Over nine years, a Havelock North chiropractor failed to take adequate notes 7156 times - failures which could place "the public at risk and lower standards in the profession."
Dr Melissa Vetter has been censured and fined $20,000 for professional misconduct, which occurred while she worked at Havelock North Chiropractic from 2007 to last year.
Inadequate records of patients shared between the two included notes stating "on the improve", "much improved", "more falling!!!!", "cough cough cough", "gardening!!!!", "was hit in the jaw".
The findings against her were released today after a New Zealand Health Practioners Disciplinary Tribunal hearing in Napier on October 18.
Dr Vetter was charged with professional misconduct by a Professional Conduct Committee (PCC) of the New Zealand Chiropractic Board, which alleged she conducted herself in an inappropriate and/or unprofessional manner on two matters.
The first referred to failing on numerous occasions to create clinical records for her chiropractic patients. The second was failing to record an adequate patient assessment on numerous occasions.
Concerns arose around late 2013 or early 2014 about Dr Vetter. Over nine years between 2007 and 2016, there were 7156 instances in which a patient was seen by Dr Vetter, and no clinical notes were recorded.
The decision states she admitted for the majority of patients she did not create any clinical record whatsoever, despite also acknowledging she had a professional responsibility to record a patient's progress, including clinical presentation, examination data, and the treatment provided at each appointment.
On occasions Dr Vetter and her colleague Dr John Hawtin would see each other's patients. He became concerned Dr Vetter's patients' notes did not contain sufficient information to enable him to do a proper assessment, or to continue with treatment.
He raised these concerns informally on a number of occasions.
It was also found that a number of Dr Vetter's patient notes were incomplete, or "substandard", and did not contain enough information for Dr Hawtin to do a proper assessment.
This included an occasion in June 2014 when he raised concerns she had not maintained or recorded any x-ray measurements, factors, or dosages for the previous year.
In September 2014 Mr Hawtin provided emergency care to one of Dr Vetter's patients and found only one record containing the word "improved" for the previous eight appointments.
In December 2015 Dr Hawtin made a complaint to the New Zealand Chiropractic Board about his concerns.
The decision states he said he had no understanding why Dr Vetter chose not to keep records, or to keep inadequate of substandard records. Their record keeping system was electronic and readily available.
The decisions states there had been a "clear failure" by Dr Vetter to create adequate clinical records, and to record adequate patient assessment.
"The severity of this aspect is aggravated by the fact that Dr Hawtin drew the inadequacies to Dr Vetter's attention but she did nothing to improve things," the decision states.
These failures placed patients at risk, including that she would be relying on her memory, or might not be addressing all of the questions needed to for a proper consultation.
"There was malpractice and negligence on Dr Vetter's part in these failures and
they constitute acts and omissions which bring discredit to her profession."
"Dr Vetter needs to know, and the profession needs to know, that failures of this kind place the public at risk and lower standards in the profession."
The tribunal ordered Dr Vetter be censured. It also ordered a number of conditions were to apply to Dr Vetter's practice.
These included supervision of Dr Vetter as a chiropractor for 18 months - at her cost by a supervisor nominated or approved by the New Zealand Chiropractic Board - with the supervisor reporting to the New Zealand Chiropractic Board at least 3-monthly with express focus on note-keeping and to take courses on note taking.
Dr Vetter was also ordered to contribute $20,000 towards the costs of the PCC and of the tribunal - $13,333 to the PCC and $6,666 to the tribunal.
She left the centre in March 2016 to relocate her chiropractic practice to premises where she had already established a Pilates practice.