20 August 2018

Homicides could be missed if forensic pathology service collapses,warns senior doctors

The national forensic pathology service in this country is on the brink of collapse – and Justice Minister Andrew Little is refusing to intervene despite the advice of clinical experts, says the Association of Salaried Medical Specialists (ASMS).

“The seriousness of the current situation cannot be over-stated,” says ASMS Executive Director Ian Powell.

“If these services fall over, we will be left with a gaping hole in our ability to determine the cause of death in situations that are unclear or complex, or where we think a crime might have occurred. Forensic pathologists are deeply concerned that homicides could be missed as a result or miscarriages of justice occur.

“This situation has been entirely caused by the Ministry of Justice’s cack-handed fumbling of the contractual arrangements for the national forensic pathology service, and lack of any real attempt to understand what forensic pathologists do.

“Their decision is driven by a deadly combination of bureaucratic incompetence and an ideological belief that a commercial ‘free market’ approach will sort things out.

“What’s even more shocking, however, is that forensic pathologists, with ASMS’ support, have gone directly to the Minister of Justice to ask for his intervention, and he’s refused. This is a very small workforce of highly trained and specialised senior doctors who know the requirements of their work better than any official in the Ministry of Justice, yet they are not being heard. Andrew Little is choosing to take the advice of officials instead of clinical experts.”
Mr Powell says the Ministry has dragged out the process of determining the specifications for the national forensic pathology service - including how it will be run, resourced and funded – for seven years. And now it is proposing to dismantle it and fragment it over four different providers.

“There’s a worldwide shortage of forensic pathologists and the unsettled situation with the service here makes it very difficult to recruit suitably trained people or to keep them once they come to New Zealand.”

A letter from forensic pathologists to Andrew Little in March 2018 made the following points:

* The national forensic pathology service performs about 60% of all coronial post-mortems and all of the forensic post-mortems each year. The remaining coronial post-mortems are performed by coronial pathologists, who are anatomical (laboratory) pathologists. Coronial post-mortems are carried out to determine the cause of death, where this is unclear.
* Deaths in complex or suspicious circumstances, however, require a forensic post-mortem. Forensic pathologists are required to visit crime scenes, testify in court and manage multiple fatality events.

* The Ministry of Justice has rejected the idea that the national forensic pathology service should continue as a single entity, with investigation of suspicious deaths, homicides and complex cases being carried out by forensic pathologists. It wants these cases managed locally, and in some regions by coronial pathologists who have no knowledge, training or professional oversight in these types of cases. (This is currently being reviewed).

* Forensic pathologists say this will jeopardise police investigations and legal proceedings, and may result in some homicides being missed.

* The Ministry of Justice is relying on coronial pathologists to provide coronial autopsy services. However, a change of training requirements by the medical college responsible for this specialty means that forensic pathologists will soon be the only ones trained to carry out post mortems – and they’re already working shorthanded. As the aging coronial workforce retires, forensic pathologists will not be in a position to cover the gaps.

* A complete collapse of local coronial and forensic pathology services in some regions later this year is inevitable.

In addition to the letter from forensic pathologists to the Minister, a small delegation from the forensic pathology team and ASMS met with the Ministry of Justice (8 June 2018) and then separately with Mr Little (25 June 2018) to communicate their concerns face to face. ASMS has written to the Minister several times to seek his assistance, and has made an urgent OIA request for information about the Ministry of Justice’s procurement process. ASMS has also appealed to Prime Minister Jacinda Ardern to intervene.

Mr Powell says the national forensic pathology service provides an essential service for both the justice and health systems, and it is critical it is resourced adequately to maintain a high quality, consistent service that is able to attract experienced medical specialists.

“This service has been vulnerable for a long time, and we really don’t want this service run any further into the ground. The Ministry of Justice needs to be told to pull its head in and sort out the mess its created.

“The Justice Minister’s refusal to get involved runs directly counter to the approach of Health Minister David Clark in his dealings with the sector, his Letter of Expectations to district health boards, and his handling of attempts to privatise Taranaki’s public laboratory.”

ASMS has previously highlighted the crisis facing the national forensic pathology service (p13, July 2016: https://www.asms.org.nz/wp-content/uploads/2016/08/11106-The-Specialist-July-WEB-v3.pdf).

More information about the national forensic pathology service – what it does and the issues it faces - is in the attached Q&A. Copies of the following correspondence are also attached:

* ASMS letter to Andrew Little (10 May 2018)

* Letter from the Ministry of Justice to ASMS (12 June 2018) following a meeting on 8 June 2018

* Letter from Andrew Little to ASMS (24 July) following 25 June meeting

* Letter from ASMS to Andrew Little (10 August 2018).
* Letter from Andrew Little to ASMS (15 August 2018)

* ASMS makes OIA request to Andrew Little (15 August 2018)

* ASMS letter to Andrew Little (16 August 2018).

http://img.scoop.co.nz/media/pdfs/1808/ASMS_media_release.pdf

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