Dr Graham Rowlands and the bizarre attempt to ditch him for a super clinic dream

Listening to Dr Graham Rowlands describe his career would probably give GPs the idea that he is treasured by the community he cares for.

He mentions his years of service in Norseman in WA along with a few references to the on-call hours, the emergency work and his training in obstetrics and anaesthetics.

Like most doctors, he says this with no bombast.

But he is one of those rare doctors working in the middle of nowhere, in a place which to him is the middle of everywhere.

Norseman is tiny, a population of around 700 people, sat at the gateway of the Nullarbor on the traditional land of the Ngadju about 700 km east of Perth.

For the past 17 years, he has been its only full-time GP — at least until recently before he and his wife, Ruth, became embroiled in a bizarre battle with the local council, the Shire of Dundas.

“I think it started with the perception [among some within the council] that a local government body could run a GP practice and turn a profit,” he says.

“There was a belief that I was making shitloads of money.”

He says things came to a head last year when he turned to the council for help, asking for more funding for locum cover.

“The idea was to facilitate a discussion about a long-term health service. I am nearing retirement age, but I am a very isolated solo practitioner.

“The vast majority are aged pensioners or disability pensioners who are unemployed; most do not have the means to pay a private fee, so I bulk-bill.

“I am a bit of a socialist at heart. To support that, I do the 72 hours on call at the regional centres in emergency and anaesthesia. It is about maintaining my skills and maintaining the cash flow.

“But you know what? It is about $16 an hour to be on call.

“The average train driver does not get paid that. And no train driver can work more than 8-10 hours without a break, but in country general practice, you have to.

“People come in overnight with a heart attack, or there are babies that need delivering, or someone is experiencing respiratory failure — they are urgent cases that arrive at any time.

He says dealing with these pressures, means he needs around eight weeks of locum cover to mentally survive.

But for reasons it is yet to explain fully, the council’s response to Dr Rowlands’ request for help was to terminate its memorandum of understanding (MOU) with him.

So along with the existing locum cover it was funding through the MOU, he was facing the loss of his shire-owned house and a car.

The council’s next step was to put out a tender for GP services. 

What happened? As anyone who has ever googled ‘Australia’s rural workforce crisis’ would expect, only one bid was made — by Dr Rowlands himself.

He says the council reviewed his bid and declared it “uncompliant” with its procurement processes.

So it seems the thought process was why not dispense with the services of Dr Rowlands altogether and find someone else.

This is what it did and in his place, a new clinic was launched run by a GP provider called I-Medical.

At this point, things started to go wrong.

Although I-Medical was only registered as a business back in March this year, its Norseman clinic was billed as the region’s first super clinic.

It sounded good: an upgrade from a solo GP practice.

But the doctors recruited by I-Medical were fly-in fly-out. On their arrival earlier this year, the first two recruited to work at the Norseman clinic quickly began to wonder if they had made a mistake in coming.

“When we got there, they had not even done the painting, so the clinic had to be shut for two days,” says Dr Ashley Sood.

 “The skirting boards were not done for the whole time I was there. There was no treatment bed for the first two-and-a-half weeks, so you had to examine patients standing up.

“Half the equipment was missing. There was no nurse.”

Also missing were vaccines and emergency drugs, such as adrenaline, she claims.

Dr Sood and the other GP she worked with only saw a handful of patients a day — no doubt because Dr Rowlands was around the corner still seeing his own patients.

They were also nervous about the cash flow. 

The I-Medical model was also universal bulk-billing, but the GPs could see the Medicare billings they were generating were nowhere near enough to cover the salaries they were promised.

“It would have to be extremely busy even with us doing health assessments,” Dr Sood says.

“But there was no equipment, and we were not doing health assessments; we could never have survived.”

Although Dr Sood says her contract with I-Medical stipulated that she be paid weekly, by the end of the third week of her four week locum stint, she says she had yet to receive a cent.

So when she and the locum agency that had recruited her could not get hold of I-Medical’s owner — an audiologist called Ashley Yong — by phone, Dr Sood drove two hours to Kalgoorlie to see him in person.

Mr Yong gave a convoluted excuse involving computer software, Dr Sood alleges.

“To cut a long story short, I did not follow what he was saying. He said not to worry and that the accountant was all over it. I would get my money.

“I said, not in a raised voice, ‘It is unacceptable. We have been here for three weeks. I have come from Queensland and left my friends and family to come to do this locum job and help out.’

“To which he replied, ‘Well, you are raising your voice to me, so I am calling the police.’

Dr Sood says the police never arrived.

She said she eventually received two payments totalling about $17,000, which did not match the invoices she submitted.

She says she is still owed about $14,000.

In Kalgoorlie itself, it seems there were similar issues at the I-Medical clinic, which had also opened for business in the town.

Dr Sally Partington, who was brought in for an 11-day shift in mid-August along with another GP, says she was stunned when she arrived.

She says they were given consulting rooms in Mr Yong’s audiology clinic. 

There was no signage to indicate a GP clinic was available.

“The problem was that the other GP did not have an examination couch in his room,” Dr Partington tells AusDoc.

“There was no treatment room, so if there was an emergency, there was no treatment room set up.

“We were told we would have nursing support. There was a nurse for three hours on one Saturday.

“There was no light, so I had to use my phone light to insert a speculum. 

“Luckily, the patient thought it was a joke, but you can see the standard of what we were offering. It was very poor general practice — it just was not set up for it.”

Dr Partington and the other GP also had misgivings about the financial viability of the clinic. 

“We were seeing five patients a day max, so we were hardly seeing any patients.”

“We spoke to Ashley Yong, and he said, ‘Do not worry. The council is paying; it is sponsoring this clinic

“We thought that was a relief because there was no way we were earning enough for $2000 a day bulk-billing.”

Five weeks after she finished the locum, Dr Partington was still waiting for her agreed salary — $2000 a day — to come through.

She was eventually paid $11,000 — half what she was owed. The other GP is yet to receive a cent.

Both I-Medical and Mr Yong have been contacted for this article for right of reply.

They have not responded.

Last week, the ABC reported that it had seen documents showing that I-Medical amassed $180,000 in locum fees since the clinics had opened. 

It may not be related, but its parent company (Osdex Enterprises Ltd) has recently hired a restructuring practitioner to manage its debts.

Dr Sood says the company has offered a payment plan to the GPs involved.

The plan was meant to be sent to them last week. But the restructuring company has pushed the deadline to December.

“At this stage, I am not really hopeful anyone will get their money back,” she says.

Dr Rowlands says the whole thing has been a pantomime. But he is also angry.

He says following his request for more support for locum cover, he felt he was suddenly being portrayed in the media as greedy. There were statements declaring he was asking for a “$250,000 pay rise”.

“It was being implied that I was holding the community for ransom. For the past 17 years, I have had a house and a car; it is the sort of arrangement offered to almost every rural doctor.”

The council was approached by AusDoc for comment. It said our original deadline was too short. We extended the deadline. There has been nothing since.

Last week, its president, Laurene Bonza, told the ABC that I-Medical, towards which the shire had contributed $57,000, still had the council’s support.

“At the moment, yes,” she said.

“We have not had any reason not to at this stage. He [Mr Yong] has been keeping us updated pretty regularly.

“There have been a few teething problems, as expected. It is a brand new undertaking. [There have] been a couple of hiccups along the way.”

But maybe the weight of community democracy is being felt.

There was an outcry back in April when it was rumoured Dr Rowlands, described by many locals as a compassionate and caring doctor, was shutting his doors for good.

That alarm seems to have continued through the subsequent trials and tribulations.

But there is hope.

With the I-Medical clinics now floating in troubled waters, there was meant to be a council meeting today to decide whether to go back to the way things were. It has apparently been deferred until next week.

The idea is to sign a new MOU with Dr Rowlands, allowing him to provide the care he has been giving the community of Norseman for the past 17 years.

“Right now, my commitment, and my wife’s commitment, is to the community,” he says.

“With that in mind, we offered an olive branch, sending the council a letter before the expiry of the MOU urging them to reconsider…

“But they have kicked me out of the house and car. My wife and I now rent a local cottage privately.”

More information: Australian Securities and Investments Commission registration