraising opportunity,
please consider Lifebox as a truly worthy
recipient. It may save a life.”
Speaking of fundraising, members of the
Association of Anaesthetists of Great
Britain & Ireland (AAGBI) have been
cooking up a storm with their Great
Anaesthesia Bake.
Link to http://www.aagbi.org/international/
lifebox/bake
Link to www.makeit0.org
Link to https://docs.google.
com/forms/d/1p_qufEl2H0P_
aAjxtxPdbbc9Exj7mjbYOl9XVyTonjM/
viewform.
The Bake was launched at the UK’s
trainee conference in April 2013 and
has so far raised almost NZ$40,000.
Enthusiasm and kitchen creativity from
anaesthetists and theatre colleagues has
been amazing – and often anatomicallycorrect. If you’d like to bring the Great
Anaesthesia Bake to your hospital, drop
a line to info@lifebox.org for more details
and a fundraising pack.
Unsafe surgery is everyone’s issue, of
course, but for International Women’s
Day on 8 March this year Lifebox focused
on how it effects one particular group:
women. Women around the world play a
vital role in delivering safe surgery – and
surgery plays a vital role in saving them.
More than 50% of emergency operations
in low-resource settings are obstetric
procedures, performed on women
because they have no other choice, and
often it is desperately unsafe.
And sign up to receive news from Lifebox
to find out how you can get involved to say
no, we won’t stand for this; and yes, this
is our issue too.
lifebox/bake
viewform
Check out Lifebox’s new online resource
of interviews, audio and visual footage
from around the world featuring women
who know firsthand why safe surgery is
directly related to health, family, career
and community.
lifebox/bake
viewform.
David Murchison and John Hyndman handing over an
oximeter to a district clinic in Sa Pa, October 2013
Distribution and training in Phu Yen Province, August 2012
webAIRS News – Change of ANZTADC Chair
The Australian and
New Zealand Tripartite
Anaesthetic Data
Committee (ANZTADC),
was formed in 2006 following the
recommendations of two taskforces
set up by Professor Michael Cousins
during his tenure as President of
the Australian and New Zealand
College of Anaesthetists (ANZCA).
These were the Quality and Safety
taskforce and the Data taskforce.
Both of these taskforces included
representation from the New
Zealand Society of Anaesthetists
(NZSA) and the Australian Society
of Anaesthetists (ASA) in addition
to ANZCA. Tripartite support
continued, resulting in the formation
of ANZTADC. This committee
continues to function with the close
support, ideas and knowledge of
the three founding organisations.
Professor Alan Merry led the
formation of the committee and
guided it through its infancy into the
mature organisation that it is today.
Following the development of a
strategic plan and evaluation of
existing software, webAIRS was
created. It is based on knowledge of
best practice in incident recording
and has become a pre-eminent
morbidity and mortality reporting
resource. Alan led the development
of a robust framework for both
committee function and software
development with a focus on
integrating webAIRS into a tool that
is available to every anaesthetic
department and private practice
group in Australia and New Zealand.
It had always been intended that
the Chair of ANZTADC would
rotate periodically. The incoming
Chairperson is Neville Gibbs, well
known for his role as the Chief
Editor of the journal Anaesthesia and
Intensive Care as well as previously
being Chair of the ANZCA Mortality
Subcommittee. His experience will
be invaluable as webAIRS has now
collected a critical mass of around
2000 critical events, which will be
analysed and published.
ANZTADC wishes to sincerely thank
Professor Alan Merry for supervising
the creation of the ANZTAD
Committee and the webAIRS
website. His expertise and insight
has been invaluable and he will stay
involved as a committee member.
ANZTADC warmly welcomes the
incoming Chair Dr Neville Gibbs for
this next phase of analysis and the
publication of existing and future data.
Program Improvements
The webAIRS program has been
updated and now includes a feature
that allows a single email address to
be used to log in to multiple hospitals,
day surgeries or private practice. In
order to add additional sites to an
existing account, first of all, log in and
then select Register from the menu.
Registered users will then be able to
select from existing sites or will be
able to add new sites. For fellows
without an existing account, register
as a user and then select or add
sites as above. Local administrator
functions have been upgraded and
during 2014 more user functions
will be added to give feedback to
all users.
at the Gold Coast, Australia in
October 2014. Details of this ASA
session will be announced in a future
NZSA newsletter.
ANZCA 2014 CPD program
Reporting, case discussion or
analysing incidents using webAIRS
qualifies for 2 credits per hour
in the new Practice Evaluation
CPD category. After reporting an
incident there is an option to email
a confirmation of the credits to
your email address. This provides
a convenient way to document
this online CPD activity as well as
assisting fellows who may find it
difficult to attend larger meetings as
a result of distance, time or other
constraints.
Adjunct Professor Martin Culwick
FANZCA, MIT Medical Director,
ANZTADC
Email: mculwick@bigpond.net.au
Administration Support
Email: anztadc@anzca.edu.au
Presentations at Annual
Scientific Meetings in
2014
The first presentation of the year was
at the 2014 Combined AACA and
ASURA meeting in Auckland tilted
“Insights from the ANZTADC web
based anaesthesia incident reporting
system (webAIRS)”. The second
presentation will be a summary of
the webAIRS airway events, the risk
factors and outcomes. This will be
presented at the Airway SIG meeting
which immediately precedes the
ANZCA ASM 2014 in Singapore.
The third presentation will be at
the ANZCA ASM on Thursday 8th
May where webAIRS data will be
presented in the Human Factors
and Patient Data session. This will
be titled ‘A standardised but flexible
approach to managing anaesthetic
incidents’ and will explore the active
use of data to improve safety in
anaesthesia. Finally ANZTADC will be
organising a patient safety session at
the ASA National Scientific Congress
NEVILLE GIBBS
ALAN MERRY
Are you the
Linkperson?
The executive is looking for ways to
communicate more effectively with
colleagues around the country. We are
keen to facilitate communication among
members, between department groups,
and back to the executive. This is particularly
important for those areas which don’t have a
current executive member.
Based on a similar system in the UK, we
are running the Linkperson concept. It
gives you the opportunity to share issues
in your hospital where we could possibly
help, and a channel for your valuable
input into some issues that arise at
central level. The underlying philosophy
is to make executive and office resources
more accessible and to assist in resolving
any issues that may arise quickly.
Each site has a designated local contact
that links in with Executive Committee
link people David Kibblewhite and Emma
Patrick. If you would like to be the local
linkperson in your area or you would like
David or Emma to contact you please
call us on 04-474-0124 or email nzsa@
anaesthesia.org.nz
NZSA AGM
- call for
nominations
The New Zealand Society of
Anaesthetists will hold its Annual
General Meeting as part of the Annual
Queenstown Update in Anaesthesia
(AQUA) being held in August.
NZSA is calling for nominations for three
office-holder positions on the Executive
Committee. The positions are: Secretary,
President and Treasurer.
NZSA is also calling for nominations
for Life and Honorary Members of the
Society. These nominations require
a citation in support of the nomination
which will be tabled at the AGM.
Nominations for the three officer
positions and Life and Honorary
Members close on 21 July 2014.
Nomination forms are available on our
website www.anaesthesia.org.nz, or
if you would like the forms sent to you
please call 04-494-0124 or email us
at membership@anaesthesia.org.nz.
For more information on AQUA see
www.aqua.ac.nz
MARCH 2014 | Issue 37
We Thank All of Our Contributors
For Their Stories
NZSA Advertising Rates
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For contributions to the Newsletter or feedback on
this issue of New Zealand Anaesthesia
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INSIDE ISSUE: President`s Column

Transcription

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