Surgeon’s two-year ban reinforces need to address impairment issues

By: Helen Turnbull, BA, LLB, Special Counsel – Professional Conduct, Avant Law, NSW

Jun 26, 2018

A recently reported case involving a consultant surgeon whose mental health affected his ability to practise, reminds all doctors to seek professional help if problems arise.

While an extreme case, the surgeon was the subject of a complaint made by the Health Care Complaints Commission regarding his management of four patients and impairment. This involved a major depressive disorder and opioid dependence with a risk of relapse from environmental, professional and personal stressors.

In an earlier hearing, the tribunal found the surgeon guilty of unsatisfactory professional conduct and professional misconduct for his management of the patients. This included inappropriately performing a major operation on a patient contrary to his agreement with the anaesthetist, given the patient’s condition and relying on a first year surgical trainee and resident to examine another patient in his absence.

The tribunal found the surgeon left an anaesthetised patient on the operating table without allowing the operation to proceed and threatened to stop operating on the patient until one of his other patients was admitted into hospital.

Furthermore, he failed to keep adequate medical records and improperly prescribed drugs of addiction for himself and his partner.

Personality disorder affects capacity to practise

A second hearing concerned the question of the surgeon’s impairment and protective orders.

While the surgeon had conceded he was impaired under the Health Practitioner Regulation National Law, the tribunal was “not so satisfied”. This was based on evidence that while the surgeon was impaired due to a risk of lapsing into drug dependency or depression, the risk could be managed.

Based on expert evidence, the tribunal concluded his depression and opioid dependence had been effectively controlled by medication and the removal of significant stressors in his life.

Ultimately, the surgeon was found to be impaired due to an obsessive compulsive personality disorder which detrimentally affected his capacity to practise medicine.

The tribunal examined whether some of the surgeon’s misconduct, especially his interaction with others, could be casually linked with his personality disorder. The tribunal highlighted a consultant psychiatrist’s report which said it was likely the surgeon’s personality disorder had a negative impact on his functioning, particularly in the work and social realms.

The tribunal also noted he did not present as an experienced surgeon able to perform with the necessary degree of collegiality as part of the surgical team.

Surgeon’s two-year registration ban

Although the surgeon had ceased practising prior to the original proceedings, he was disqualified from applying for reregistration for two years. The tribunal stated that if the surgeon were still registered, they would have cancelled his registration.

In handing down their decision, the tribunal noted the serious nature of the surgeon’s conduct and uncertainty about whether he possessed meaningful insight into his misconduct. It was also emphasised he had not yet commenced undertaking therapy and until very recently had resisted formal therapy with a psychiatrist.

Seeking professional help

Increasing pressure on the profession has placed even greater importance on doctors’ health and wellbeing.

However, support for mental and other health issues can be uniquely difficult for doctors. Delays in seeking help can be due to perceptions of lack of confidentiality, embarrassment and fears about career implications. These barriers often lead doctors down a path of self-treatment and self-medication.

The Medical Board of Australia’s Good Medical Practice: A Code of Conduct for Doctors in Australia says good medical practice involves “having a GP” that is not you, and “seeking independent objective advice when you need medical care.”

Seeking objective external help is essential to pick up on subtle cues, particularly when it comes to mental health issues. Doctors' Health Advisory Services are independent of the Medical Board and provide personal advice to doctors facing difficulties, personal crisis and stress. For contact information in your state, click here.

A supportive environment that emphasises collegial support is also important, where doctors are encouraged to be proactive about looking after their health and one another. If you notice a colleague is struggling, take them aside for a friendly word and encourage them to seek professional help.

Key takeaways

• If you are experiencing a health issue, ensure you seek independent professional help to identify subtle signs and address issues early.
• Good medical practice means having your own GP.
• If you notice a colleague is struggling, encourage them to seek professional help.

More information

Visit our Doctors’ Health and Wellbeing website for health and wellbeing information, support and advice and see our list of key support services.

Avant’s Personal Support Program provides confidential counselling to members who are suffering mental health issues on: 1300 360 364. Members can access a range of support including up to six sessions of confidential, external counselling provided by Benestar a leading global provider of corporate psychology services.