Health reporter Elspeth McLean caught up with him earlier this year on a visit to Dunedin and asked him to reflect on a decade in the commissioner's job.
In 10 years as Health and Disability Commissioner, Ron Paterson has heard some heart-rending stories.
And while the job has required "a certain level of detachment", he would worry if sometimes he was not emotionally affected by some of the letters he receives.
Some of the hardest cases were those where something had gone wrong during labour and delivery and a family had a brain-damaged baby, something which would change the whole course of their lives.
An investigation might be only mildly critical of the actions of the health professionals concerned, but the family naturally believed the professionals were to blame and must be held to account.
"It's very difficult," Mr Paterson said.
Similarly, where harm had occurred where someone had died, "obviously, that harm cannot be undone".
"What we try to do is provide answers.
People and systems are held to account where there have been significant failures."
Mr Paterson agreed people sometimes had unrealistic expectations of his office.
"It is very hard dealing with complaints from people who are still in grief.
"That's going to affect how they respond to the information they are receiving.
"We can't say go away and complete the grieving process and come to us.
"Sometimes, answers can help with the grieving process."
This could happen in instances where families might have worried they should have done more and "quite often getting some more information can put that concern to rest".
Mr Paterson described the job as endlessly fascinating, even though it meant being surrounded by conflict.
He used to get impatient with doctors for what he saw as their overreaction to the dreaded letter turning up with the HDC logo on it, but came to realise there was still a deep perception that "your job is on the line and something terrible is going to happen to you".
The truth was that, in "the vast majority of cases", the worst that would happen was the health professional concerned would be asked to provide an apology and "pull their socks up".
Individual health professionals and providers of disability services were virtually never named by his office unless found guilty of professional misconduct, although in some instances families did take their concerns to the media.
Sometimes, health professionals did not realise that the biggest risk for them, if they did not try to resolve complaints early, was that the patient would feel brushed off and, in their frustration, air their grievance publicly.
The culture was changing slowly within the medical profession, although Mr Paterson said there were still some providers in the rest-home sector who were "so focused on self-justification, they don't manage to stop and think 'what's making this person unhappy? Could I have done something differently?'
"Defensive responses usually add fuel to the fire."
Asked about the situation in Otago and whether it had changed during his term, Mr Paterson said he had always enjoyed co-operation from practitioners in Otago, and over time the district health board management had become more understanding of the HDC system and how it worked.
One of the high points of the job had been getting the complaints system embedded to the point where it was now seen as firmly established as part of the regulatory landscape for health and disability services throughout the country.
If all the office did was resolve individual complaints, however, it would feel a "bit like the ambulance at the bottom of the cliff" so another highlight had been helping to shift the focus from individual problems to safety and quality across the whole health and disability system.
He had been pleased to see the national public reporting of sentinel and serious events in public hospitals since 2008, but would like to see it extended to community care and private hospitals.
Mr Paterson did not support those who suggest sentinel events should be immediately reported publicly in much the same way as a major health and safety incident would be.
Such negative publicity early when an event had just occurred, when there would be no context around the incident, would be likely to make doctors and nurses reluctant to participate in review processes, he said.
While he was not leaving a perfect complaints system, he was happy that he had set the complaints system on a good course.
On a personal level, there was some abuse, which "goes with the territory in a job like this" which could be hard on staff "and on you personally".
He had to try to find ways to cope, although he admitted it was a hard job to get away from.
"Inevitably, the job takes over your life".
He is looking forward to more time to read and think and challenges of a different sort in his new role as a chair of law at his alma mater, the University of Auckland.
He would like to help build closer links between law, medicine and philosophy within the university and also with the University of Otago.
There was already a community of scholars between the two organisations which could be strengthened.
Asked if events such as the recent book published by Auckland University Press, written by medical historian Prof Linda Bryder suggesting the Cartwright Inquiry reached the wrong conclusion might affect relations, Mr Paterson said he saw no evidence of that happening.
Scholars from both universities had critiqued Prof Bryder's methodology and conclusions.
One aspect of the Bryder publication he had found disheartening was the way in which it reached its conclusion about the inquiry.
Judge Silvia Cartwright had sifted through a massive amount of evidence, including first-hand accounts from patients, expert opinions and challenges to that opinion and, while he accepted that an inquiry's findings were always open to review, it had to be remembered that "only the inquiry sees the whole picture".
He did not consider that patients' rights and the complaints system were set back by anything raised in the book.
Most of those doctors who did not accept the Cartwright Inquiry findings now accepted the need for an independent complaints system.
Mr Paterson's move to the law faculty does not mean an end to his involvement in issues to do with medicine and patient safety.
In May, he begins a major research project examining the notion of "a good doctor" and how patients can be confident that a registered doctor is one.
Funded by the New Zealand Law Foundation, it will involve case studies and interviews with New Zealand and overseas authorities on the issue.
It would explore "whether we've got the balance right" between the morality and professionalism of doctors and the need for external regulation, such as that by the HDC, Mr Paterson said.
Ron Paterson
- Has law degrees from Auckland and Oxford Universities
Mid-1980s: Visiting law professor at the Universities of Ottawa and British Columbia
1986-99: Senior lecturer in health care law at the University of Auckland
1993: Fulbright visiting professor of biomedical ethics at Case Western Reserve University
1998-99: Harkness fellow in health care policy at Georgetown University
1999-2000: Deputy director-general, safety and regulation, Ministry of Health.
1996: Helped to draft New Zealand's Code of Consumer Rights
- Mr Paterson is recognised internationally for his expertise in regulation of patients' rights and healthcare quality improvement.
- His international work has included chairing two major health system reviews in Australia.
- In May, he will take up a chair in law at the University of Auckland.
Commissioner
- Health and Disability Commissioner Act 1994 created the office, a move which followed the recommendations of Judge Silvia Cartwright in the 1988 Cervical Cancer Inquiry report.
- The role of the commissioner's office is to promote and protect the rights of patients and organise fair, simple, speedy and efficient resolution of complaints.
- It also has an educative function.
- It upholds the code of health and disability services consumers' rights (1996).
- Robyn Stent was the first commissioner, appointed in December 1994.
- Ron Paterson became the second commissioner in March 2000.
- He leaves the office at the end of this month.
- A new appointment has not yet been made.
