Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A CAC charged that Dr McIlwraith was guilty of conduct unbecoming a medical practitioner, which reflects adversely on his fitness to practice medicine, in that in the course of his management and treatment of his patient between 23 October 1992 and 20 March 1996 he failed:

1. To adhere to the recall suggestions on her cervical smear tests; and
2. To have appropriate systems in place to ensure appropriate treatment and follow-up of abnormal smears.

Background:

The patient had been Dr McIlwraith's patient since the age of 10 years. The patient had two abnormal cervical smears on 5 December 1984 and 4 March 1986. The results of repeat smears (taken within the recommended 12 month period) were normal. In June 1992 the patient presented with lower back pain and bleeding from the bowel. She referred to a recent incident of post-coital bleeding. On 23 October 1992 a smear test from the patient showed an abnormal result. The specimen was not optimal. The report recommended a repeat in 6 months. In April 1993 the patient became pregnant with her first child. In late February/ March 1995 she became pregnant with her second child. On 4 May 1994, another smear was taken, one year and six months after the previous smear. The report advised the smear was less than optimal because of inflammation and recommended a repeat within 12 months. On March 21 1996, one year and 10 months after the previous smear, the patient returned another abnormal smear test. The report reported features of an endocervical adenocarcinoma. On 16 May 1996 the patient's condition was diagnosed as Stage 1B adenocarcinoma of the cervix. On 19 June 1996 at laparotomy it was diagnosed as Stage 3B. In February 1994 she was diagnosed at Stage 4. The patient is receiving palliative treatment only.

Finding: 

Dr McIlwraith admitted the charge on the basis that his conduct reflected adversely on his fitness to practise medicine.

Penalty:

The Tribunal considered Dr McIlwraith's admission of responsibility appropriate on the facts. It considered the errors that had occurred were regrettable but understandable. The Tribunal considered leniency in the imposition of penalties was appropriate, and did not consider that censure, or the imposition of conditions of practice or a fine was warranted. In mitigation the Tribunal took into account the rarity of adenocarcinoma of the cervix prior to the 1990's and the comment in the report of 21 March 1996, when reviewing the 1992 slide, that it was of sub-optimal quality due to airdrying artefact.

The Tribunal ordered that Dr McIlwraith pay 30% of the costs of the inquiry and hearing.

A late application for name suppression was declined. The Tribunal found that under section 138 of the Act publication of the practitioner's name is mandatory unless suppression is already in place under section 106 of the Act. No order was made under section 106 and the Tribunal found the late application for name suppression must be declined.