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.

Macquarie University Hospital Death of Patient Paul Lau

A coroner’s inquest has found that Mr Paul Lau died on 19 June 2015 as a result of prescribing error by an anaesthetist, which led to Mr Lau receiving medication intended for another patient whilst he was recovering from ACL reconstruction surgery. The error was not detected by Hospital staff before his death.

Dr Kim opened Paul’s TrakCare record to prescribe a small amount of fluids, which he had forgotten to prescribe during Paul’s surgery. Dr Kim then failed to close Paul’s TrakCare record and opened GS’s (another patient’s) TrakCare record before prescribing post-operative medications for GS at 1:55pm.

Mr Lau was prescribed a Fentanyl Patch and a Fentanyl PCA. He died of fentanyl toxicity.

According to the inquest findings:

It is clear that Dr Kim failed to exercise proper care, diligence and caution whilst prescribing medication erroneously in Paul’s TrakCare record from 1:55pm to 2:00pm. Dr Kim accepted that a patient’s name is displayed on screen in TrakCare at all times and that he overrode 22 alerts presented in three batches whilst prescribing, selecting “consultant’s decision” and entering his password each time. Dr Kim accepted that he bears primary responsibility for the error.

Criticism was made of the hospital’s pharmacist:

In the Pharmacy, Ms Bui, the dispensing pharmacist, failed to adequately assess the appropriateness of the Fentanyl patch for Paul, particularly having regard to the fact that an opioid naïve patient had been prescribed the strongest dose and the fact that Fentanyl patches were not regularly prescribed for postoperative pain.

Criticism was also made of the nursing staff:

A similar absence of critical thinking was displayed by the nursing staff. The Recovery nurses did not question the order for the Fentanyl PCA, despite the Fentanyl PCA not being discussed during handover. The Ward 1 nurses did not assess whether the Fentanyl patch was appropriate medication for a patient in Paul’s circumstances and did not adjust their practices to reflect the risks posed once the Fentanyl patch was administered.

Dr Gregory Robinson – drug addicted surgeon Shoalhaven Hospital banned

The HCCC prosecuted general surgeon Dr Gregory Robinson before the NSW Civil and Administrative Tribunal (‘the Tribunal’), in relation to his management of 4 patients at Shoalhaven District Memorial Hospital.

Allegations were found proven as follows:

  • On 17 February 2015, a patient was admitted under Dr Robinson with symptoms of vomiting and suspicion of an incarcerated abdominal wall hernia. Dr Robinson performed a laparotomy and bowel resection on the patient later that day.  Dr Robinson delayed his review of the patient and he inappropriately conducted major surgery on the patient contrary to his agreement with the anaesthetist to limit the surgery, given the patient’s clinical condition.
  • On 10 December 2013, a 10 year old boy, was admitted under Dr Robinson to the hospital complaining of abdominal pain. Dr Robinson failed to examine or assess the boy until the morning of 13 December 2013 and he inappropriately relied on a first year surgical trainee and resident to examine the patient in his absence.
  • On 24 November 2010, a patient was on the operating table, anaesthetised and intubated with Dr Robinson ready to perform repair of a left inguinal hernia. Dr Robinson left the patient on the operating table intubated without allowing the operation to proceed for some time, and threatened to stop operating on the patient until another of his patients was admitted into hospital.

Dr Robinson had a history of depression and narcotics abuse from 2000, which lead to the him being on the New South Wales Medical Council and Board’s impairment program from 2002.

The doctor explained that he had voluntarily ceased practising in 2015 because he felt that he needed time to heal after the incidents which gave rise to these proceedings.  The Tribunal noted that during the last 12 months he had undertaken reading, meditation, engaged in Buddhism and developed strategies for dealing with stress.

The Tribunal found that Dr Robinson was impaired and imposed a 2 year ban from practice from 26 February 2018.

Sydney doctor misdiagnoses tuberculosis

A man went to his GP in Chippendale, Sydney with symptoms of persistent cough, shortness of breath, on multiple occasions and was initially told that he had asthma. He was subsequently told by the GP that he had lung cancer and was referred to Royal Prince Alfred Hospital, Camperdown.

The hospital conducted various tests which showed that he had tuberculosis and X-rays later found the man had a 6cm hole in his lung. The patient was kept in isolation in RPA for 3 weeks and treated accordingly.

During the period of alleged misdiagnosis, members of the patient’s family became infected with tuberculosis. There are fears that members of the wider community may have also been infected. There are media reports that at least 10 people have been infected and are receiving treatment.

Tuberculosis is a contagious disease caused by a bacterial infection of the lungs. The disease can spread to other parts of the body and can be spread to other people by coughing or sneezing.

Symptoms include:

  • Persistent cough
  • Coughing up mucous and/or blood
  • Fatigue
  • Fever
  • Loss of appetite
  • Weight loss
  • Chills

Making a diagnosis of tuberculosis involves taking a thorough medical history, including symptoms, physical examination of the patient, ordering specific blood tests, testing samples of phlegm. A chest x-ray may also be ordered. Treatment includes various medications. A misdiagnosis can occur because the symptoms of TB can resemble other illnesses.

Robert Starkenburg, Bondi Dentist Deregistered

Dr Robert Starkenburg, a Bondi Junction dentist was found to have engaged in professional misconduct. The New South Wales Civil and Administrative Tribunal found that the dentist’s surgery had inadequate infection control and he was de-registered from the profession of dentistry.

This was a dentist with a history of hygiene issues, stemming back to inspection in 1998. Further complaints arose in 2014 and 2016. In 2016, the inspector found that he was “now mostly compliant with infection control requirements” but there were on-going concerns with hand hygiene, out of date stock and inadequate health records. The tribunals concern was that despite the dentist’s extensive experience, “the breaches that occurred have been gross, repeated, and occurred over a considerable period.”

Whilst this is not a medical negligence action for compensation, it is a disciplinary case, and it is however quite possible for a civil suit to arise where failing to observe proper standards of cleaning of instruments and hygiene results in a patient being infected with HIV and other blood-borne viruses. Establishing causation in these cases can be problematic however.

Dr Jonathan Stern, GP misdiagnosed heart attack

The HCCC recently prosecuted a complaint involving an alleged failure by Dr Jonathan Stern, General Practitioner to make a diagnosis of a heart attack and administer Aspirin.

The patient in question attended the GP’s St Ives’ medical practice complaining of chest pains. He was briefly seen by Dr Stern and was advised by the doctor to go to the hospital. The doctor did not call an ambulance nor phone the hospital ahead, and his referral letter was deemed to be inadequate. There was no provision of aspirin however Dr Stern did afford the patient some treatment by administering a Nitrolingual spray.

The patient’s work colleague who turned up to the practice drove the patient to the hospital. Unfortunately the patient collapsed and died at the reception desk at the hospital. The cause of death was ischemic heart disease and coronary atherosclerosis.

Expert evidence suggested that in situations like this a GP should-

  • Give aspirin
  • Perhaps give nitrolingual spray.
  • Call an ambulance
  • Monitor the patient whilst waiting for the ambulance to arrive
  • Be ready to administer CPR

The Professional Standards Committee imposed restrictions on Dr Stern’s registration, the main one being that he be mentored for a minimum period of 12 months.

Whilst this case is a disciplinary case, and not a tort action for medical negligence, it is important that medical practitioners take appropriate and timely action when a patient presents with symptoms of a heart attack.

In civil law suits for medical negligence however, medical evidence will need to be adduced to show that taking appropriate action would have made a material difference to the patient’s outcome in order for damages to be awarded. This legal issue is known as “causation”, and is not often addressed in disciplinary cases.