It is now more than 5 years ago in 2015 an investigation was conducted at St Vincent’s Hospital into the practitioner’s prescribing practices. The inquiry focused particularly on the prescribing of the chemotherapy drug carboplatin in a flat dose of 100mg for a number of patients receiving definitive or adjuvant chemoradiotherapy as part of their treatment for cancer. An investigation of the practitioner’s treatment for his patients at Macquarie University Hospital followed. The Chief Executive Officer of that hospital lodged a complaint with the Health Care Complaints Commission (HCCC) about the practitioner’s prescribing.
Published yesterday was the decision in Health Care Complaints Commission v Grygiel [2021] NSWCATOD 28 (on Caselaw), by which time the practitioner had ceased practising. The content of the original complaint had changed over time.
Admissions were made that the treatment of 11 paitents were significantly below standard ([140]). The Tribunal was also required to cosnider Patient M1 and the other 51 patients in respect of whom it is asserted the practitioner failed to provide adequate advice of the existence of alternate treatment options to the patient to enable that patient to provide “informed consent” by reference to the authorities on this topic ([255]).
The Tribunal commented at [343] – [345]:
“…there is a fundamental responsibility for a clinician to negotiate with the patient appropriate goals of treatment. A patient may elect to accept treatment toxicity if it will improve survival or may accept a compromise in efficacy to reduce toxicity. These very different treatment philosophies cannot be determined without the input of the patient. Clinicians have a responsibility to invite and respect patient preferences so that treatment recommendations are congruent with the patient’s own goals.In summary, as we later discuss when considering appropriate protective orders we found, even if the practitioner’s desire was to shelter his seriously ill patients from additional stress, that did not obviate his duty to provide adequate information to his patients. In saying this, we accept Professor Clarke’s opinion that some patients may be further stressed by the provision of detailed information prior to treatment. But here, as is aptly illustrated by the patients we have discussed, they were men and women well able to absorb basic information and agree to or not agree to a flat dose of carboplatin. The patient’s right to know that the regimen the practitioner proposed was unusual and was not supported by meta-analysis or relevant clinical trials was paramount. Provision of that information inexorably should have led to advice that other established regimens were available.We find that the practitioner’s concession of unsatisfactory conduct in respect of this category of conduct is properly made”
Admissions were also made in relation to record keeping.
The practitioner has admitted that he is guilty of professional misconduct based on the cumulative effect of his concessions of unsatisfactory professional conduct, in particular, relating to consent.
The Tribunal held that if the practitioner was still registered it would have cancelled his registration. He was precluded from seeking reinstatement for 2 years.