UPDATE: On 21 April 2022, the Tribunal ordered that Dr Mooney’s medical registration be cancelled with a non-review period of 12 months. In determining to cancel his registration the Tribunal considered the seriousness of the conduct, the need for general deterrence, the maintenance of confidence in the medical profession and the necessity to give Dr Mooney an opportunity to complete the journey into gaining full insight .
Source: Health Care Complaints Commission v Mooney [2022] NSWCATOD 44
PREVIOUSLY: We previously reported that Dr William Mooney was under investigation by the Health Care Complaints Commission. The HCCC has since prosecuted complaints against Dr William Mooney before the NSW Civil and Administrative Tribunal (‘the Tribunal’). The Tribunal made a finding of professional misconduct. The case can be found here.
Findings included-
Patient A:
Patient A, a 24-year-old man, died in March 2018 following a botched operation performed at Strathfield Private Hospital by Dr Mooney. Dr Mooney performed a septoplasty /turbinate reduction and UPPP with dissection tonsillectomy on Patient A far too quickly. The patient suffered from an arterial bleed. The Tribunal accepted joint expert evidence that performing these procedures too quickly impacts on the quality of the surgery and surgical outcomes. The time taken for the operation was significantly below standard and accordingly unsatisfactory professional conduct.
Patient A was discharged (without review by Dr Mooney, although he says he had spoken to staff). Dr Mooney’s failure to provide post-operative care was also found to be unsatisfactory professional conduct. Patient A subsequently returned to hospital via ambulance as they were vomiting blood. Whilst in hospital they suffered a cardiac arrest, massive haemorrhaging and multiple organ failure. CPR was performed for 45 minutes. On 2 March 2018 patient A was pronounced brain dead and on 3 March 2018 he passed away. The cause of death was noted as recurrent haemorrhage following the operation.
Patient B:
Patient B was 41 when he died as a result of a sinus operation performed by Dr Mooney at East Sydney Private Hospital in December 2017 during which Dr Mooney caused “significant intracranial trauma.” Dr Mooney conceded he didn’t have the CT scans when doing the operation, and the injuries occurred because he became disoriented. The tribunal held it was not possible for Dr Mooney to have navigated his way through the frontal recess without having CT scans to guide him.
The tribunal also said this operation “was a complex procedure fraught with potential serious risks”. By operating so quickly, Dr Mooney “could not have been taking appropriate care”.
The patient quickly deteriorated whilst in the recovery ward. He was stabilised, intubated and then transferred by ambulance to Prince of Wales Hospital.
At Prince of Wales Hospital a CT spiral angiography with contrast found an extensive subarachnoid haemorrhage, with a clot extending through a defect in the right cribiform plate. The cribiform plate is a bone which is adjacent to the frontal sinus from which Dr Mooney had intended to remove tissue. Above the cribiform plate is the brain.
Another CT scan conducted at approximately 12pm on 12 December 2017 showed there was no blood flow to the brain.
At 10:30am on 13 December 2017, patient B passed away at Prince of Wales Hospital.
The coroner concluded that the instrument used during surgery had caused the 0.6 diameter bone defect in the cribriform plate and disruption of the right anterior cerebral artery accompanied by a haemorrhagic defect in the right frontal lobe.
The Tribunal stated “We are satisfied that the most likely explanation for the injuries to patient B is because Dr Mooney became disoriented while performing the operation and was in the cranial cavity when he thought he was in the frontal sinus. He then inserted an instrument into his endoscope, and while moving that instrument, probably with some force, made a hole in cribiform plate and damaged an artery. Some brain tissue containing bone shards moved into the hole in the cribiform plate.”
At the s 150 hearing on 15 March 2018 Dr Mooney he said he did not think initially there had been an intracranial event. When the patient was stabilised in recovery he examined his nose with a scope. There was no bleeding and there was no CSF leak, but his general neurological status caused Dr Mooney great concern, and he realised immediately that something terrible had gone wrong. At this time that he feared patient B had suffered a hypertensive post-operative stroke. He discussed this with the anaesthetist who also felt it was the likely diagnosis.
Dr Altmann, one of the expert witnesses, found it astounding that an experienced ENT Surgeon who had just operated in the frontal ostia of a patient who had had multiple previous sinus operations with distorted anatomy would consider any possibility other than that he had just caused an iatrogenic intracranial surgical complication as the first, second and third most likely possibilities before even imagining other potential causes for the patient’s poor neurological status and seizures in recovery.
Patient C:
From 2013-2016, Dr Mooney inappropriately formed a personal relationship with and prescribed medication to patient C. In mid 2014 patient C asked Dr Mooney out. They had drinks, then dinner and then went to a hotel room. Dr Mooney told the delegates he had drunk wine and his memory was unclear, but he did not have any memory of “sexual congress”. He said “Did we kiss? Perhaps.” He woke up in his own bed at home. Dr Mooney said this was the one liaison he had with patient C, and his memory of it was blurry at best. The HCCC obtained records from Telstra and another s 150 inquiry was held on 25 June 2018. That information was the following:
- Between 4 October 2013 and 19 January 2016, 3,425 text messages were sent between Dr Mooney and patient C;
- Between 4 October 2013 and 19 January 2016, 807 phone calls were made between Dr Mooney and patient C.
Dr Mooney had also inappropriately prescribed the patient Duromine- a weight loss drug. The Tribunal were satisfied that the relationship was both exploitative and inappropriate. Dr Mooney had also misled the Medical Council of NSW delegates on 1 February 2017 in statements he made concerning patient C.
The Conditions Complaint:
Conditions were placed on Dr Mooney’s registration on 25 June 2018 to attend hair drug screening. The Tribunal found that Dr Mooney practiced in breach of his conditions including by: practicing for one month without the required supervision, saw patients and practiced while certified as unwell instead of attending hair testing; and, failed to provide supporting information to explain his absence from the required testing.
Final Decision:
Dr Mooney was found guilty of professional misconduct. The Tribunal will determine protective orders following a further (Stage 2) hearing.
Source: Health Care Complaints Commission v Mooney [2021] NSWCATOD 206
