MEDICAL LAW NEWS AUSTRALIA - The Medico Legal Advocate

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.