Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

The Director of Proceedings charged that Dr Jayasinha was guilty of professional misconduct in that his management and treatment of his patient was inadequate and his overall management of his patient was not carried out with reasonable skill and care. In particular:

1. He incorrectly (in the face of contrary symptoms being described by the patient) diagnosed a urinary tract infection.
2. He failed to arrange for an immediate urine specimen
3. He failed to obtain any laboratory tests to confirm the diagnosis.
4. When contacted and advised that the patient's condition was worsening he failed to arrange for a review of the patient and/or his diagnosis.
5. He inappropriately arranged for a follow up urine test on the last day of the dose of antibiotics.

Background:

The patient visited Dr Jayasinha on 18 October 1996 with a history of abdominal pain and vomiting. Dr Jayasinha examined him and found his abdomen to be distended and tender. Dr Jayasinha made a diagnosis of urinary tract infection. The patient's urine was not tested. Later the same day the patient telephoned Dr Jayasinha to tell him he was feeling worse. Dr Jayasinha told the patient to take panadol, another antibiotic and to give the medication time to work.

On Sunday 20 October the patient contacted the After Hours service and was sent to hospital with suspected appendicitis or peritonitis. The patient was operated on that day and the appendix was described as "grossly gangrenous and perforated".

Finding: 

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

Dr Jayasinha diagnosed a urinary tract infection, when it transpired that the condition was appendicitis, which developed complications. However the Tribunal did not consider it possible to find that the initial diagnosis was made without reasonable skill and care and therefore particular 1 was not established.

The Tribunal did not make a finding in respect of particulars 2 and 5. The Tribunal found that the absence of 24-hour laboratory services precluded tests to confirm the initial diagnosis, and therefore particular 3 was not established.

The Tribunal found particular 4 to be the most serious particular of the charge. The Tribunal considered that Dr Jayasinha having made a diagnosis on tentative grounds, and when dealing with a patient whose history suggested it was unlikely he would contact his GP over trivial matters, should have reconsidered his diagnosis and offered to see the patient again that evening. At the least he should have contacted the patient the next morning.

The Tribunal did not consider that Dr Jayasinha's conduct warranted a finding of professional misconduct. There was no evidence that the default was other than simple neglect. The default was not recurring and did not extend over a significant period of time.

Penalty: 

Dr Jayasinha was censured, fined $3,000 (max $20,000) and ordered to pay 35% of the costs of the investigation and the hearing. The order prohibiting publication of Dr Jayasinha's name was vacated.

The Tribunal in imposing a comparatively modest fine took into account Dr Jayasinhas' s personal circumstances and his long record of service to the community of Shannon.

The Tribunal did not consider it was necessary to impose conditions on Dr Jayasinha's future practice given that he had retired and his intention to move to Wellington where any part-time employment he might obtain would be in a structured environment.