|Practitioner:||Dr Graham Keith Parry|
|Charge Characteristics:||Inadequate physical examination|
|Additional Orders:||Doctor denied interim name
Granted application for private hearing: 01798081chearprimin
Complainant granted permanent name suppression: 0180cfindingsnamesup
|Appeal:||Doctor appealed substantive and
penalty Decisions to District Court.
CAC applied for a change of venue for the appeal hearing - application denied (Parry v MPDT Auckland District Court, 7 October 2002, PF Barber DCJ, 1749/02)
District Court upheld substantive appeal - Tribunal finding set aside - (Parry v MPDT, (Auckland District Court, 15 August 2003, Doogue DCJ))
A Complaints Assessment Committee charged Dr Parry with professional misconduct alleging serious deficiencies in Dr Parry's gynaecological practice, namely, that he failed to adequately assess and examine a patient after she presented with post-coital bleeding, by either visualisation of the cervix using the naked eye and/or the use of a colposcope.
The patient was first referred to Dr Parry in May 1993 by her general practitioner. At that time, she had experienced some intermittent inter-menstrual bleeding.
After taking a brief history Dr Parry carried out an abdominal ultrasound on the patient which did not disclose any abnormalities. Dr Parry did not carry out an internal examination at any time during this consultation. The patient thought this was unusual and asked if such an examination would be appropriate. Dr Parry told the patient that he did not need to examine her internally as he could see all he needed to from the scan. He advised her to monitor the bleeding and to see him again if the bleeding became more regular or got worse.
The patient continued to experience persistent inter-menstrual bleeding and she returned to see Dr Parry again on 21 September 1993. During this consultation Dr Parry discussed various treatment options with the patient including dilatation and curettage ('D & C'), hysteroscopy and hysterectomy. She agreed to a D & C and a hysteroscopy.
The D & C was performed on 19 October 1993 at Whangarei Hospital. A cervical smear was taken at the time of the procedure at the patient's request. However the hysteroscopy was not performed due to a problem with the sterilising equipment on the day of the operation that meant the equipment could not be used. After the D & C procedure the patient was told that nothing untoward had been detected and that no further action was required at that stage. It was Dr Parry's evidence that he would have visualised the cervix in the course of carrying out this procedure. Post-operatively, he advised the patient that if bleeding persisted she should consult with him again after six months.
The patient was again referred to Dr Parry and she saw him on 15 May 1995. The patient complained of occasional episodes of post-coital bleeding and continuing pre-menstrual spotting. It was Dr Parry's evidence that because of the regular cyclical nature of the bleeding he considered that its cause was likely to be hormonal in nature. At the consultation Dr Parry carried out another abdominal ultrasound scan to exclude uterine causes of the bleeding. He did not carry out any internal examination, or any other examination, nor did he refer the patient for any other examination or investigation.
The patient's post-coital and inter-menstrual bleeding continued until 6 December 1996. On that occasion the general practitioner whom she saw examined her and took another cervical smear. The results reported a high grade abnormality (CIN III). The patient underwent a colposcopy on 19 December 1996 and a Lletz biopsy was carried out on 20 December 1996. The results of the biopsy returned CIN I on histology and confirmed no evidence of malignant disease.
The Tribunal found Dr Parry guilty of conduct unbecoming and that conduct reflected adversely on his fitness to practise medicine.
The charge alleged serious deficiencies in Dr Parry's management of the patient after she presented with post-coital bleeding. The patient did not present to Dr Parry with post-coital bleeding until the May 1995 consultation. Dr Parry did not dispute the allegation that he did not examine her cervix visually during that consultation. The Tribunal considered therefore that it needed to determine whether that was conduct that constituted professional misconduct.
The Tribunal considered its task was to assess the conduct of the practitioner at the time of the relevant event, in this case, May 1995. The fact of a favourable outcome for the patient did not excuse any poor or inadequate management of her care by Dr Parry just as an unfavourable outcome would not, per se, be culpable.
Dr Parry did not resile from the fact that as the specialist gynaecologist to whom the patient was referred it was up to him to determine the cause of her abnormal bleeding and it was his professional duty to exclude all possible causes especially those that were potentially most serious.
Dr Parry accepted that all he had done to exclude the major concern of the post-coital bleeding, namely a malignancy of the cervix, was to rely on the examination of the general practitioner reported in the referral letter, and the results of the patient's previous cervical smears. He accepted that cancer of the cervix is "number one" of the most serious possible causes of post-coital bleeding. Dr Parry also accepted that a cervical smear test is a screening device rather than a diagnostic tool.
The Tribunal was satisfied, taking into account the presenting clinical features including:
that Dr Parry's care and treatment given to the patient was unsatisfactory and, in the circumstances, that it did constitute a professional disciplinary offence and determined that he was guilty of conduct unbecoming and that conduct reflected adversely on his fitness to practise medicine.
The Tribunal was satisfied that this case demonstrated that Dr Parry's standards of practise as a specialist gynaecologist fell short of the standards which the public of New Zealand are reasonably entitled to expect.
The Tribunal ordered that Dr Parry be censured, pay a fine of $250.00 (the maximum being $1000.00), pay 10% of the costs and expenses incidental to the investigation, prosecution and hearing of the charge, and a notice of the hearing be published in the New Zealand Medical Journal.
It further ordered that in the event Dr Parry seeks to resume his gynaecological practice then, for a period not exceeding 2 years from the date of his resuming his specialist gynaecological practice, he is to practise as a specialist gynaecologist only under the supervision and/or oversight of a specialist obstetrician and gynaecologist appointed by the Medical Council of New Zealand.
Counsel for Dr Parry appealed both the substantive and penalty Decisions of the Tribunal to the District Court.
Counsel for the Complaints Assessment Committee applied for a change of venue seeking that the appeal be transferred to the District Court in Wellington. The application was denied by the District Court (Parry v MPDT Auckland District Court, 7 October 2002, PF Barber DCJ, 1749/02).
The District Court upheld the substantive appeal filed on behalf of Dr Parry. The Tribunal finding of guilty of conduct unbecoming was set aside. (Parry v MPDT, (Auckland District Court, 15 August 2003, Doogue DCJ)).