KEY POINTS:
A GP who charged a patient's son for replying to concerns raised after her death has been put under close supervision by the Medical Council.
The family doctor admits his care of the elderly woman was inadequate.
Advanced cancer was found in her liver in July 2003 and
she died two months later, aged 80. The primary site of the cancer was never found.
She had consulted the doctor for eight years, visiting him 150 times, according to a report released yesterday by Health and Disability Commissioner Ron Paterson, who found that the care provided by "Dr C" was substandard and breached his patient's rights.
His consultation notes were "woefully inadequate"; he ordered unnecessary tests; he provided insufficient information about a complementary therapy he recommended; and he acted unprofessionally in charging the woman's son $90 (he has now refunded it) for replying to concerns raised after her death.
Mr Paterson said that while it was unlikely Mrs A's cancer could have been diagnosed earlier or treated differently - even if her symptoms and signs had been adequately documented and appropriate investigations ordered - this did not alter the fact that the doctor's care and record-keeping were substandard.
The doctor described the woman as a "frequent attender", saying she required care for around 40 conditions, including an intestinal ulcer, high blood pressure and insomnia; she had also had a stroke and a heart attack.
But her family say her medical state was normal for her age.
Mr Paterson said the doctor's note-keeping was so skimpy as to raise "serious questions about his professional competence" and impeded the investigation, but his testing was excessive.
He ordered 232 laboratory tests and x-rays - nearly 2.4 a month - which in some cases fell short of the required standards.
One was a test usually done to follow up known cancer, but the three times the test was done on Mrs A were all before her cancer was diagnosed.
Earlier, when she presented with visible rectal bleeding, he ordered a test which is designed specifically for when such bleeding is suspected but invisible.
"Either no test should have been done," Mr Paterson said, "or, if there was ongoing concern, she should have been further investigated through a sigmoidoscopy [specialised flexible viewing tube], for example, or a specialist referral."
Another needless test was a 2001 repeat of a gene test done the year before. " ... The gene does not change."
One test he should have ordered, but didn't, was a liver function follow-up in February 2003, after mildly abnormal results in preceding months, despite having written himself a note.
Mr Paterson said he had decided not to refer Dr C for possible disciplinary proceedings, for the punishment of his "unacceptably poor practice", noting he had made a comprehensive apology and the Medical Council had him on "a very tight rein".