Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A Complaints Assessment Committee charged that Dr Graham Keith Parry was guilty of conduct unbecoming a medical practitioner and that conduct reflected adversely on the practitioners fitness to practice medicine in that:

There were deficiencies in his post operative management of a patient between 3 May 1995 and 6 May 1995 namely:

1. He failed to ensure that the doctors and/or the nurses in the Whangarei Hospital Obstetric team on duty after the patient underwent a caesarean section, appropriately monitored and reported to him the progress of the disease process that had necessitated an emergency caesarean section, in particular:

1. the patient's urine output was not closely monitored.
2. the patient's biochemical changes were not closely monitored; and/or

2. He failed to ensure that there was urgent and appropriate medical intervention to assist the patient when her renal function deteriorated.

Background: 

On 3 May 1995, because of concerns relating to pre-eclampsia, Dr Parry determined that the patient should have a caesarean section and at 6.23pm and 6.25pm on 3 May 1995 the patient's twins were born.

At 5.30am the next morning Dr Parry travelled from Whangarei to Auckland to undertake his regular National Womens Hospital ultrasound clinic. During the 12 to 18 hours following the caesarean section the patient had difficulty passing urine, had been vomiting and was clearly feeling very unwell.

On his return from Auckland that evening Dr Parry visited the patient around 5.00pm. She appeared to him to be asleep and he did not wake her. He was unable at that time to locate her notes. He states that he was aware that the patient had been catheterised and that there had been 500 mls of concentrated urine passed. That catheterisation had taken place at midday on 4 May 1995.

Without locating the notes Dr Parry left the hospital. He was contacted by a nurse at 2.00am on the morning of 5 May 1995. The nurse gave evidence that she expressed serious concern about the patient's condition and the lack of urine output, Dr Parry gave instructions at that time for a fluid challenge, to re-catheterise and for blood tests to be done in the morning.

At 7.00am in the morning Dr Parry was contacted again and he instructed that the patient be given IV Lasix. At 8.00am the patient was transferred to the intensive care unit.

The patient remained in the intensive care unit at Whangarei from 5 May until 23 May 1995 and at that stage she had significant renal failure along with other complications including an enlarged heart and serious fluid overload and sepsis. On 23 May she was transferred to National Womens Hospital in Auckland because of ongoing renal failure and concerns about peripartum cardiomyopathy.

Finding:

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

While the Tribunal recognised and accepted that during the period in question there was no action possible that would have averted the onset of the patient's condition, the issue in this case was whether Dr Parry's conduct departed from acceptable professional standards.

The Tribunal found that particular (a)(i) of the charge was established. It considered that while there was regular references to urine output there was no record of action or interpretation of these references being undertaken. The Tribunal held that "monitoring" includes more than merely recording data and that it requires interpretation and reporting.

The Tribunal further found particular (a)(ii) was established. It considered the biochemical changes were not closely monitored and that there were no blood tests taken at all during the period in question.

The Tribunal found the proven conduct covered by particular (a) amounted to conduct unbecoming which reflected adversely on Dr Parry's fitness to practise medicine.

The Tribunal did not consider particular (b) established. The Tribunal expressed reservations about the fact Dr Parry did not direct blood tests be done immediately at 2.00 am on the 5th May 1995 or ensure at that time there was some medical assessment or arrange that he be informed of any developments. However it considered those omissions, while less than optimal, did not qualify as a significant enough departure to attract sanction.

Penalty:

The Tribunal considered given systemic issues contributed to the situation, and the conditions already in place on Dr Parry's practise, there should be no further additional penalty specifically imposed in respect of this finding.

However, given Dr Parry's desire to have each charge heard separately, the Tribunal considered it appropriate to order Dr Parry to pay 25% of the costs and expenses of the prosecution and hearing of the charge.

Appeal:

An appeal of the Tribunal Decision was filed in the District Court on behalf of Dr Parry.  The District Court upheld the Tribunal finding that Dr Parry was guilty of conduct unbecoming a medical practitioner.  However, the District Court held that Dr Parry was guilty of conduct unbecoming for different reasons than the Tribunal.  The Court upheld the Tribunal order for costs (Parry v MPDT (District Court, Auckland, NP 880/02, 2 July 2003, Doogue DCJ)). 

An appeal from the District Court Decision was filed in the High Court on behalf of Dr Parry.  The High Court held that the conduct which the District Court considered amounted to conduct unbecoming did not amount to conduct unbecoming.  Therefore, the charge against Dr Parry was dismissed and the order for costs imposed by the Tribunal was quashed.  (Parry v MPDT and CAC (High Court, Auckland, CIV-2003-404-4107, 2 June 2004, Heath J)).