Dr Paul Cozzi, Urologist, Sydney – Reprimanded in Conduct Case

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

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.
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.
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.

“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

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.
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

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.
The procedures for signing count sheets and safety checklists are designed to ensure patient safety.
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.

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The Doctor/Patient Relationship

The following are some guidelines as to what to expect of a professional relationship between doctor and patient:

The doctor/patient relationships is built on trust.
When a patient is undressing for an examination, the doctor should leave the room unless the patient needs assistance. If this is the case, another person should be present to assist the patient.
A doctor should not use inappropriate language, such as telling jokes with sexual content, and never use racial slurs.
When a doctor is conducting an intimate examination (such as a Pap
smear), there should be another healthcare professional present (eg a nurse). Conversations should be limited to informing the patient of what is being done
during these types of examinations or treatments.
A doctor should listen to the patient without judging.
A patient needs to feel respected and cared for, but this must be done on a professional level. Questions about marital status, sexual orientation, religion, and other highly sensitive areas should be avoided unless they directly relate to the medical concern.
Sexual contact (even flirting) is unprofessional and unethical, and should be
completely avoided.
It is unethical for a doctor to visit with a patient outside of the healthcare setting. Obviously some doctors make house calls, but this is a professional call, and not the same as a personal visit.
Doctors should not borrow from or loan money to patients.
Patients who feel that a doctor has acted unethically or violated the doctor/patient relationship have the right to make a complaint to the Medical Board or AHPRA.
A violation of the doctor/patient relationship may constitute professional misconduct resulting in sanctions against the doctor and possible deregistration.

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Complaints against Mental Health Practitioners

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:

The complaint rate among psychiatrists was more than double than among physicians.
The complaint rate among psychologists was nearly treble than among other allied health practitioners.
Psychiatrists had nearly double the risk of complaints about communication and nearly five times the risk of complaints about prescribing as their physician colleagues.
Male psychiatrists and psychologists had higher complaint rates than their female peers .
Mental health practitioners had three times the risk of complaint regarding sexual boundary breaches compared with physical health practitioners.
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

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Psychiatrist Dr Anthony Slowiaczek disqualified

Dr Anthony Slowiaczek was a specialist psychiatrist practising at the Maitland Specialist Centre, attached to the Maitland Private Hospital in Maitland (“Centre”).

Between 2012 and 2016 he engaged in an improper personal and sexual relationship with Patient A, a vulnerable female patient. Patient A had a history of childhood sexual abuse and sexual exploitation and had been previously diagnosed as suffering from Attention Deficit Hyperactivity Disorder, complex Post-traumatic Stress Disorder and depression.

Dr Slowiaczek:
• inappropriately prescribed to Patient A a drug of addiction
• inappropriately prescribed medication to a friend and a close family member
• failed to maintain adequate medical records, and
• suffers from an impairment which is managed by medication and continuing weekly psychiatric consultations and psychotherapy.

Dr Anthony Slowiaczek was found guilty of professional misconduct; is disqualified from registration as a medical practitioner; may not file any application to review the disqualification until after 30 September 2023.

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Plastic surgeon Dr Ian Holton suspended

Dr Holten is a plastic surgeon and between July 2011 and January 2014 he provided cosmetic medical and surgical services to the patient on 10 occasions. Before he provided professional services to her, they had met on numerous occasions and were in a friendship circle that revolved around common interests.

Over the period of the professional relationship, Dr Holten and the patient contacted each other regularly via telephone calls and text messages, met for coffee, and sat in his car together and discussed their personal lives and the patient’s marital difficulties. He failed to manage professional boundaries for some time. In January 2014, he had sexual intercourse with her. On or about 11 and 12 January 2014, Dr Ian Holten behaved in a way that constituted professional misconduct by engaging in sexual misconduct, in that he had sexual intercourse with a patient.

Tribunal findings:

Between about 12 July 2011 and 17 January 2014 (inclusive), Dr Ian Holten, behaved in a way that constituted unprofessional conduct, in that he failed to maintain the professional boundaries that should, and ordinarily do, exist between a medical practitioner and their patient .

Dr Holten’s registration is suspended for a period of three months, the suspension to commence on 11 July 2019.

The tribunal stated: “We are satisfied that Dr Holten is at low or no risk of repeating the conduct. He has practised safely not only for the last five years, but also for decades prior to that. He is otherwise of good character. His early admissions and cooperation are to his credit. There has already been a considerable personal impact on him. “

Source: http://www6.austlii.edu.au/cgi-bin/viewdoc/au/cases/vic/VCAT/2019/837.html

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Psychiatrist gets vulnerable patient pregnant

A Melbourne psychiatrist got a patient pregnant after she was referred to him following a workplace sex assault.

The patient saw Dr Luke Ainsworth five times during 2016 and a personal relationship unfolded between them. A sexual relationship ensued and she soon discovered she was pregnant. She alleged she felt pressure by him to terminate the pregnancy, which she did.

The Medical Board of Australia was notified of his conduct in August 2016 and referred the matter to the tribunal. After this, Dr Ainsworth gave an undertaking not to practise and allowed his registration to lapse.

The Victorian Civil and Administrative Tribunal found him guilty of professional misconduct and disqualified him from applying to register as a medical practitioner before December 31.

The Tribunal noted “We regard it as appropriate to take into account Dr Ainsworth’s period of non-practice when he was fit to practice and reject the submission of the Board that this was not relevant as he did not seek to practise during this time. We are of the view that it demonstrates some insight into the seriousness of his conduct. We felt that a period of three years of non-practice was warranted to reflect the seriousness of the conduct and to send a message to Dr Ainsworth and other practitioners and thus determined that Dr Ainsworth should be disqualified until 31 December 2019.”

http://www6.austlii.edu.au/cgi-bin/viewdoc/au/cases/vic/VCAT/2019/734.html

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Dr Hugh Joffe Psychologist Banned

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.

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Sexual Misconduct by Doctors, Health Care Professionals in NSW | Cases 2017-2018

List of health care practitioners prosecuted by the Health Care Complaints Commission in NSW for misconduct of a sexual nature/ boundary violations with patients.

2018

Dr Ian De Saxe, Psychiatrist
Mr Youngjin Jung, Physiotherapist
Dr David Kingston, Doctor and Pharmacist
Dr Anil Mathad, General Practitioner
Dr Keith Ian Brennan, General Practitioner
Dr Ibrahim Hanna, Neurologist
Mr Russell Harvey, Registered Nurse
Mr Edward Keegan, Registered Nurse

2017

Dr Phillipa Rickard
Dr Nirmit Milan Sheth, General Practitioner
Mr Robert Ferguson (Bray-Ferguson), a non-registered health practitioner providing counselling services as a qualified social worker.
Mrs Brooke Ledner, Psychologist
Dr Teresa Wong, General Practitioner
Dr Mohamed Payenda Zhouand Safi, General Practitioner
Dr Elvin Suet Pang Cheng
Dr Saeid Saedlounia
Dr Miodrag Huber, General Practitioner
Dr Elvin Suet Pang Cheng.
Mr Harry Mayr, Psychologist
Dr Aamer Sultan, Medical Practitioner
Mr Anthony Elliot, Enrolled Nurse

… more info to come on sexual misconduct and disciplinary cases.

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Youngjin Jung, NSW Physiotherapist jailed for Indecent Assault and Deregistered

Central Coast Physiotherapist jalied and deregistered

Name: Youngjin Jung

Education: Physiotherapist; graduated from Curtin University, 2009.

Practice: Ocean Beach Physiotherapy Practice at Umina Beach, Central Coast, NSW.

Criminal case: Jung v R [2017] NSWCCA 24 (6 March 2017)

Civil case/disciplinary action: Deregistered 7 years from 19 April 2018; Health Care Complaints Commission v Jung [2018] NSWCATOD 53

Overview of legal action against Youngjin Jung

In 2016 Mr Jung was convicted of eight counts of indecent assault in relation to six female patients that occurred between 23 April and 12 June 2014. Mr Jung was sentenced to an aggregate sentence of five years’ imprisonment with a non-parole period of three and a half years. He will be eligible for parole on 22 August 2019.

Indecent assault accusations against the physiotherapist included massaging patients’ breasts and touching pubic area of a patient. The “conduct was not in any way related to therapeutic treatment,” Judge Clive Jeffreys said in handing down his sentence. “It was undertaken by the offender for sexual gratification.”

The Health Care Complaints Commission (‘the Commission’) prosecuted Mr Youngjin Jung before the NSW Civil and Administrative Tribunal (‘the Tribunal’). The Commission alleged that because Mr Jung had been convicted of criminal offences in NSW he was not a suitable person to hold registration as a physiotherapist.

On 19 April 2018, the Tribunal found that Mr Jung was not a suitable person to hold registration as a physiotherapist. The Tribunal cancelled Mr Jung’s registration and ordered a non-review period of 7 years. The Tribunal also made a prohibition order that Mr Jung be prohibited from providing any health services for a period of seven years.

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Dr Ian De Saxe, Psychiatrist, Professional Misconduct Case

Professional Misconduct case against Dr De Saxe, Psychiatrist

Name: Dr Ian De Saxe

Specialty: Psychiatry. Graduated from the University of Sydney, Dr De Saxe had been practising since 1987.

Practiced at: The Rocks, Sydney; Mosman Private Hospital.

Summary: Engaged in mutual masturbation and penetrative sex with male patient; massaged legs of another patient; made statements that sexual conduct with under-aged children was “okay”. Inappropriate prescribing and self-prescribing; and inadequate record keeping.

Findings: Professional misconduct; registration cancelled for 2 years. Date of order: 29 March 2018.

Case: HCCC v De Saxe [2018] NSWCATOD 45

Facts of Case

The Tribunal found that the practitioner engaged in inappropriate sexual conduct with patient A. Dr de Saxe engaged in mutual masturbation with patient A on two occasions and engaged in penetrative sexual intercourse with patient A on one occasion.

Dr de Saxe prescribed Methadone/Physeptone, a Schedule 8 drug of addiction to patient A in quantities which did not accord with the recognised therapeutic standard for the appropriate treatment in the circumstances. The patient was not the subject of a treatment plan and the practitioner was not an accredited NSW OTP prescriber and accordingly held no authority to prescribe such drugs. The practitioner prescribed patient A other drugs in similar circumstances, namely Alprazolam and Dexamphetamine. The records of such treatment were not maintained.

Patient B, a 27-year-old male was referred to the practitioner for an opinion and management of alcoholism and major depression. During one consultation Dr de Saxe massaged patient B’s legs and asked patient B words the effect: “Do you want me to go any higher?”. The practitioner acknowledged that he was sexually attracted to patient B.

Dr de Saxe treated patient C whilst he was under his care at the Mosman Private Hospital between 16 August 2010 and 15 September 2010. He consulted patient C on at least six occasions between 17 August 2010 and 10 September 2010. He did not communicate with the patient’s former treating psychiatrists or psychologists; nor put a treatment plan in place. Further, the Tribunal found as a fact that Dr de Saxe engaged in inappropriate discussion concerning the patient’s sexuality and desires and made statements to the effect that sexual conduct with under-aged children was “okay”. Not that patient C had been charged with child sex offences involving a 15 year old male.

The Tribunal found, but that Dr de Saxe claimed to have no recollection, that he looked into the patient’s eyes whilst the patient was talking about his sexuality and invited the patient to engage in a sexual act with him by saying to the patient “suck my cock”. The Tribunal found that the patient’s version of events was correct in respect of the words used by Dr de Saxe to the patient concerning the writing of a report that was required to be used in pending court proceedings involving the patient.

The Tribunal also found that Dr de Saxe stated words the effect that he was willing to lie for the patient in respect of the report. He also failed to keep adequate records of his treatment for patient C. He failed to prepare a comprehensive admissions assessment and treatment plan; to record sufficient corroborative information from other mental health practitioners; to record specific information concerning treatment during admission and to record sufficient detail in the progress notes and discharge summary.

The Tribunal also found that between 7 April 2010 and 28 October 2014, Dr de Saxe inappropriately self-prescribed medication including Schedule 4D prescribed restricted substances.

News Articles for further reading:

Sydney psychiatrist banned for 2 years (news.com.au)

“Sydney psychiatrist suspended over telling an accused paedophile having sex with an underage boy ‘wasn’t that bad’ and that he was ‘willing to lie for him’ after asking him for oral sex”, dailymail.co.uk

Banned Psychiatrist starting another career: “The tribunal heard that Dr de Saxe was attracted to young men and had moved his practice away from ‘the sort of risky type’. Since being suspended from practising medicine, he had started a course to teach English as a second language and told the tribunal he thought it would ‘be helpful to be able to test his boundaries around students’, despite acknowledging that being around young men was a ‘potential risk’.” Source: ABC news.

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