The Health Care Complaints Commission of NSW prosecuted a complaint against Dr Paul Cozzi, a consultant urologist before the Medical Professional Standards Committee (the Committee).

The complaint alleged that Dr Cozzi, in November 2015, failed to properly supervise a trainee urologist operating at St George Public Hospital, Sydney, in circumstances where Dr Cozzi was operating elsewhere at a private hospital at the same time; did not have appropriate medical records; and made false or misleading statements to investigators in 2016-2017.  

On 3 November 2020, the Committee found Dr Paul Cozzi guilty of unsatisfactory professional conduct on the basis that:  

Failure to Supervise Trainee Doctor

1. Dr Cozzi was responsible for supervising a trainee urologist (“Dr X”) operating on his patients at St George Public Hospital, Kogarah, Sydney (SGH). After his public list started, Dr Cozzi then drove to the Mater Private Hospital and operated on his private patients, whilst Dr X operated without direct supervision on 4 patients at St George Public Hospital. Dr Cozzi did not tell Dr X where he was going.
2. Dr Wong, the expert witness for the Commission, stated that a supervising consultant must be available to assist in case of difficulty or emergency. Patient safety requires this. He was strongly critical of a supervising consultant leaving the grounds of SGH during an operating list, and particularly leaving to go to another operating theatre.
3. The Committee was of the opinion that having two concurrent surgical lists is not acceptable professional practice. Dr Cozzi’s failure to properly supervise the trainee was significantly below the relevant standard.
4. “His conduct is reprehensible and it is only fortuitous that no patient suffered as a result of his actions,” paragraph 176, Professional Standards Committee Enquiry; Dr Paul Joseph Cozzi, Decision 3/11/2020.

Lack of credibility and trustworthiness as a witness

1. The Committee did not find Dr Cozzi to be a credible or trustworthy witness. Dr Cozzi gave inconsistent and contradictory information about his conduct and activities on 12 November 2015. He made incorrect statements to the investigators on five occasions.  
2. The Committee considered that “many of his answers were designed to obfuscate and deflect attention from the relevant issues. He did not make a genuine attempt to answer questions in a frank or open manner,” paragraph 49.

Signing of blank documents

1. Dr Paul Cozzi pre-signed blank count sheets and safety checklists for surgeries on patients at St George Public Hospital which he did not attend.
2. The procedures for signing count sheets and safety checklists are designed to ensure patient safety.
3. Signing sheets for surgeries when he was not present infringes basic standards of professional practice and contravenes the record keeping regulations.

Determination: Unsatisfactory Professional Conduct

The Committee found that Dr Paul Cozzi’s conduct was reprehensible and unsatisfactory professional conduct. He was reprimanded in the strongest possible terms.

The Committee ordered that Dr Paul Cozzi must be subject to supervision, must complete an ethics course and must not supervise trainees.

Source:  HCCC media release: Dr Paul Cozzi ; Statement of Decision.

UPDATES:

According to the article “Dr Paul Cozzi reprimanded by the Health Care Complaints Commission over unsatisfactory professional conduct” by M Porter, The Leader 16.11.2020, Dr Cozzi has defended his actions and said he would be appealing the decision. The article quotes Dr Cozzi as saying “The decision to proceed and supervise the experienced trainee both directly and indirectly to complete the list without incident was made in the patients’ best interests and after careful consideration, knowing that the nature and complexity of the cases was such that they could be completed safely… The decision was made with the full approval of the Department of Urology and the trainee.”

However a letter to The Leader published on 07.03.2021 from a group of urological surgeons comprising the Department of Urology at St George Hospital (Dr Peter Aslan, Prof David Gillatt, Dr Anthony Hutton, Dr Dominic Lee, Dr David Malouf, Dr Peter Nash, Dr Anu Ranasinghe and Dr James Thompson) stated:

“There was written and verbal discussion between Dr David Malouf, Dr Anthony Hutton and Dr Cozzi in the days prior to the list. It was noted he had simultaneous operating lists in different hospitals scheduled on the Thursday morning and that this represented a breach of his duties as a surgical trainer.

It was made clear to Dr Cozzi that if his supervision of the trainee was not going to be appropriate, then the only option would be to cancel the St George Hospital list. Dr Cozzi gave a verbal undertaking that he would appropriately supervise the list, and this was the basis for the agreement to allow the list to proceed.”

Dr Joe Grech, General Practitioner has been suspended by the Civil And Administrative Tribunal, NSW, for a period of 6 months. It was found that-

1. Dr Grech inappropriately prescribed erectile dysfunction medication, benzodiazepines, anti-psychotic drugs, Duromine- a weight loss medication. With one minor exception, the Tribunal found Complaint 1 to constitute unsatisfactory professional conduct.
2. Dr Grech breached professional boundaries with patients, particularly by providing medical treatment to his mentally ill girlfriend, and this amounted to unsatisfactory professional conduct.
3. Dr Grech gave false and misleading information to the Medical Council when he denied that Patient C had ever been his patient. This is unethical, and the Tribunal found that it constituted unsatisfactory professional conduct.
4. Dr Grech failed to notify the National Board within 7 days, that he had been charged on 24 April 2018 with criminal offences punishable by 12 months imprisonment or more and that on 4 February 2019 he had been the subject of findings of guilt for offences punishable by imprisonment. Technically, this complaint constitutes unsatisfactory professional conduct.
5. The Tribunal found: “… we consider the appropriate order to be that Dr Grech be reprimanded and that his registration be suspended for 6 months. During that time, if Dr Grech wishes to resume practice, he must satisfactorily complete a tailored education program….On resuming practice, Dr Grech’s registration will be subject to the conditions identified below. He must practise under what is known as category C supervision. He must practise only in a group practice where there are at least two other registered medical practitioners. Such a condition helps ensure that Dr Grech will receive support from professional colleagues. He will not receive that support if he engages in home visits or visits to aged care facilities, so he is prohibited from consulting in those environments. Although Dr Grech’s inappropriate prescribing related to Schedule 4D drugs, he should also be prohibited from dealing with Schedule 8 drugs. Both Schedules comprise drugs of dependence and Dr Grech has not demonstrated that he can appropriately prescribe such drugs. In addition, we strongly recommend that Dr Grech be subject to a Performance Assessment.”
6. Dr Grech had practised in various locations in Sydney including Broadway and Darlinghurst.

Source: Health Care Complaints Commission v Grech [2021] NSWCATOD 14

According to the Herald, “for nearly two decades police received a steady stream of intelligence suggesting that Dr Grech has been involved in drug supply and possession and has been providing false medical certificates in return for cocaine, heroin and ice.”

Source: “Prominent GP suspended for lying to medical body, inappropriately prescribing drugs”, SMH 04.02.21

According to a study using complaints data from health regulators in Australia, mental health practitioners (psychiatrists and psychologists) are more likely to be the subject of complaints than physical health practitioners.

Areas of increased risk are related to professional ethics, communication skills and the health of mental health practitioners themselves.

Other findings included:

1. The complaint rate among psychiatrists was more than double than among physicians.
2. The complaint rate among psychologists was nearly treble than among other allied health practitioners.
3. Psychiatrists had nearly double the risk of complaints about communication and nearly five times the risk of complaints about prescribing as their physician colleagues.
4. Male psychiatrists and psychologists had higher complaint rates than their female peers .
5. Mental health practitioners had three times the risk of complaint regarding sexual boundary breaches compared with physical health practitioners.
6. Older mental health practitioners had a higher risk of complaints than their younger peers, after adjusting for sex and practice location. For both psychiatrists and psychologists, complaint risk increased steadily by age band, with practitioners aged ≥65 years having around twice the risk of complaint compared with those aged 36–45 years.

The authors of the study analysed 7903 complaints over a 6 year period from 2011-2016. The complaints dataset consisted of information on all complaints about these practitioners lodged with regulators during the study period. AHPRA provided complaints data for all states and territories, except New South Wales. HPCA provided equivalent data for New South Wales.

It was also noted that “the complaints in our study probably underrepresent harm and concern experienced by patients as we only included complaints to regulators, thus missing complaints made directly to the practitioner, their employer or other agencies, and adverse events where no complaint was laid.”

Source: Veness BG, Tibble H, Grenyer BFS, et al. Complaint risk among mental health practitioners compared with physical health practitioners: a retrospective cohort study of complaints to health regulators in Australia. BMJ Open 2019;9:e030525. doi:10.1136/ bmjopen-2019-030525

Here we have a case of a psychologist over-servicing and taking advantage of a vulnerable patient.

Dr Hugh Ian Joffe, a registered psychologist practising in Vaucluse, Sydney, charged his banker patient almost $220,000 in sessions that were overtaken by his plans to make a Holocaust documentary with the patient.

The Tribunal heard Dr Joffe proposed to see the patient six days a week and, knowing what salary he was earning, told him he would need to borrow money to fund the therapy. The patient claimed that he had spent a total amount (on therapy and film): $360,000 plus ongoing interest on mortgage payments.

Dr Joffe also advised the patient to reconnect with Judaism, in particular Orthodox Judaism, and to worship at the same synagogue as him; stop eating non-Kosher food and attended the patient’s home for religious ceremonies.

The patient said, “I believe I was taken advantage of by Dr Joffe. I believe I was over-serviced by Dr Joffe and that he was wrong to enter into a film project with me and to encourage me to incur excessive costs, funded [by] my mortgage.”

After 41 years, Dr Joffe retired from practising in April 2017, surrendering his registration the following month.

The Civil and Administrative Tribunal of NSW found that Dr Hugh Joffe’s “conduct was aimed at his own gratification; was egregious in that it was an extreme and invasive manipulation of Patient A’s life at many levels; and that it took advantage of Patient A’s weaknesses that he, Dr Joffe, as therapist, had a unique insight into.”

The Tribunal further stated “the conduct complained constitutes boundary violation of the most serious kind and exploitation of a vulnerable patient, and breaches all relevant codes of conduct in relation to the maintenance of trust and confidence in the psychologist/patient relationship. The Tribunal finds that the respondent has consistently displayed a concerning lack of insight into the seriousness of his conduct.”

The Tribunal cancelled Dr Joffe’s registration, prohibiting from providing any health services, and barred him from re-registering for 4 years.