New Book reveals a legal and medical travesty of justice with adverse repercussions on our health services

‘Our health services are broken’. Decades of reforms have offered superficial band-aid solutions, ignoring the root cause of our overwhelmed and demoralised health services: managerialism. Until we confront that root cause, we can only treat the symptoms – not cure the disease.

This book is about the undeserved vilification of Professor Herb Green, and examines the process that enabled this travesty of justice, while revealing the origin of the deep-seated issues our health services face.

In the 1980s the Labour Government had plans to revamp the New Zealand health services; ‘market-orientated reforms’ where health services would be run on a business model with minimal clinical leadership.

To succeed, the Government needed to discredit and disempower the medical profession, who were opposed to those reforms. Public accusations against doctors at National Women’s Hospital (NWH) in 1987 provided them with a perfect opportunity to do this – The Cartwright Inquiry.

Dr Overton says that, in principle, the Cartwright Inquiry was about screening issues; that context is vital to understanding the miscarriage of justice created by this Inquiry. Screening is a vital medical tool, but even from its earliest days, the uncertainty it introduces has led to unrealistic expectations and worldwide controversies in management of the ‘abnormal cells’ it uncovers. This has held true for CIS
(carcinoma in situ), mammography, and later in controversies over PSA (prostate specific antigen). In 1989 Maureen Roberts reflected that there was an air of evangelism about screening, but few people questioned what exactly was being offered.

Even now there are controversies concerning whether to screen for prostate cancer using PSA, but few appreciate that the uncertainty is because up to 80% of screens can be false positives, which leads to significant harm from overtreatment.

The same problem existed for CIS. The standard treatment for women of all ages presenting with CIS was a hysterectomy, based only on a belief, not evidence. Green was a world leader in recognising the underlying uncertainties. He recognised screening could cause harm from overdiagnosis and overtreatment and he sought to reduce this. Misunderstood, Green was judged out of context and incorrectly demonised.

“Professor Green was one of the few at that time asking the awkward questions. From the 1950s, doctors, including Professor Green, were struggling with uncertainties of what screening for CIS actually revealed and what was the best treatment for women who appeared healthy.”

Silvia Cartwright, the head of the eponymous Inquiry, maintained it was a “judicial inquiry, not a scientific one”.

From the outset the doctors at NWH were fighting an uphill battle against a force that disregarded scientific validity.

“The Inquiry relied heavily on expert opinions. It lacked expert scientific evidence. There is a world of difference. Without evidence, an opinion is just that – an opinion.”

“Cartwright acknowledged she: ‘put more weight on the overseas authorities’, even when there was no evidence to back them up. ‘Deference to authority and majority,’ not by evaluation of the quality of evidence, can lead to injustice.”

“We can see the devastating results of over-reliance on opinion rather than evidence in the Peter Ellis case, whose convictions were quashed posthumously by the Supreme Court in 2022. It took 30 years for the legal profession to finally understand this issue and reverse the Ellis ruling.”

“The outcome of this Inquiry, based on Cartwright’s – in my opinion, incorrect – conclusions, created a huge wave of antagonism against the medical profession at that time.” They were disempowered and the way was clear for the government to introduce the damaging changes in our health services. While everyone focused on ‘untrustworthy’ doctors, the destruction of our health services by ‘managerialism’
continued unhindered for decades.

The consequences can be seen around you. They include shortages of medical professionals, many of whom left New Zealand, the closure of NWH, research stifled, the removal of GPs as part of the maternity workforce, and the failure of the National Cervical Screening Programme in its first 10 years, and more. At that Inquiry, Professor Green’s work was judged out of context, relying more on opinion than evidence, and he was wrongly demonised. The consequences of that Inquiry are still being inflicted on Kiwis today. Demonising a Good Doctor details every aspect of an Inquiry which should go down in history as one of the worst travesties in New Zealand medico-legal history. It needs to be recognised and addressed, and Professor Herbert Green’s mana restored.

Demonising a Good Doctor: The Medical Scandal That Wasn’t by Dr Helen Overton is published by Your Books with a strict embargo of Friday 14 April 2023 priced at $35.