A foul-mouthed surgeon has been reprimanded for swearing at a severely obese patient and for punishing her by removing her from a waiting list.
The doctor, known as "Dr B", told his gastric bypass patient, "Ms A", that she was "going on a f****** diet" after she complained she disliked the word "diet" and preferred to talk about "lifestyle".
He had put the Maori 44-year-old on a list to be considered for surgery after a tense consultation last April at which he used forms of the F word at least three times.
In a letter written seven weeks after she complained, the surgeon offered what Health and Disability Commissioner Ron Paterson calls a half-hearted apology - and took her off the list, asserting they no longer had a "therapeutic relationship".
"This appears to be retribution on Dr B's part for Ms A's action in laying a complaint," Mr Paterson says in a decision to be published on the commission's website today.
He finds the general and gastro-intestinal surgeon - and his district health board - breached the code of patients' rights. He does not name those involved, nor the DHB.
Associate Health Minister Tariana Turia, who has had the operation herself, was approached by the woman and told the Herald yesterday that the surgeon's behaviour was "scandalous".
"I just can't believe this person, who is extremely powerful. He abused his specialist role. He's abused his power by taking her off the waiting list when she complained."
The woman's DHB does not currently offer obesity surgery. Mrs Turia said it should refer her to one that did.
The woman's weight is not stated, but her body mass index (BMI) is recorded as 68, suggesting that if she is of average height, she would weigh more than 180kg.
She works fulltime, is a mother and reported swimming three times a week, but had repeatedly failed at dieting, quickly regaining weight after relapsing.
Dr B explained to her the necessity of patients changing their lifestyle and dieting if they were to shed kilos and maintain their new weight after the operation.
She told him she disliked the word "diet" and preferred to talk about "lifestyle".
Ms A said in her complaint letter: "[Dr B] disagreed and said if I couldn't handle the word diet then he challenged my motivation and stated that I would never survive surgery because I was still bullshitting myself and therefore my thinking was still f****d."
A nurse told the investigation that Dr B said: "You are going to be on a f***ing diet."
The DHB's medical director said Dr B was "direct and coarse" with patients and, under stress, had a "foul mouth". He was highly qualified and it would be a "terrible shame" if severe penalties were imposed.
Mr Paterson said Dr B, who admitted using the bad language, showed no understanding of the vulnerability of an obese Maori in her 40s.
His language and conduct were demeaning, insulting and unprofessional. "He showed disrespect for a patient who understandably felt embarrassed about her obesity."
The DHB had partly tolerated his language, done too little to address his behaviour and responded too slowly to the complaint.
He recommended Dr B undertake a communications skills course and meet Ms A and her whanau to address her concerns.
The medical director said the DHB would comply. Dr B knew he had a problem.