Michael Bachelard
January 30, 2011
.LATE last year, trauma surgeon Thomas Kossmann finally settled all
outstanding issues with the Transport Accident Commission - the
organisation he had been accused of systematically rorting of perhaps
hundreds of thousands of dollars.
The settlement involved each party paying the other some money.
But in a twist befitting the extraordinary case of The Alfred hospital's
former trauma director, The Sunday Age can reveal it was the surgeon
who ended up in front - pocketing considerably more than $100,000
after the TAC paid him for bills he had not previously submitted.
After an exhaustive examination of amounts already paid to him by the
TAC, Dr Kossmann - accused in 2008 of double-dipping and charging
for surgeries he had not performed - agreed to reimburse the commission
a far lower amount, in the tens of thousands of dollars.
In further vindication, WorkSafe, which insures injured workers,
investigated more than 1900 invoices submitted by Dr Kossmann
over seven years, and found unequivocally, according to a statement to
The Sunday Age, that there was ''no evidence of improper billing
practices, illegality or fraud''.
Before his reputation was destroyed, the Germany-trained surgeon was
a hero, dubbed ''Mr Fix It'', feted by the media for his work with Bali-
bombing burns victims, and credited with saving ''countless lives''.
But in 2007, two damning reports, by his peers appointed by the hospital
and then by the Victorian Ombudsman, forced him out of his job. Allegations
against him were referred to the police and the Tax Office. The TAC and
WorkSafe were ordered to examine his billing; the Royal Australasian
College of Surgeons and the Medical Practitioners Board of Victoria to check
his competence. Monash University reviewed his allegedly fraudulent CV.
He sued his former employer.
But as each successive investigation over the the past three years has been
completed, it has found largely in his favour. Dr Kossmann claims to have
been vindicated; others say he has simply got away with it.
The Kossmann saga has damaged careers, and raised serious questions
about the ad hoc way doctors are paid through the public purse and the
way inquiries are conducted.
For Dr Kossmann, there was no confession or apology. He always fought
for redress, insisting that he had been maligned and had done nothing wrong.
The allegations against him seemed compelling and, to Victorians who place
great trust in medical specialists, horrifying. The Ombudsman painted a
picture of a doctor ''harvesting'' compensable patients for cash. His surgery,
the peer report found, was ''beyond any level of acceptable behaviour …
flawed in its conception and harmful in its effect''. He did not even understand
basic scientific concepts. He was systematically over-billing, particularly the
TAC. He reaped $58,000 from one patient, $35,000 in one single day,
and, in 2007, $1.5 million from the insurer, almost three times more than
the next-highest earner.
But successive investigations cleared him of wrongdoing.
The TAC repayment was small, and WorkSafe's investigators ruled
unequivocally in his favour. Then, nine days ago, the final action ended -
the law suits that Dr Kossmann and The Alfred had launched against
each other were settled out of court. The hospital admitted no fault, but
apologised for the distress the events had caused Dr Kossmann and his
family and agreed to pay him an amount under $2 million.
Their agreed statement acknowledged that any blame for bad billing
practice could be attributed to the hospital and the TAC - it was a
''systematic problem'', not Dr Kossmann's.
Dr Kossmann, who refused to be interviewed for this story, now works
in Mildura where he has resumed performing pelvic and spinal surgery
(for which the 2007 peer review said he ''does not have the required expertise'')
after being approved by his professional bodies. He is also helping a hospital in
Antwerp, Belgium, set up a specialist spinal surgery unit. Sources say he is
using the same techniques criticised so harshly in 2007.
So what happened here?
The most obvious outcome is the trail of destruction through the lives of many
of its protagonists. Dr Kossmann's life was put on hold for three years.
At least some of the whistleblowers who complained about him no longer
work at The Alfred, some allegedly hounded out by pressure from colleagues.
The head of the TAC resigned from his job and the chief executive of The
Alfred also resigned, although she denied her departure was related to the
Kossmann case.
As for Ombudsman George Brouwer, by the time the former state government
lost office, it was preparing to strip him of some of his powers after a review
into the state's anti-corruption bodies noted that his conduct of investigations
was ''the most widely identified concern''.
Although the review did not specify the Kossmann case, it is believed to have
been a major factor. It is unclear what role he will have within the state's new
anti-corruption commission.
The TAC and WorkSafe have changed their billing systems, tightening rules
and keeping a closer watch on doctors' billing.
As for how these events came about, opinion in the medical community remains split.
Dr Daryl Wall, a senior Queensland-based trauma surgeon, supports Dr
Kossmann. He suggests the ball was set rolling by a ''clique of orthopaedic
surgeons who basically created a conspiracy'' against him within what the
Ombudsman called the ''dysfunctional [Alfred] hospital, racked by back-biting''.
Dr Wall admits Dr Kossmann's Germanic approach (he was the boss, ask no
questions) did not help. He set about monopolising operating theatres, which are
strictly limited in public hospitals, and earning huge money.
Dr Wall says the doctor appointed to chair the peer review, Bob Dickens, a
paediatric orthopaedic surgeon, ''may not have the necessary specialist insight''
into Dr Kossmann's practice to make the strong judgments he did. But, once
started, each review fed on the other and was further fuelled by the regular
media exposure, Dr Wall claims.
When The Sunday Age contacted Bob Dickens, he refused to comment, even
when asked if he stood by his report.
Not everyone, though, is prepared to believe that Dr Kossmann has been exonerated.
Supporters of the peer review and the Ombudsman, speaking anonymously,
stand by those reports. They say the evidence in them remains compelling;
that Dr Kossmann's relentless resistance to the findings has prevailed.
According to Dr Wall, though, Dr Kossmann's experiences were just a
public manifestation of a wider problem in trauma medicine in Australia.
Here the specialty is not recognised by the college of surgeons, and those
who come to practise it from overseas, where it is recognised, often
encounter tensions with other surgeons.
''We've had 10 surgeons that trained overseas who came to Australia and
served in trauma management systems, and most of those surgeons have
not been respected and they've departed,'' Dr Wall said.
''Surgeons working as trauma doctors are not very secure here.''
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