The phrase ‘conspiracy of silence’ is defined by Collins Dictionary as: ‘If there is a conspiracy of silence about something, people who know about it have agreed that they will not talk publicly about it, although it would probably be a good thing if people in general knew about it’.1
Sadly, this term accurately describes the state of play within Australian healthcare. The culture of turning a blind eye is pervasive across all echelons – at the level of the individual, wards, hospitals, and various governing boards.
During the time I worked for now infamous cosmetic surgeon Dr Daniel Lanzer I witnessed countless acts of inappropriate conduct and poor patient care, as evidenced by the Cosmetic Cowboy documentaries and articles.2 When I share my experience, the most common response is that people believe they would have done the same thing as I did but even sooner. I’m often met with – what took you so long? If this were truly the case, someone would have blown the whistle on the cosmetic surgery industry much earlier – prominent surgeons had been operating with impunity and in subpar conditions for decades. It would have saved me a lot of trouble.
This astonishing lack of insight calls to mind the phenomenon of ‘main character syndrome’. Main character syndrome describes people who behave like they’re the main character in the movie of their life. They view their actions or potential actions as those of an idealistic cinematic hero who comes in to save the day.3
There is a gulf between this idealistic response, and the way that people respond to challenging situations and adversity in real life. The stark reality is that most people choose to remain silent. Two specific examples of nurse whistleblowing spring to mind.
Registered nurse Will Gordon blew the whistle on paedophile nurse James Griffin at the Launceston General Hospital in Tasmania. Griffin had worked on the LGH’s Children’s Ward, which has some 70 plus employees, for 18 years. In total, the LGH employs 2,000 staff members. It was an open secret that James Griffin was a predator, but his alarming behaviour was trivialised and excused. Not until Will Gordon called journalist Camille Bianchi did Griffin finally get exposed – Camille produced ‘The Nurse’ podcast, and the Tasmanian Commission of Inquiry into Child Sexual Abuse came about.
It’s hard to believe that, in the 18 years that Griffin worked on the children’s ward at the LGH, not one other staff member took seriously the rumours and innuendo that surrounded James Griffin. No one pushed hard enough that Griffin would be investigated. No one took their concerns to the regulator. It’s a shameful oversight.4,5
Another example is registered nurse Toni Hoffman. Toni exposed Jayant Patel, dubbed the ‘Butcher of Bundaberg’, who had mutilated hundreds of patients and caused the deaths of dozens. During the period Patel was operating at Bundaberg Base Hospital, there were 850 employees including 65 medical practitioners. Many of these practitioners were aware of the damage Patel was causing, but the hospital’s bottom line was more important.6
When I ask people what prevents them from speaking out against the things they witness in healthcare, the common responses include fear and intimidation or coercion, the assumption that someone else will speak up, that they are unsure of how to proceed, or that they didn’t even know that something was wrong or harmful.
The International Council of Nurses (ICN) Code of Ethics has four principle elements that provide the framework of ethical conduct:
- Nurses and patients or people requiring care
- Nurses and practice
- Nurses and the profession
- Nurses and global health
The document that sets out the Code of Ethics is 32 pages long, and at times is verbose and repetitive.7 I believe that any Code of Ethics for nurses can be distilled into three key duties:
- A duty to the patient
- A duty to the public
- A duty to the profession
A nurse’s duty to their patient should be their paramount concern – the nurse’s primary role is to deliver care that is in the patient’s best interests. Following on from this primary duty is a duty to the public, and the obligation to prevent the public from harm and to call out dangerous and disconcerting practice in healthcare that puts the public at risk. Finally, nurses owe a duty to the profession, and should act in a manner that upholds the integrity of that profession. It is critical that nurses address wrongdoing whenever they see it.
Every year, numerous studies list nursing as being one of the most trusted professions the world over.8 The reality is, other less trusted professions have much higher ethical standards for admission.9 It is our job as nurses in the field to challenge poor ethical standards when we see them and to ensure that our behaviour aligns with the high standards that we should be setting for ourselves. It’s this small shift in thinking that can lead to a radically different destination and patient outcome.
Nursing boards throughout the world play an integral role in upholding the values and reputation of the nursing profession. If these boards acknowledge and support nurses who have demonstrated the courage to speak up against wrongdoing, they will ensure that the profession remains synonymous with truth, justice, and respect but also encourage others to follow suit.
As it stands the Nursing and Midwifery Board of Australia has never formally acknowledged any of the following nurses which have demonstrably upheld the values of truth, justice, and respect.
- Toni Hoffman – who exposed Jayant Patel aka the ‘the butcher of Bundaberg’.10
- Will Gordon – who exposed paedophile nurse James Griffin.4
- Jacinta O’Leary – human rights abuses in offshore detention.11
- Lynne Elsworthy – human rights abuses in offshore detention.12
- ‘Shona’ – re. Mr Mujed Muderis failed osteointegration and13 substandard patient care.
“Well, aren’t they just doing their job? Why should we even acknowledge them?”
These nurses behaved in an extraordinary and exemplary manner in stark contrast to masses that ignored such problems. These nurses are why the profession is synonymous with honesty and trust, as they maintain and preserve the profession’s values and integrity.
The Nursing and Midwifery Board of Australia’s deafening silence is emblematic of a culture that routinely silences and ignores nurses who advocate for their patients and the community. It is now time to appraise the way we have treated those who have sought to protect us.
References
1 Definition of ‘conspiracy of silence’ – Collins Online Dictionary [Internet], Collins [cited 2023 28 November] Available from: https://www.collinsdictionary.com/dictionary/english/conspiracy-of-silence
2 Topic: Cosmetic Cowboys [Internet], The Sydney Morning Herald, [cited 2023 28 November] Available from: https://www.smh.com.au/topic/cosmetic-cowboys-1nuo
3 What is the Main Character Syndrome? [Internet] Imperium Publication, [cited 2023 28 November] Available from: https://www.imperiumpublication.com/post/what-is-the-main-character-syndrome
4 It took a call between two old housemates to expose a paedophile and change a state forever, [Internet], ABC News [cited 2023 28 November] Available from: https://www.abc.net.au/news/2023-09-24/the-nurse-camille-bianchi-podcast-expose-paedophile-griffin/102868038
5 About Launceston General Hospital, Tasmanian Department of Health, [cited 2023 28 November]. Available from: https://www.health.tas.gov.au/hospitals/launceston-general-hospital/about-launceston-general-hospital
6 Wilkinson, A. et al. (2015) ‘Fatal consequences: An analysis of the failed employee voice system at the bundaberg hospital’, Asia Pacific Journal of Human Resources, 53(3), pp. 265–280. doi:10.1111/1744-7941.12061.
7 The ICN Code of ethics for Nurses. [cited 2023 28 November] Available at: https://www.icn.ch/sites/default/files/2023-06/ICN_Code-of-Ethics_EN_Web.pdf
8 The most trusted professions in Australia | Reader’s Digest Australia (readersdigest.com.au), [Internet], Reader’s Digest Australia, [cited 2023 28 November] Available from: https://www.readersdigest.com.au/true-stories-lifestyle/work/the-most-trusted-professions-in-australia
9 Admission to Practice, [Internet] The College Of Law, [cited 2023 28 November] Available from: https://www.collaw.edu.au/your-career/admission-to-practice
10 Queensland’s “Dr Death” linked to 80 deaths [Internet]. The Age. 2005. Available from: https://www.theage.com.au/national/queenslands-dr-death-linked-to-80-deaths-20050525-ge089n.html
11 Refugee children on Nauru are Googling how to kill themselves, whistleblower warns, [Internet] ABC News, [cited 2023 28 November] Available from: https://www.abc.net.au/news/2018-08-27/refugee-children-on-nauru-googling-how-to-kill-themselves/10153568
12 Australia’s Brave Whistleblower Nurse, [Internet] The New York Times, [cited 2023 28 November] Available from:https://www.nytimes.com/2016/12/20/opinion/australias-brave-whistleblower-nurse.html
13 Oozing and maggots: The stories one of Australia’s most celebrated surgeons doesn’t want you to hear, [Internet] The Sydney Morning Herald, [cited 2023 28 November] Available from: https://www.smh.com.au/national/oozing-and-maggots-the-stories-one-of-australia-s-most-celebrated-surgeons-doesn-t-want-you-to-hear-20220906-p5bfr8.html
Author:
Justin Nixon Bachelor of Nursing (University of Tasmania) 2009, Post Grad Cert in Mental Health (University of Tasmania) 2022 currently works at the Mental Health Hospital In The Home Team, Southern Mental Health Tasmania. Justin is a registered nurse with 13 years experience across a variety of healthcare settings including surgical units, forensic health, detention centres, mental health, and cosmetic surgery. His experience at Daniel Lanzer’s clinics eventually led to the ABC Four Corners program “Cosmetic Cowboys”, which blew the whistle on substandard practices in the cosmetic surgery industry. He has since featured in several other TV programs relating to the cosmetic surgery industry including 60 Minute’s ‘A Bad Look’ and ‘A Worse Look’, and The 7.30 Report’s ‘How cosmetic surgeons are taking advantage of Medicare’. Justin is passionate about healthcare reform, patient advocacy and protecting the public from harm.
