Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Finding:

The practitioner was found not guilty of a charge by a Complaints Assessment Committee of conduct unbecoming a medical practitioner which reflects adversely on his fitness to practice medicine.

Charge:  

A CAC charged that the practitioner was guilty of conduct unbecoming a medical practitioner which reflects adversely on his fitness to practice medicine, in that on 30 April 1996 and 3 September 1996 in the course of managing the treatment of his patient the practitioner failed to:

1. Examine and assess appropriately the nature and extent of an injury suffered by the patient to her right ankle on or about 1 April 1996 and on or about 23 May 1996; and
2. Diagnose correctly that the patient was suffering from a ruptured Achilles tendon which injury later required reconstructive surgery.

Background: 

The patient was referred to the practitioner by her GP following an injury to her right ankle on 1 April 1996. The GP put the patient in a below the leg plaster which she remained in for four weeks. The practitioner first saw the patient on 16 April 1996. The practitioner saw the patient again on 30 April 1996, following removal of the plaster. He did not consider a follow-up appointment was necessary, as he found no evidence of ankle instability. Thereafter the patient continued to have severe pain in her right ankle. Several weeks after coming out of plaster she injured the same ankle again. Her GP again did some X-rays and put her back in plaster. The patient saw the practitioner again on 3 September 1996, two weeks after removal of the second plaster. The practitioner's diagnosis was sprain lateral ligament right ankle. He noted she had excellent movement in her ankle and a normal gait. The patient's ankle remained swollen and she was in constant pain. After several months she was referred to a second orthopaedic surgeon who diagnosed a torn Achilles tendon. A third orthopaedic surgeon confirmed this diagnosis. The patient had reconstructive surgery on 9 April 1997.

Finding:

The Tribunal found the practitioner was not guilty of conduct unbecoming a medical practitioner.

The Tribunal found that the patient was not suffering from her ruptured Achilles tendon when she first presented to the practitioner in April 1996. Therefore it was unnecessary to examine the practitioner's management of the patient's injury on or about 1 April 1996.

The Tribunal found that the patient's Achilles tendon was almost certainly ruptured at the time of the consultation on 3 September 1996.

The Tribunal considered the issue was whether the history and physical findings would have made the diagnosis evident. It considered that it was unlikely the patient had mentioned to the practitioner the presence of an indent at the top of her right heel. The Tribunal accepted the practitioner's explanation that ideal practice was to have GP's notes, but that not to have them did not impair his ability to take his own history, conduct his own examination and reach a specialist conclusion. However, the lack of communication between the referring doctor and the practitioner compromised the patient's management in that concerns raised by the general practitioner were not brought to the practitioner's attention.

The Tribunal held that assuming no dent was apparent and the patient's gait was normal (a strong indication there was no ruptured Achilles tendon) then the treatment of the patient's injury in September 1996 was reasonable and appropriate in the circumstances.