An experienced obstetrician and gynaecologist has been prosecuted for professional misconduct and had their registration suspended after forging consent forms for over 30 patients.
The case, reported earlier this year, raises an important reminder to all doctors of the fundamental importance of trust in the doctor-patient relationship and the informed consent process.
Forged consent forms
At the time, the doctor practised at multiple practices and performed elective surgery at a community hospital.
The doctor’s behaviour was uncovered when another hospital took over the maternity and gynaecology services at the community hospital. During this handover it was reported that some of the doctor’s patients had claimed they had not signed the appropriate consent forms for surgery.
Following a hospital investigation, the matter was handed over to AHPRA and the police. An examination of the doctor’s past patient admissions revealed they had forged the signatures of 37 patients for surgical operations, procedures or medical treatment over a 12-month period. The doctor had also provided the forged consent forms to the hospital knowing they would form part of the patients’ medical records.
Doctor frustrated with hospital bureaucracy
The Medical Board of Australia referred the doctor to the tribunal.
The Board made a submission to the tribunal concluding that the doctor’s conduct breached the Good Medical Practice, a Code for Conduct for doctors in Australia. This was based on the obligation of trustworthiness of a doctor, and the need to obtain a valid authority before undertaking any examination, investigation or treatment, and the keeping of accurate medical records.
During the hearing, the doctor admitted to forging the consent forms and conceded their actions amounted to professional misconduct.
The doctor said they were under personal stress at the time and had become frustrated with the community hospital’s bureaucracy when new elective surgery admission forms were introduced. The doctor explained that a simple one-page form had been replaced with a complex, eight-page form, causing a number of issues.
The doctor submitted that the nature of the operation would often change due to the time that expired from when the forms were originally signed to the date of the operation and many non-native English speakers had difficulty filling out the forms. They also believed that if the nature of the operation had changed a new consent form would be filled out, making the initial consent form unnecessary.
This significantly increased the administrative burden, so the doctor decided to circumvent the hospital’s requirement for consent in their patients’ interests.
“I decided to cut the middle man out and fill in the form myself,” the doctor said.
Behaviour found to constitute professional misconduct
The tribunal found the doctor’s conduct constituted professional misconduct.
“It was not just a mere act of oversight or a demonstration of lack of skills. It was a deliberate pattern of fraudulent conduct stretching over 12 months and striking at the heart of the doctor-patient relationship,” the tribunal said.
Tribunal deliberates over penalty
In deliberating over the doctor’s penalty, the tribunal highlighted their concern about their decision’s effect on the reputation of the medical profession.
“We consider that the public’s faith in the medical profession would be severely undermined if a doctor who forged their signatures on important medical documents was not severely dealt with. Trust is fundamental to the doctor-patient relationship and that trust would evaporate if it were thought that doctors who engaged in this conduct were permitted to remain in practice,” the tribunal stated.
The tribunal did not believe the Board’s proposed penalty, a reprimand, was adequate given the gravity of the doctor’s misconduct. The tribunal also rejected the Board’s argument against suspension or cancellation of the doctor’s registration, stating this did not take into account the way in which the doctor’s actions placed their colleagues and patients at risk, the length of time over which the offences occurred and the harm to the reputation of the profession.
Doctor’s actions leads to suspension
In handing down the doctor’s penalty, the tribunal took into account that the patients’ care had not been compromised, the doctor’s previous flawless record and their remorse for their actions.
The tribunal highlighted that forging a patient’s signature is also a clear breach of the criminal law. The doctor faced charges of falsifying a document in the Magistrate’s Court and was placed on a diversion program, meaning there was no finding of guilt and they could avoid a criminal record.
“Secondly, in forging the signature of the patient, [the doctor] has effectively taken away the patient’s ability to exercise an informed consent to the operation,” the tribunal said.
The tribunal also raised concerns that the forged consent forms included, for example, consent to anaesthesia, blood transfusions and the removal of tissue during the procedure. Therefore, the doctor had placed other medical professionals at great risk as they may have relied upon the consent.
Nor was the tribunal completely satisfied that the doctor had gained sufficient insight into the seriousness of their conduct and appeared to misunderstand the reasons for the need to document consent.
“The documentation is not required because of bureaucracy. It is required in order to fulfil the doctor’s obligation to involve patients fully in decisions of a critical nature concerning their care,” the tribunal said.
Ultimately, the tribunal suspended the doctor’s registration for six months and imposed conditions on their registration including the completion of education courses on informed consent.
Key lessons
It is important to think of consent as an ongoing discussion which will be influenced by, among other things, the seriousness of the procedure and the level of information required by the patient. Failure to obtain consent could expose you to a claim, complaint or criminal charge.
Documentation for consent should include:
- A signed consent form customised to include:
- procedure-specific risks and outcomes
- checklists of support material (brochures, diagrams, DVDs etc.) provided to the patient
- particular information about risks material to the patient’s circumstances
- a statement which the patient signs, to the effect that they had an opportunity to ask questions, and had them answered to their satisfaction.
- Contemporaneous notes in the patient file documenting your discussion with the patient.
- A copy of any information brochures, diagrams or photos given to the patient should also be included in their notes.
More information
For more information, download our Consent Essentials factsheet or view our webinar, Sign here – how to overcome obstacles in gaining consent. You can also read our article Overcoming the challenges of informed consent for anaesthesia.
For advice on the consent process, visit our website or call our Medico-legal Advisory Service (MLAS) on 1800 128 268 for expert advice, 24/7 in emergencies.
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