How the Australian Craniofacial Unit succession plan became a crisis

ADELAIDE’S Australian Craniofacial Unit has changed thousands of lives, restoring function and form to people with craniofacial deformities, tumours and injuries. It’s the last place you would expect to find a swirling controversy.

Professor David David AC. Picture: Matt Turner.

• Call for probe over craniofacial succession fiasco
• Craniofacial Unit upheaval as legendary chief leaves
• David, Wade hold “constructive” talks
• David says Government craniofacial unit claims ‘nonsense’

IT’S the ugly face of a beautiful concept.

The Adelaide-based Australian Craniofacial Unit has changed thousands of lives, using a multidisciplinary team to restore function and form to people with craniofacial deformities, tumours and injuries.

The function can be things as crucial as eating, swallowing, talking, even breathing. The form can be multiple surgeries to help people with deformities look more mainstream which can be vital for self-esteem and acceptance in sometimes cruel societies.

Its quiet work helping Australians has been magnified by emotive media coverage of disfigured children brought in from Third World countries for transformative treatment.

The Unit became a byword for hope and humanity.

Now it is at the centre of an ugly slanging match, legal action and intense political brawling.

Set up in 1975 at the Women’s and Children’s Hospital under then-Premier Don Dunstan, the Unit has been driven by founder Professor David David, the current South Australian of the Year.

He is known as a hard taskmaster who does not settle for “near enough is good enough” — a precious quality if you are the person going under the knife.

Prof David stepped down with a clear succession plan a year ago and recently retired — the plan included continuing to perform surgery on children brought in from overseas which he says was about 15 patients a year.

However, earlier this month Prof David told The Advertiser the Unit had stopped taking overseas children, and he was “stunned” to hear one of the best doctors there, oral and maxillofacial surgeon Dr Ben Graves, had been ‘booted’ with no explanation.

Minister for Health and Wellbeing Stephen Wade. Picture: AAP Image/ Brenton Edwards

Health Minister Stephen Wade subsequently responded that there had been “no changes” to the model of care, and fluctuating demand was why there were only three overseas children booked in last financial year — two of these pulled out as they were treated in their home countries.

But Prof David called this “nonsense”.

Mr Wade and Prof David have since had a private meeting to discuss concerns which Prof David described at the time as a “very long, positive meeting”.

“I’m confident the Government will get it back on track,” he said.

Err, not quite.

The derailing includes the Opposition swooping on Prof David’s concerns, holding press conferences and demanding answers in State Parliament.

Opposition health spokesman Chris Picton has led the charge, but the bicameral system of government means he has been directing questions to other Liberals in the House of Assembly because Mr Wade sits in the Legislative Council.

This resulted in Liberal Minister Dan van Holst Pellekaan telling Parliament the government had undertaken an independent review and that Prof David “is well aware of it. He has had every opportunity to contribute to that review.”

Prof David responded saying: “I am staggered that it can be said that I was aware of a review. I have not been approached by a reviewer or had any knowledge of a review.”

Cue political outrage.

The Opposition has demanded an investigation into whether Mr van Holst Pellekaan had misled the Parliament and impugned the reputation of the South Australian of the Year.

“This is a new low for the Marshall Liberal Government,” Mr Picton raged.

“Going after the South Australian of the Year, a great humanitarian like Prof David David is beneath contempt.

“Mr van Holst Pellekaan must withdraw his comments and apologise to Prof David.”

Dan van Holst Pellekaan. Picture: AAP Image/Luis Ascui

Labor now wants a Privileges Committee investigation into whether Mr van Holst Pellekaan misled Parliament.

Labor says if the government has ‘nothing to hide’ they will support the motion — unlikely, especially since Mr van Holst Pellekaan later corrected the record.

The motion will be put to Parliament tomorrow, guaranteeing further headlines.

Mr Wade, when he realised Prof David had not, in fact, contributed to the review, immediately rang and asked him to be part of it.

This is despite Mr van Holst Pellekaan telling Parliament the review was over and he had been given the report but not yet read it.

But it gets uglier.

The senior surgeon who was removed from the Australian Craniofacial Unit, Dr Ben Grave, is now launching legal action against the State Government over the recruitment process.

That appointment, and the processes to reach the decision, was part of the internal review.

The Opposition is demanding Dr Grave be returned to the Unit, which they say can be done at no cost via his clinical appointment at the University of Adelaide.

Today Prof David backed that view, saying it would help resolve the issue.

“He (Dr Grave) is a symptom of unnecessary change,” Prof David said.

“The unit is famous and has functioned very well, and his contribution to it … has added, over the last eight or nine years, a very big component of patient care.

Labor health spokesman Chris Picton. Picture: AAP Image/David Mariuz

“This is not primarily about him or me, it’s primarily about patients — the reason this is a world famous unit is because patient care is extremely high and he is a big component of that.”

Prof David said it would be easy to restore Dr Grave’s position with a few phone calls.

“He was already there as a university person, there should be leaps of joy from the hospital to know they can still keep him without any additional payments,” Prof David said.

“The minister could do that quickly.”

Prof David feels an obligation to help the Unit in future but noted he would need to be asked, adding: “I was not asked to be on any of the selection committees nor asked to continue to give any advice at all.”

This surgical storm is not going away any time soon, with investigations, an internal review, legal action and queries over the Unit’s direction — all of which will be used for political ends.

And the question remains — how many, if any, overseas children with deformities will be treated by the Unit this financial year?

Whatever the number, expect some happy photo opportunities when the Unit performs its next miracle on a foreign youngster battling a deformity as the Government moves into damage control.

The Australian Craniofacial Unit:

■ Was founded in 1975 by surgeon Professor David David with support from the Dunstan Government.

■ ITS fundamental purpose is: “To ensure that patients can ultimately assume a place in society with renewed hope and restored dignity.”

■ BASED at the Women’s and Children’s Hospital it provide a service for South Australian, interstate and overseas patients, using a multidisciplinary team approach to tackle complex cases, often requiring multiple surgeries.

■ IT has treated about 15 overseas patients a year for the past 44 years.

■ IN September 1988 the Australian Health Ministers’ Advisory Council officially designated the Unit a National Centre of Excellence.

■ CRANIOFACIAL surgery is concerned with the treatment of patients with rare and/or complex congenital or acquired anomalies which together affect the head and face.

■ SOME conditions are present at birth, while others, such as tumours and malignant growths, may develop in later life.

■ MANY people require treatment and support from birth to adulthood and the Unit treats both children and adults.