A doctor accused of telling a 15-year-old patient she should try masturbating and initiating inappropriate breast examinations with women has appeared before a disciplinary tribunal.
The former North Island doctor faces a charge of misconduct, which relates to alleged incidents with eight female patients between 2011 and 2017.
Two further patients were named in the charge, but their cases were removed because they were not prepared to attend the Health Practitioners Disciplinary Tribunal hearing in Wellington today.
The Medical Council of New Zealand imposed a condition in 2018 on the doctor's practice that he not be allowed to have consultations with female patients without a chaperone present.
The alleged misconduct includes making comments such as "you know that you're very attractive don't you?" and "you have good looking breasts for your age" as he examined the patients.
The examinations were suggested and performed at times when the patients were visiting for unrelated matters, such as throat infections or asthma.
On all occasions the Professional Conduct Committee (PCC) said the examinations were not "clinically justified" or expected by the patients.
One of the later alleged incidents happened despite the doctor's workplace making him agree to a written undertaking he would "utterly avoid" raising breast cancer prevention unless it was brought up by a patient.
He had also at that point been ordered to never undertake a physical examination without a chaperone nurse being present, something which the PCC said he was in breach of.
According to the PCC summary of facts, the doctor breached his ethical obligations and accepted standards of practice.
On multiple occasions when female patients presented with unrelated health issues, he is accused of performing breast examinations without offering for a chaperone to be present and without being asked by the patients.
In one case in 2012, the PCC said he examined the woman's breasts "in a manner that was inconsistent with accepted medical practice, namely by feeling only the front of her breasts".
In most cases he did not record in their patient notes that he had offered or performed the examinations.
Another case involved him examining the patient's breasts "for an unreasonable length of time" despite the fact she was there for an upper respiratory tract infection, the PCC said.
Another patient complained during the examination he asked her if she had sex with her husband, while another woman said he asked her to demonstrate self-examination in front of him when she hadn't asked for any advice on self-examination.
In 2015 a 15-year-old patient came in with a throat infection, and the doctor began to ask her whether she was sexually active and if she masturbated, the PCC said.
The girl said he told her masturbation was "healthy and good for you" and told her to consider trying it. During that visit he indicated to her the questions about sexual matters were required for general health screening purposes, but did not make any record of the discussion in the teenager's notes.
The final alleged incident occurred in May 2017, during a consultation about a repeat prescription of an anti-depressant. He again raised the subject of breast health and while performing the unrequested breast examination, told the patient "for your age, they're quite full".
He also offered to perform a cervical smear test.
The doctor has interim name suppression, at least until a decision on the charge has been made.
The practice manager at the centre he used to work at gave evidence today, saying some of the doctor's patients found his questions and late-night follow up phone calls to be "intrusive".
She said she began hearing "murmurings" from other staff about the inappropriate breast examinations, and began telling the doctor to stop, eventually escalating from informal warnings to written reminders.
She said the doctor was "adamant" it was important for GPs to conduct exams to catch out breast cancer, and that he could find breast lumps that a mammogram couldn't.
The woman also said she attended a meeting in which the doctor was asked about his comments to the teenager about masturbation. He said it was his duty to talk to young people about sexual activity.
After multiple complaints, the doctor agreed to sign a document saying he would not raise breast health with patients unless asked about it.
But a while later, the practice manager received another complaint.
"It was an 'oh no' moment. Huge disappointment . . . here we were again," she said.
"My heart sank."
She said in other areas of his practice the doctor was "exemplary" as well as "caring and hardworking", and many patients thought highly of him.
After years of complaints, the centre reported the doctor to the Medical Council in mid 2017.
The doctor denies the charge and his lawyer is expected to set out the case in his defence.
The hearing is set down for 10 days.