The former head of the Launceston General Hospital allegedly falsified medical certificates of death to avoid coronial investigations, a parliamentary inquiry has heard.
Launceston General Hospital (LGH) registered nurse and midwife Amanda Duncan gave evidence to the House of Assembly inquiry into ambulance ramping in Hobart on Tuesday.
"I am bringing to light allegations of serious misconduct, among these are the falsification of medical certificates of death by the LGH's former executive director of medical services Dr Peter Renshaw," Ms Duncan told the committee.
"I have received 11 reports from doctors and nurses who have disclosed alleged misconduct relating to the death of a patient including falsified medical certificates of death."
Dr Renshaw held the hospital's top job from 1989 until he retired in 2022.
He retains a non-practising medical practitioner registration from the Australian Health Practitioner Regulation Agency.
Dr Renshaw was found by the Commission of Inquiry into the Tasmanian Government's Responses to Child Sexual Abuse in Institutional Settings to have engaged in misconduct by misleading the inquiry.
The commission of inquiry also examined the case of Zoe Duncan — Ms Duncan's sister — who was allegedly raped when she was 11 years old and a patient at the LGH in 2001.
Zoe died in 2017 from epilepsy complications. She had refused to return to the LGH for treatment.
Zoe's father Craig told the commission he reported the allegation to Dr Renshaw in 2001, and alleged Dr Renshaw downplayed his concerns.
On Tuesday, Ms Duncan told the committee she had worked in the health sector for 10 years.
"Despite my own personal experiences as an employee and as a patient of the Launceston General Hospital, I have been shocked by what I have discovered whilst reviewing Magistrates Court of Tasmania documents and by listening to the number of experiences shared by current and former state service employees of the LGH."
She told the committee she reviewed more than 55 coronial investigation reports relating to people who had died at the LGH.
"Amongst these, I discovered two deaths which were not reported to the coroner by the LGH," she said. "In … [another] report, the coroner states that he disagrees with the medical certificate of death and post-mortem cause of death.
"In total there are 15 deceased patients who I am concerned may be impacted."
In Tasmania, deaths relating to medical procedures, treatment or lack of treatment, must be reported to the coroner in certain circumstances.
Last month, registered nurse Tom Millen told the committee that LGH staff had become concerned that causes of death were not being correctly reported to the coroner.
Emergency department death
Ms Duncan told the committee about a death in the LGH's emergency department.
She said multiple doctors and nurses involved had told her the death may have been avoided if the patient had been reviewed in a timely manner and the resuscitation happened in a hospital bed.
"They expected a coronial investigation … multiple staff involved suspected the coroner would likely make scathing findings against the LGH regarding the person's death," Ms Duncan told the committee.
"Doctors and nurses have stated to me the cause of death Dr Renshaw documented on the deceased's medical certificate defied basic common sense.
"Further, staff stated to me that the nature in how Dr Renshaw made this determination was in their view unethical."
Claims anaesthetist denied treatment to patient in order to give 'kinder' death
Ms Duncan told the committee about a resuscitation she was involved in.
She told the committee a patient was brought into the post-anaesthetic care unit after a simple procedure.
Ms Duncan said a nurse was concerned about the patient's heart rate and blood pressure, and raised concerns immediately with the anaesthetist.
"The anaesthetist was ignoring our urgent request to administer more aggressive medications to the patient to prevent a cardiac arrest.
"The patient's primary nurse reached for the emergency alarm to call for further medical assistance. I witnessed the anaesthetist slap the nurse's hand away, shaking his head and stating 'no'.
"The in-charge nurse and I immediately escalated the situation to an emergency code blue in response to the deteriorating patient. Concurrently the patient went into cardiac arrest.
"Resuscitation commenced, which was unsuccessful after more than 90 minutes of CPR."
Ms Duncan told the committee she and other nurses raised concerns with the management of the operating room suite "that we felt the death was likely preventable given the conduct of the anaesthetist prior to the cardiac arrest".
She said she understood an incident report was prepared outlining those concerns.
"I am not confident any internal investigation into the anaesthetist's conduct was undertaken as a result of the [incident report].
Ms Duncan told the committee that a few days later, she questioned the anaesthetist about his conduct.
"The response from the anaesthetist was, 'Peter Renshaw and I believe the patient would have died at home that day anyway — we gave the patient a kinder death'.
"This remark has disturbed me ever since."
Ms Duncan said she was unable to find a coroner's report relating to that patient's death.
She raised several other concerns with the committee:
- Allegations that Dr Renshaw had refused to pay overtime to junior doctors at the LGH
- A breach of the hospital's code brown (external emergency) policy on the day of the Hillcrest jumping castle tragedy, which meant elective surgery continued at the hospital when it should not have. Ms Duncan said no one was alleging patient outcomes would have been different if the policy was followed
- Allegations that employees do not feel comfortable accessing the LGH emergency department as patients because of concerns about their patient records being accessed inappropriately
- A complaints process that can be difficult to navigate, particularly for patients who are recovering from illness
She told the committee that while Dr Renshaw was no longer at the hospital, "the culture he fostered continues to exist, according to senior doctors".
Call for a commission of inquiry
Ms Duncan called for further investigation into the allegations she raised.
She said there should be a commission of inquiry set up to investigate health system failures in Tasmania.
Ms Duncan said she acknowledged her evidence to the committee may be distressing for members of the community and for state service employees.
"I hope my evidence may bring validation for families who have suspected something amiss with their loved ones' death and/or the legal documentation they received from the LGH," Ms Duncan told the committee.
"I also hope that truth and justice may follow. People deserve dignity in life and in death. Their families deserve truth."
Committee chair and Greens leader Rosalie Woodruff thanked Ms Duncan for the material she provided to the committee.
"We thank you for the incredible body of work that you've provided to us today … if the allegations that you've presented were shown to be true, it's incredibly important that there's justice and there's a proper investigation of the matters you've raised with us."
Premier Jeremy Rockliff said, "any allegation that comes forward as a result of any inquiry will be fully investigated by the appropriate authorities".
Health Minster Guy Barnett said the government took the allegations "very seriously".
"It is a concern. I will be asking my Health Department to follow up and investigate and report back to me as soon as possible," Mr Barnett said.
Health Department secretary Kathrine Morgan-Wicks said preliminary investigations were already underway following nurse Tom Millen's evidence last month.
"The department is aware of further associated allegations raised during today's select committee hearings and will seek additional identifying information to support further investigation into these reports," Ms Morgan-Wicks said.
"Employees or ex-employees with concerns or allegations relating to care or behaviour in our hospitals that is inappropriate can report them confidentially to the Office of the Secretary at any time using our online form."
The ABC has attempted to contact Dr Renshaw.
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