Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A CAC charged that the Doctor was guilty of professional misconduct in that:

1. Prior to or at the time of administering a lumbar epidural injection of the steroid drug depo-medrol to his patient on or about 27 June 1989, he failed to obtain his patient's informed consent when he was or ought to have been aware of the medical controversy surrounding the use of depro-medrol intraspinally epidurally and within the spinal joint and should have adequately informed the patient of the possible adverse consequences associated with the use of depro-medrol epidurally and obtained her informed consent prior to carrying out the procedure.
2. On or about 14 October 1994 when having been specifically requested by the patient not to use the same steroid drug used in the previous epidural injection, he in fact administered bilateral facet joint injections of the same drug (depro-medrol) contrary to the patient's request and failed to obtain the patient's consent to do so.
3. On or about 14 October 1994 prior to or at the time of administering bilateral facet joint injection of depro-medrol to the patient, he failed to obtain the patient's informed consent in that he should have explained the possible adverse consequences associated with the use of depro-medrol on facet joint injection to the patient and obtained her consent prior to carrying out the procedure.

(The particulars are as amended by the Tribunal at the commencement of the hearing.)

Finding: 

The Tribunal found the Doctor was not guilty of professional misconduct.

The Tribunal found that particular 1 of the charge could only be established if the CAC could show on the balance of probabilities first that a "medical controversy" surrounding the use of depo-medrol epidurally existed at the time of the 1989 consultation. The Tribunal found that was not established on the evidence.

The Tribunal also determined that particular 2 of the charge was not established. It found that what the complainant stipulated could not now be determined with a sufficient degree of certainty to find the particular proven. The Tribunal was satisfied on the balance of probabilities that the patient told the Doctor she did not want him to use the "same steroid drug" used in 1989. The Tribunal was equally satisfied that the Doctor either did not hear the instruction, or failed to appreciate the significance of what the patient was saying to him regarding her concerns. If the Doctor did not hear the patient's stipulation then the administration of depro-medrol was "mere inadvertence" and not necessarily culpable. In support of the Doctor's position that he did not understand any such stipulation to be made it was significant that an alternative steroid drug, kenacort, was readily available and could have been substituted. There was no record of a reported allergy or of the patient's request for an alternative steroid in the complainant's hospital records made at the time of her admission to the hospital for the spinal injection

When considering particular 3, the Tribunal found that such controversy regarding the use of depro-medrol as did exist related only to its use epidurally and itrathecally and not to its administration by facet joint injection. In any event the expert evidence given to the Tribunal was that the body of medical opinion in New Zealand regarded such controversies as had arisen as being settled by October 1994. On this basis, the Tribunal determined that particular 3 was not established.