witch hunt : OTD Professor Thomas Kossmann

Discussion in 'Australian Medical Council (AMC) EXAM' started by IMG, Nov 5, 2007.

  1. IMG

    IMG Guest

    A case of local surgeons rallying to push out talented outsiders. Has anyone thought about item number fudging with medicare?

    What percentage of relevant surgeries have flexure of colon takig down added to gain extra 400 $ ...even when it was not done? What I mean to say is most ozzie surgeons fudge operations and claims..


    Hospital divided over surgeon

    The Age
    Richard Baker and Nick McKenzie
    November 5, 2007


    * The charismatic surgeon and the mutiny


    VICTORIA's leading hospital trauma centre has been in disarray for several years, with top surgeons refusing to operate with its director, Professor Thomas Kossmann.

    Since 2004, several surgeons working at The Alfred hospital have avoided operating with Professor Kossmann due to concerns about whether his treatment of some patients was excessive. They also complained about his billing arrangements with the Transport Accident Commission — which pays for medical treatment of road crash victims in Victoria.

    The Age can reveal the medical department heads and senior managers at the hospital, which last month announced an external review into Professor Kossmann's clinical practices, have dismissed multiple complaints made by surgical staff over the past three years. Staff have told of a culture of fear and silence at the trauma centre, which treats most of the severe road crash victims in the state.

    Several surgeons who complained to department heads were told to keep quiet. One who confronted Professor Kossmann about his decision to operate on a patient, judged by other doctors to have such serious injuries that surgery was futile, did not get his contract renewed in 2005.

    Professor Kossmann has stood down from surgery while the review takes place. He has declined requests to be interviewed, but in a brief statement through the hospital, he said: "I refute the allegations."

    The Alfred has declined to release the review's terms of reference. It has also declined to answer questions and told The Age that it had only recently received complaints about Professor Kossmann, who was recruited from a Swiss hospital to head the trauma unit in 2001.

    However, an internal memo obtained by The Age suggests that problems in the trauma unit are longstanding. The memo, written in February 2005 by the then head of neurology, Professor Jeffrey Rosenfeld, orders surgeons to assist Professor Kossmann in theatre when requested. "It is expected that you will assist Professor Kossmann … in spinal surgery," it says.

    The memo was written after some surgeons refused to assist him. Several surgeons who still work at The Alfred continue to avoid operating with Professor Kossmann.

    "It's true. People have chosen not to participate in surgical procedures that he's been involved in," said a doctor with recent experience at The Alfred.

    Over the past 12 months, The Alfred conducted a review of its trauma department with a focus on patient care. It is believed doctors raised concerns about Professor Kossmann during this review, which were not acted on.

    The Age has interviewed more than a dozen medical sources who tell a consistent story about concerns over Professor Kossmann's performance and the hospital's repeated failure to act.

    One concern is about his treatment of TAC-funded patients. The commission pays for the medical care of every Victorian injured on the state's roads under the personal injury insurance scheme, paying doctors generous fees for procedures performed on victims.

    It is believed Professor Kossmann has a deal with the hospital that allows him to receive payments direct from the commission, with a percentage going to The Alfred. This contrasts with many other staff doctors, whose payments are pooled, with the money distributed equally.

    It is believed the review into Professor Kossmann was ordered by Alfred chief executive Jennifer Williams after she was recently given a series of patient cases that doctors believed warranted scrutiny. Hospital insiders say Ms Williams is now taking the issue seriously and may not have been aware of all the previous complaints, with senior managers and department heads not passing them on.

    http://theage.com.au/investigations


    COMMENT:

    Professor Kossmann , a leading world authority on trauma surgery was recruited to Australia several years ago. Is it that he is being scrutinised?harrassed (justifiably or not) by colleagues and others? Is it because he is a tall poppy and OTD - and needs to be trimmed for size? Or are such concerns genuine? Or, is it related to reimbursements/cost shifting and fee splitting (commercial arrangements and envy)?

    Your starter again in the Aussie merry go round game of obsession with outcomes! For heaven’s sake, medical practice is an art as well as a science and a judgment call is acceptable. It does not mean that if the majority thinks otherwise, it is correct. It may not be correct and there may not be a correct approach.

    The chronology of events is going to move like this: investigation; if there is anything which can be made to stick, the issue will be reported to the Vic Medical Practitioners' Board. The next step would be either a Disciplinary or Performance Inquiry; either way, Professor Kossmann's career will be ruined - like many other OTDs' careers

    Hospital divided over surgeon

    The Age
    Richard Baker and Nick McKenzie
    November 5, 2007


    * The charismatic surgeon and the mutiny


    VICTORIA's leading hospital trauma centre has been in disarray for several years, with top surgeons refusing to operate with its director, Professor Thomas Kossmann.

    Since 2004, several surgeons working at The Alfred hospital have avoided operating with Professor Kossmann due to concerns about whether his treatment of some patients was excessive. They also complained about his billing arrangements with the Transport Accident Commission — which pays for medical treatment of road crash victims in Victoria.

    The Age can reveal the medical department heads and senior managers at the hospital, which last month announced an external review into Professor Kossmann's clinical practices, have dismissed multiple complaints made by surgical staff over the past three years. Staff have told of a culture of fear and silence at the trauma centre, which treats most of the severe road crash victims in the state.

    Several surgeons who complained to department heads were told to keep quiet. One who confronted Professor Kossmann about his decision to operate on a patient, judged by other doctors to have such serious injuries that surgery was futile, did not get his contract renewed in 2005.

    Professor Kossmann has stood down from surgery while the review takes place. He has declined requests to be interviewed, but in a brief statement through the hospital, he said: "I refute the allegations."

    The Alfred has declined to release the review's terms of reference. It has also declined to answer questions and told The Age that it had only recently received complaints about Professor Kossmann, who was recruited from a Swiss hospital to head the trauma unit in 2001.

    However, an internal memo obtained by The Age suggests that problems in the trauma unit are longstanding. The memo, written in February 2005 by the then head of neurology, Professor Jeffrey Rosenfeld, orders surgeons to assist Professor Kossmann in theatre when requested. "It is expected that you will assist Professor Kossmann … in spinal surgery," it says.

    The memo was written after some surgeons refused to assist him. Several surgeons who still work at The Alfred continue to avoid operating with Professor Kossmann.

    "It's true. People have chosen not to participate in surgical procedures that he's been involved in," said a doctor with recent experience at The Alfred.

    Over the past 12 months, The Alfred conducted a review of its trauma department with a focus on patient care. It is believed doctors raised concerns about Professor Kossmann during this review, which were not acted on.

    The Age has interviewed more than a dozen medical sources who tell a consistent story about concerns over Professor Kossmann's performance and the hospital's repeated failure to act.

    One concern is about his treatment of TAC-funded patients. The commission pays for the medical care of every Victorian injured on the state's roads under the personal injury insurance scheme, paying doctors generous fees for procedures performed on victims.

    It is believed Professor Kossmann has a deal with the hospital that allows him to receive payments direct from the commission, with a percentage going to The Alfred. This contrasts with many other staff doctors, whose payments are pooled, with the money distributed equally.

    It is believed the review into Professor Kossmann was ordered by Alfred chief executive Jennifer Williams after she was recently given a series of patient cases that doctors believed warranted scrutiny. Hospital insiders say Ms Williams is now taking the issue seriously and may not have been aware of all the previous complaints, with senior managers and department heads not passing them on.

    http://theage.com.au/investigations


    COMMENT:

    Professor Kossmann , a leading world authority on trauma surgery was recruited to Australia several years ago. Is it that he is being scrutinised?harrassed (justifiably or not) by colleagues and others? Is it because he is a tall poppy and OTD - and needs to be trimmed for size? Or are such concerns genuine? Or, is it related to reimbursements/cost shifting and fee splitting (commercial arrangements and envy)?

    Your starter again in the Aussie merry go round game of obsession with outcomes! For heaven’s sake, medical practice is an art as well as a science and a judgment call is acceptable. It does not mean that if the majority thinks otherwise, it is correct. It may not be correct and there may not be a correct approach.

    The chronology of events is going to move like this: investigation; if there is anything which can be made to stick, the issue will be reported to the Vic Medical Practitioners' Board. The next step would be either a Disciplinary or Performance Inquiry; either way, Professor Kossmann's career will be ruined - like many other OTDs' careers
  2. OTD

    OTD Guest

    Call for open review of Alfred doctor

    The AGE
    Richard Baker and Nick McKenzie
    November 6, 2007


    THE State Opposition has called on the Brumby Government to order The Alfred hospital to publicly release the terms of reference of an inquiry into the director of its trauma centre.

    The Alfred is refusing to reveal the terms of the external review into Professor Thomas Kossmann's clinical practices, but Opposition health spokeswoman Helen Shardey yesterday said the Government had to act to ensure the inquiry was "open and transparent".

    "It must publicly release the terms of reference, the members of the inquiry review and the findings of the inquiry," Ms Shardey said.

    "These are serious allegations against Professor Kossmann, and about processes within the hospital dating back several years. The Health Minister and the Department of Human Services should immediately disclose when they first became aware of these issues at The Alfred hospital and what steps were taken to investigate these issues."

    Her comments came after The Age yesterday revealed that several surgeons working at The Alfred's trauma centre in recent years had avoided operating with Professor Kossmann due to concerns about whether his treatment of some patients was excessive and about his individual billing arrangements with the Transport Accident Commission, which pays for the treatment of road crash victims in Victoria.

    The story also referred to staff concerns that medical department heads and senior managers at the hospital, which last month announced an external review into Professor Kossmann's clinical practices, repeatedly dismissed complaints in recent years.

    A spokesman for Health Minister Daniel Andrews said the Government would not be commenting on the situation at The Alfred until the review process had been completed.

    He said there would be no instruction to The Alfred to make the review's terms of reference public. The review, which began this month, is led by respected child orthopaedic specialist Bob Dickens.

    Alfred spokeswoman Tracey Ellis told The Age last week that the terms of reference could not be released due to issues of confidentiality. It is not known whether the review will examine concerns about Professor Kossmann's TAC billing arrangements.

    "We believe that this is a robust and independent process and we are careful in that we don't want to do anything to undermine the process," Ms Ellis said.

    Professor Kossmann, who has temporarily stood down from surgery, has released a statement through the hospital saying he refutes allegations against him. He has declined interview requests. Some of his patients contacted The Age yesterday to support the professor, with several saying he had saved them from terrible injuries and was a caring doctor.
  3. Guest

    Guest Guest

    [Some of his patients contacted The Age yesterday to support the professor, with several saying he had saved them from terrible injuries and was a caring doctor.]

    Hehe, he didn't look after his fellow colleagues (aussie assisstants) well and he should have paid them "fairly" for surgical assisstance.

    Remember, Money talks!!!!!!!!!!
  4. OTD

    OTD Guest

    Money talks but if you are a honorable member of the profession (sadly there are only few in Oz), you will desist from letting money talk. Prof Kossmann is one of these dignified few
  5. OTD

    OTD Guest

    Press update on investigation

    Hospital was warned on top surgeon

    The Age
    Richard Baker and Nick McKenzie
    November 29, 2007

    THE Alfred hospital's administration was notified of concerns about its now suspended trauma unit director almost three years ago, a series of confidential documents show.

    One of the documents, written early in 2005 and copied to senior hospital managers, refers to conflict between a senior surgeon and the trauma unit chief, Professor Thomas Kossmann, over his surgical conduct.

    But The Alfred's chief executive, Jennifer Williams, has dismissed the significance of the document and defended the hospital's handling of the inquiry into Professor Kossmann.

    As the State Opposition yesterday called for a judicial inquiry into the matter, Ms Williams also said she had full confidence in the level of care provided by the trauma unit.

    She insisted that the first she knew of serious complaints about Professor Kossmann, including claims that he had performed unnecessary surgery, was only three months ago.

    This was despite a document written by the director of neurosurgery, Jeffrey Rosenfeld, on February 8, 2005, and copied to senior managers including Ms Williams, which refers to conflict between a senior surgeon and Professor Kossmann.

    The document orders the senior surgeon to apologise for publicly attacking Professor Kossmann over his treatment of a car crash victim in 2004. The conflict concerned Professor Kossman's decision to operate on the woman despite the views of other surgeons that her spine and head injuries were so serious that surgery was futile. She subsequently died.

    The document referring to the incident says hospital managers including Ms Williams, medical services director Dr Kim Hill and operations director Andrew Stripp "are all aware of the issues … (the senior surgeon) does have some valid points to make."

    Yesterday Ms Williams conceded that a senior medical department head had been aware of longstanding concerns but had decided they did not warrant investigation. She said she had no reason not to support this department head.

    Ms Williams told The Age last night that the dispute between Professor Kossmann and the senior surgeon centred on a personal issue rather than patient care. The 2004 case was an isolated incident that Professor Kossmann had defended, she said.

    "There were not specific complaints that we were asked to investigate, and I think you are drawing a long bow," she said.

    However, the 2004 case is likely to have been reviewed in the past fortnight by the hospital-commissioned inquiry into the trauma unit director.

    COMMENT:

    An initial 'self initiated' standing down has now become somewhat different. What has been presented suggests differences in opinion and the practice of "the art" being taken overenthusiastically into a political arena and then becoming a smear campaign.

    It is loosely called coherent 'teamwork' and even if there is a procedural flaw, if the majority of the team thinks that way, it goes (democracy or just plain obsession with outcomes?).

    These concerns, from the evidence base point of view can sometimes neither be proven nor disproven and good governance should give the 'victim' OTD the benefit of the doubt whilst closely continuing to monitor the outcomes. I could be wrong.

    This, unfortunately is the culture of Oz...that dissent, even if valid, may not be taken constructive but viewed as disruptive: any takers?.
  6. OTD

    OTD Guest

    'I feel like Mokbel'

    THE AGE
    November 30, 2007 - 2:57PM


    A top Melbourne trauma surgeon at the centre of misconduct allegations says he is distressed at the constant media attention he is receiving.

    etc

    note: the auto spam filter blocked this despite the absence of a taboo word!

    COMMENT:

    See how it has transformed? Just as we predicted it! Prof Kossmann will find it difficult to continue in Australia in another job, and, if he moves back to Europe, the same scenario applies. He has been the subject of an investigation and registration authorities and new potential employers will have to tackle the uncertainty created.

  7. Paul Kiss

    Paul Kiss Guest

    Prof Kossmann

    I worked with Prof Kossmann and some of his German colleagues at the Alfred as an operating theatre technician, where I was constantly impressed by the man's energy. Having worked in operating theatres in Austria I was kind of used to the way he was, but being Australian it's no surprise to me that he got up the nose of a lot of people there - the old Anglo-Aussie medical establishment. I heard rumblings & rumours about him while there. I expected it, found it slightly amusing, and I'm sure in a way at the time he did too, but I'm convinced he was doing the best he could in an effort to bring efficiency to his unit, and the best outcome for patients - it's inevitable that he'd step on toes along the way. He can operate on me anytime, particularly if I'm on death's door (as just about every single patient of his is), and I don't say that lightly. As for other allegations going round, the TAC billing, uneccessary procedures etc etc... of course that's not for me to comment on - I just he can receive a fair hearing on these matters, and I wish him courage through this time.
  8. Galileo

    Galileo Guest

    Mr Kiss (or whoever you are!) These are encouraging words from an Australian. Please reassure Thomas that I can really empathise with him as I have been in the same situation. It takes time to recover but one must never rest to bring the truth and justice to the surface. We hope the honesty of the Rudd leadership will flush out all the bad hats, coalition and labour etc
  9. Sheepish

    Sheepish Guest

    Be careful what you wish for

    Thomas Kossman was a high profile trauma surgeon in the European mould - he took charge whether he was asked to or not, he didn't stick to Australian or UK-style specialty boundaries. He stepped on a lot of toes.

    But he was recruited from overseas to come to the Alfred for a reason: to clear the cobwebs and establish and build a trauma centre from the ground up. Part of the package to tempt him to come to Australia was to bypass the normal restrictions and payment limitations in Australia - after all, why should he come to Australia, and piss off a lot of locals, unless he was going to be paid well? The Alfred did not have the funds or the political ability to give him a large salary - so it struck a deal (which has annoyed a lot of locals) to give him TAC payments where he would not normally be entitled to it.

    He has done the job that he was hired for very successfully, and now The Alfred is getting cold feet because of the political problems his appointment has raised.

    Thomas Kossman is not a typical OTD, and his appointment was not a typical OTD appointment. There is no doubt he is an excellent surgeon in his area of expertise, but The Alfred got what it asked for when they hired him.

    regards,

    Sheepish
    Blog: The Paper Mask
  10. Galileo

    Galileo Guest

    You are correct because the 1996 amendments to s19AB of the Health Insurance Act 1978, though giving some scope for the OTD specialist to claim monies, is sometimes abused by employers (like in my case) with an offer of a salaried post, thence an intended application for a Provider Number for the purposes of s2.2.1 (provider number solely for referral to other specialists) but occultly changed to an electronic payout (overriding the handwritten application for no group pay link - i.e. no payouts) invoking form DB1.

    The change can then be applied for occultly and money claimed using the OTD's name without him knowing it and disbursed into a trust fund. Firstly it is wrong in law, if this type of application process is done; secondly if irregular claims are made, this is a additional offence under this Commonwealth Law and can lead to serious consequences. The events leading up to this may constitute corruption under another Act or Statute.

    In a nutshell, the complex rules made up by the Commonwealth government (presumably under the Howard administration under pressure from the local protectionist Oz medical profession) have actually backfired into a more tightened hangman's noose 8)

    This sounds very complex for OTD specialists and I would advise all reading this NOT to sign anything before carefully studying the sections of the Health Insurance Act 1978 and the 1996 amendments (all searcheable and downloadable from the net)

    If what you said is true, it is then possible that this may be a very sophisticated exercise in cost shifting!
  11. Paul Kiss

    Paul Kiss Guest

    'Kiss' is my family name Galileo, and Paul is my given name... what's this 'whoever you are' business all about?!
  12. Galileo

    Galileo Guest

    G'day Paul,

    Sorry if you are offended. Many people use pseudonyms (including myself) in this India based forum. Sometimes one cannot choose one's parents! Yours have an interesting surname; I went to medical school with a fellow with a surname called 'Coffin' and we have always wondered what career he subsequently pursued!

    Cheers

    Galileo
  13. Guest

    Guest Guest

    The AGE

    Nick McKenzie and Richard Baker
    December 3, 2007


    THE state's chief trauma surgeon has claimed that The Alfred hospital's decision to deny him access to files and X-rays hindered his ability to respond to the allegations that led to his suspension last week.

    In an interview with The Age, Professor Thomas Kossmann also dismissed allegations of inappropriate surgery and of billing fraud, saying the claims were concocted by a small group of disgruntled surgeons.

    Professor Kossmann said his ability to present a defence to the hospital-commissioned inquiry by last Friday's deadline was made impossible.

    "I am cut off completely, which makes the whole thing more difficult," he said.

    "I am not allowed on The Alfred premises, which is just shocking because I gave so much effort in the hospital.

    "The locks are changed, I have no ID access, I cannot access my X-rays in the response."

    The Alfred's chief executive, Jennifer Williams, last week suspended Professor Kossmann due to the "seriousness of the findings" in the draft report by a three-surgeon review team examining his clinical and billing practices.

    Professor Kossmann, who now has until next week to respond, has questioned how he could have been praised less than a year ago in an internal hospital review, only to be stood down last week.

    "In 2006, I was attributed in excellent clinical leadership, and a year later I am a villain," he said. "It doesn't fit."

    He added that until August this year, he had never been the subject of any formal complaints, nor been asked to alter his clinical practices. "I am working in an extremely transparent area, I cannot hide anything. I show all my X-rays all the time."

    He said nobody would have allowed him to do what he had over the past six years had there been questions.

    Professor Kossmann refused to comment directly on the hospital administration's handling of his case, but his comments raise questions about why surgery now considered contentious was not examined when it occurred.

    Professor Kossmann said the allegations against him had been driven by visiting surgeons who feared their hospital surgery time would be cut back as part of his plan to overhaul the trauma centre by employing more full-time staff.

    "It is a very small number of disgruntled visiting medical officers who were fearing that they will get left out in such a system," he said.

    It is believed the inquiry into Professor Kossmann has heard evidence from at least six surgeons who have raised concerns about his conduct.

    A source close to one of them said four of the surgeons had decided to make a formal complaint in August after numerous verbal complaints went unheeded.

    Professor Kossmann said the internal inquiry had backed his handling of a case in 2004, which was later queried by other surgeons and has been the subject of several reports by The Age.

    Professor Kossmann said the hospital had stopped him discussing other cases examined by the review, but insisted he had had never compromised patient care. He also said:

    ■ He had never supervised junior staff in areas outside his expertise.

    ■ An analysis of the thousands of cases in which he had a role in managing showed excellent outcomes.

    ■ A claim by an overseas surgeon that he bullied staff had no basis, and he had, in fact, made himself available to give advice to junior doctors 24 hours a day.

    "If you look at my complication rate, it is very low," he said.

    "Where is there evidence that someone got killed, or harmed? Where is the evidence? You see, this is all fabrication."

    Numerous senior medical staff from the hospital's intensive care department, including its deputy director, Professor James Cooper, have also backed Professor Kossmann's surgical ability, and said they believed the allegations had no foundation.

    Professor Kossmann declined to reveal the extent to which his salary was supplemented by his billing of the Transport Accident Commission, whose lucrative insurance scheme covers all road trauma patients.

    But he insisted he had never fraudulently billed the TAC, and had never previously been queried about his billing practices, which he said he learnt from his colleagues.

    "Because there is no formal introduction to the rules, nobody could tell you if you made a mistake," he said.

    The Age revealed on Saturday that the TAC had last week contacted the police after being briefed by The Alfred about the contents of the draft report, but was yet to lodge a formal complaint.

    "I could solve things which other people could not solve," Professor Kossmann said.

    "We came here invited to Australia.

    "I gave all my professionalism, my lifeblood to The Alfred.

    "My family has made major changes. Our commitment to the community is enormous."
  14. OTD

    OTD Guest

    The article has now been removed 2 hrs later!

    It is clear that press censorship rules in Oz
  15. Guest

    Guest Guest

    Australians see Dr Death in every overseas-trained doctor

    The AGE
    June 14, 2005


    Many doctors are now being judged by their skin colour and accent, writes Sanjov Wijesinha.

    The unfair situation facing many overseas-trained doctors who provide a vital service in this country has been aptly described by the president of the Australian Medical Association, Dr Mukesh Haikerwal: "Doctors who looked different or spoke differently are being targeted for racial slurs or abuse." He said in The Age last Saturday that patients were also demanding to see doctors' credentials, refusing to accept appointments and abusing foreign-trained doctors.

    The fact remains that Australia today needs overseas-trained doctors because, in years gone by, those responsible for educational policies and health-care planning badly underestimated our 21st-century workforce requirements. We now need more medical practitioners than was previously anticipated because our present population needs - and demands of its politicians - high-quality health care.
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    Sadly, the output of our medical schools over the past couple of decades has failed to keep up with this demand, with the result that we have to import doctors (just as we have to import other professionals in short supply in this country, such as pastry chefs and skilled factory workers).

    It is well known that in many parts of the country, particularly in rural and remote regions that have failed to attract and keep "home-grown" medical graduates, the local population is heavily dependent on overseas-trained doctors.

    Unfortunately, these doctors do not wear a badge stating their qualifications or experience, or even if they have passed the Australian Medical Council's qualifying exam, which patronisingly recognises them to be "of a standard equivalent to that of an Australian trained doctor". Sadly, the only criteria by which the general population of patients can judge the competence of a doctor are the criteria they can see and hear - in other words the doctor's skin colour, physiognomy and accent.

    We are now encouraged to refer to doctors from overseas as international medical graduates rather than "overseas-trained doctors" because this has acquired what is almost a derogatory connotation. And once the media get hold of the kind of story that sells newspapers, like that of Dr Jayant Patel ("Dr Death"), it becomes easy for all overseas-trained doctors in our country to be tarred with the same brush.

    "People," said Winston Churchill, "tend to believe what they want to believe" - and it becomes all too easy for simple folk to see a Dr Death in every doctor who bears an ethnic resemblance to Patel or speaks with the kind of accent they expect the Patels of the world to have.

    I have recently read the annual report of the Medical Board of Victoria. Most of the medical practitioners whom the board informs us were "deregistered" or censured were Australian-trained graduates - but does this fact make patients refuse to see an Australian-trained doctor? Why then the reluctance on the part of some people to see an overseas-trained doctor?

    The answer may be that the story of Patel served to reinforce innate xenophobic prejudices and long-held stereotypes.

    If the medical boards in our country want to encourage overseas-trained doctors to come and work here, and to encourage our people to accept these doctors, then they owe both the patients and the doctors a serious responsibility - that of ensuring that the doctors who work here are adequately trained and appropriately assessed.

    At the medical school where I teach and examine some of the next generation of Australian doctors, we teach our students to rely on the time-honoured triad of history, examination and investigation when it comes to diagnosing a patient's condition. Surely, should not the Queensland Medical Board that assessed Patel have taken the trouble to intelligently ascertain his suitability by getting an adequate history of his work experience, subjecting him to a proper examination and investigating his credentials before granting him the privilege of practising?

    We in Australia have got used to seeing overseas-trained sportsmen and women doing yeoman service for the Wallabies, and bringing home gold and silver medals at the Olympics and Commonwealth Games and world championship titles. These people are adequately vetted and professionally trained so that they can do for Australia what they were originally trained to do overseas - irrespective of whether their initial training was in Argentina, Fiji, Sri Lanka or Russia, or whether they carried unorthodox names like Noriega, Tuqiri, Van Heer or Tszyu.

    Would it be too much to ask that we provide our doctors with the same privileges of competent assessment and appropriate training that we provide our overseas athletes?

    Or should we have to live with the stigma that in this country our sportsmen and women are treated with greater respect than our doctors?
    Dr Sanjiva Wijesinha is a senior lecturer in the faculty of medicine at Monash University.
  16. Guest

    Guest Guest

    I see a pattern here. It is similar to the business regarding Professor Paddy Dewan. Clearly, some doctors are too darn good for Australian hospitals.
    If there is a complaint against a surgeon for any reason it should be investigated properly by the hospital concerned before a person's reputation is smeared and their chances of employment spoilt in the future.
    I note in the case of Prof. Paddy Dewan and Professor Kossman, women managers are in charge of the complaints. Is there an anti-male agenda here one wonders? Are these women encouraging complaints so that they can get tough on males who do not appear to be part of the in-group who will support them if necessary? Is Kossman attacked because he is not liked ('nazi' stereotype perhaps because of his manner?) and others who prefer to be left alone, not challenged by the 'too hard' basket?
    I believe Prof. Kossman has been doing his job to the best of his ability until proven otherwise. If people cannot work with someone who is really excellent then perhaps they should have counselling.
    I am sure there are people who are over-servicing out there. They range from the eye specialist (Australian) who wanted to remove cataracts from my grandmother-in-law. She had another opinion and was found not to have cataracts. Her problem was incurable. There was the surgeon who put a scaffold into the spine of my father-in-law who was aged 84, probably knowing full well that there was insufficient bone there to support it and that the man was so advanced with prostate cancer that he was not going to survive it anyway. No stress to the surgeon or my mother-in-law as Repatriation paid for the deal. There was the eye specialist who removed a tag from my eye and billed me for the removal of a 'tumour'. One could go on. The lay person has few legs to stand on. If we complain too much we will not have anyone to treat us at all. If we complain about surgery done to those who are virtually on their deathbed, we would be denying ourselves the exception who could survive such surgery and be improved and survive another day. I know such a case in the U.S. who has had many surgeries on various parts of his body, each time his family has thought he was going to die. He has survived a few precious more years when his various conditions deemed he should have died. He is not complaining.
    I have had more problems with vets who have performed procedures on my cats which have cost me lots and lots when the animals should have been put down. Humans are different though. They are not dead until they are dead. That goes for coma cases which may survive further down the track but are often switched off life support. Numerous other cases like burns victims are probably allowed to die when other cases that have had extensive treatment have lived under similar circumstance. There is surely no rule as to what constitutes a hopeless case. More public money has been wasted on causing casualties by western powers (Australia participating) in Iraq than has been spent on the 'hopeless' case in Australia - of that I am sure.
  17. Galileo

    Galileo Guest

    ".........I note in the case of Prof. Paddy Dewan and Professor Kossman, women managers are in charge of the complaints. Is there an anti-male agenda here one wonders?......."

    How interesting! I have never wish to play the sex or the race card, but now that you have mentioned it, all my troubles in Oz have been caused by women managers - and I can assure you that they all gang up and do their bit...there is even evidence of their meeting up socially in parties as evidenced by the photos they display on their walls in their offices!

    Given that I am a non white male and was an easy target being and OTD, they considered this fair game.

    Galileo
  18. Galileo

    Galileo Guest

    How interesting!

    I had never wished to play the sex or race card: I can confirm that all my troubles in Oz had been caused by women administrators and managers lording over the minority males....

    G
  19. Guest

    Guest Guest

    don't forget FEMALE NURSES!!!!
  20. Galileo

    Galileo Guest

    YES! The subgroups are:

    1. Nurse Unit Managers (some)
    2. Those with homosexual (female) leanings (their right)
    3. Others - eg who may be racist etc

    Generally, nurses everywhere are reasonable I would say, even in Australia...but, I have no real desire to return despite any offer of PR (I have my Specialist recognition) to work as a doctor. I will however, consider return to study law and specialise in medico legal issues or to work as a specialist Medicare Investigator (I have to be an Oz citizen though and if the same thing happens to me again, I cannot easily move elsewhere to pursue my profession)
  21. OTD

    OTD Guest

    Surgeon's patients can't believe claims

    HERALD SUN
    Grant McArthur

    November 30, 2007 12:00am

    JASON McCartney says he owes his life to trauma surgeon Thomas Kossmann.

    The former AFL star and Bali bombing survivor can't believe the allegations against Prof Kossmann, which saw him stood down by the Alfred hospital this week.

    McCartney is one of several patients throwing their support behind the leading trauma surgeon who is fighting claims he undertook unnecessary and excessive surgery.

    McCartney said he was dumbfounded when he first heard concerns about Prof Kossmann's conduct several weeks ago at an Alfred Foundation meeting.

    "Without doubt I owe my life to him," McCartney said.

    "He was the one who stabilised me (after the Bali bombings) and got me through the early stages, the worst part, and the burns surgeon took over.

    "I got to know Thomas quite well and he is amazing. He is cutting edge in what he does and he works so hard for the hospital in raising a lot of money for the trauma research centre.

    "He is quite an incredible individual."

    Rather than overservicing, Steve Thomas said Prof Kossmann talked him out of an excessive TAC-funded operation in 2003.

    Having had his broken back repaired by Prof Kossmann after a 2002 motorcycle crash, Mr Thomas went back a year later when he was told another operation would stop it locking.

    Mr Thomas said instead of placing a steel cage around four damaged vertebrae, Prof Kossmann talked him into physio, which repaired the damage over time.

    "I would have been more than happy to go ahead with it because I was in severe pain," Mr Thomas said.

    "I don't know if he would have made a packet out of it, but he absolutely talked me out of the surgery because at that moment I was open to anything because of the pain I was in and not being able to move too well.

    "He was always the nicest, most courteous doctor I spoke with at the Alfred, and I saw a few of them."

    After arriving at the Alfred with a broken back, smashed right leg and jaw, head injuries, internal bleeding and multiple fractures after a January 2004 car accident, Xavier Bell, 20, believes allegations against Prof Kossmann are "100 per cent rubbish".

    COMMENT:

    I am not a friend or supporter of Thomas Kossmann. Only a very concerned individual to note that a pattern against OTDs is emerging: it first started with Patel which was widely publicised; then more occult cases like Galileo (disclosed here in this forum incognito) which has remained confidential to the Press. Then it came Dr Haneef, which everyone knows about. Another is Dr Alkazali (also discussed in a thread here). Now it is Professor Kossmann. There was also a Paracelcus but this appears to have been wiped out and altered to Nostradamus (also in this forum)

    What has gone wrong with the Australian Health System?
  22. OTD

    OTD Guest

    Surgeon to legally challenge hospital

    The AGE

    Richard Baker and Nick McKenzie
    December 8, 2007


    VICTORIA's chief trauma surgeon is expected to challenge The Alfred hospital's decision to suspend him.

    The Age believes that lawyers for Professor Thomas Kossmann are considering taking action in the Supreme Court early next week to argue that his suspension was invalid and did not comply with the Health Services Act.

    The legislation stipulates that medical professionals cannot be suspended until they have had the opportunity to defend themselves before a hospital's board. There is doubt over whether Professor Kossmann was able to do this before his suspension last month.

    A spokesman for Professor Kossmann said yesterday: "Thomas Kossmann is exploring legal options to remove the stain on his otherwise exemplary record as a surgeon."

    Hospital chief executive Jennifer Williams yesterday stood by her decision, saying the director of Australia's biggest trauma centre had been suspended because of the seriousness of the findings in the draft report from an expert panel commissioned to investigate misconduct allegations.

    "The hospital has a duty to investigate complaints in a robust and fair manner," she said.

    The panel is investigating allegations that Professor Kossmann performed unnecessary surgery on scores of road accident victims and wrongly billed the Transport Accident Commission insurance scheme that pays for their treatment.

    Professor Kossmann has described the allegations of excessive surgery as "obscene lies". He has defended his TAC billing, saying he had never received any complaints since joining The Alfred in 2001, and had learned how to submit the paperwork by watching fellow surgeons.

    Professor Kossmann is due to respond to the draft report on Tuesday, having been given a 12-day extension by the hospital. It has pledged to publicly release a summary of the final report's findings.

    It is believed that the inquiry is also examining complaints about Professor Kossmann's supervision of junior staff and unwillingness to participate in peer review programs.

    Professor Kossmann said this week his workload may have led to a breakdown in communication between himself and other surgeons.

    He said he performed many roles at the hospital and he had asked for two deputy trauma directors to be employed to ease his workload. His request had been denied.

    "I am a surgeon first of all, I take care of patients. I am an administrator, I am trying to organise the freelancers," he said.

    "I am managing the National Trauma Research Institute. I am a fund-raiser. I am a political adviser for the (State) Government and the Health Minister. I went on several trips with them to advise them … my role is enormous."

    COMMENT:

    Thomas Kossmann has done the right thing. But, what people do not know is that a Supreme Court Legal challenge costs at least AUD100K and if he loses, he will have to pay the other side. This is the downside. How many OTDs have the luxury of having access to AUD 100K and also an ability to support a 'security for costs' challenge by the other side if challenged?

    We hope that he will get his justice.
  23. Guest

    Guest Guest

    And, of course for the recalcitrant health chiefs, they are using bottomless funds ultimately borne by the Ozzie taxpayer

    Could it be that they are trying to show the public that they are doing their work? i.e. in large numbers, they have nothing better to do?
  24. OTD

    OTD Guest

    The Herald Sun


    December 11, 2007 12:00am

    Geoff Wilkinson

    EMBATTLED trauma surgeon Thomas Kossmann has sued the Alfred hospital over the decision to suspend him.

    Prof Kossmann's lawyers claimed in a Supreme Court writ issued yesterday that his suspension was illegal and invalid, and denied him natural justice.

    The writ said Prof Kossmann's reputation had been significantly damaged by his suspension and he had lost income from his practice as an orthopedic surgeon.

    Prof Kossmann, the Alfred's director of trauma as well as director of the National Trauma Research Institute, has also gone on the front foot over allegations he defrauded the Transport Accident Commission.

    He said through a spokesman that he had offered to hand over all relevant documents to the TAC's chief executive for assessment.

    The spokesman said only four cases billed to the TAC were now in dispute and Prof Kossmann was confident his name would be cleared.

    The writ issued yesterday alleged that health provider Bayside Health breached its employment agreement with Prof Kossmann by suspending him without giving him adequate opportunity to be heard.

    It said Bayside Health chief executive Jennifer Williams suspended Prof Kossmann on November 27 after telling him a peer review had raised very serious matters against him.

    The peer review was launched on September 10 after allegations of clinical and administrative malpractice were made against Prof Kossmann.

    Prof Kossmann, who started work at the hospital in 2001, had attracted overwhelming support from former patients since the allegations were made public a fortnight ago.

    He has been given until today to respond to issues raised in the review panel's draft report.

    The writ said the directors of Bayside Health acted outside their powers under the Health Services Act by delegating to Ms Williams the power to suspend senior medical staff.

    It said Prof Kossmann was never provided with particulars of the allegations concerning billings before the review hearings.

    The review's terms of reference outlined the general tenor of allegations concerning treatment of patients, but did not

    identify any of the patients or the people who had made allegations.

    The writ alleged Prof Kossmann was provided with 24 patient records between October 18 and November 9, and did not have adequate time to prepare a response to complex medical issues before he first appeared before the review on November 18.

    He was allegedly refused permission to be legally represented, given limited time to respond to matters raised at the review hearing and repeatedly cut off when trying to answer questions.

    Prof Kossmann has sought unspecified damages and costs.

    He has also asked the court for an injunction restraining Bayside Health from treating his suspension as valid.

    COMMENT:

    Good on you! Thomas, we are behind you but after this post will now refrain from commenting as we cannot be seen to be influencing.

    Maldministration, deceptive conduct, unreasonable protectionism, malfeasance (and, mala praxis in the case of medically qualified administrators) etc all over Australia should be exposed, critically surveyed and taken to task by the new Commonwealth government. Cheers
  25. OTD

    OTD Guest

    The HeraldSun

    December 12, 2007 12:00am
    Geoff Wilkinson


    SUSPENDED trauma surgeon Thomas Kossmann has strenuously denied performing unnecessary surgery in his formal response to allegations against him.

    Prof Kossmann's 250-page response, delivered to the Alfred hospital by his lawyers late yesterday, also rejects claims he had performed procedures to defraud the Transport Accident Commission.

    He is believed to argue that there is no link between any allegedly ill-advised or unnecessary medical procedures and any bills for service he lodged with the TAC.

    Prof Kossmann's submission will now be considered by a peer review panel considering allegations against him by other doctors.

    The German-born surgeon is director of the Alfred's trauma department and director of the National Trauma Research Institute.

    He blames a small number of the 30 visiting medical officers who work part-time for the trauma unit for making the claims that have threatened his job and reputation.

    Prof Kossmann has said previously the disgruntled medical officers had been upset by his attempts to change rostering and the culture of the unit.

    The review panel's draft report is believed to have examined 24 surgery cases involving Prof Kossmann since he started at the hospital in 2001.

    The draft report is believed to have also addressed claims of inadequate supervision by Prof Kossmann of younger doctors and complaints related to peer review meetings at the hospital.

    A spokesman for Prof Kossmann said there had been no adverse outcomes for patients in any of the cases considered by the panel.

    The Alfred's chief executive, Jennifer Williams, said Prof Kossmann's response would be considered by the review panel, which would make its final report as soon as possible.

    Prof Kossmann is likely to remain suspended on full pay until the final report is released.
  26. Guest

    Guest Guest

    Retaliation by authorities a high possibility

    I predict that out of pure retaliation rather than the true merits of the case, Professor Kossmann will be referred by the administrators/peer reviewers to the Medical Board for concerns.

    If, on further investigation, any adverse findings deemed to be tantamount to professional misconduct or unprofessional conduct as defined in the terms of reference of the act regulating medical practice in Victoria (Health Professions Registration Act 2005), will most certainly either lead to disciplinary action and/or lead to conditions being imposed on the Professor's practice.

    However, to his advantage could be the Medical Treatment Act 1988.

    This pattern of attack is quite regular with administrative authorities dealing with Overseas Trained doctors in Australia.

    It is known by administrators and the Colleges as a valid and permissible means of putting a blot on a doctor's cv however unjust and uncivilised.

    The chances of one allegation sticking out of the large number launched is fairly high. Here it is said that there were >20 allegations related to surgery and there may be more.

    If Professor Kossmann is wise (which he is), he will now ensure that his patients whose names had been associated with these complaints be shown such allegations. Very often it is not the patient who had complained but some third party (usually a trouble maker) using and strongly relying on hearsay.

    And, if the hearsay is not related to competence issues (which the patient can also reasonably judge), there may be recourse to obtaining a patient's opinion. Then, for example, Statutory Declarations should be immediately obtained from these patients. Press statements are useless and serve as publicity stunts of one's word against another's.

    If it can be established that such hearsay is false and even malicious, then, one remedy would be to make a report to authorities on a breach of a section of the Victorian Crimes Act 1958 or even the Criminal Code Act 1995, a Commonwealth Act which is linked to any offence against any Commonwealth Act (eg related to financial benefit claims, or event the Criminal Code Act itself). Commonwealth Law prevails over State Law in Australia in the event of a conflicting interpretation or judgment.

    The remedies for convicted offences for Commonwealth Acts are very heavy and can be up to and exceeding 10 years of imprisonment amongst other things. I am sure quite a few perpetrators of Professor Kossmann's current troubles deserve to be taken down this path if they are guilty of misfeasance.

    It is perhaps why that the action by authorities is so heavy handed.

    However, also note that two eminent British professors of paediatrics (Sir Roy Meadow and Dr David Southall) have recently been struck off the GMC Medical Register for furnishing false expert evidence which had led to several people being imprisoned erroneously. The errors were said to have been arrogantly maintained by claims of presumed infallible superior expertise, which unfortunately proved to be truly wrong. Sir Roy has succeeded in getting a higher court to reverse the decision - for different reasons; Dr Southall was only struck off over the past fortnight and he is expected to appeal.

    No one is infalliable, especially so, the mandarins of the Royal Australasian Colleges or the Health Authorities who may wish to deny their megalomaniac tendencies.

    So, in conclusion, Professor Kossmann has an option of a defence and also another of a defence combined with an attack which will more likely increase his chances of compensation.

    But, at the end of the day, he will have some difficulty finding a job in Australia and in developed nations.

    He will be joining the merry band of the late Paracelcus, Galileo and Haneef...

    The vital remedy which he has proactively sought and, which is very tactical is the very costly Supreme Court action.


    N
  27. Guest

    Guest Guest

    The AUSTRALIAN

    Natasha Robinson | December 12, 2007

    ONE of the nation's most renowned trauma surgeons claims to have "systematically dismantled" allegations that he recommended and performed rogue surgery and fraudulently billed the Victorian Government's insurer.

    The chief of the Alfred Hospital's trauma centre in southwest Melbourne, German-born surgeon Thomas Kossmann, has responded to allegations levelled by other doctors at the centre. The accusations are at the heart of a health authority investigation over possible serious misconduct.

    The Australian has learned that a draft report compiled by a peer review panel, which examined serious allegations against Professor Kossmann, details three instances in which the surgeon allegedly suggested or recommended "ill-advised" surgical procedures in consultation with other doctors.

    The surgical procedures did not take place, but the controversial professor's surgical techniques are understood to have deeply concerned fellow surgeons.

    A fourth case of alleged "ill-advised" surgery relates to one instance in which the surgeon is understood to have carried out spinal surgery using a two-step method that troubles many Australian surgeons.

    It is understood that Professor Kossmann has rebutted all of the allegations in a response provided yesterday to the health authority responsible for the Alfred Hospital, Bayside Health.

    Allegations that Professor Kossmann rorted the Transport Accident Commission system are understood to relate to four insurance transactions considered potentially suspect by the peer review panel.

    The professor is believed to have drawn on analysis by former TAC officers who have found no irregularities in the transactions.

    The furore surrounding Professor Kossmann has revealed that the working arrangements at The Alfred's trauma centre have been dysfunctional for years, with several surgeons refusing to operate with Professor Kossmann. The professor has also launched a Supreme Court action challenging The Alfred over his suspension on November 27.

    Professor Kossmann has hired public relations consultants to defend his name and, while refusing to release Professor Kossmann's documented response to The Australian yesterday, a spokesman for the surgeon said Professor Kossmann believed he had filed watertight defences to every allegation against him.

    "The response systematically dismantles the allegations contained in the draft report," Professor Kossman's spokesman said.

    Professor Kossmann is seeking a Supreme Court injunction on his suspension by Bayside Health chief executive Jennifer Williams, claiming he was given inadequate opportunity to respond to the allegations against him before he was asked to appear before the review panel on November 18.

    The peer review panel examining the allegations against the surgeon, headed by child orthopedic surgeon Bob Dickens, is expected to publicly release a summary of its final report once it has examined Professor Kossmann's responses.
  28. Guest

    Guest Guest

    The Supreme Court action is very appropriate as it will also make authorities think twice about reporting any frivolous matter to the Medical Practitioners Board and also for the MPB to think again before it dares make any statement about Prof Kossmann: 2 levels of danger temporarily blocked if not averted.

    Well done Prof Kossmann! You did the right thing

    N
  29. OTD

    OTD Guest

    Vic Opposition calls for inquiry into trauma unit

    ABC Website
    PM - Friday, 30 November , 2007 18:34:00
    Reporter: Alison Caldwell


    MARK COLVIN: On one side there's an extremely senior surgeon who says the media are hunting him as if he were a criminal like Tony Mokbel.

    On the other, there are accusations against that surgeon that he performed operations that weren't needed because if he did more operations he'd make more money.

    It's the saga of the Alfred Hospital in Melbourne, home to one of Australia's leading hospital trauma units. The accusations against Professor Thomas Kossmann come from fellow surgeons, but the professor's defended himself in the media.

    Now Victoria's Opposition is calling for an independent judicial inquiry into the way the Alfred Hospital has handled the complaints.

    Alison Caldwell reports.

    ALISON CALDWELL: As head of the Alfred Hospital's trauma unit, Professor Thomas Kossmann is one of the highest paid surgeons in the country.

    According to surgeons who have worked alongside him over the past six years, he's been performing unnecessary and excessive surgery on patients as a way of making more money for himself.

    Speaking for the first time since he was suspended earlier this week, Professor Kossmann says he'd do it all again.

    THOMAS KOSSMAN: There are always different ways how you can treat patients. You see, one of the things for, my aim was to deliver better patient care and to be also very efficient.

    If you look for example on the figures we have in the length of stay, we have, I can proudly say that instead of being nine days in the hospital, the average trauma patient is not a little more that six days in the hospital, which means we are actually saving taxpayers money to get these people quicker, out of the hospital.

    ALISON CALDWELL: It's a unique situation because on top of his salary, the surgeon and the hospital both receive payments from insurers each time he operates. In the case of serious road crash victims, it's Victoria's Transport Accident Commission which pays him and the Alfred.

    Professor Kossmann says he was only doing what he was told.

    THOMAS KOSSMAN: If there is no clause, there's no real instruction, and by asking colleagues how they are going, I learn somehow, the system. So the statement I can do, if I have got it wrong, I'm pretty sure some other people have got it wrong and probably that is something which needs some more, let's say, inside and some more investigation of the others.

    ALISON CALDWELL: The Alfred Hospital suspended him pending the final report from an external peer review into his conduct. That report will be made public early next week.

    There are concerns however that the hospital failed to act on complaints when they were first made three years ago. And questions are being asked about the hospital's system of third party payments for surgeries.

    Dr Stephen Bolsin is the anaesthesiology director at Geelong Hospital. He says an independent inquiry is needed to investigate what happened at the Alfred.

    STEPHEN BOLSIN: I think it's important to hold a very open and a very wide range of inquiries. I think that it seems that there was some very unusual, perverse incentives in Professor Kossman's contract, and we need to know who put that contract in place and what was going through their mind at the time the contract was being drawn up.

    And we need to make sure that they had the best interest of the patients at heart and weren't actually doing something that they knew might gain the hospital or gain the surgeon or lead to some kind of inquiry.

    ALISON CALDWELL: Dr Bolsin sparked a major public health inquiry in Britain after he revealed the deaths of young children at the Bristol Royal Infirmary over a decade ago.

    He says serious questions need to be asked of the Alfred's administrators.

    STEPHEN BOLSIN: This is an issue of what a hospital was hoping to achieve in setting up the contract that it did for Professor Kossman, whether it could have done it in a much more fitting manner, and whether it would have been possible to avoid the potential conflicts of interests and potential perverse incentives that seem to have been included in his contract at this time, and I think that as the major trauma centre in Victoria, it is very important that the hospital administration are seeing to learn the lessons of this debacle, rather than having the ability to avoid questioning by a properly set up inquiry.

    ALISON CALDWELL: Victoria's Opposition agrees. Health spokeswoman Helen Shardey.

    HELEN SHARDEY: I think there's a very serious consideration, a very serious matters in any workplace, but particularly in a hospital. And for that reason, I think this hospital should have its processes examined by an independent body.

    MARK COLVIN: Victoria's Opposition health spokeswoman Helen Shardey, ending Alison Caldwell's report.
  30. OTD

    OTD Guest

    Suspended Alfred surgeon working at Epworth
    The Age
    Nick McKenzie and Richard Baker
    January 29, 2008

    THE trauma department chief suspended by The Alfred hospital over allegations of serious misconduct is operating on patients at the Epworth Hospital.

    Reports of Professor Thomas Kossmann's return to the operating theatre come as an Alfred-commissioned medical panel completes its report on whether he carried out unnecessary surgery or used inappropriate billing practices. Professor Kossmann was suspended from The Alfred hospital last year after a draft report from the panel made adverse findings against him.

    The panel is expected to submit its final report next month.

    A spokesman for Professor Kossmann said yesterday the German-born surgeon, who is fighting his suspension in court and has denied any wrongdoing, was frustrated at not being able to conduct surgery at The Alfred.

    "He does not want to get into the details of what he is doing at the Epworth, except that he is doing procedures he is amply qualified to do," the spokesman said. "There is a need there and a demand and he wants to keep practising as much as possible to maintain his surgical skill levels to the highest degree possible."

    A spokesman for the Epworth Hospital said Professor Kossmann's suspension from The Alfred did not alter the private hospital's view of him. "His accreditation as a surgeon has not been suspended and he is highly respected by staff here (at the Epworth)."

    A senior doctor from The Alfred said Professor Kossmann's return to surgery undermined The Alfred's investigation and suspension process. Until matters were resolved, Professor Kossmann should not be allowed to operate in any Victorian hospitals, the doctor said.

    The Age last year revealed the investigation into allegations that Professor Kossmann conducted unnecessary procedures on road accident victims and rorted the Transport Accident Commission scheme that pays for their care.

    The medical panel's draft report contains adverse findings against Professor Kossmann in the four key areas of surgical procedures, his TAC billing, participation in peer review and supervision of junior staff.

    Many of the findings have since been challenged by Professor Kossmann.

    The Age can reveal that the Victorian Managed Insurance Authority, which insures all public hospitals in Victoria, is advising The Alfred's lawyers on Professor Kossmann's decision to fight his suspension in the Supreme Court.

    The Alfred is believed to have taken out an extra insurance policy with the authority to protect senior hospital figures, including chief executive Jennifer Williams and several doctors, from facing personal litigation.

    The TAC is also believed to have become a recent client of the authority. Several of its top executives were in senior roles at the TAC when Professor Kossmann's alleged irregular billing occurred.

    COMMENT:

    It appears that the Press is being confused between being suspended (and investigated) by a hospital - an internal matter....and, being suspended by the Medical Board (a statutory matter). As the far as one is aware, it is the former and one should not pre-empt the Supreme Court case by any comment or reporting. This is just poor journalism.

    Of course, if Prof Kossmann had not filed a Supreme Court challenge, anyone can speculate on anything and this is how the majority of health administrators in Australia are trained to do - in order to destroy a targetted clinician's career. The training, it is said, had originated from the previous (not know whether it is the present) Queensland Health and is spreading as these characters disseminate their filth across the region and indeed the world.

    For OTDs wanting to come to Australia, one must be warned that you are automatically a target and continue to be prime targets of this tactic.
  31. OTD

    OTD Guest

    Surgeons' billing questioned by secret TAC audit

    The Age

    Richard Baker and Nick McKenzie
    February 8, 2008


    A SECRET Transport Accident Commission audit of The Alfred hospital reveals surgeons may have billed the TAC for treating patients they had not actually seen.

    The 2007 TAC draft audit also asks why the commission is pumping millions of dollars it receives from Victorian drivers into hospital services that are already taxpayer-funded.

    The release of the audit under the Freedom of Information Act comes amid continuing controversy over the suspension of The Alfred's trauma director, Thomas Kossmann, who is being investigated by a medical panel over allegations that he performed unnecessary surgery on patients and wrongly billed the TAC. He has rejected the allegations.

    The identities of two doctors named in the audit were removed from the documents, but The Age has confirmed Professor Kossmann is one of the doctors named. It has been reported that The Alfred received a percentage, possibly as much as 50%, from each of his TAC billings.

    Written by the deputy of the TAC's clinical panel, David Bolzonello, the audit found irregular note-keeping in patient files at The Alfred made it impossible to correlate doctors' billing records with patient data.

    The February 2007 audit, done without the knowledge of The Alfred, was unable to ascertain if senior doctors who had billed for treating patients had actually seen them or whether more junior doctors — who cannot charge the TAC — had done the work. It concluded: "It is unclear from the notes if this reflected actual review by these people themselves (who submitted bills) or the unit staff such as registrars as I could not see regular entries in the files to correlate the billing."

    The TAC pays for the treatment of road accident victims in Victoria through compulsory third-party insurance premiums on motor vehicle registrations.

    Several doctors at The Alfred have accused some senior colleagues of billing the TAC for work they have not done.

    The disclosure of the audit has renewed pressure on the Brumby Government to review the relationship between the TAC, doctors and public hospitals, with Opposition Leader Ted Baillieu yesterday saying it enhanced his call for a judicial inquiry into the controversy at The Alfred. "There are numerous doctors and public officials involved in this matter and it is imperative that their roles and actions are clarified as soon as possible," he said.

    Other issues raised by Dr Bolzonello's audit included:

    ■A review of the State Government policy governing financial transactions between public hospitals and the TAC. "… The Alfred and its equipment are owned already by the people of Victoria. The resident staff is also paid by public funding. The TAC is then billed at private rates for radiology, pathology and bed fees. There is some argument for review of this."

    ■A lack of clinical notes to summarise the "management and decision making" of The Alfred's emergency department.

    ■Queries over whether the use of scans and hospital equipment — for which the TAC could be billed — was excessive.

    The TAC took no further action after receiving Dr Bolzonello's audit, which examined 50 patient files and concluded the medical management to be reasonable. His audit did not review individual billings.

    A TAC spokesman said the rules governing billing "rely to some degree on the honesty of the individual or organisation submitting the account". Procedures were in place for fraud to be investigated, he said.

    A spokeswoman for The Alfred said the hospital had not received any billing complaints from the TAC. "There is a funding system set up by the Department of Human Services and the TAC. We follow the rules and we are no different to other hospitals working in that system."

    Professor Kossmann, who is awaiting the final report of a medical panel commissioned by The Alfred to investigate serious allegations against him, said the TAC audit contained nothing to undermine his reputation.

    The German-born surgeon was suspended by The Alfred in November due to adverse findings in the panel's draft report. He has challenged his suspension by Bayside Health in the Supreme Court.

    Professor Kossmann said he would be happy to work under a more efficient TAC billing system if one could be established. "I'm a surgeon not a policy maker. These issues are for the (TAC) minister and the TAC board."

    The final report into the allegations against Professor Kossmann is expected to be released this month.
  32. OTD

    OTD Guest

    Kossmann: I followed standard practice

    The Age
    Richard Baker and Nick McKenzie
    February 27, 2008


    SUSPENDED Alfred hospital trauma chief Thomas Kossmann yesterday said concerns over surgeons' billing practices were a "hospital-wide" issue and not just confined to him.

    Responding to yesterday's report in The Age about Victorian Ombudsman George Brouwer's decision to investigate allegations of excessive surgery and suspicious billing at The Alfred, Professor Kossmann said he would co-operate fully with the inquiry.

    "I've consistently said I have nothing to hide with respect to my billing practices. They are completely in line with procedures followed by surgical colleagues," he said.

    "My billing has been accepted by the TAC and The Alfred over six years. Any concerns about these practices are a hospital-wide issue. The Ombudsman's decision to become involved confirms this."

    Earlier this month, The Age revealed a secret 2007 Transport Accident Commission audit of The Alfred was unable to verify if doctors who had billed it for patient consultations had actually seen the patients because of irregular note-keeping.

    The TAC pays hospitals and doctors for treating road accident victims through a compulsory third-party insurance premium that is part of annual motor vehicle registration fees.

    The TAC has begun a review of its relationship with Victoria's public hospitals and its billing arrangements with doctors.

    Professor Kossmann was suspended by The Alfred in November after a draft report from a medical panel investigating misconduct allegations against him made adverse findings in the areas of clinical practice, TAC billing, staff supervision and peer review.

    CONCLUSION:

    Interesting findings indeed. Does it mean that if 5000 Australian doctors bill irregularly (thus raising potential concerns if not covered up), an OTD doctor who toes the line can be hauled up as the scapegoat and the rest exonerated? Certainly not! An alleged irregularity is exactly what it is - it has to be investigated and dealt with whether it is by an Australian qualified doc or an OTD. Even when it has been committed by 5000 Australian doctors. Or, is TAC (or Medicare) quite selectively blind?
  33. OTD

    OTD Guest

    Baillieu calls for trauma unit inquiry

    Julie-Anne Davies | April 07, 2008

    THE Brumby Government is being urged to launch a judicial inquiry into one of the nation's most renowned trauma centres run out of a top Melbourne hospital as new questions have emerged about the competence of the European-born surgeon running the unit.

    Victorian Opposition leader Ted Baillieu called for the inquiry today after The Australian revealed details about in internal inquiry into Thomas Kossmann, the head of the nation's busiest and most prestigious trauma unit at The Alfred hospital in Melbourne.

    Professor Kossmann's career is in tatters after a three-month investigation by an expert panel raised serious questions about his surgical qualifications. Until today's report, Professor Kossmann had come under scrutiny over his billing practices, with accusations that he was charging Victoria's Transport Accident Commission, the WorkCover Authority and Medicare Australia for operations he had not undertaken.

    But, according to the confidential report obtained by The Australian, Professor Kossmann is accused of performing unnecessary operations and undertook surgery he was incapable of doing.
    The scandal once again raises serious questions about the ability of medical authorities to properly assess doctors before allowing them to work in this country.

    The panel reports that more attention needs to be paid nationally to how specialist doctors are credentialled to practise in the public health system.

    Mr Baillieu said today a judicial inquiry should be immediately established to investigate the relationship between Professor Thomas Kossmann and the state government.

    “Professor Kossmann has claimed he has had an ‘enormous’ role as a political adviser for the state government and the Health Minister. These are extraordinary developments,†said Mr Baillieu.

    “The reported findings of the independent review into Professor Kossmann’s activities are damning and raise serious questions about the Alfred Hospital and the Brumby Government’s
    failure to investigate earlier complaints about Professor Kossmann, some dating back several years.

    “The Brumby Government must disclose when they first became aware of concerns surrounding Professor Kossmann and what steps were taken to fully investigate the matter.

    “The independent report should be immediately publicly released, to restore community confidence in the management and handling of the issue by the Alfred Hospital.''

    The expert panel found he invoiced for operations that were not performed, surgery he did not carry out and surgery that was unnecessary.

    The panel found that in his billing he used multiple Medicare item numbers that are mutually exclusive and used item numbers not in the spirit of funding agreements.

    They found he did not have the required expertise to practise or teach spinal and pelvic surgery - something he was routinely doing at The Alfred.

    He was found to have misrepresented his surgical experience on his curriculum vitae by overstating his level of experience and training in the area of orthopaedic surgery.

    And he was found to have performed surgery that had not been performed in Australia or overseas before and which was flawed in its conception and harmful in its effect.

    The expert panel's final assessment of Professor Kossmann is scathing. In relation to his invoicing habits, it concluded: "The professor failed to perceive a problem, almost to a level where he seemed to have no concept of what constituted a moral approach to patient billing."

    The panel recommends that the TAC - Victoria's publicly funded traffic accident compensation system - Medicare Australia and the WorkCover Authority conduct audits of Professor Kossmann's entire billing history.

    He told the panel his billing practices were no different to those of his colleagues. He said that because the TAC had never questioned his billing, he assumed he was billing appropriately.

    The panel was also critical of Professor Kossmann's clinical performance. It called his surgical practices and decision-making inappropriate, unnecessary and beyond the accepted norm.

    "The nature of these practices and decision-making was beyond any level of acceptable behaviour and standard of care, and was flawed in its conception and harmful in its effect," the report states.

    It dismisses Professor Kossmann's defence that if such an audit were conducted of other surgeons a comparable rate of incidents would be found.

    Professor Kossmann argued to the panel that the cases where he was found to have exercised wrong clinical judgment reflected differences of medical opinion. The panel disagreed.

    The investigation was established by Bayside Health, which runs The Alfred hospital, after four surgeons lodged complaints against Professor Kossmann last August. Respected Victorian child orthopedic specialist Bob Dickens led the panel. The other members were Brisbane orthopedic surgeon John Tuffley and Sydney orthopedic surgeon Stephen Ruff.

    The panel examined 24 cases raised by the four doctors in their complaints against Professor Kossmann. In all but seven of the cases, the panel substantiated the complaints. It randomly reviewed a further 31 of Professor Kossmann's cases and, of these, found three where there were significant concerns about his clinical and/or administrative practices.

    During the investigation, Professor Kossmann was interviewed by the panel members - two of whom are examiners in orthopedics for the Royal Australasian College of Surgeons - to test his understanding of basic science. He failed dismally.

    "All panel members are of the opinion that if an orthopedic candidate in his/her final exam had given the answers which the professor had given, they would have seriously considered failing that candidate," the report states.

    It is understood the hospital has sent the final report to Professor Kossmann. He has two weeks to respond.

    Professor Kossmann has taken legal action in the Victorian Supreme Court against the hospital following its suspension of him on full pay last November after adverse preliminary findings were made against him in a draft report.

    Spokesman for The Alfred, Corey Nassau, today told AAP the hospital could not comment on the alleged findings reported today.

    A woman at Prof Kossmann's home today told AAP there would be no comment.

    Mr Nassau said The Alfred, which is run by the Bayside Health network, was given the final report on Prof Kossmann's conduct late last month.

    “The external peer review panel, headed by Mr Robert Dickens, submitted its final report to Bayside Health on March 27,†Mr Nassau said.

    “Bayside Health is now considering the report. It has provided the report to Professor Kossmann and asked him to respond.â€

    Victorian Education Minister Bronwyn Pike, who was until last August the state health minister, also refused to comment on the report's findings.

    “The government hasn't seen the final report as yet, but there has been a very thorough process that The Alfred has been engaged in and it's certainly totally inappropriate for me to comment on that,†Ms Pike told reporters in Melbourne today.

    - with wires


    COMMENT:

    Here we go. They have nailed him on the rarities of basic science! This is not only unfair but ludicrous. I wonder how dirtier one can get and how many Australian Orthopaedic surgeons know what a Graeme Steele murmur is let alone the details of the Cory cycle! This is coming off the top of my head as an Australian recognised specialist (who has declined Australian Fellowship)

    They will use these findings to file a formal complaint the the MPBV and then they will fix him....just watch this space! And, of course, unless the Supreme Court has any jurisdiction over this matter, it will flow and destroy his career.
  34. guest1

    guest1 Guest

    we love TK, NOT

    So the report is out and it is now clear how TK really practices medicine. I hope now that all the lovers of TK who have started this thread now realise how back he is for the Alfred and the Australian patients. We train the best doctors in the world and all who come from overseas needs to go through the same process before being accredited to work in australian so as to protect the unsuspecting public. I have not operated with TK but have been involved in a lot operations to fix his mistakes. We are not perfect but most surgeons do not operate in areas where they were not trained and understand the limitations of there expertise.
  35. OTD

    OTD Guest

    Investigative Reports are not foolproof: if misinformation is given and if this is relied upon serially, you see the result. I am not defending Thomas Kossmann. I need to stress that we need to take all investigative reports against OTDs with a grain of salt. Exaggerations are not uncommon.

    The truth can easily be massaged as the previous poster has just shown: 'we train the best doctors in the world' so he/she claims.
    I really beg to differ. In every race and every culture there are very intelligent people who can realise their potential in even the most adverse circumstances. These people may or may not blossom in third countries including Australia.

    Who says an Inquiry into a medical practitioner's conduct could include a test on basic science? Where is the scope?

    If Thomas Kossmann was not that good, why did they not pick that up at the beginning but wooed him and seduced him to come to Australia and even made him Associate Professor? Does this mean Australian medical appointments are made by fools?

    May I ask whether evidence taken during investigation were of a high enough standard and conformed to witnesses taking oaths etc.?

    Surgical techniques are judgment calls and cannot be accurately standardised and thus judged. Outcomes are surrogate measures of competence of a surgeon, not direct measures. We all know of the successfull surgical operation with the loss of the patient! The RACS acknowledges it and for example in their audit of Dr Patel's work found fairly similar final outcomes as other surgeons. Getting there bothered some people and they capitalised on these to complain.

    It sounds like given the general debacle around the country, there are many petty and ignorant and evil bureaucrats around.

    Try NSW and look what the Special Commission is systematically unravelling in every single hospital where it has held a sitting!

    I would say that the relationship between the Alfred and Thomas K had turned sour for whatever reason and they used this to get him out of the system. The best and most effective way is to completely destroy him globally.

    Only my views - and I am sure there are others who think the same.
  36. Guest

    Guest Guest

    The scientific test Prof. Kossmann had to take and which he would have failed acccording to the committee asking the questions is amusing to me. I think most of the Australian-trained doctors who have treated me would have failed a similar test. I have spent most of my adult life educating doctors about treatments I have read about in women's magazines and also telling them about hereditary conditions which I have read about in up-to-date textbooks. Many of these doctors simply do not attend conferences or in-services in order to update their knowledge.
    When my brother was found to have Haemochromatosis and I was thought to be the only person at risk of having the disease, I read up all I could on the matter. The specialist liver surgeon I went to see at a local hospital who also had a reputation for being one of the foremost liver surgeons in Australia did not know the genetics of Haemochromatosis. I told him it was an autosomal recessive gene. That meant nothing to him. He said it meant nothing to him as he only operated on livers and left the genetics to the geneticists. Similar things happened when I visited other specialists in regard to other complaints. The specialisation in one area often blinded them to relationships in another one.
    Clearly, Kossmann was concerned with operating on trauma victims and that is where his knowledge and concentration lay. If he was asked some ordinary old questions about basic science, obviously, without swotting it up, he would not know offhand. In addition the questions were asked in English and expected to be answered in English. Most people's early school knowledge is retained in the language they grew up with. It is hard to spit it out in another language.
    I agree that his career and prospects are probably ruined now. It is a great pity. I heard through a little bird that the man has done something like 4000 operations at the Alfred. If there are only twelve complaints out of that lot, proportionately that is not much.
    I wish him luck for the future.
  37. OTD

    OTD Guest

    State 'pressured' college to accredit Alfred surgeon

    The Age

    Richard Baker and Nick McKenzie
    April 12, 2008


    SENIOR Victorian health bureaucrats allegedly pressured the Royal Australasian College of Surgeons into immediately accrediting controversial surgeon Thomas Kossmann as an orthopedic surgeon, despite reservations about his training.

    The Age believes the college panel that awards surgical fellowships, the censor-in-chief's committee, twice decided against granting immediate orthopedic fellowship to Professor Kossmann, who left Europe in 2001 to become trauma director at The Alfred hospital.

    The committee was concerned that Professor Kossmann's training in orthopedics in Europe was not equivalent to Australian standards.

    It is believed the committee decided to delay granting orthopedic fellowship to Professor Kossmann to allow him to be supervised for 12 months. But it overturned its decision after pressure from senior bureaucrats in the Department of Human Services, State Government and surgical sources said. "The trauma position at The Alfred was still vacant. The department was clear that he had to have it (accreditation) … the pressure was obvious," said a source.

    It is believed that the college's change in position was the source of much internal disquiet.

    A Department of Human Services spokesman said yesterday there was no substance to the allegations. The department's secretary at the time, Patricia Faulkner, yesterday denied that she or other senior health bureaucrats had any involvement in Professor Kossmann's accreditation. "I'm just as likely to tell the college what to do as I am to jump in front of a train," she said. A spokeswoman for the college declined to comment.

    This week, the findings of an expert medical panel investigating Professor Kossmann's surgical and billing practices revealed the college used a special provision to allow him to practise surgery in Australia without sitting the customary exams.

    In its final report to Bayside Health, the panel recommended that more attention needed to be paid to how specialist doctors gained credentials to work in the public hospital system. It also found Professor Kossmann had put misleading information in his CV to overstate his orthopedic experience.

    The panel's most serious finding was that Professor Kossmann was practising surgery he was not trained to do, sometimes with harmful results for patients. He was found to have done unnecessary surgery and billed for procedures not done.

    The panel tested Professor Kossmann's basic knowledge of science and found deficiencies.

    "If an orthopedic candidate in his/her final exam had given the answers which the professor had given, they would have seriously considered failing that candidate," the panel concluded.

    Although Professor Kossmann was trained in Germany and Switzerland, the panel found that his surgical performance and judgement did not "accord with acceptable standards of care that any doctor trained in orthopedic surgery would be expected to meet".

    Professor Kossmann and his supporters have strongly rejected the panel's findings. His spokesman said this week that to claim Professor Kossmann was under-qualified was absurd. His former boss before coming to Australia, Otmar Trentz, this week described Professor Kossmann as a gifted and dedicated surgeon, with "special experience in spine surgery".

    COMMENT:

    These people are doing their utmost to use a fine tooth comb to trawl for excuses to fit into their intended outcome. This is poor forensic science as we all know. Nothing new with the culture of Australia. If they were so thorough and good and Thomas Kossmann so 'incompetent' why did they not discover it in the first place? It shows that either way they had acted corruptly! Welcome to Australia!
  38. OTD

    OTD Guest

    Anatomy of Trauma

    The Age
    Richard Baker and Nick McKenzie
    April 12, 2008

    WHEN Thomas Kossmann arrived at The Alfred hospital's trauma centre in 2001, he came as the great white hope. Six years later he left the wards he had ruled so imperiously, this time led by two security guards.

    What happened in the years between is now the subject of one of the most serious medical scandals in recent Victorian history. This week, the professor's carefully constructed aura has been demolished by the leaked findings of an expert panel investigating misconduct allegations against him.

    The panel of three senior orthopedic specialists found that the man in charge of the nation's busiest trauma centre was not all he appeared to be. The panel has alleged serious flaws with his surgical ability and judgement; his honesty and integrity have been severely questioned.

    The panel's six-month inquiry found considerable problems in all but seven of the 24 patient cases reviewed. An audit of a further 31 cases randomly chosen uncovered significant issues in three of them.

    The panel's final report is an extraordinarily damaging document, revealing that Kossmann had been performing spinal and pelvic surgery of which he was incapable. The report claims he was unable to "self-limit" his surgery. In other words, he had no sense of his own surgical limits.

    "It was as if God spoke to Thomas one day and said, 'Today you are a pelvic surgeon,' and he went on and did surgery he was not qualified to do," said one of his colleagues this week.

    The panel found he was attempting procedures not seen anywhere in the world. No one died, but some of his surgery was found to be "harmful … flawed" or simply unnecessary. "The nature of these practices and decision-making was beyond any level of acceptable behaviour and standard of care," the panel stated.

    Also subject to fierce criticism were Kossmann's billing practices. According to the panel, he invoiced publicly funded bodies, such as the Transport Accident Commission, for surgery that was not undertaken or was done by others. The panel found Kossmann had "no concept of what constituted a moral approach to patient billing".

    But, as throughout the whole saga, Kossmann and his supporters bitterly refute the findings. Kossmann's former boss, Professor Otmar Trentz, has described Kossmann as a gifted and dedicated surgeon who had been targeted by people driven by "envy, jealousy and insider deals".

    One Kossmann insider said that had any surgeon been subject to similar scrutiny, flaws would be found. Kossman's camp remains furious at the lack of fairness in the panel process. "He would have had a better go if he was in Guantanamo Bay," an insider said. "The panel refused to compare his billing to other surgeons' billing. It is because they are scared of what they might find is wrong with the system, because it reflects badly on them ."

    Putting aside the strongly held views from both camps, the Kossmann saga has raised a range of serious issues now being probed by the Victorian Ombudsman. How could such questionable surgical and billing practices of such a prominent surgeon remain unchecked for so long?

    When the Zurich-based Kossmann was first approached in late 2000 to head The Alfred's trauma department, the concept of a stand-alone trauma surgery unit in Australia was under threat. Trauma surgeons, who are able to manage a patient suffering severe injuries in different parts of their body, are common in Europe. But in Australia, surgeons stick to specific areas — the neurosurgeons with the nervous system, orthopedic surgeons the bones.

    Kossmann flew into Australia as the ultimate outsider — a foreigner championing a a foreign concept. In Melbourne's close-knit surgical community, a certain degree of opposition and scepticism about the professor was inevitable. Newspaper clippings help tell part of the Kossmann story in his first few years at The Alfred. In 2002, a calm and confident Kossmann told journalists about his department's care of victims of the Bali bombing attacks. In a profile piece in The Age in 2003, he spoke of his passion for his job: "Somebody can come in after falling off a construction site with some metal going through his body. I don't know, when I open him, what to expect. I can save him, he can die … It's never boring, it's always exciting and it's always rewarding." The article describes Kossmann's CV as "nine densely typed pages of international experience and glittering qualifications".

    In 2004, the square-jawed and handsome professor was photographed alongside then premier Steve Bracks, launching the National Trauma Research Institute at The Alfred. Kossmann was appointed the director and his wife, Christina Morganti-Kossmann, a respected medical researcher, was made co-director.

    Kossmann's success lay partly in his ability to reach outside of the hospital's walls, impressing those with financial clout. The research institute was funded by the TAC, insurance company AAMI, car manufacturers, medical implant companies and charitable foundations. Kossmann donated almost $290,000 to the institute, an act he highlighted when the accusations of overbilling first surfaced last year.

    The institute not only placed The Alfred on the map in the international trauma scene, but created an avenue for local surgeons to build on their academic credentials via research papers and projects. Kossmann's power extended outside the trauma department to its research arm as well. Occupying key posts at the research institute were several Alfred surgeons in senior positions at the hospital, sitting alongside or above Kossmann in terms of seniority and dealing with complaints about any surgeons' behaviour.

    But exactly how complaints about surgical problems or billing concerns were handled at The Alfred remains unclear.

    One of the audit systems, known as peer review, involved weekly meetings in which surgeons could critique each other in a group setting. Directors of medical units and senior administrative staff could also be sought out when a doctor had concerns about a colleague's work.

    When Kossmann's activities first began to trouble several surgeons — according to some internal sources, this happened as early as a year after his appointment — the complainants faced several hurdles. They were, after all, complaining about their boss. Some of the senior staff these surgeons turned to were tied up in research institute projects with Kossmann, or appeared to believe his strengths outweighed the mutterings of his critics.

    Kossmann had his own response, claiming the concerns were an extension of the anti-foreign-surgeon syndrome that had afflicted some of his colleagues when he was first appointed. Kossmann, who declined to be interviewed for this article, has previously said his attempts to streamline the trauma department had annoyed the part-time specialists because it froze them out of the public hospital system, which offers prestige, academic opportunities and lucrative billing opportunities for TAC patients.

    During peer reviews, surgeons' concerns about Kossmann were often downplayed or ignored. One headstrong surgeon who fiercely critiqued Kossmann was asked to apologise. In a development The Alfred's chief executive, Jennifer Williams, says was unrelated to his outburst, the same surgeon's contract at The Alfred was not renewed.

    In 2005, at least one surgeon raised serious concerns about Kossmann with the then director of neurosurgery, Jeffrey Rosenfeld. But although he had influence in the hospital, Rosenfeld had no direct-line control over Kossmann. The complaining surgeons were told to put aside their disputes and continue to assist Kossmann when asked. Says a surgeon: "There were six years when we couldn't question Thomas. The hospital simply wouldn't allow it."

    But the complaints would not go away. Some surgeons had to interject when Kossmann pushed for surgery they considered inappropriate. On several occasions, they had to help complete surgery Kossmann had started. Concerned that they were acting as a "safety net" for the trauma director, at least four surgeons began to compare notes.

    By August last year, the group lodged a complaint with Williams, who decided to commission an expert panel to examine their concerns. If there was truth to the allegations, Williams and other senior staff, including the director of operations, Andrew Stripp, were facing a crisis. Williams sounded out the former head of orthopedics at the Royal Children's Hospital, Bob Dickens, who, along with two interstate orthopedic specialists, began to examine the complaints.

    Initially, Kossmann appeared unconcerned. He assured hospital management that the allegations of excessive surgery and wrongful billing were without foundation.

    In the final week of November, Williams and the Bayside Health board were briefed on Dickens' preliminary findings. They were shocked at the contents. Kossmann was now fighting for survival. He began to search for material to attack the credibility of his accusers. Central to Kossmann's defence throughout the saga has been his claim that billing discrepancies would also be found in the records of other surgeons and he was only billing as he had been taught. With Kossmann intent on building this defence, Williams moved to suspend him from the hospital premises. On the evening of November 26, two security guards escorted him from The Alfred.

    Kossmann hit back with a well-orchestrated public relations campaign and a Supreme Court challenge to his suspension, which he claims was illegal. As the panel continued its work over summer, the relationship between Kossmann and the hospital continued to sour.

    "He has behaved very badly and turned The Alfred into a circus," a senior Bayside Health figure recently said. "But he is not the only surgeon out there with problems, particularly with TAC billing. This saga has exposed flaws in the entire system from accreditation of doctors to auditing processes in the TAC, DHS and public hospitals."

    Based on the findings of the report, Kossmann is likely soon to either resign or be sacked by The Alfred. If that happens a fresh outpouring of support from former patients and some of his still-supportive colleagues is also likely. Regardless, finding equivalent work in Australia will prove difficult. Sources say police are likely to investigate whether he has defrauded the motorist-funded TAC but will require a much higher burden of proof than the panel. Medicare is about to start its own audit of his billings. WorkCover has been advised to do the same.

    But what lies ahead for the many other individuals and institutions involved in this sad affair? The extent of the system-wide problems in Victoria will be further revealed later this year when investigations by the Ombudsman and the TAC are concluded.

    The State Government and the Department of Human Services will be scrutinised, especially given the revelation that senior health bureaucrats pressured the Royal College of Surgeons into giving Kossmann orthopedic accreditation despite its reservations about his suitability without further training. The State Opposition wants to explore Kossmann's self-professed role as an informal "political adviser" to former health minister Bronwyn Pike.

    The Kossmann affair has revealed serious failings surrounding the accountability of public money in the state's health system. Also exposed has been the absence of a rigorous and independent system to handle complaints about doctor misconduct. As a senior TAC figure said recently: "The trust we had that doctors would do the right thing has been broken".

    Richard Baker and Nick McKenzie are Age investigative reporters.


    COMMENT:

    Didn't I tell you so? They are jealous of talent and are skillful in spin. Thomas K has become a fall guy for the dysfunction in Victoria. Perhaps a NSW type Special Commission of Inquiry ought to be set up too!
  39. OTD

    OTD Guest

    Medicare to probe allegations of surgeon's fraud

    The Age

    Richard Baker and Nick McKenzie
    April 9, 2008


    MEDICARE Australia is set to become the latest government agency to investigate suspended Alfred hospital trauma chief Thomas Kossmann.

    The Age believes the federal public health insurer is preparing to examine evidence that the high-profile surgeon wrongly billed it or invoiced it for surgery that was not performed or was unnecessary.

    A Medicare spokesman yesterday said that while he could not comment on individual investigations, the agency was duty-bound to examine all allegations of fraudulent or inappropriate practice.

    "If it becomes apparent that incorrect claims have been paid, Medicare Australia will pursue recovery of that money … against the provider who incorrectly billed the item," he said.

    "Where fraud is detected, matters are investigated and referred to the Commonwealth Director of Public Prosecutions."

    The Medicare spokesman's comments come after an expert panel appointed by The Alfred to investigate Professor Kossmann this week recommended Medicare and WorkCover Victoria audit billings by the trauma surgeon, because of evidence he billed for surgery he did not carry out or did unnecessary operations.

    The recommendation, delivered in a report leaked this week, comes on top of a separate probe by the Transport Accident Commission — the motorist-funded body that pays for medical treatment of road accident victims in Victoria.

    The Age last year revealed Professor Kossmann was likely to be investigated by Victoria Police over his TAC billings, which the expert panel found lacked morality.

    But the most serious aspects of the surgical panel's findings relate to some of the German-born doctor's clinical practices and basic anatomical knowledge.

    The surgical section of the panel's report, obtained by The Age, concludes Professor Kossmann undertook surgery he was incapable of doing and performed unnecessary procedures.

    The panel recommended he not be allowed to engage in or teach spinal surgery or pelvic surgery until he undertook further training. It found he performed procedures not tried anywhere else in the world, which in some cases were "flawed" in their concept and "harmful" in their effect.

    "The nature of the inappropriate and unacceptable practices of Professor Kossmann are way beyond any level of acceptable behaviour and standard of care, such that no competent surgeon would condone or engage in such practices," the panel, headed by orthopedic specialist Bob Dickens, wrote.

    The panel's report also contained comments from one of the professor's initial supporters, Melbourne doctor Graeme Brazenor, that one of his procedures under review was "stupid" and would have resulted in a stern rebuke if it had been done by one of his registrars.

    Professor Kossmann was also criticised by the panel for placing misleading information in his CV, with the panel alleging he overstated his surgical experience by counting the numerous incisions required to do one operation as examples of having performed the procedure on multiple occasions.

    The panel found the professor was appointed chief of Australia's busiest trauma centre in 2001 without having done general orthopedic procedures such as hip or knee replacements.

    The Royal Australasian College of Surgeons is likely to face questions as to why it accredited Professor Kossmann as an orthopedic surgeon without making him take the usual exams.

    Professor Kossmann has this week rejected many of the panel's findings and expressed disappointment in the leaking of the panel's report. He has sued Bayside Health over his suspension last November. Further action regarding his future at The Alfred is expected this week.

    COMMENT:

    This has some resemblance to Galileo's story: posted in this website under the thread "Thinking of Coming to Australia" page 1

    Early in his job, he uncovered fraud using his specialist provider number (in NSW), reported it and he was suspended on false and fraudulent allegations. They then reduced his hours whilst he was under suspension: this is in breach of the 457 visa. Galileo complained to DIMIA and applied for a short term locum in another state. This visa was then cancelled - and with this cancellation he had no right of work: so he did not renew his NSW Medical Registration. He was literally forced out of his job and remain unemployable till today in Australia.

    The other point about Galileo was that he had British specialist registration but this was not good enough as, with a history of an unresolved investigation, no one would give him a job! The NSW Medical Board did not prosecute him or take disciplinary action against him - because they could not find an excuse to do so despite using their fine toothed comb and cherry-picking techniques. And, they refused to give him a certificate of good standing, thus paralysing his career since then.

    They are doing the same to Thomas Kossmann, in a different way.

    How do we not know that Thomas K was an unwilling victim of false billing? This is quite commonly managed by NUMs and Clinic Managers and when one gets a corrupt person doing that, its a free for all - for the bureaucrats
  40. Guest

    Guest Guest

    This piece was found on a government site and describes Prof. Kossmann with others doing many pelvic surgeries using non-invasive techniques. This particular fact did not emerge on any of the reports in The Age regarding article Anatomy of a Trauma written by Richard Baker and Nick McKenzie. The impression given is that Prof. Kossmann had NO experience in pelvic surgery and worked alone because others would not work with him because he was so impossible to work with. It appears from this relatively recent article that that is not the case. I wonder if the authors of The Age articles bothered to do any online research whatsoever and whether they inquired from the names beneath as to what Kossmann's actual role was in each operation. Does anyone on this forum know the persons mentioned beneath? Were they complainants at all?
    Was this the technique that he could not do? Was this the technique that had never been before used in Australia or overseas? Could it be a revolutionary technique that is just the thing for accident victims and which by virtue of its diagnostic and operational simplicity once mastered put many an orthopaedic surgeon whose specialty is the pelvis right out of business. Comments please!

    August 2007
    New treatment for Alfred patients with pelvic fractures


    Alfred Hospital Trauma Surgeon Matthias Russ is part of a team at the forefront of new treatment for pelvic injury.

    An increase in major trauma patients has seen a corresponding growth in the number of pelvic fractures treated at the Alfred Hospital.

    As a result, Alfred surgeons are at the forefront of treating pelvic fractures and have successfully trialled new ways of managing this injury.

    The pelvic bone, the biggest bone in the body, can often be fractured in serious car crashes and workplace accidents.

    Orthopaedic Surgeon Max Esser—together with Trauma Surgeon Matthias Russ and Director of Trauma Surgery Professor Thomas Kossmann—has been collaborating to surgically repair the pelvis using minimally-invasive techniques.

    This includes the use of percutaneous computer-navigated screw placement within days of the injury being sustained.

    ‘We operated and internally fixed 113 pelvic fractures at The Alfred in 2006 compared to about 80 the year before.

    ‘This would put us among the top 10 hospitals in the world by volume of fractures treated,’ Mr Russ said.

    ‘Inside the pelvis are all the major blood vessels so it is difficult to operate—it requires very specialised skills.

    ‘We have changed our attitude to the way that we treat these injuries—moving to a team approach with new techniques, including more computer navigation intervention.

    ‘This means less invasive treatments and better outcomes for patients.’

    While surgeons have traditionally waited for patients to stabilise before operating on pelvic fractures, Alfred surgeons have found earlier surgery is delivering better results.

    The findings were presented at a recent Trauma Grand Round, organised by the Department of Trauma Surgery and the National Trauma Research Institute.
  41. Guest

    Guest Guest

    Survival of the best-fitted
    January 20, 2004 (The Age)

    Above is the title of an article from which I have quoted beneath the essence of the story. Prof. Thomas Kossmann is shown here as being involved in the surgery of a Mrs Margaret Vise. So his 'experience' goes back at least four years in spite of what more recent articles suggest in The Age.



    ....Moments after the crash, Margaret Vise (Geelong lady) woke in pain, "surrounded by a white cloud". She was driving at 100 km/h in northern Victoria when a tyre blew out. With no control, she veered into the path of an oncoming car. She doesn't remember the crash, just waking to the white cloud that saved her life: her airbag.

    At The Alfred hospital, trauma surgeons Thomas Kossman and Annette Holian treated Vise's fractured pelvis and, more seriously, her bleeding liver. Both doctors said that without the airbag, she would have been dead.
    ...After 10 days at The Alfred, Mrs Vise, 58, moved to Geelong hospital, where she spent five weeks as the breaks in her pelvis healed.
  42. Guest

    Guest Guest

    Dr Patel saved many lives. But you can mention about it in the current political environment, because Australians are told that Dr Patel is "Dr Patel", he only killed patients and he never saved anyone.

    Dr Kossmann's situation now is the same. He never saved anyone, did he? What he did are unnecessary surgeries. He did what he shouldn't have done.
  43. Guest

    Guest Guest

    Anyone knows how many Australian orthopaedic surgeons have first aid certificate or basic life support certificate? How many of them know current CPR recommendation?
  44. Guest

    Guest Guest

    Correction:

    Dr Patel saved many lives. But you CANNOT mention about it in the current political environment, because Australians are told that Dr Patel is "Dr Patel", he only killed patients and he never saved anyone.

    Dr Kossmann's situation now is the same. He never saved anyone, did he? What he did are unnecessary surgeries. He did what he shouldn't have done.
  45. Guest

    Guest Guest

    Dr Kossmann may have performed 'unnecessary surgery' in the perception of his peers: but he did restore quality of life and he did save lives.

    The problem is that these 'unnecessary surgery' is not classed as 'fraudulent' or overservicing: something debatable.

    What is really needed is a an Independent audit by reputable overseas surgeons on this work by outside experts who do not have vested interests. This includes FRACS characters who are probably milking Medicare in their own way which remain concealed by their mates.

    I would say that Thos Kossmann probably stepped on too many toes and they decided to fix him - just like probably what Dr Patel did.

    Just remember that Australia is a land of mediocrity: not of top rate excellence - they shoot their own kind who excel and this is call trimming the tall poppy.
  46. wc

    wc Guest

    Someone should have told Dr Kossmann to send the radiology films back to the radiologist to be accurately reported before he operated.

    TAC go by what is on the radiology reports.

    The common practice of incomplete and inaccurate radiology reports on accident and work injury patients will continue to be a problem for OTD.

    This system is now affecting the surgeons as well as the patients.
    Some Doctors want to do the best for the patients.

    Dr Kossmann is one of those doctor's
  47. citizenwatch

    citizenwatch Guest

    Witch Hunt: Investigation Seriously Compromised

    HERALD SUN

    Editorial

    April 19, 2008 12:00am

    THE investigation that has led to the controversial resignation of the head of the Alfred hospital's trauma unit has been seriously compromised.

    What was supposed to be an internal investigation of the work practices of Professor Thomas Kossmann has become a public witch-hunt.

    This is because the allegations by four of his fellow surgeons were leaked as soon as they were made to an investigating panel.

    Prof Kossmann has endured public humiliation, while his detractors remain cloaked in anonymity.

    He is right when he says his treatment has been un-Australian. Prof Kossmann has a right to a presumption of innocence until any case against him has been proved.

    "I am a proud Australian. I love this country, but I have not been given a fair go," Prof Kossmann complains.

    He has been described as a gifted surgeon who came to Australia in good standing and has performed thousands of operations, including surgery on Bali burn victims.

    But he says he has been pilloried in a process that determined his guilt before giving him a chance to refute any of the allegations.

    Prof Kossmann says he made an 800-page submission refuting the original allegations that he performed unnecessary operations and operations he was not qualified to perform, and has now been asked to reply to further claims.

    Health Minister Daniel Andrews must step in to ensure this eminent surgeon receives a fair and open hearing.

    http://www.news.com.au/heraldsun/story/0,21985,23562501-24218,00.html
  48. citizenwatch

    citizenwatch Guest

    Witch Hunt: Investigation Seriously

    Witch Hunt: Investigation Seriously Compromised


    Herald Sun
    Editorial

    April 19, 2008 12:00am

    THE investigation that has led to the controversial resignation of the head of the Alfred hospital's trauma unit has been seriously compromised.

    What was supposed to be an internal investigation of the work practices of Professor Thomas Kossmann has become a public witch-hunt.

    This is because the allegations by four of his fellow surgeons were leaked as soon as they were made to an investigating panel.

    Prof Kossmann has endured public humiliation, while his detractors remain cloaked in anonymity.

    He is right when he says his treatment has been un-Australian. Prof Kossmann has a right to a presumption of innocence until any case against him has been proved.

    "I am a proud Australian. I love this country, but I have not been given a fair go," Prof Kossmann complains.

    He has been described as a gifted surgeon who came to Australia in good standing and has performed thousands of operations, including surgery on Bali burn victims.

    But he says he has been pilloried in a process that determined his guilt before giving him a chance to refute any of the allegations.

    Prof Kossmann says he made an 800-page submission refuting the original allegations that he performed unnecessary operations and operations he was not qualified to perform, and has now been asked to reply to further claims.

    Health Minister Daniel Andrews must step in to ensure this eminent surgeon receives a fair and open hearing.


    http://www.news.com.au/heraldsun/story/0,21985,23562501-24218,00.html
  49. Guest

    Guest Guest

    What has happened to Prof. Kossmann has already been experimented with and successfully implemented in the teaching profession. Prior to Kennett coming power, a number of teachers, especially older ones with just a few years to go to superannuation, were harassed and driven out for a range of reasons but mainly incompetence. The reason then was that sacking them at that time would prevent them from accessing their benefits which were their due for all their years of service in the department.

    The Superannuation department was virtually bankrupt then and there was little money in the pot. Getting rid of people who were 'incompetent' saved what moneys there were for school principals and special people. When Kennett came in, he sacked hundreds of thousands of public servants and others and so gradually the benefits built up again. Those public servants were in the same boat as the teachers but by that time were offered meagre redundancies and were driven out en masse. The same scenario could always happen again though, at any time if superannuation funds are similarly mismanaged in the future. Then employment conditions changed with the contract system. Now, only special people can be retained in the same job for long enough time to access their benefits. Others are shoved out promptly before they can access a thing like long service leave. It is so easy to say a person has not fulfilled the conditions of their contract these days.

    The process goes as follows. Senior teachers who lived in the local community and who knew some parents who also then knew other parents were the ones who drummed up the original complaints. These parental complaints are put in writing to the principal who then called in the member of staff whom he wanted to leave but could not sack at that time because of conditions and then he would ask for answers to the allegations. If the teacher was smart, he would call in a Union member and wait for the 'Kangaroo Court' or panel of his peers to hear him out. If he had no friends on that panel, he was done for. No wonder today that no-one wants to become a teacher. The results were always pre-ordained. The person was not liked by the principal or other staff for some reason and so was drummed out with a damaged reputation. The real reason for the sacking was saving superannuation funds and therefore many teachers were sacrificed on that basis.

    Various issues would arise like dishonesty. I recall a member of staff of being accused of stealing a class set of books. The books were for a junior class, rubbish as literature and no use to anyone. There was a question mark held over that person's integrity. The same person was accused of stealing used magazines at another time. Some of the drummed up issues were so ludicrous, they were unbelievable. There were matters like being late for class by a whole ten minutes. Many issues were about curriculum and teaching method. This, like Prof. Kossmann's example of a bunion being operated on in many different ways was similar. There are many ways of killing a cat so to speak. In teaching there is no one method of achieving a result and similarly, there is no one method in achieving a desirable surgical outcome, especially in trauma surgery.

    The medical panel judging Kossmann used the same methodology of sacking which is current in Australia, already widely tested in the education system. The way of doing it inevitably ruins the person professionally for any other job. Kossmann will be ruined for his profession in the future at any other hospital in Australia and possibly worldwide.

    It is possible that he should have just have resigned in the first instance without any attempt at defending himself until it became an issue for the courts. He has already been tried by media and it is to no avail now for the Herald Sun editorial to say that he should be given a 'fair go'.
    Bulldust! He never had a fair go and I doubt whether he will ever be given a 'fair go' ultimately whatever John Brumby has to say about the matter.

    He has latched on to him allegations by an 'expert' panel that he does not know basic science, that he did operations that he could not do and had no training or experience to do and that he had taken money from the TAC for not doing operations he said he had done. All shocking stuff! Even if he did have every reason to argue against these allegations in view of the practices done by other staff at the hospital, I doubt a comparison with others would be made. Similar situations with teachers were never considered. He is not the senior member of an in-group. He is judged by a gang of peers who feel their interests were threatened by him and he is out on his ear now of his own accord.
    Bayside management has something to answer for also as they have not sat on the allegations appropriately and have not given him a graceful way out. One cannot be a hero one moment in his profession with the full support of peers at the time and then thrown out shortly afterwards after several years of hard work as though he were rubbish. That is not natural justice and he knows it. He had no deaths on his watch and no dissatisfied patients. That speaks tons. His personal presence is fantastic and his reputation from his home country from whence he had been head-hunted, is excellent.
    The recent allegation regarding a junior surgeon who said he was forced to alter a patient file prior to investigation is a nonsense I feel. Kossmann's response that that surgeon was miffed on not getting a personal reference from Kossmann has the ring of truth. Kossmann did not obviously understand the subtleties of references. He could have written something like: This person works really well under supervision. Or:
    I would recommend he does the following duties but not X others.
    He gets on quite well with some colleagues and some patients (damn with faint praise here). He has done X operations, a number of which were OK but the others had to be reviewed by senior surgeons.
    He could benefit from many more years of surgical experience in the following areas. And so on. The reference would be given, not refused, but would not be a reference in the true sense.
    I wonder if this junior surgeon was offered a fantastic reference from someone else if he complied with a trumped up charge in relation to Kossmann. Anything is possible in this scenario.

    I fear Kossmann will now find that variously underemployed litigious individuals out there will try to move in on his assets.
    They will have interests in common with his accusers and may even be linked with them in some way.
    He has only begun on a very expensive ride in the Australian system which could see him ruined in every possible way imaginable.


    Australia has done it again to a senior professional person, one who happens to have a very attractive, charismatic personality and then will wonder why no-one wants to enter the professions here.
    Welcome to Australia! Take care! You could fall off the bus here!
  50. OTD guest

    OTD guest Guest

    Alfred surgeon says justice being denied

    This article appeared in The Age dated December 3, 2007.



    Alfred surgeon says justice being denied

    Nick McKenzie and Richard Baker
    December 3, 2007

    THE state's chief trauma surgeon has claimed that The Alfred hospital's decision to deny him access to files and X-rays hindered his ability to respond to the allegations that led to his suspension last week.

    In an interview with The Age, Professor Thomas Kossmann also dismissed allegations of inappropriate surgery and of billing fraud, saying the claims were concocted by a small group of disgruntled surgeons.

    Professor Kossmann said his ability to present a defence to the hospital-commissioned inquiry by last Friday's deadline was made impossible.

    "I am cut off completely, which makes the whole thing more difficult," he said.

    "I am not allowed on The Alfred premises, which is just shocking because I gave so much effort in the hospital.

    "The locks are changed, I have no ID access, I cannot access my X-rays in the response."

    The Alfred's chief executive, Jennifer Williams, last week suspended Professor Kossmann due to the "seriousness of the findings" in the draft report by a three-surgeon review team examining his clinical and billing practices.

    Professor Kossmann, who now has until next week to respond, has questioned how he could have been praised less than a year ago in an internal hospital review, only to be stood down last week.

    "In 2006, I was attributed in excellent clinical leadership, and a year later I am a villain," he said. "It doesn't fit."

    He added that until August this year, he had never been the subject of any formal complaints, nor been asked to alter his clinical practices. "I am working in an extremely transparent area, I cannot hide anything. I show all my X-rays all the time."

    He said nobody would have allowed him to do what he had over the past six years had there been questions.

    Professor Kossmann refused to comment directly on the hospital administration's handling of his case, but his comments raise questions about why surgery now considered contentious was not examined when it occurred.

    Professor Kossmann said the allegations against him had been driven by visiting surgeons who feared their hospital surgery time would be cut back as part of his plan to overhaul the trauma centre by employing more full-time staff.

    "It is a very small number of disgruntled visiting medical officers who were fearing that they will get left out in such a system," he said.

    It is believed the inquiry into Professor Kossmann has heard evidence from at least six surgeons who have raised concerns about his conduct.

    A source close to one of them said four of the surgeons had decided to make a formal complaint in August after numerous verbal complaints went unheeded.

    Professor Kossmann said the internal inquiry had backed his handling of a case in 2004, which was later queried by other surgeons and has been the subject of several reports by The Age.

    Professor Kossmann said the hospital had stopped him discussing other cases examined by the review, but insisted he had had never compromised patient care. He also said:

    ■ He had never supervised junior staff in areas outside his expertise.

    ■ An analysis of the thousands of cases in which he had a role in managing showed excellent outcomes.

    ■ A claim by an overseas surgeon that he bullied staff had no basis, and he had, in fact, made himself available to give advice to junior doctors 24 hours a day.

    "If you look at my complication rate, it is very low," he said.

    "Where is there evidence that someone got killed, or harmed? Where is the evidence? You see, this is all fabrication."

    Numerous senior medical staff from the hospital's intensive care department, including its deputy director, Professor James Cooper, have also backed Professor Kossmann's surgical ability, and said they believed the allegations had no foundation.

    Professor Kossmann declined to reveal the extent to which his salary was supplemented by his billing of the Transport Accident Commission, whose lucrative insurance scheme covers all road trauma patients.

    But he insisted he had never fraudulently billed the TAC, and had never previously been queried about his billing practices, which he said he learnt from his colleagues.

    "Because there is no formal introduction to the rules, nobody could tell you if you made a mistake," he said.

    The Age revealed on Saturday that the TAC had last week contacted the police after being briefed by The Alfred about the contents of the draft report, but was yet to lodge a formal complaint.

    "I could solve things which other people could not solve," Professor Kossmann said.

    "We came here invited to Australia.

    "I gave all my professionalism, my lifeblood to The Alfred.

    "My family has made major changes. Our commitment to the community is enormous."

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