Charlie Teo's parting swipe at medical regulator

Controversial neurosurgeon Dr Charlie Teo has done little to hide his contempt for the system which has accused him of wrongdoing by misleading patients, conducting dangerous surgeries and, in one case, slapping a comatose woman in the face.

Following a final disciplinary hearing this week, he didn't miss the chance for another shot at authorities as a panel of experts adjourned to decide whether to impose a reprimand and restrictions on his activities as a surgeon.

"It is a broken system," Dr Teo told gathered media on Wednesday.

"You're guilty until proven otherwise.

"They take away your livelihood, you lose your reputation, you lose your self respect."

Dr Teo is far from the first person to raise issue with the medical complaints system but has been one of the most vocal, using his profile to call for a royal commission. 

Australian Medical Association President Dr Steve Robson agrees the system is skewed against doctors, saying investigations are overly drawn out, opaque and lacking in support for practitioners.

"The process absolutely needs root and branch reform and it needs it urgently," he says.

Data released by the Australian Health Practitioner Regulation Agency (Ahpra) last week showed over a period of just four years, 16 health professionals, a number of them doctors, had taken their own lives while under investigation by the organisation.

In NSW, the regulatory Health Care Complaints Commission operates similarly but separately to Ahpra, which oversees all other states and territories except for Queensland.

The HCCC is investigating complaints in relation to two of Dr Teo's patients diagnosed with terminal brain tumours who never regained consciousness after surgery, and whether they and their families were properly informed of the risks.

Dr Teo, who is known for taking on risky cases where others would not operate, lamented a scenario where surgeons couldn't offer a second opinion for fear of reprisals.

"This is all about me getting two bad outcomes for something that others said I shouldn't do," he said. 

"In other words, pushing the envelope and thinking outside the box a little bit."

Dr Robson stresses that, as an ongoing matter, he isn't commenting on Dr Teo's case directly. Rather, his remarks concern Australia's broader regulatory system.

"Ahpra are part of a very complex system and we would strongly argue there needs to be overall reform of the regulation landscape to make it simpler," he says.

A spokesman for Ahpra and the National Boards says while patient safety is the primary focus, regulators are open to working with the AMA and wider health industry to reduce stress on practitioners.

"We have long understood that regulatory scrutiny can take a huge toll on practitioners and have been rolling out work to improve our processes and approach since 2017," he says.

"We want to do everything we can to ensure our processes don't make it harder for practitioners than regulatory scrutiny already is."

Head of neurosurgery at Macquarie University Hospital, Professor Marcus Stoodley says in some cases HCCC investigations can take up to five years to reach a resolution, and should be much quicker.

However, he adds, in other ways the regulatory framework is too loose.

With most oversight occurring at a hospital level, Prof Stoodley says, there are quality assurance issues in private hospitals in particular that still leave room for outlying issues.

"The private hospital is happy if there's activity, they don't necessarily follow up on the clinical outcomes or the complications," he says.

"So I think there are also arguments for a strengthening of the process.

"Because there are problems occurring that get swept under the carpet."