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Decision No: 97/13C
Practitioner: Dr Paul Gillespie Cooke
Charge Characteristics: Inadequate diagnosis
Proceeded when should not have
Relied too heavily on a test result which he knew to be unreliable
Follow-up care inadequate
Additional Orders: Denied application for private hearing:  9713chearpriminlaw
Complainant granted name suppression: 9713chearpriminlaw
Decision: 9713cfindingslaw
Addendum Decision: 9713cfindingsadd



A CAC charged that Dr Cooke was guilty of professional misconduct. It charged that his management and treatment of his patient was inadequate in that he failed to perform an adequate pre-operative diagnostic assessment prior to removing the right kidney and ureter of the patient and in particular he:

  1. Assumed the right kidney of the patient contained a malignancy when he knew or believed that the local cytology expertise was then of a standard which he did not consider to be reliable, and relied too heavily on the results of a urinary cytology report.
  2. Failed to arrange further radiological or other investigation, especially when the intravenous Urogram report on the patient suggested that that was appropriate.



The patient was referred to Dr Cooke, by her GP, following three urinalysis tests which each showed microscopic haematuria and an Intravenous Pyelogram x-ray (urogram) which showed a filling defect laterally in the renal pelvis. Dr Cooke arranged for further urine cytology and a cytoscopy to be carried out. In his notes Dr Cooke described the results of two urine cytology specimens as "equivocal". When Dr Cooke carried out the cytoscopy on 21 July 1994, he noted no abnormalities. At the consultation with the patient on 21 July 1994, Dr Cooke told her that she had cancer of the right kidney and it should be removed. A further urine specimen taken on 21 July 1994 was reported as normal. A chest x-ray and bone scan were also normal. On 19 August 1994 Dr Cooke performed a right nephroureterectomy on the patient. The histology report on the kidney and ureter showed no malignancy or diagnostic abnormality.



The Tribunal found Dr Cooke was guilty of conduct unbecoming a medical practitioner and that conduct reflects adversely on his fitness to practise medicine.

The Tribunal found the facts as alleged were proven to the required standard. It found that Dr Cooke's management and treatment of the patient was inadequate in that he failed to perform an adequate pre-operative diagnostic assessment prior to removing her right kidney and ureter.

The Tribunal was unanimous in finding that Dr Cooke's behaviour did not amount to professional misconduct. It considered that the Radiologists report of the Urogram contributed to the problem encountered in this case.



Dr Cooke was censured, fined $750 (maximum $1,000) and ordered to pay 50% of the costs of and incidental to the inquiry and hearing.

The Tribunal also imposed the following conditions on Dr Cooke's practice over the next three years:

  • The Medical Council appoint a mentor to supervise Dr Cooke's practice over the next three years.
  • In any surgical case involving a partial or total resection of the ureter or kidney, Dr Cooke must consult with a view to having his proposed course of action approved by his mentor, such consultation and outcome to be documented in the patient's notes. Additionally Dr Cooke is required to send a copy of the pathology report of the resected specimen to his mentor.
  • The mentor is to provide an annual report with recommendations on Dr Cooke's practice to the Medical Council.

In an addendum decision the Tribunal ordered publication of the hearing in the New Zealand Medical Journal.