Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A CAC charged that Dr Court in the course of his management of his patient:

1. Failed to perform a cervical biopsy prior to the performing of a laser procedure in about June 1996; and
2. Failed to manage the care of the patient to the proper standard for the period June 1995 to December 1996 when the patient transferred to another specialist.

Being conduct unbecoming a medical practitioner which reflected adversely on Dr Court's fitness to practice medicine.

Background:

The patient was referred to Dr Court by her GP, in June 1995, following two atypical smears in the previous six months. Dr Court took a brush specimen smear and performed a colposcopy and biopsy. The results showed CIN 3 was present. Dr Court performed laser ablation on the patient on 5 September 1995. The patient was advised verbally to return in 3 - 4 months but no further recall was given. The patient saw Dr Court again on 17 May 1996 following a smear showing CIN 3 cells present. Dr Court performed a colposcopy, which showed a further CIN lesion in the area previously treated. Dr Court arranged for the patient to have a second cervical laser ablation. No biopsy was undertaken at the time. Following the second laser ablation, no written recall was given to the patient. Nevertheless the patient made her own appointment to Dr Court on 9 September 1996 with chronic lower pelvic pain. He performed a further colposcopy and took a cervical smear; again no biopsy was taken. The smear results indicated abnormal squamous cells and recommended colposcopy and a biopsy. Dr Court wrote to the patient suggesting she make another appointment in March 1997. She was not sent a copy of the diagnostic report. In December 1996 the patient, at her request, was referred to a second specialist. She was diagnosed as having invasive squamous cell carcinoma requiring urgent treatment. On 28 January 1997, the patient underwent a radical hysterectomy. In order to treat the cancer adequately fertility could not be preserved. Subsequently, in August 1998, a biopsy revealed further squamous cell carcinoma requiring further surgery, chemotherapy and x-ray therapy. The patient has been advised she has a 50% chance of surviving.

Finding: 

At the commencement of the hearing Dr Court pleaded guilty to both of the two particulars of the charge and also acknowledged that both particulars amounted to conduct unbecoming a medical practitioner which reflects adversely on his fitness to practice medicine. On the basis of these admissions and expert evidence the Tribunal found Dr Court guilty of conduct unbecoming a medical practitioner which reflects adversely on his fitness to practice medicine.

Penalty:

Dr Court was censured, fined $5,000 and ordered to pay 30% of the costs of the inquiry and hearing (not exceeding $9,500).

In addition the Tribunal ordered that if Dr Court remained in or decided to return to colposcopic practice he is required to present himself to the NZ Committee of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to complete the module in Colposcopy and the treatment of pre-invasive cervical disease.

In imposing these penalties the Tribunal stated that the general failure to carry out adequate follow-up was a particularly disappointing aspect of the patient's care. It noted the devastating consequences to the patient of the cancer. In mitigation, the Tribunal accepted that the patient's current state of health might have been inevitable even with proper management. The poor clinical practice (excluding the failure to follow up) was limited to colposcopy rather than general gynaecological practice. Dr Court's good reputation and admission of the charge were also taken into account.