|Practitioner:||Dr Paul Gillespie Cooke|
|Charge Characteristics:|| Inadequate
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
Complainant granted name suppression: 9713chearpriminlaw
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:
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:
In an addendum decision the Tribunal ordered publication of the hearing in the New Zealand Medical Journal.