Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A CAC charged that Richard Warwick Gorringe, medical practitioner of Hamilton, from mid 1994 to mid 1997 in his clinical management of a patient (now deceased), acted in a way that amounted to professional misconduct in that he:

1. Reached his various diagnoses of the patient’s ongoing complaints, in the absence of any acceptable medical diagnostic proof;
2. Failed to consider other diagnoses and continued his treatments of the patient long after it was clear that no significant improvement had taken place and that serious bowel symptoms were still present;
3. Failed to effectively consider and act on such consideration, that the symptoms presented by the patient could be related to something other than an infection (bacterial or parasitic);
4. Failed to arrange appropriate investigations including faecal testing in the presence of ongoing symptoms;
5. Failed over a long period of time to arrange for the patient to have a colonoscopy or reference to an appropriate specialist to investigate his continuing rectal bleeding and bowel symptoms.

Background: 

The patient first saw Dr Gorringe on 16 March 1994. The patient was seen by Dr Gorringe on a regular basis (19 times) from March 1994 until July 1997. It was Dr Gorringe’s position that he was at no time the patient’s general practitioner.

The symptoms that the patient presented with were related to stomach pain, bloating, flatulence and blood in his bowel motions. Throughout the period that he was seen by Dr Gorringe those symptoms remained in some form or another. During the three years Dr Gorringe was treating the patient he diagnosed 10 different conditions, one of these being giardia which he diagnosed twice. He further diagnosed Salmonella, campylobacter, helicobacter, bowel bug, blood fluke, Tordon poisoning, amoebic infection, colitis and irritable bowel.

Dr Gorringe arranged for blood tests to be done on five occasions. He arranged a barium enema on 5 July 1994 and one faecal test on 18 August 1994. Dr Gorringe gave evidence that he recommended to the patient that he have a colonoscopy, and that the patient was not amiable to that course of action. There was no record in the notes that a colonoscopy was recommended by Dr Gorringe and declined by the patient.

On 20 August 1997 the patient had a colonoscopy examination which had been arranged by another doctor. The examination found a small polyp and a moderated sized adenocarcinoma. On 25 September 1997 a biopsy showed the cancer had spread to the patient’s liver and lymph nodes.

The patient died on 5 April 1998.

Finding:

The Tribunal found Dr Gorringe guilty of professional misconduct.

The Tribunal was not concerned with the alternative and complementary practices that Dr Gorringe undertook, but rather with his management and treatment of the patient as a registered medical practitioner.

The Tribunal was of the view that whether or not Dr Gorringe considered himself the patient’s practitioner was irrelevant. Dr Gorringe acknowledged that he was primarily responsible for the patient in respect of the symptoms that the patient presented with when he saw Dr Gorringe.

The Tribunal considered particular 1 was established. There were acceptable medical diagnostic tests available for all of the diagnoses made by Dr Gorringe, but he did not use any of those tools.

In most instances Dr Gorringe’s diagnoses were done by Bi-Digital O-Ring Testing which Dr Gorringe described as a non-conventional bio-energetic test method which has been developed from older forms of muscle testing. Dr Gorringe accepted this was not a serious test that should replace traditional testing.

The Tribunal considered particular 2 was not established as it was not clear that Dr Gorringe did not consider other diagnoses.

The Tribunal considered particular 3 was established. The Tribunal was satisfied that Dr Gorringe did fail to effectively consider and act on other considerations.

The Tribunal considered particular 4 was established. The Tribunal considered it was Dr Gorringe’s responsibility to follow-up and ensure that proper faecal testing was undertaken. This was not done.

The Tribunal considered particular 5 was established. The Tribunal did not accept Dr Gorringe recommended a colonoscopy and that the patient refused to follow that recommendation. Given the patient’s agreement to a colonoscopy in 1997, it was difficult for the Tribunal to understand why he would not have agreed to a colonoscopy earlier if Dr Gorringe had insisted on it. The Tribunal found it clear the patient had a lot of faith in Dr Gorringe and considered that he would have followed Dr Gorringe’s recommendations.

The Tribunal considered that treatment of the patient by Dr Gorringe ignored basic symptoms that would cause many lay people to be suspicious. It was of grave concern to the Tribunal that a diagnosis of bowel cancer was ruled out on the basis of a clear barium enema in 1994.

Penalty:

The Tribunal ordered Dr Gorringe be censured, fined $600.00 (maximum $1,000), 10% of the total costs incurred in respect of the investigation, prosecution and hearing, excluding costs related to the evidence of a witness who did not give evidence at the hearing. In setting that amount, the Tribunal took account of Dr Gorringe’s precarious financial position.

The Tribunal further ordered a notice be published in the New Zealand Medical Journal.

The Tribunal strongly recommended to the Medical Council of New Zealand that conditions of practice should be imposed as to supervision if Dr Gorringe’s name was to be re-instated to the Register.