Censured psychiatrist fights to keep name secret

A psychiatrist whose sloppy note-taking and failure to manage medicines led to a patient's mental breakdown is battling to keep his identity secret.

The patient, a 62-year-old woman, became paranoid and began hallucinating and swearing at voices in her head after the doctor "rapidly reduced" her medicine.

The doctor pleaded guilty to professional misconduct at a hearing by the Health Practitioners Disciplinary Tribunal, which said his actions "amounted to malpractice".

And despite the case happening almost six years ago, the tribunal said concerns about note-taking remained up until last year.

"These issues therefore appear to still be current."

But the psychiatrist has gone to the High Court to fight for permanent name suppression after claiming that revealing his identity would interfere with his relationship with other patients and cause them to lose faith in him.

The crux of the doctor's argument is that he works in the public sector where patients do not have the luxury of choosing their consultant.

The case dates back to 2000. The patient had a history of schizophrenia going back to 1974. She had spent time in secure mental units but was living with one of her daughters at the time.

She had been diagnosed with paranoid schizophrenia and depression when she first went to see the doctor in October 2000.

He determined she did not have schizophrenia, but depression with psychotic features. He rapidly reduced her anti-psychotic medicine and changed her anti-depressant prescription.

But he made no clinical notes. The tribunal heard that there was another appointment, but the doctor did not record symptoms, diagnosis or the reasons behind his treatment plan.

He also failed to document her mental state or psychiatric history.

In December 2000 she went to stay at her daughter's home, where her mental state deteriorated rapidly.

The daughter contacted mental health services on January 15, 2001.

Her mother had been "talking all day and night, hearing and swearing at voices, she had hallucinations, paranoia and was continuously talking and answering voices".

Three days later, the woman was taken back to the psychiatrist for an urgent review. He again failed to make full notes.

The tribunal said that represented a "failure to discharge his professional obligations" and was a significant shortcoming in the management of the patient's care.

Notes were not just window-dressing or of minor importance. Detailed notes were imperative.

"They are serious matters and reflect on his clinical competency."

The doctor was censured, fined $2000 and ordered to pay 30 per cent of the costs of the hearing. He must also be watched by a Medical Council-approved supervisor for 18 months.

The tribunal said granting name suppression would not be a service to the vulnerable - "it would be patronising and destructive".

But interim suppression was granted for 14 days to allow the High Court appeal.