Don’t let them gag doctors. We are your canaries
I am a doctor and an activist; a vocal, obstinate activist. Some people, mainly those in authority, think I’m an obnoxious troublemaker. That comes with the territory. Others, mainly those at the coalface, think I’m their champion. That comes with the territory too. I have been making a lot of noise since March on PPE and healthcare worker (HCW) protections against COVID. At other times I have been active on refugee rights, global healthcare corruption, genital mutilation and the rights of doctors and other HCWs to speak out. Today, through necessity, I find myself once more active on the question of the right of HCWs to speak freely.
Back in early August 2020, or, as we now like to measure time, over 4000 Victorian HCW infections ago, I received a ‘back channels’ message through a third party, apparently originating from an emergency doctor in Victoria (I don’t work in Victoria, by the way), telling me he had been asked to communicate that my activities were angering senior public service medical officers there, that this was ‘unhelpful’, and would I please therefore tone it down? “Anyway,” he went on to tell me, “apparently the local doctors say they are quite happy with PPE supplies and protocols in Victorian EDs.”
At that time, HCW infections in Victoria were running at 50–100 per day and I knew for a fact that the local doctors weren’t “quite happy with PPE supplies and protocols”, so I didn’t tone it down. I toned it up.
All went quiet for a while, but in late October there was another attempt by a senior doctor to shut me up. This one was so much more direct and threatening to both my job and medical registration that it would be imprudent for me to divulge further details here. There is a long tradition of brutal suppression of whistleblowers and dissidents in medicine and doctors have not been shy of contributing further to the genre during this pandemic. In March 2020, Dr Rob Hackett was reported to AHPRA by a fellow doctor for this public protest against sending children to school. Without talking to him first, AHPRA required that he undergo a four hour psychiatric assessment. A hair’s breadth separates this action from the abuse of psychiatry in the former Soviet Union, where he would no doubt have received a diagnosis of ‘sluggish schizophrenia’ for his ‘counter-revolutionary activities’.
Rates of HCW COVID infection of the kind we have seen in Australia are of fundamental importance for a variety of reasons. Firstly, they signify that HCWs are being denied their right to safe working conditions. Secondly, the delivery of healthcare is imperilled by mass HCW infections and furloughing and consequent facility closures. Thirdly, patients risk contracting infection in unsafe facilities. Fourthly, the impact on public confidence risks people delaying treatment for non-COVID conditions. Finally, HCW infections significantly fuelled the overall infection rates and thus helped prolong the Victorian lockdown with its attendant economic and personal cost.
Nothing is more critical to controlling the pandemic than eliminating occupationally-acquired HCW infection, which we know is possible, because other countries have done it. Unfortunately, what we saw in Victoria was a persistent attempt to draw a veil of secrecy over the true scale of HCW infection, from the implication that only 15% of HCW infections were acquired at work, long past the point where that was credible, to the repeated failure to report healthcare infections in a timely manner, to the contentious claim that “We [Victoria] have the strongest PPE guidance … in the world, particularly for the N95 masks”. Meanwhile, transparency remained deficient to the last. PPE guidelines were eventually upgraded in Victoria, a stable door shut long after the horse had bolted, which now places Victoria in the paradoxical position of having guidelines more protective than those of the Federal government.
It is fundamental to our democracy that public servants, including those who are medical doctors, must be able to be held accountable for public policy failures, such as the egregious failure to keep healthcare workers and institutions safe in Victoria. Public servants must be able to be challenged robustly in public by people who have the specialist knowledge to do so effectively: their peers. The possession of specialised knowledge and inside information, along with their ability to network and communicate, renders doctors and other healthcare workers uniquely dangerous to those wishing to conceal uncomfortable truths. That’s why the government tried to gag HCWs under threat of imprisonment in the 2015 Border Force Act, a repressive measure, later challenged in a legal action of which I was part, and which was ultimately amended.
Their status as professionals subject to a regulatory body and employment within large networks make HCWs uniquely vulnerable to suppression. Attempts by authority figures to stifle the voice of healthcare worker advocates by means of sweeping gagging clauses, threats of employment termination, legal action for defamation and reporting to regulatory authorities strike at the heart of transparency in government.
Our democracy can only remain healthy if we fight continuously to keep it that way, if we fight for the right of all our citizens to make “necessary trouble”, as the late U.S. Representative John Lewis called it. The 2016 candidate for the Republican presidential nomination and former CEO of Hewlett-Packard, Carly Fiorina, says that leaders must have the courage “to see the truth, speak the truth and act on the truth”. When they fail to do so, the only and last line of defence is the freedom of citizens, whoever they may be, to call them out without fear of retribution, even if they are professionals and even if their colleagues do find them thoroughly obnoxious.
