Ex-Gisborne surgeon censured

A109 Light Utility Helicopter flight with mayor Gisborne City from the air in November 2023.

US authorities will be alerted to a decision by the New Zealand Health Practitioner’s Disciplinary Tribunal, in which former Gisborne Hospital orthopaedic surgeon Stephen Augustine is labelled a “danger to the public”.

Augustine, a US national, returned to his home state of Florida after admitting in March 2016 he forged a Gisborne Hospital colleague's signature on prescriptions to fraudulently obtain 1970 tablets of codeine phosphate - an addictive drug with similar qualities to morphine.

On returning to the United States, where his counsel said he informed regulatory authorities of his offending, he was without work for 16 months before he joined the Orthopaedic Surgeons of Georgia last year and took employment at a medical centre.

This week, the NZ Health Practitioner’s Disciplinary Tribunal released its findings on a professional conduct committee’s charge against Augustine — that he acted fraudulently by forging another doctor’s signature to obtain prescriptions for himself and his wife Mindy Augustine, and that he inappropriately prescribed a drug of dependence for a family member (his wife).

The tribunal said it “had no hesitation in finding the charge and each of its two particulars both severally and cumulatively amounted to professional misconduct”.

It struck Augustine off the NZ medical register, censured him, and ordered him to pay costs totalling $19,000.

The tribunal also requested the New Zealand Medical Council send a copy of its decision to the appropriate authorities in the states of Florida and Georgia and to US federal authorities “so that those authorities are fully conversant with the matters raised . . . ”

Augustine was employed at Gisborne Hospital from October 2014 to March 2016, during the last seven months of which he forged prescriptions 20 times, circulating them around seven Gisborne pharmacies until one reported the matter.

Augustine’s offending led to his colleague being temporarily barred by the hospital from writing any further prescriptions.

Police charged Augustine with 20 counts of making a false document to obtain property — controlled drugs — an offence that carries a maximum prison term of 10 years.

The charges were heard in May 2016 by Judge Tony Adeane, who discharged Augustine without conviction, saying he was left with little choice but to do so off the court’s own motion.

An application with supporting affadivit stating the drugs were not for Augustine’s personal use, and that nothing relating to the charges had affected his work, was withdrawn without reason at the last minute. The inference was that it was unreliable.

Had he been satisfied with the information in the affidavit, he would have granted the application without hesitation, the judge said.

But left without any information as to reasons for the offending, he faced a stark choice — one which favoured Augustine or one which did him unjustified damage. Either could be mistaken, but obviously the first was the preferable one.

The judge rated the offending as being at the lower end of the scale.

The tribunal heard the PCC case against Augustine in April this year, noting that to his credit he accepted the charge against him.

While his offending might have been low-end in the context of criminal law, it was serious in terms of professional obligations and conduct. There had been significant personal consequences for his colleague.

It was a gross breach of trust.

Standards must be maintained in proper completion of prescription forms. The public must be protected from the type of activity in which Augustine engaged, the tribunal said.

It was critical of an attempt by Augustine to resubmit a copy of the same affidavit he withdrew from the criminal court proceedings.

It was also critical of Augustine and his wife’s failure to appear at these proceedings or otherwise offer any information as to reasons for the offending.

By attempting to introduce the previously- retracted affidavit, Augustine was treating the tribunal with disrespect and was minimising its processes and jurisdiction, the tribunal said.

It rejected the affidavit and explanations in it.

The Augustines’ lack of participation left serious questions unanswered, the tribunal said.

There was no evidence or explanation as to why the offending occurred and it was not known who it was to benefit — Augustine, his wife or another person.

The tribunal did not know if Augustine’s wife was aware of previous explanations that involved her, and she had not made herself available to the investigation.

Augustine was seeking for the tribunal to make assumptions as to the reason for his offending based on statements from his counsel, who was reliant on the rejected affidavit.

The only direct affidavit evidence of which the tribunal was willing to take account, was from Dr Johan Peters, a clinical director at Gisborne Hospital who had worked with Augustine.

In it, Dr Peters said Augustine had not shown any signs of inappropriate use of a medication and had presented as an honest person, who would not offer a false explanation — “least of all on oath”.

Dr Peters said he had no reason to doubt the explanation the codeine phosphate was for Augustine’s wife.

However, the tribunal noted other supporting material to the submissions on Augustine’s behalf inferred it might well have been Augustine who needed assistance with substance abuse.

A letter from the medical director of the Professionals Resource Network confirmed Augustine’s involvement in a course and emphasised his focus was on “boundary violations” and the like.

But the predominant nature of the course was for issues around substance abuse and participants were subject to random toxicology screening of urine, hair, and blood.

A similar inference could be drawn from other course completion certificates that were supplied for courses concerning opioid use disorders.

Augustine’s participation might have been because he needed help rather than in the context of fulfilling ethical obligations to his profession or patients, the tribunal said.

Given the lack of evidence and the unanswered questions, the tribunal said it had to conclude, “Dr Augustine is a danger to the public which needs protection from him”.

“He cannot be trusted in the practice of medicine.”