|Practitioner:||Dr Jonathan Graham Wright|
|Charge Characteristics:|| Inadequate
Failure to obtain informed consent
Failure to obtain advice from a specialist
The Director of Proceedings charged Dr Wright was guilty of conduct unbecoming a medical practitioner and that conduct reflects adversely on the practitioner's fitness to practise medicine in that whilst treating his patient he:
On 20 March 1998, the patient took one of her children to see Dr Wright. In the course of the consultation the conversation turned to the patient's weight. The patient told Dr Wright that she had tried a number of ways of losing weight. Although it was documented in the patient's notes which Dr Wright had, that the patient had in 1989 experienced tachycardia, in 1995 suffered from anxiety and in 1997 suffered from palpitations, Dr Wright did not take her blood pressure, pulse or check her heart. He suggested diet pills, weighed her and wrote out a prescription for 30 75mg tablets of tenuate dospan which is an appetite suppressant.
The 1996 New Ethical Catalogue recommends a dosage of one 75mg tablet daily. The New Ethical's Compendium also stated that tenuate dospan may be given for periods up to twelve weeks, with intervening periods of one month without treatment. It also stated the recommended dose should not be exceeded in an attempt to increase the effect; rather the drug should be discontinued when the patient stops losing weight.
On 3 April 1998, the patient saw Dr Wright and was weighed. She had lost weight. He prescribed a further 30 75mg tenuate dospan tablets and told her to increase the dosage to two per day. Thirty further tablets were prescribed in each of 17 April, 14 and 29 May and 2 June 1998. On 16 June when it was established the patient had not sustained any weight loss, he prescribed 30 30mg tablets of duromine. On 15 July 1998 Dr Wright prescribed a further 30 tenuate dospan tablets. On 31 July 1998 he prescribed 60 of those tablets and on or about 31 August 1998 he gave the patient a further prescription for tenuate dospan. On both 24 September and 8 October 1998 he prescribed 30 further tablets. On the latter date he told the patient that this would be her last script and told her to take one tablet per day. (From 3 April 1998 until 24 September 1998 he had been telling her to take two tablets per day.)
At no point during the period from 20 March to 8 October 1998 did Dr Wright check the patient's blood pressure or pulse or advise her of any possible side effects of tenuate dospan. He weighed her at each consultation.
In November 1998 the patient consulted another doctor. By that time she was suffering from tremors, nervousness and jitteriness. She was advised to, and did, stop taking the drug. Most of the side effects have since subsided. The patient still suffers from a racing heartbeat but the agreed summary recorded that the Director did not allege that the continued tachycardia is a direct result of the continued use of tenuate dospan.
The charge was, and all of its particulars were, admitted.
The Tribunal considered all of the particulars separately and found all the particulars were established; and that the conduct alleged therein amounted to conduct unbecoming. It considered the conduct in particulars 1 and 3 to be at the higher end of the range of seriousness in cases of conduct unbecoming. It found the conduct of particular 1 to be in the middle of that range and conduct in particular 4 to be in the lower end of that range. It concluded that the overall gravity of the conduct of which it found Dr Wright guilty was somewhat higher than the middle of the range of seriousness in cases of conduct unbecoming.
The Tribunal further found the proven unbecoming conduct reflected adversely on the practitioner's fitness to practise medicine.
The Tribunal considered that there were features of the case which would ordinarily have called for the imposition of a significant penalty for the dual purposes of punishing the practitioner and of sending a message to other practitioners that such conduct is unacceptable and cannot and will not be tolerated. This applied with particular force to the failure to obtain the patient's informed consent and to the inappropriate prescribing over an extended period. However, the Tribunal also considered Dr Wright was entitled to credit for his commendable response to the patient, his prompt and repeated apologies and the numerous steps he had taken in an endeavour to improve his performance and avoid a recurrence.
The Tribunal ordered Dr Wright be censured, fined $2,500 and that he pay a total of $5,500 ($1,925 to the Health & Disability Commissioner and $3,575 to the Tribunal) towards the costs and expenses of and incidental to the investigation, prosecution and hearing. It further ordered publication of the hearing in the New Zealand Medical Journal.