Now here's Mark with Close Up. Tonight on Close Up ` Due to the live nature of Close Up, captions for some items may be incomplete. ONE News captions by Lauren Strain and Richard Edmunds. What you're going to see next is very very rare: a doctor actually fronting up over complaints. Some of Dr Fris' patients aren't at all happy with him. They complained, and they aren't happy about that either. They think the system is stacked in the doctors' favour. In this case, Dr Fris has done 2000 weight loss procedures. He's had eight complaints about that, one upheld ` over communication problems. So why are these patients not satisfied? Here's Gill Higgins. TENSE MUSIC He never ever, you know, took me seriously or listened when I was saying that I was in pain and me feel almost like, it's sort of, 'it's all in your head.' My specific complaint would be the way that he dealt with me. I trusted him with my life, and he hasn't respected me enough to follow up. They are frustrated and fed up. Three women who've suffered complications. A hernia op, leaving a screw where it caused nerve pain. I woke up and was just in absolute agony. A gastric lapband causing erosion of the stomach wall. It all corroded and started to, like, become infected. And that's why I was in so much pain in that side. And another lapband that failed to work. It wasn't clipped. So, the band needs to be like that to lose weight, and it was just lying there. Their doctor is sympathetic. Complications are a fact of surgery, and he says that sadly, they are especially frequent when it comes to procedures for weight loss. I'm told that the complication rate is even higher than open heart surgery. So what about your own complication rates? I'm very comfortable. I've done over 2000 of these type of operations, and so I think statistically, my results would stand up. Well below the international recommendations. But these patients say the problem wasn't the complication per se, but how they felt let down by the doctor's response. If he'd ever acknowledged or taken me seriously, it would have been a different story. But it was almost like, just, off you go. You've done your job now, and I've got my money, and, you know, 'next, please.' That's how I felt. My dad died young, so I chose to do this to look after my innards. And then for him to wash his hands of me and basically say, 'You're on your own now,' where you should be supported. It's very disappointing to hear, because I think we all feel very deeply about the complications. I could see that a patient would get very frustrated and feel let down, because even though we discuss that with them, or try to discuss that with them, you know, when you're sick and unwell and worried, I don't think you're gonna absorb everything that's told to you. But Arnse Cassrells feels it's the other way around. After simple hernia surgery, she experienced severe pain, but felt Dr Fris didn't take it on board. But he undermined me and tried to portray me as a person that was just seeking drugs, um, sleeping pills, painkillers, for the hell of it ` rather than the fact that I was actually genuinely really in pain, really really unwell. And when did it stop? Immediately after the operation. An operation after months of discomfort, performed by a different surgeon. For the first time, after that operation, I had the relief of that pain. Arnse's sister, who's a lawyer, helped her complain to the Health and Disability Commission. She felt not believed, she felt minimised, she felt marginalised, she felt, um, as if he hadn't taken her seriously. The complaint was upheld for a failure to treat with respect. She got an apology by letter. I don't think an apology was enough at all, no. He also had to go and do a communications course, which I think was a good thing. Amalia also made a complaint about her care and the doctor's attitude. Her case was dismissed. They said that the service he provided was adequate. They basically have my point of view and his point of view... they went with his side over me. The Health and Disability Commission has a code of patient rights. Number one is the right to respect. And they didn't say, make any comment on his manner towards you? Nothing about that. Another patient, who didn't want to go on camera, sent a statement. She says she was told to 'harden up', even though her complications led to months in intensive care. She officially complained too, but Dr Fris denied being unsympathetic. Again, it was her word against his; again, the complaint was dismissed. Dr Fris believes the decisions were right, but the system is wrong. It takes one or two years for the patient to get the result, and so you can see that the resentment would build up. And he says he'd like to be more involved in correcting complications, but the surgery's often an emergency and gets transferred to the public system. The unfortunate thing with that is, I transfer everything; I transfer the care as well. So I cannot the care there. I can visit them in hospital, but I can't make any decisions regarding investigations or treatments or medications, nothing at all. And so that's very frustrating. But patients like Janine feel the system's biased against them. She felt Dr Fris was uninterested when it became clear her lapband wasn't working. I continued to ring him, they didn't ring me back. Um, I felt like I had lost my voice. And she didn't think the complaints body would be any different. I just feel I wasn't listened then so what` (LAUGHS) what's gonna happen now, you know? Like, I just feel they'll look after him and not look after me. We asked the Health and Disability Commission if any other complaints had been laid against Dr Fris. They refused to tell us, saying the privacy of the doctor outweighed the interests of the public. Dr Fris volunteered this information, saying of 2000 weight loss patients he's had eight complaints. But could we confirm it? No. Again the complaints body refused to help. These patients and their doctor agree: the complaints process needs improving. I think the system does need to be looked at. We have to have a system that` where the doctors are accountable in a way that we find acceptable. We approached the Health and Disabilities Commissioner for comment, and got the standard: 'It wasn't usual practice to discuss publically the conduct of named individuals.' Then, as if to perfectly explain why complainants get so frustrated, they went into full bureaucratic mode to explain the investigation process: Great, that's explained everything (!) More forthcoming is Dr Ron Paterson. He used to be the boss of the Health and Disability Commission. GOOD EVENING, DR PATERSON. YOU WEREN'T THAT BUREAUCRATIC WHEN YOU WERE THERE, WERE YOU? WE NEED BETTER INFORMATION FOR PATIENTS ABOUT THEIR DOCTORS. LOOK, IS IT THE COMMISSION THAT IS THE COMMISSION THAT IS THE PROBLEM IN TERMS OF WHY YOU WROTE THE BOOK? WE'VE GOT A GOOD SYSTEM AND COMMISSIONER HERE IN NZ. WHEN PEOPLE MAKE THE COMPLAINTS, WHEN THEY ARE ABOUT FOLLOW-UP AND COMMUNICATION AND ISSUES THAT HAVE ARISEN AFTER SURGERY, EVERY ONE OF THOSE COMPLAINTS IS NOTED, NOT DISMISSED. IF THERE IS A RUN OF THEM, THE COMMISSIONER WILL ALERT THE MEDICAL SO IT'S WORTH COMPLAINING FOR THE CUMULATIVE EFFECT? THE THING THAT STRUCK ME ABOUT THIS BOOK - VEILS OF SECRECY, ROAD BLOCKS WE CAN DO BETTER, OTHER COUNTRIES DO. IT IS CERTAINLY TRUE FOR COMPLAINTS AND DISCIPLINE WE NEED TO BECOME MORE OPEN. IT'S HAPPENING,BUT THERE'S MORE TO GO. WE ALSO NEED TO KNOW NOT JUST THE NUMBER OF COMPLAINTS, BUT COMPLICATION RATES SO THE SURGEONS NEED TO AGREE AMONG THEMSELVES. A LEAGUE TABLE IS NEEDED? WHY NOT? WHAT ABOUT WHO HAS HAD THE LEAST AMOUNT OF COMPLICATIONS. ARE DOCTORS FIGHTING THAT? SOME DOCTORS HAVE RESISTED THAT. IN ENGLAND, THE CHIEF SURGEON SAYS IF HE DOESN'T KNOW HOW WELL HE IS DOING COMPARED TO COLLEAGUES, HE DOESN'T KNOW HOW WELL HE IS DOING AT ALL. I'M CONCERNED THAT IN NZ, SOME HAVEN'T EVEN AGREED WHAT DATA TO COLLECT. WE ARE NOT COLLECTING THE DATA AND SHARING WITH OTHER DOCTORS, AND THEN WITH THE PUBLIC THAT FEEDBACK FROM COLLEAGUES AND FROM PATIETNS SHOULD BE PART OF WHAT WE USE WHEN WE RECERTIFY A DOCTOR. THEY STARTED OVERSEAS. HAS THE SKY FALLEN IN? IT'S COMING IN IN ENGLAND LATER THIS YEAR. WHAT I FIND GALLING IN THIS BOOK ` DOCTORS KNOW WHO AREN'T GOOD DOCOTORS. THEY WON'T SEND THEIR OWN FAMILY THERE. IT IS LIKE INSIDER TRADING. I AGREE THAT'S WRONG, AND THAT'S PART OF THE MOTIVATION OF THIS BOOK. WE NEED TO ENCOURAGE DOCTORS TO COME FORWARD WITH THIS INFORMATION. IN OTHER COUNTRIES WE ARE SEEING MORE WILLINGNESS TO DO THAT. WE NEED THAT CULTURE CHAGNE. IN THAT STORY, THE COMMISSION CAME BACK AND SAID THE PRIVACY OF THE DOCTOR OUTWEIGHED PUBLIC INTEREST. I DON'T WNAT TO SECOND GUESS THE COMMISSIONER'S DECISION. THEY ARE USING THE LAW. SO IT'S NOT LIKE THE COMMISSION COULD JUST CHANGE IT? SO WE NEED LEGISLATIVE CHANGE? BUT ACTUALLY WE NEED OUR REGULATORS TO START GETTING A BIT TOUGHER, THE NURSING COUNCILS, MIDWIFERY, MEDICAL IF YOU HAD A PROCEDURE COMING UP, WOULD YOU CHECK OUT THE DOCTOR FIRST? I WOULD ASK FRIENDS AND FAMILY, BUT ALSO ASK DOCTORS DIRECTLY. ALSO ABOUT THEIR COMPLICATION RATES AND WHO THEY ARE. IN THE STORY, THOSE PATIENTS WEREN'T LISTENED TO. I WOULD ALSO GAUGE IF THE DOCTOR WAS LISTENED TO AND IF I WAS RECEIVING GOOD FEEBACK. DR PATERSON, GOOD LUCK TWISTING ARMS. DO YOU HAVE ANY THOUGHTS ON THE COMPLAINTS SYSTEM GO TO OUR WEBSITE OR EMAIL US Coming up ` taking the doctor to the patients. Bringing that, sort of, ED-type knowledge. We're enabling ourselves to do more for our patients. The emergency medical try-out that's set to save lives. And ` we first met Chrystal ten years ago, weighing less than a tin of beans. So how's she thriving now? Like any family man, I like my toilet time. I also like my toilet clean. So I use Harpic White & Shine. Its improved thick formula has five times power action, and the bleach and baking soda,... and the bleach and baking soda,... ANGELS SING and the bleach and baking soda,... ANGELS SING well, it kills 99.99% of germs, with a delightful... (SNIFFS) fresh scent. Excuse me. Harpic White & Shine, with five times power action. Like a new loo every time. You've probably heard a lot about the golden hour ` that crucial window to get a badly injured patient to a hospital. Choppers have played a big role in this, but now a twist. How about getting the hospital to the patient? Put an emergency-room doctor on board the helicopter, fast-forward the whole process. It's been tried overseas and saved lives. Matt Chisholm looks at what it could do for us. Flossie's entrapped. We're extricating the baby now. It's captivating. I'm actually struggling to get pulses now. Emergency specialists hard at work. OK, guys, she's dead. It looks and sounds like the real deal. But, no, this is helicopter crewmen, paramedics, and now doctors, in training. Barry, you're not doing yourself out of a job, are you? There's an element of risk of that, but I don't think so. (LAUGHS) HELICOPTER WHIRRS In the past, if Auckland's rescue helicopter came to your aid, it would have been up to the paramedic to get you into safe hospital hands. It's a very lonely place out there if you're working on your own. But since September, that's all changed, in a two-year pilot programme which sees volunteer emergency department doctors climb on board with the paramedics, bringing the hospital to the roadside. You've got this seamless care. You've got roadside care by the knowledge experts, the paramedics, being met, if you will, and woven in with a hospital-level care that we normally provide in the emergency department, and we're bringing that quickly, as kind of a critical intervention. You can't beat having a person right there who` who would be a person that you would take the patient to in the first place. We believe that together we are enabling ourselves to do more for our patients. So what is it the doctors do that paramedics can't? Whether it's definitive airway management or use of critical drugs in life-saving interventions, or you can use point-of-care ultrasound to get a diagnosis, but we can also begin that definitive care, whether it's re-expanding a collapsed lung or starting to give people life-saving therapy en route to hospital. That early diagnosis and life-saving therapy obviously crucial. There are lives that have been saved. That's Australian lives, where they've been using the doctor-paramedic model for 20 years. What we have shown is a decrease in the number of those significantly head-injured long-term patients. There are huge ongoing problems with having somebody who should be a full member of society disabled or worse. We'll tie off. Care Flight, the Australian equivalent of our helicopter emergency medical service are in Auckland, bringing our new doctors up to speed on working in a different environment. The last thing you want is a doctor arriving, thinking he's Superman with his underpants on the outside and his cape behind him. But, at this stage, everyone concerned says both the training and the real-life rescue missions have been going very well. Are you short of breath at the moment? No, not too bad. Not too bad? On this particular journey, the doc didn't make a huge difference, but he could do tomorrow. That's where I need some shock treatment. (LAUGHS) One case I'd relate to you is a gentleman who had had an injury over in the Coromandel, where his hip had been dislocated, and was in obvious pain, with his hip contorted. We were able to work together to safely apply some procedural sedation, so put the patient off to sleep, reduce his hip just there in the airfield. When you've got another pair of hands and another brain with a lot of education, a lot of experience, a lot of bringing that ED-type knowledge with you to the scene, I mean, it makes a huge difference. Considering this two-clinician model has been operating successfully in Australia, Europe and North America for decades, it begs the question why hasn't this been done here sooner. Was there some reluctance to let the doctors come on board? I can tell you, it was kicked around a little bit. I mean, I had to sell it to our guys to some degree. It ends up being a case of trying to understand what the region needs and, obviously, what the region can afford. DHBs have to watch their pennies. We're a charitable trust; we have to watch ours. But if we can get even half a dozen or something people within that two-year period that have lived that wouldn't have or have recovered that much quicker that wouldn't have, I mean, we've actually saved the state a whole lot of money. Can we afford not to do this? No, I don't think we can. We are a decent, thoroughly decent society in this country and we know what's best for people and we try to look after our citizens in the best way that we can, and the visitors, for that matter, and, you know, we want to do the right thing. Just ahead ` she was a miracle girl ten years ago. So what's happened since to help the way we care for premature babies? A lot can happen in 10 years. You can complete a mission to the moon, train to be a psychiatrist or, like Chrystal Henson, grow from something weighing less than a can of spaghetti to a thriving little girl. We covered Chrystal on this programme when she was born 10 years ago. She was 390g and struggling to survive, and we wondered whatever happened to Chrystal. So Abby Scott was dispatched to a 10th birthday party in Invercargill. This is a doll's nappy and that's what she used to have on her when she was a baby. And this is... What do they look like? Feet? Booties. This was Chrystal's first little hat she used to wear in the incubator. Yes? Keep her head warm. And then we went up sizes coz her head got bigger, see, bigger now. I mean, 390g ` I didn't expect her to be here, to be honest. I expected, actually, to lose her, so I'm really proud of her. She's done really well. # Happy birthday, dear Chrystal... Chrystal Henson's come a long way in 10 years. This is how tiny she was when she entered the world ` born three and a half months early. Waking up and seeing the photo I did see, it was hard. We first met Michelle Hancox and baby Chrystal nearly a decade ago. It was when you couldn't hold her ` that was the hard part. For a month, that was the case for first-time mum Michelle, who had to have a caesarean after a scan showed Chrystal had stopped growing. To be honest, I didn't expect to get this far with her for a start off, and we've got a lot to go through yet, but we'll make it. And she sure has. What's this, Chrystal? What's that? Each milestone extra special. # Happy birthday to you. Happy birthday to you. I make the most of every day I have with her, because if it wasn't what everyone had done for her, I wouldn't even have this right now. We thought she'd make it all along, but it's just so nice to actually see their first birthday. Now look at you. You're huge. # Happy birthday, dear Chrystal. Happy birthday to you. Is it good? Today the cake's just as tasty. Yum. Chrystal was the third-smallest baby born in NZ at the time. Now she measures up with her peers. She's just like a normal little 10-year-old. You wouldn't even know, wouldn't even notice. What's your favourite thing at school? Learn maths. She will argue and if she doesn't want to do something, she'll put her foot down and not do it. We know what the corner is. She's got her mother's temper I think any baby who survives at less than 500g is a miracle in itself and, certainly, when you're less than 400g, 390g, that's a very small baby indeed. Dr Malcolm Battin is one of those trying to improve life for those very small babies. I think the focus of the last 10 or 15 years is very much on the quality of survival ` how well these children are going to do, what their quality of life is like and what their neuro development is going to be like. Chrystal's quality of life is practically unaffected by her premature birth ` the ultimate goal for neonatologists. So what do you want for your birthday? My Little Pony. It's a My Little Pony. READS: To Chrystal, happy birthday, love Nicole D. Very high numbers of babies will function very well through childhood after a period of time in intensive care. I think I'm more excited than what she is because we've succeeded ` the both of us together. It was worth it ` every second of it was worth it. Time for your feedback now, and it's on the lead story. FROM ALL OF US, CHRYSTAL, HAPPY BIRTHDAY. A lot of you emailed with more on Dr Fris himself, others had a wider view. 'Save the dolphin'; it's a common enough slogan. But what's the human cost? It was <BLEEP>ing gut-wrenching. By losing the two-mile, it's going to lose about $100,000 of my income. Absolutely destroyed our fishing careers. Ocean Pearl Fisheries is the first to cut jobs in anticipation of the ban. There's not even one job in here at all. I don't know what I'm gonna do. And what's the minister doing? Jobs vs. environmental principles. That's tomorrow night. And that's NZ Close Up. Captions were made possible with funding from NZ On Air.