Medical Council News - August 2020

Message from the Chair

Tēnā koutou e ngā rata, e ngā tāngata o te motu,

Nau mai ki tēnei pūrongo i te Kaunihera Rata ō Aotearoa – welcome to this edition of the Medical Council news.

As this newsletter was being finalised, our nation has just learned of the new cases of COVID-19 in the community and the need to re-enter higher levels of lockdown. We have had two new Council members appointed and also in this newsletter are the outcome of two Health Practitioner Disciplinary Tribunal (Tribunal) decisions, which we are required to publish in accordance with the Tribunal’s orders.

COVID-19 pandemic

It has been a very unusual year so far and with the community transmission of COVID-19 announced this week, it appears this is far from over. Nonetheless, our country and the medical profession have been in this situation before and succeeded, and we will do so again.

I would like to make mention of the resilience, commitment and compassion (for patients and each other) that the medical workforce has shown throughout the pandemic.

Recently, I was fortunate to hear first-hand from prevocational educational supervisors and clinical directors of training about the challenges faced at the front line of health care, but also, pleasingly, the many opportunities the pandemic provided for learning and flexibly meeting the needs of our populations. It was great to hear how interns, registrars, and senior doctors rose to the wero, and were able to use this time for upskilling and development – both in their own practice and for the health services they provide.

Council put in place a number of measures to support doctors during this time, such as the pandemic scope of practice, deferring recertification requirements, and supporting flexibility in training. You can find all of the information on these on our website.

It is notable that here in Aotearoa New Zealand we led the world in terms of the speed and success of our response in the health sector and a number of our international regulatory counterparts have been highly complementary of our agile approach. This is a credit to the medical profession.

We will all need to continue to work together in the months ahead. That is our commitment to you.

Noho ora mai,

Curtis Walker
Chair
Medical Council of New Zealand


Extension of COVID-19 Pandemic scope of practice

The recent community outbreak in Auckland reminds us that the pandemic continues to unfold in New Zealand. We have recognised that by extending the COVID-19 Pandemic scope of practice that we first activated in March this year. The expiry date of this special purpose scope of practice has been extended out from 30 September 2020 to 31 March 2021. Further information about the COVID-19 Pandemic scope of practice can be found at the link below.

https://www.mcnz.org.nz/about-us/news-and-updates/extension-of-pandemic-scope-of-practice/


New Council member appointments

We are pleased to advise of our two new appointments to Council, who have been officially Gazetted to join us as of 13 August 2020.

Dr Rachelle Love

Dr Rachelle Love is of Ngāpuhi and Te Arawa descent. An otolaryngology, head and neck surgeon in Ōtautahi Christchurch, Dr Love is a member of the Royal Australasian College of Surgeons (RACS) Māori Health Advisory Group, is an elected member of the National Board of RACS, is on the Specialist Council for the New Zealand Medical Association, the executive of the NZ branch of the Australasian Sleep Association, Urutā National Māori Pandemic Group and is a Trustee of the Hearing Research Foundation.She is a cultural advisor to the ORL Training Board. 

Dr Love’s research interests are in Māori health, particularly cultural competency and cultural safety in surgical education, and in sleep surgery, where she is part of a multinational research group.

Dr Kenneth Clark

Dr Kenneth (Ken) Clark, is vocationally registered in both obstetrics and gynaecology and in medical administration. He is a practicing gynaecologist in Palmerston North and is also currently working as the Acting Medical Director of PHARMAC. Dr Clark is a past president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Dr Clark was Chief Medical Officer (CMO) of MidCentral DHB for 17 years and he chaired the national DHB CMO group for 9 years until leaving his CMO role in 2019. He has been involved in many Council initiatives over recent years to improve prevocational medical education, and for the last year has been serving on the Council’s Education Committee.

Our Council is greatly looking forward to welcoming Drs Love and Clark, and look forward to the wisdom and experience they will bring to Council’s work.

Farewell to two Council members

 

The arrival of new Council members inevitably means we must also sadly farewell two members who have completed their time on Council.

Professor John Nacey

The contribution of Professor John Nacey who has been on Council for 10 years – one of our longest ever serving members – cannot be overstated. His leadership in the New Zealand health sector and in medical education was rightly recognised though the honour of Companion of the New Zealand Order of Merit (CNZM) in the 2020 Queen’s Birthday Honours List.

A urologist, Professor Nacey has worked in Wellington most of his professional career, and held the position of Dean and Head of Campus at the University of Otago’s Wellington School of Medicine for 10 years.

He has been extensively involved and led much of the work to redevelop, improve and set standards for the delivery of the prevocational medical training programme for interns. The effect these changes have had is borne out in the outstanding quality of doctors coming through prevocational and into vocational training. His sage advice and expertise will be greatly missed in Council.

Dr Paul Hutchison

While the second member of Council leaving us has been with us a shorter time, Dr Paul Hutchison has made a huge contribution to Council’s work. Dr Hutchison served on Council’s Audit Committee, and also left a lasting legacy at Council, through his experienced decision-making and perspectives informed by a lifetime of service to the New Zealand health system.

Appointed to Council in 2017, Dr Hutchison has held executive positions in the New Zealand Obstetric Society, New Zealand Medical Association and the Royal Australian and New Zealand College of Obstetrics and Gynaecology.

Dr Hutchison became Member of Parliament for Port Waikato, then Hunua from 1999–2014 and chaired Parliament’s Health Select Committee from 2008–2014. In 2014, Dr Hutchison received the New Zealand Medical Association Chair’s Award for making ‘an outstanding contribution to health in New Zealand’. Dr Hutchison currently works in a high needs South Auckland general practice.

We thank both members for their tremendous contribution not only to Council’s work, but to the wider health sector, and wish them well for the future. Both doctors are still actively practising and involved in many other contributions to our nation's health care.

Nōreira, ngā mihi ano e ngā rangatira. Tēnā kōrua.


Tribunal finds doctor guilty of professional misconduct for leaving patient medical records in unlocked car

Recently, the Health Practitioners Disciplinary Tribunal (Tribunal) considered a charge that was laid by a Professional Conduct Committee (PCC) against Dr Medhane Hagos Mesgena. The Tribunal ordered that a summary of this decision was included in MCNZ news.

The Tribunal found that Dr Mesgena’s conduct amounted to professional misconduct. There were two main areas of concern for the Tribunal:

  • Concerns with care he provided to a patient and adequacy of medical record keeping.
  • Leaving patient’s medical records unlocked in a car that was parked in a public car park.

Dr Mesgena left his car parked at Hawke’s Bay Airport in the short-term public car park for around 8 weeks. He left his car unlocked and in his car were documents containing private health information of patients, a controlled drug pad, and a lap top.

The concerns around the care to patient involved Dr Mesgena not adequately examining a 12–year- old girl who had a developmental age of about 6-years old when she attended the surgery with her social worker. The patient was under the care and protection of Child Youth and Family Services at the time and was living in a family group home. The patient was vulnerable.

On arrival at the surgery the patient was triaged by a nurse who established that the patient was most likely sexually active and she complained of vaginal discharge and other symptoms. Dr Mesgena failed to take an adequate clinical history, did not carry out any physical examination other than checking the patient’s vital signs, and the consultation was too short to be adequate in that it took 4 minutes. 

Dr Mesgena failed to make contemporaneous patient medical records for a number of patients and failed to either make any patient medical records or to do so within 24 hours after the date of consultation.

In a number of cases, he also failed to adequately to document the care he provided. His notes did not provide sufficient information to determine a baseline from which to review a patient’s progress. 

The Tribunal imposed the following penalty:

  • A censure;
  • A fine of $2,000;
  • Conditions on Dr Mesgena’s practice which will apply for a period of 3 years, following his commencement of practice in New Zealand;
  • Costs of $40,000; and
  • Publication of the decision and a summary included in Medical Council news.

The full decision relating to the case can be found on the Tribunal website at: 

https://www.hpdt.org.nz/Charge-Details?file=Med19/446P .


Tribunal finds patient’s medical records must include reference to prescribing of controlled drugs

For nearly 3 years between January 2014 and December 2016, Dr R prescribed pethidine (a Class B, synthetic opioid, medication) for two of his patients – Ms S and Ms N for the treatment of their migraines. He was charged with inappropriate and/or excessive prescribing to both patients, failing to keep accurate and/or adequate records in relation to this prescribing, and failing to maintain an accurate and adequate Controlled Drug Register (CDR).

Both patients had experienced migraines for many years. They had been prescribed pethidine by previous doctors, and had multiple referrals to neurologists and/or pain clinics. Specialists had raised the possibility of medication overuse headaches and suggested alternatives. Dr R had sought alternative treatment, but had been unsuccessful during the time relevant to the Charge, and continued to prescribe pethidine for pain management frequently to both women.

The Tribunal did not find the particulars relating to inappropriate and/or excessive prescribing to be established. In making this finding it took into account that:

  • Dr R started prescribing pethidine when he inherited a pain management plan for each patient from another practitioner who had been prescribing them pethidine.
  • Others in the practice continued to prescribe pethidine to both patients and there was a long standing practice of other local GP’s providing pethidine to both patients.
  • Dr R had explored other options with both patients, but (in the time relevant to the Charge) had not identified an effective alternative pain management strategy.
  • Both patients appeared to have significant medical difficulties and appeared to be difficult to deal with.
  • The PCC failed to prove that medication overuse was a factor.

The Tribunal was satisfied that Dr R had not taken proper and comprehensive notes for either patient, and that this amounted to negligence. The Tribunal stated that it was not sufficient to have an entry in the CDR without record in the patient’s records, as Dr R (and any other practitioner) should not be expected to look at the CDR to make an analysis of prescribing prior to deciding whether to prescribe further.

The Tribunal found that the requirement for a CDR was clear and important as it records the movement of controlled drugs in the practice’s safe and in the premises. Dr R failed to accurately record the dosages of pethidine checked out/administered on multiple occasions in respect of both patients and/or failed to complete all required details.

The Tribunal found that there were too many inaccuracies in the CDR to ignore, and that it amounted to malpractice.

For the failure to accurately or adequately document the prescribing of pethidine to the patients, and failure to maintain a CDR as required by the Misuse of Drugs Act in respect of the pethidine prescribing to both patients the Tribunal censured Dr R and fined him $2000. Dr R was also directed to contribute to the costs of the hearing. The Tribunal ordered that a summary of this decision was included in Medical Council News.

The full decision relating to the case can be found on the Tribunal website at:

https://www.hpdt.org.nz/Charge-Details?file=Med19/444P