Tribunal fines and censures 'Dr N' over cancer test failures

A doctor who misled health authorities about failures to order tests for a woman who later died of bowel cancer has been fined and has lost her initial bid to hide her identity permanently.

The Health Practitioners Disciplinary Tribunal yesterday released its written verdict, which finds the GP guilty of professional misconduct, censures her and orders her to pay a fine of $15,000 and costs of $20,000.

It also lifts interim suppression of "Dr N's" name, but she still cannot be identified, since the tribunal has given her until Thursday to appeal.

Her patient, Virginia Duncan, died aged 43 in February 2003.

A tribunal hearing in July heard Ms Duncan had a series of consultations with Dr N in 2002 mainly for constipation and often suffered severe pain.

Dr N was found not guilty of five charges and guilty of five, including failing to refer Ms Duncan for further tests like colonoscopy, making undated, retrospective additions to her medical notes and deliberately misleading the Health and Disability Commissioner about the additions for nearly a year.

"Dr N only admitted the additions to her records when she realised the commissioner was proposing to have the original notes examined," the tribunal says in its decision.

One of the additions recorded that the patient was: "Not keen on further IX [investigations]".

"This addendum was made," the tribunal says, "after Dr N learnt of Ms Duncan's surgery for bowel cancer and her poor prognosis."

The tribunal rejected Dr N's evidence that on October 11, 2002, she encouraged her patient to have a faecal blood test and other investigations and that the consultation reached a stand-off.

The tribunal believed the doctor wished she had urged Ms Duncan to undergo the tests - but did not recommend them, after examining her abdomen and feeling nothing inconsistent with her earlier diagnosis of irritable bowel syndrome.

Dr N told the tribunal the additional entries were advice to another doctor, whom Ms Duncan was about to see.

" ... [they] were not made for the purpose of any cover-up."

She said she misled the commissioner because she was "shocked, scared and worried" that she was being investigated and feared he would view the additional entries as a cover-up.

The tribunal emphasised Dr N was not being criticised for failing to diagnose bowel cancer.

It said that even if this disease had been diagnosed in the second half of 2002 there was no assurance Ms Duncan would have survived.

Auckland University professor of surgery Bryan Parry, an expert witness called by Dr N's lawyer, said colo-rectal cancer was an unlikely diagnosis in Ms Duncan's case and that Dr N's management of her condition was reasonable.

Professor Parry thought her outlook would have been grim even if the cancer had been picked up sooner.