Western NSW Health urged to review standards for fly-in fly-out doctors in chemotherapy dosing report finding

IN THE SPOTLIGHT: Dr John Grygiel, who provided outreach clinics to cancer patients in Orange for 23 years, appeared before the parliamentary inquiry.
IN THE SPOTLIGHT: Dr John Grygiel, who provided outreach clinics to cancer patients in Orange for 23 years, appeared before the parliamentary inquiry.

Fly-in, fly-out medical specialists should be subject to the same safeguards as locally-based doctors, a review into the under-dosing of chemotherapy to patients in Orange has found.

The NSW Upper House committee into the under-dosing of cancer patients treated by Dr John Grygiel in the Western NSW Local Health District [WNLHD], St Vincent’s Hospital Sydney and at Macquarie University Hospital, delivered its findings on Thursday.

Dr Grygiel practiced as a fly-in, fly-out oncologist for 23 years from 1989-2012, holding regular clinics in Orange and Bathurst.

An inquiry found that 23 patients in the WNLHD were prescribed a chemotheraphy drug at a “substantially reduced dose” by Dr Grygiel.

The committee’s finding called for the WNLHD to focus on providing the same safeguards for fly-in, fly-out specialists as those required for local doctors.

“Fly-in, fly-out doctors will always be a necessary component of health care in rural areas,” the report said.

“The committee urges the district to ensure that its review of medical specialist outreach service arrangements encompasses all of the WNLHD, with a strong focus on fly-in, fly-out medical specialists and that proper governance structures are established.

“A comprehensive clinical governance framework will ensure that fly-in, fly-out medical specialists are subject to the same safeguards as locally-based clinicians.”

Committee chair, Upper House MP Paul Green praised the WNLHD for its swift response after it became aware of the situation.

He said its actions were an example to other areas.

The report found St Vincent’s Hospital had failed to respond effectively once it became aware of the situation – although it has now addressed these failures.

Mr Green said a key theme of the inquiry had been about the trust patients placed in their doctors.

“Every patient must be able to trust that their doctor is acting within the bounds of reasonable care, with their consent.

“They must also be able to trust if their doctor’s actions are called into question, their hospital will act quickly to inform and protect them.”

A WNLHD spokesperson said they would examine the recommendations.

“The Health District has accepted and responded to all 11 recommendations that were made that apply to the Health District following the inquiry,” he said.