Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charges:  

A CAC charged Dr White with five charges alleging he was guilty of the following:

1. Conduct unbecoming a medical practitioner which reflects adversely on his fitness to practice medicine. In particular that Dr White failed to exercise and show due care when prescribing or ordering drug treatments in that he:
   
1. Treated a patient at various places in Cambridge during late 1997 by changing his heart medication without proper clinical examinations.*
2. During the years of 1993 to 1997 treated a patient on a regular basis during which time he caused to be administered the prescription drug Kenacort without appropriate warnings as to the possibility of adverse side effects.*
3. On one occasion between the years of 1993 and 1997 at Cambridge prescribed to a patient sixty tablets of the prescription drug Halcion without warning her as to its addictive potential.
4. Between the years 1996 to 1998 at xx, Medical Centre, Cambridge, failed to maintain or adequately maintain a record of narcotic use in accordance with accepted clinical practice.
5. During 1997 at xx, Medical Centre, Cambridge, altered the existing treatment regime of patients of the Centre attended to by another doctor without consultation or proper clinical examination.
   
   
2. Professional Misconduct. Dr White failed to observe the acceptable standards required of a medical practitioner in clinical procedures in that he:
   
1. During the year of 1997 at xx, Medical Centre, Cambridge inadequately or inaccurately labelled pathological specimens.
2. During the years of 1993 to 1998 at Cambridge failed to evaluate and follow up cervical smear results in respect of a patient.
3. During the years of 1996 and 1997 in Cambridge failed to adequately monitor and respond to abnormal INR results.
4. During 1997 and 1998 at Cambridge re-used hypodermic needles on different patients.*
5. During the years of 1997 and 1998 at Cambridge in the course of his clinical practice used unsafe techniques thus exposing his patients to the risk of cross-infection.*
   
   
3. Conduct unbecoming a medical practitioner which reflects adversely on his fitness to practice medicine. Dr White failed to observe patient privacy and confidentiality in breach of the Code of Ethics in that he:
   
1. During the year 1997 allowed an unqualified person (his partner) to be present during consultations and surgical procedures.
2. During the years 1996 to 1998 in the waiting/reception area in xx, Medical Centre, Cambridge made statements about personal and medical matters concerning his patients in the hearing of other patients and members of the public.
   
   
4. Conduct unbecoming a medical practitioner which reflects adversely on his fitness to practice medicine. Dr White failed to conduct himself in a professional and ethical manner in dealings with other medical practitioners, staff and patients in that he:
   
1. During the years 1993 to 1997 at Cambridge used offensive language in consultation with patients and in public areas of the centre.
2. During the years of 1997 and 1998 impugned the reputation of other health professionals.
3. During the months of August and September 1997 at Cambridge applied undue pressure on his former patient and his patient's wife to return as patients to his practice.
4. During the months of April and May 1998 at Cambridge in his capacity as designated doctor for Income Support solicited patients seen pursuant to that scheme to return to him for ongoing care.
   
   
5. Professional Misconduct. Dr White failed to ensure that medical care was available to patients in that on 19^th and 22^nd of December 1997 at Cambridge he intentionally interfered with the after hours emergency medical phone service of the xx Medical Centre in such a manner it prevented patients from accessing emergency medical care.

(The charges marked with an * are as amended by the Tribunal)

Background:

Prior to the hearing Dr White admitted each particular and that particular amounted either to conduct unbecoming or professional misconduct, as charged by the CAC.

Finding:

The Tribunal found Dr White was guilty of conduct unbecoming a medical practitioner which reflects adversely on his fitness to practice medicine, professional misconduct and disgraceful conduct.

The Tribunal reached a unanimous guilty decision on all of the particulars except the fourth particular of Charge A, which was a majority decision.

The Tribunal elevated the level of misconduct of the fourth and fifth particulars of Charge B from professional misconduct to disgraceful conduct. It applied the test for disgraceful conduct established by the full court in Brake v Preliminary Proceedings Committee, (8 August 1996, Full Court Auckland, HC 169/95). The Tribunal held that the prevention of infection and cross-infection is fundamental to basic medical practice. The doctor/patient relationship must be based on the patient's expectation that the doctor will try to do his or her best for the patient under all circumstances. A doctor using a dirty needle, deliberately and knowingly injecting a patient with a needle contaminated with the bodily fluids of another patient, is deliberately putting the patient at risk of death or tremendous suffering. The Tribunal regarded such behaviour as repugnant.

When Dr White ignored the standard practice of washing his hands following one surgical procedure before embarking on another he deliberately and knowingly exposed his patients to the risk of life threatening infections. The Tribunal found Dr White's standard of practice had fallen to an appalling level.

The Tribunal also elevated the level of misconduct of Charge E from professional misconduct to disgraceful conduct in a professional respect. It found the charge illustrated a callous disregard for patient safety. Dr White left a message on the answer phone deliberately designed to mislead patients. The altered message meant patients might not have received urgent treatment which they required or alternatively such treatment might have been delayed. The Tribunal held that for a doctor to do this knowingly and in a premeditated fashion was absolutely disgraceful.

Penalty:

With the consent of Dr White the Tribunal arranged for Dr White to undergo psychiatric, psychological and physical medicine examinations.

A decision as to penalties was reserved.  The Tribunal ordered that Dr White's registration be suspended pending determination of the proceedings.

Supplementary Penalty Order:

In a supplementary penalty decision the Tribunal ordered that Dr White’s suspension order be vacated and that his name be removed from the Register. It further ordered that Dr White be censured, pay $23,000 towards the costs and expenses of the inquiry and hearing, and publication of the hearing in the New Zealand Medical Journal.

The Tribunal recommended that the Medical Council exercise extreme care and caution in considering any application by Dr White for reinstatement to the Register. The Tribunal also recommended that if Dr White was reinstated to the Register, mechanisms to ensure patient safety must be put into place.

The Tribunal considered the question of whether it was open to Dr White to refuse to answer questions at the hearing. It followed Bowen-James v Walton (NSW, Court of Appeal, unreported 5/8/91) and found that Dr White had no right to silence or privilege against self incrimination in hearings before the Tribunal.