Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A CAC charged that a doctor was guilty of professional misconduct. The CAC alleged that during the course of his clinical management and treatment of the patient between October 2001 and April 2002 the Doctor:

1. Made frequent inappropriate telephone contacts with the patient, outside normal office hours and for reasons unrelated to her clinical need; and/or
2. During the course of the telephone contacts and on other occasions, made inappropriate repeated references to the use of the provisions of the Mental Health Act such that the patient felt she was being threatened with being re-admitted to hospital under the provisions of the Mental Health Act; and/or
3. During the course of the telephone contacts attempted to develop a personal relationship with the patient by inviting her, during those telephone contacts with her, to lunch and dinner; and/or
4. During a professional consultation with the patient, offered her work as his housekeeper and then, when she was at his home, tried to embrace her; and/or
5. In professional consultations with the patient and contrary to the therapeutic relationship, began to disclose to her his personal problems and issues.

Background: 

The patient first came under the Doctor’s care in late 1999 when she was admitted to her local hospital’s mental health ward. Over the next two years she was admitted to hospital a further three times. The longest admission was for twenty days. During the admissions the patient was under the Doctor’s care with whom she had a good therapeutic relationship.

The Doctor saw the patient in an outpatient’s facility on 7 December 2001. The patient’s marriage had begun to deteriorate in July 2001 and by this time the patient’s husband was not staying at their home. A further outpatient’s consultation occurred on 13 December 2001 and from 28 December 2001 to early April 2002 the patient regularly saw the Doctor, primarily to discuss her marital problems. These consultations occurred almost every week.

On the evening of 6 February 2002 the Doctor telephoned the patient at her home. The patient felt slightly uncomfortable about the Doctor contacting her but she was reassured when he explained he was concerned about her. During the course of this telephone call the Doctor invited the patient to “come for a cuppa”. The patient noted this call in her journal and that the telephone call was for “three hours or so”.

The patient’s evidence was that the Doctor telephoned her at home on approximately 4 or 5 occasions after 6 February 2002. Two of these telephone calls were noted by the patient in her journal (8 and 10 March 2002). She found it difficult to terminate the telephone calls. The patient was feeing very uneasy about the telephone calls and also thought the calls were threatening. She said that on three occasions the Doctor said words to the effect that he did not want to have to put her back in the ward. The patient thought these comments meant the Doctor was threatening to use the Mental Health Act to have her re-admitted to hospital.
The patient was at this time suffering financial stress as a result of her marriage breakup. She told the Doctor that she would like to do some housework, or similar activities to try and improve her financial position.

During a consultation with the Doctor on 25 January 2002 the patient raised the possibility of her doing some of the Doctor’s housework. Subsequently the Doctor asked the patient if she would go to his home to iron his shirts. On about 7 March 2002 the patient went to the Doctor’s house and she noticed it was “neglected and dishevelled”. The Doctor and the patient discussed the possibility of the patient working for the Doctor on a regular basis at his home. It was during the course of this discussion the Doctor placed his hands on the patient’s shoulders and then kissed her. After this incident the patient resolved not to return to the Doctor’s house.

On 8 March 2002 the Doctor telephoned the patient at her home. During this call the Doctor invited the patient to dinner at a restaurant. When this offer was declined the Doctor invited the patient to lunch. The patient also declined this invitation.

The patient was by this time becoming increasingly uneasy. On 11 March 2002 the patient spoke to her lawyer and explained her concerns about the Doctor. The patient advised her lawyer that she did not want her lawyer to take matters further, that she believed she could deal with the situation herself. The patient said she simply wanted her lawyer to be aware of the situation.

At the next consultation the Doctor asked her on two occasions why she had not accepted his invitation to go to dinner or lunch. The patient told the Doctor that she thought going to dinner or lunch would be inappropriate because of their doctor/patient relationship. At this consultation the patient told the Doctor she would not be returning to his home to do his housekeeping. There were two further consultations between the patient and the Doctor after which she was transferred to the care of another clinician.

Finding:

The Doctor pleaded guilty to the charge at the commencement of the hearing. The Tribunal found the Doctor guilty of professional misconduct.

The Tribunal was satisfied particular one was established and it constituted a serious departure from the standards ordinarily expected of a psychiatrist in the Doctor’s circumstances.

There was no doubt the Doctor made a number of evening telephone calls to the patient at her home. The Tribunal considered there are occasions when it is necessary for a psychiatrist to make contact with a patient at their home and outside of normal working hours. Occasions of that kind are rare and only arise out of clinical necessity. None of the telephone calls which the Doctor made to the patient during the time in question were based upon clinical need.

The Tribunal was satisfied particular two was established and his breaches of his professional responsibilities in this regard were serious. The Tribunal considered the Doctor did make comments to the patient that led her to believe she was being threatened with being re-admitted to hospital under the provisions of the Mental Health Act.

The Tribunal was very clear that it is not appropriate for a psychiatrist to threaten a patient with admission to hospital under the mental health legislation unless there are sound clinical reasons for doing so. There was no evidence the patient was displaying any signs or symptoms that would have justified the Doctor raising the possibility of the patient being re-admitted to hospital during the time in question

The Tribunal was satisfied particular three was established. It is a cardinal principle that a psychiatrist should not indulge in social interaction with a patient. When the Doctor invited the patient to dinner, and then to lunch on 8 March 2002, the Tribunal considered he committed a serious breach of the standards ordinarily expected of a psychiatrist.

The Tribunal was satisfied particular four was established and the Doctor’s behaviour constituted a significant serious breach of standards. The Tribunal considered it totally inappropriate for a medical practitioner to employ a patient to undertake domestic duties. When the Doctor embraced his patient he breached a fundamental tenet of the doctor/patient relationship. The Tribunal was satisfied the Doctor’s conduct was particularly dangerous because:

• He breached the trust which the patient had developed in him. The patient trusted the Doctor to discharge his professional responsibilities in an objective and professional way. That trust was breached when the Doctor endeavoured to embrace the patient;
• By trying to develop a personal relationship with the patient the Doctor compromised his ability to objectively discharge his clinical responsibilities to his patient;
• The patient was clearly a vulnerable person, highly susceptible to suffering significant harm if she had allowed herself to succumb to the Doctor’s attentions.

The Tribunal was satisfied particular five was established. The patient’s evidence was that during both formal consultations and during the course of his telephone calls to the patient, the Doctor told her various things about his personal life. The Tribunal considered it was not appropriate for the Doctor to use the patient as a “sounding board” for his personal problems. The Doctor’s breaches of his professional responsibilities in this regard were unacceptable.

Penalty:

The Tribunal ordered the Doctor:

• not to practise medicine for a period of three years except under the supervision of a vocationally registered psychiatrist who is available on site to ensure that he is closely monitored;
• to pay costs in the sum of $12,448.23.

The Tribunal further ordered publication of the hearing in the New Zealand Medical Journal in a way which did not name or identify the doctor or the complainant.