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RESPONSE TO THE AGE
3 December 2015
The following response has been prepared with respect for the privacy of Dr Kosky, who was contracted to the organisation, during the times under review.
The answers to your questions are as follows:
1) When did the Nagambie Healthcare board receive allegations about Dr Kosky's provision of end of life care for patients in its care?
In 2010, NHC was investigated by the Aged Care Investigation Scheme who had received some complaints about medication treatments delivered by Dr Kosky. The subsequent investigation found that there were no issues and the hospital’s medication system had integrity.
In May 2013 the CEO and Board received allegations from another clinician about Dr Kosky’s end of life management of palliative patients. At this time, Dr Kosky was no longer working at the hospital. The issues raised were supported by informal feedback from staff so the hospital immediately moved to have an independent peer review of Dr Kosky’s end of life patients, to identify any concerns with individual patients and to establish if there were systemic issues.
The Board was committed to ensuring that there was fair process and therefore approached experts from outside the hospital catchment to undertake the review.
2) What action did the board and then CEO take in response to the allegations?
The Board and CEO took all allegations seriously. Following the allegations above, the hospital commissioned an independent peer review comprising of an Aged Care Medical Specialist, a Palliative care medical specialist and an Anaesthetist with pain management expertise.
3) Were any cases provided for peer review?
Dr Kosky managed 118 patients from 2008 to 2013. Of these, six cases were referred further for peer review. Of these six, one was referred to the State Coroner for investigation. On the issue of contributing factors to the patient’s death the Coroner found there was no cause for further action regarding that case.
4) What regulatory or investigatory authorities were contacted and when?
As a result of the above mentioned peer review in 2013, a recommendation was made by the independent reviewer that one of these cases be forwarded to the State Coroner for further investigation. The case was forwarded in April 2013 with the’ Investigation Without Inquest’ report released November 2015. The report’s final comment states “I am unable to find on the evidence before me that Dr Kosky’s conduct caused or contributed to (the patient) death.”
We refer you to the State Coroner’s report ( REF: COR 2013 001824 ) for further detail.
5) Was the full board made aware of the allegations? If not, why not?
Yes. The Board has been kept fully informed throughout this process. It approved the appointment of the peer review panel.
6) Is the board/CEO aware of any recent concerns (past six months) about Dr Kosky's intention or instructions to provide terminal care?
A subsequent case raised by a member of the public in June 2015 was brought to the Board and CEO’s attention. The case was formally reviewed and it was found that there was no evidence to support the concerns raised.
The commencement of a new CEO in early February 2014 saw a robust governance structure introduced which includes a monthly accountability report. This provides the Board with information on data and trends in clinical incidents, complaints and adverse patient/resident outcomes. There have been no issues of concern identified in these reports.
7) When was Dr Kosky banned from attending the hospital by the board and what was the reason for his banning?
Dr Kosky’s privileges as a visiting practitioner were removed in June 2012. For privacy reasons, NHC is unable to discuss the specifics of the case however it can say that the Board considered a range of evidence that identified that the previous cordial relationship between the CEO of NHC and Dr Kosky had broken down.
It was felt that, to ensure the highest quality of care for patients and residents, that a good relationship between NHC and those providing services was essential. The hospital does not prevent its residents visiting him in his surgery, if that is their choice.
8) What action did the board take to have a complaint from the previous CEO of an assault by Dr Kosky properly investigated?
There was an incident in 2012 that raised the concern of the Board which appeared to demonstrate that the relationship between the CEO and Dr Kosky had further deteriorated. Dr Kosky denies the allegations made at that time however has accepted the hospital’s decision to deny him visiting rights. Given that an agreement had been reached between the parties involved, an investigation was therefore not needed.
Health Services are required to notify AHPRA of a decision to remove visiting medical practitioner privileges. NHC complied with this requirement.
Bronwyn Beadle
CEO/DON Nagambie HealthCare