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.
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.”