Country's most prestigious doctors at war

Australian Doctor examines the furore surrounding recent elections at the Royal Australasian College of Physicians and asks is it time for an independent inquiry?

The feud over the Royal Australasian College of Physicians and the election of its future president refuses to end.

The allegations are simple enough.

Some of the biggest names in medicine say the election of gastroenterologist Professor Mark Lane earlier this year should be declared void, claiming the ballot was unfair and blighted by "irregularities".

A series of complaints have been made, which the college says were investigated and found to be without foundation.

However, since then the college has refused to make any details public - even to its own membership - despite rumours the investigation process itself was seriously flawed.

With the issue expected to come to a head at a make-or-break board meeting in Sydney on 2 December, Australian Doctor offers an account of what happened: what we know, what we don’t know, and the extent of the college’s silence surrounding its conduct.

We also reveal for the first time details of the board’s investigation into its presidential elections and the reasons why the college’s critics believe an independent inquiry is urgently needed.

The aim is to provide the information for the college’s members — all 23,000 of them — so they can decide for themselves.

Paul Smith, Deputy Editor, Australian Doctor.

March 2016
The election campaign kicks off

The story starts with an email sent a week into the college elections, where five leadership positions are up for grabs.

The college management has already been receiving details on the total number of votes being cast, directly from the returning officer, a company called Computershare.

Initially, it seems to be about trying to ensure the message is getting out to college members to cast their vote.

But a second request is made in this new email dated 10 March on behalf of the college’s CEO Linda Smith — she wants regular updates on the number of votes being cast for individual candidates. 

“Thank you for sending the data to me on Mondays, Wednesdays and Fridays on the total number of votes cast in each of the five ballots,” the email from a manager at the college reads. “We are reading that report to gauge the turnout of voters ... I now have an additional new request.

“For each of the five ballots underway, our CEO would like to know the number of votes cast for each candidate. She would like this report each Friday and Monday morning. The report should be emailed to [email protected] only.”

It adds: “Please do not send the report or copy the email to any other person at RACP. Would you be able to arrange and produce this report for Linda please?”

The response from a Computershare employee is sent 20 minutes later and says: “That is not a problem at all, I can send these reports solely to Linda and won’t include anyone else in it. I will start doing so tomorrow morning.”

Australian Doctor alleges no wrongdoing by any individuals. But the college, including Ms Smith herself, has been repeatedly asked by this magazine over the past three months why she wanted the information and what it was to be used for.

The college, including Ms Smith, has refused to respond.

The president's message to voters
The next day, on 11 March, a message from college president Professor Nicholas Talley (pictured left) is sent via an email to thousands of college members.

Again there is no evidence that this intervention is linked to the information requested by Ms Smith, and there is no claim of impropriety against Professor Talley.

But for some candidates on the campaign trail, the move comes as a surprise, at least in the way they understood the election would be run.

The message outlines the “RACP office holding experience of the candidates”.

Names are listed and beneath them, in bullet points, an outline of the candidates’ various roles with the college. This is also published on the college's website.

But as the email lands, there is consternation in some quarters. A number of candidates claim the information about them is flawed, either with factual errors or omissions, to the point where voters could be misled by what they were reading.

Dr Paul Bauert (pictured left), director of paediatrics at Royal Darwin Hospital, is standing for president  of the RACP paediatrics and child health division.

He says the president’s message fails to mention he is a fellow of the RACP and incorrectly describes him as part of the college’s faculty of addiction medicine, which he believes may raise questions in the minds of some college members about the relevance of his specialty to his sought-after role.

He sends an email to Professor Talley, then, as now, editor of the Medical Journal of Australia, asking for the message to be corrected.

Another candidate, this time battling for the job of president-elect of the college, is Professor Philip Morris (pictured left), a psychiatrist and medical director of the Gold Coast Memory Disorders Clinic.

He also reads the message with alarm. The information about him is misleading, he claims, with significant omissions about his years with the college’s chapter of addiction medicine, specifically the fact he was one of its original founders.

He also claims that unlike other candidates, he was never given a chance to vet the content of the president’s messages before it was sent. 

He writes to the college, demanding a second president's message be sent out to members with a correction, along with an apology.

That doesn't happen, but he does receive back a written commitment from Professor Talley to correct the record of the president’s post on the college website so it "align[s] with your college related experience". 

The vote
When the election results are announced on 6 April, the fight for president-elect is close — perhaps because so few members voted, just 1901 out of the 22,669 who were eligible.

Associate Professor Mark Lane, a New Zealand gastroenterologist, wins with 581 votes, followed by Professor John Wilson, the president of the college’s Adult Medicine Division, with 518 and Professor Morris with 463.

Dr Bauert fails in his bid as president of the paediatrics and child health division.

The election is independently audited by Grant Thornton Australia, which issues a report saying the election was above board.

The demand for an inquiry
After the results, Professor Morris launches an official complaint. He wants the elections declared void. There are a series of allegations, but he says the "President's message" may have distorted the results. 

“I request that the college board investigate my challenge with an independent committee ... I ask that the findings of the enquiry be made public to all college members," he writes in his complaint.

Two days later there is another formal complaint, again calling for the election results to be shelved, pending an independent inquiry.

It refers to serious flaws "owing to a range of irregularities in the procedures".

This letter is signed by seven of the biggest names in Australian medicine, including Professor Peter Brooks (pictured left), a Professorial Fellow at the school of population and global health at Melbourne University, and Professor Stephen Leeder, former MJA editor and emeritus professor of public health at the University of Sydney.

 

Related News: Call to void latest RACP election results after 'irregularities'

The college takes action
In response the college board sets up a working group to investigate. It may be hard to describe the group as independent of the college because it is made up of three RACP board members.

It is not clear what terms of reference the group is given or who they interviewed or the information they collected, but the focus of the investigations, which takes a few days, is on the election of the president-elect.

The working group's report then goes before the college board on 13 May, where its findings, concluding the election was legitimate, are formally accepted.

The board’s backing is not quite unanimous — there are rumours that one long-standing member, Dr Greg Stewart, subsequently quits.

He makes no public comment (either then or now), but Australian Doctor understands he was unhappy that the investigation, given the serious nature of the allegations, was not performed independently of the college itself.

Nothing to worry about?
Those who have demanded full transparency over what happened face various struggles. The biggest problem is that the findings of the investigation — the working group's report and the subsequent board discussions — have been shrouded in secrecy.

And this is not just about secrecy faced by the wider world, those outside the college.

Not only has the inquiry report not been shared with the membership, Australian Doctor has been told it has not been shared with the election candidates themselves - so they could satisfy themselves the election was fair.

Are there reasons for concern here? Well, possibly.

For example, Australian Doctor has learnt that Dr Jonathan Christiansen, a New Zealand cardiologist  — one of the board directors chosen to carry out the investigation — was not a disinterested observer during election.

He in fact nominated one of the candidates for president-elect, the Melbourne physician Professor John Wilson, who came second. 

Dr Christiansen then appears to have been behind a rallying call during the campaign itself, canvassing support for another of the candidates, the eventual winner Professor Lane.

Three days before the ballot closes, in one of a series of his emails obtained by Australian Doctor, he writes:

Hi everyone,

I see that other Pres-Elect candidates are ramping up their email campaigns this weekend.

Once again anything you can do to get more NZ Fellows and Trainees voting for Mark will help. Turnout remains low (<10% I understand).

The ballot closes at 3pm NZ time on Monday.

With thanks,

Jonathan

Australian Doctor does not suggest any impropriety by Dr Christiansen.

But it has to be asked whether he should have been recruited for an investigation into an election in which he took an active role, not only by nominating one of the candidates, but also in actively backing the eventual winner.

Dr Christiansen was contacted this month for a response and has declined to comment.

Certainly, once his role as a nominator of Professor Wilson became known, this became a central part of the campaign by the seven doctors led by Professor Brooks calling for the election results to be shelved.

And it is the triggers for the group's second formal complaint tot he college, made shortly after the board signed off the investigation report.

In this complaint, they also demand to know why real-time voting tallies on individual candidates were being given to the college CEO while the election was running.

This time, the college’s response was blunt.

It wrote back: “The elections were validly and properly conducted, and the board members and CEO acted appropriately, for a proper purpose, and in accordance with the law and usual practice.

“I confirm my previous advice to you that the result of the election of the President Elect stands. 

“The decision of the board is final, and this matter is now closed. No further correspondence will be entered into in relation to it.”

The big silence
Since sending that response, it appears the college hierarchy has shut up shop. Over the past three months, its response to Australian Doctor’s ever-growing list of questions has taken various forms.

The first was two long emails marked “not for publication” from college lawyers threatening legal action against journalists if any story published besmirched the reputation of Professor Talley or the college.

The second response was to send emails urging election candidates not to talk to us.

The third tactic was to issue the college’s only public response to Australian Doctor, the following 20-odd words: “The election was conducted in accordance with all college by-laws. It was independently audited by [the assurance firm] Grant Thornton, with Computershare acting as scrutineer.” 

And the last tactic has been a refusal to say anything — even to simple questions, as basic as whether Dr Christainsen was involved in the college’s internal investigation.

So what is the secret?
But while the college has become mute, Australian Doctor can reveal a few salient details, including the college's “highly confidential - do not distribute” investigation report, which it has refused to put in the public domain. 

It is a thin document. But reading through its three pages, it does make some attempt to deal with the main issues even if you would question the force of the logic it employs.

It refers to the CEO’s request for progressive vote tallies of individual candidates. There is no explanation in the document as to why she made the request or what it was about the information that she saw as important - you would think that important. It is not clear she was even asked to explain.

But the report says nothing sinister was afoot.

“There is no impropriety in the college’s CEO having this information,” it states bluntly.

Yes, candidates’ individual vote tallies were shared on 1 April with Dr Catherine Yelland, who at the time occupied the post of president elect.

But again: “There is no impropriety in the CEO sharing this information with the president elect as confirmed by external advice”.

The report also says there is no evidence that this information was shared with anyone else, including other election candidates.

It goes on: “Even if this did happen as alleged, it is not clear how a candidate’s possession of a progressive vote tally assists their cause.

“All candidates had the opportunity to communicate their messages and to encourage members to vote for them.

"How they chose to run their campaign, their means of communicating their candidacy, where they chose to concentrate their efforts, the network they chose to tap into, and when they chose to stop campaigning was a matter entirely for the candidate.”

The report also looks at the key question as to whether the President's Message and its omissions had any material impact on Professor Morris's bid to become president-elect.

It says: “There is no indication that the president’s message prompted an increase in voting or caused a spike to be cast for candidates other than Professor Morris.”

The members of the working group base this conclusion on the somewhat dubious argument that Professor Morris only dropped to third place in the election rankings 12 days after the president’s message was sent out.

The board decides
So what does the board make of the investigation report?

Few outside the college board itself have ever been given the full details.

But Australian Doctor has obtained a copy of the minutes for the college's 13 May board meeting where under section 4.1 - marked "confidential items" - the report is discussed at length.

There are a number of issues to address  — including Dr Christiansen’s role in the investigation.

There is no mention in the board minutes of his work canvassing for votes for Professor Lane - although this may have been discussed during the board meeting itself.

There is however reference to the fact that he was a nominator of Professor Wilson.

“Did this give rise to a material conflict of interest?” the minutes ask.

The answer given is no. The board's reasoning runs thus: “After discussion, directors agreed that nominating a candidate did not give rise to a material conflict. Every director, like every fellow, has the right to nominate a candidate for president elect.

“Whilst a nominee would have a natural interest in how the candidate they nominated fared, directors considered that such an interest was not material or relevant to the complaints received or to the consideration of the working group’s recommendations.”

But there was another potential conflict of issue to deal with, this time relating to another of the board directors chosen to investigate the election complaints — Associate Professor Grant Phelps (pictured left).

The minutes refers to the fact that he was a former shareholder of Computershare, which had agreed to send the vote tallies to the college CEO.

The minutes stress that Professor Phelps, a gastroenterologist based in Victoria, divested his shares on 10 March - just after the election started but two months before he took part in the investigation.

So, was this a problem?

The minutes say the board directors agreed this did not constitute a material conflict of interest, because the shareholding was "insufficient to be able to exert any influence over the management of Computershare or the conduct of the college's elections in particular". 

Before the meeting ends there is discussion about whether failure to make the investigation independent of the college board could trigger "accusations from some [college] members of an attempted 'cover up' of the issues raised in the complaints".

The answer again is no.

The minutes says the board agreed that the working group was "entitled" to conduct the investigation and there was "no requirement that the working group had to be independent of the board just because the complainants requested this".

The argument doesn't seem to run much further than that, at least based on the information given in the minutes.

There is also discussion about the working party's methods. It turns out that it had decided not to conduct interviews with any "relevant parties" as part of its investigation.

According to the minutes, the working group had thought about it but concluded that conducting interviews would not provide any new information.

Two resolutions are then put to the board.

The first is that the board accepts the investigation that none of the matters made in the complaints affected the result of election of the president elect.

Eleven voted yes, two said no, and one abstained.

The second resolution was that the board confirms the election of the president elect. Twelve voted in favour, two against.

Was the investigation into the complaints robust?
Professor Brooks, having been shown the college documents, is dismissive of the entire enterprise.

“It has done nothing to answer the genuine concerns that were raised and puts the current board and CEO in a very sad light,” he says.

“The really sad thing is that it also reflects on the college as a whole if we don’t stand and say this is not on.

“We live in an age where it seems best to be transparent.” 

Remaining questions relate to Professor Lane –  due to take up the presidency in 2018. 

Has he seen the investigation report?

Does he believe there are question marks surrounding his election to one of the most prestigious positions in medicine?

Does he think there should there be an external inquiry into what happened?

At the end of July, Australian Doctor contacted his practice, asking him to respond. He said nothing. This month we submitted the same questions again.

Again he did not respond.

What next?
On 2 December, the college is due to hold another board meeting in Sydney.

The growing army of critics hope the board will finally agree to an independent and detailed inquiry into what has gone on.

Professor Ian Kerridge (pictured left), professor of bioethics and medicine at the University of Sydney, one of the seven doctors who put their name to the complaint letters, says: “The college has an important place in Australian healthcare and society, and is widely respected around the world.

“But the status that the college enjoys is fragile, and requires that it is open, honest and democratic in all it does.

“What is at risk here is not simply the propriety of internal college processes, but the probity of medical institutions in Australia and the extent to which the public can trust the people on whom their lives depend.

“For the college to refuse to support a full and independent inquiry of the election can only harm the college and erode its social and professional status.”

Disclaimer: Professor Stephen Leeder is an Australian Doctor columnist.

Additional reporting by Tessa Hoffman.