Gynaecologist 'failed ill patient'

By MARTIN JOHNSTON health reporter

Cervical cancer treatment opportunities for Paihia woman Colleen Poutsma were restricted because of an "incomprehensible" failing by her gynaecologist, Dr Graham Parry, says an expert witness.

Mrs Poutsma, who is dying of the disease, yesterday sat in a wheelchair through most of the first day of the hearing in Paihia into the charge of disgraceful conduct against Dr Parry.

Three women's health specialists gave evidence for the Health and Disability Commissioner's independent prosecutor, who laid the charge at the Medical Practitioners Disciplinary Tribunal.

Dr Parry has admitted the prosecutor's factual allegations - that he cared inadequately for Mrs Poutsma from August 1997 to February 1998 - but denies this amounts to disgraceful conduct. If the charge is proven, Dr Parry, who has been suspended by the tribunal, could be struck off the medical register.

When Mrs Poutsma was referred to Dr Parry after a heavy vaginal bleed in 1997, he performed an abdominal ultrasound scan but no internal examination.

Despite receiving a pathology report around January 9, 1998, confirming cancer, he did not refer her to the National Women's Hospital cancer unit for about a month. On January 19, he performed an unnecessary cone biopsy - removing a large section of the cervix.

A Palmerston North obstetrician-gynaecologist, Dr David Cook, told the hearing yesterday that the cone biopsy was the "most questionable" aspect of the case. It led to an emergency "simple" hysterectomy - removal of the uterus including the cervix.

"This surgery is insufficient to eradicate cancer and absence of the uterus complicates the application of radiotherapy and possibly undermines its value."

Without this surgery, radioactive rods can be inserted as part of the radiotherapy. "Failure to consider and investigate cervical disease in August 1997 can be tenuously understood by the mistaken focus on endometrial disease [a uterine condition]," Dr Cook said.

"The performance of a cone biopsy when a biopsy had already clearly established the diagnosis is incomprehensible and suggests a lack of understanding of cervical cancer management principles."

Despite the delay in diagnosis, Dr Cook notes that even with the most skilful management, a positive outcome for Mrs Poutsma would not have been assured because of a possibly rapidly growing tumour and other clinical factors.

An Australian witness, Dr Amanda Sampson, like Dr Parry an ultrasound sub-specialist in obstetrics and gynaecology, said in written evidence that a vaginal scan should have been performed as well as an abdominal one. Other checks should have been made, too.

One of Dr Parry's lawyers, Christopher Hodson, QC, told the five-member tribunal, headed by lawyer Wendy Brandon, that it should disqualify itself.

He suggested the tribunal was biased and tyrannical, referring to its suspension of Dr Parry without giving him advance notice and its reliance on media reports that up to 40 women had complained about Dr Parry (which he added was untrue).

Ms Brandon said tribunal members had deliberately avoided a TV3 programme and newspaper reports about Dr Parry., but then added they had only in"a cursory way" watched news bulletins or read news reports about him.