Junior doctor Dr Z contacts Medical Protection for assistance when the Medical Council investigates her falsified notes. By Mohammad Shahid, Legal Adviser, Medical Protection.
Dr Z was a junior doctor working in her GP rotation. She consulted Mrs A and reviewed the notes after the consultation. On reflection, she considered there were gaps in her assessment of Mrs A, in light of her presentation; Dr Z was concerned about how this would be perceived by her training principals. In order to make her consultation look better, Dr Z retrospectively recorded several observations that had not taken place.
The fact of the false entries came to light when Mrs A requested her records, and noted the additional actions that she said had not taken place.
When asked about the entries by her supervisors, Dr Z stated that Mrs A must have been lying or was confused. Dr Z went further and suggested possible misdocumentation from another patient case.
Dr Z’s actions were said to be dishonest and she appeared before a hearing at the Medical Council.
How Medical Protection assisted
Dr Z requested assistance from Medical Protection and we were able to support her through the regulatory process. This included during the investigation phase, guiding Dr Z through the procedural rules, the statutory considerations of the Council and its case examiners, and the particulars of a response to the allegation.
During the three-stage hearing, we further supported Dr Z by explaining the principles and law underpinning matters of probity, and their significance as a fundamental tenet of good medical practice. We also provided guidance on the meaning of impairment of fitness to practise, to help inform Dr Z’s understanding of the process, but importantly Dr Z’s understanding of the concept of remediation.
Outcome
All facts were admitted and found proved. The hearing found that Dr Z’s actions amounted to misconduct but it also concluded that a fully informed member of the public or profession, made aware of Dr Z’s exceptional efforts to gain insight and remediate, would be reassured by Dr Z’s thorough and professional response to the allegation. It considered that Dr Z had developed a level of insight sufficient to offset concerns engendered by their previous misconduct and that a finding of impairment was not necessary to maintain public confidence in the profession or maintain proper professional standards and conduct.
Learning points
This was an exceptional outcome given the nature of the allegation. At the time, matters of probity and dishonesty routinely attracted at least a finding of impairment, usually on the basis such a finding is necessary to maintain public confidence in the profession and maintain proper professional standards and conduct.
While this was a fairly low level probity matter, such issues should still be regarded as serious and merit a careful and thorough approach to case presentation, whether contested or not.
This case served to demonstrate that even against the backdrop of serious, repeat dishonesty, the law on impairment of fitness to practise does not prevent a favourable outcome. What is called for, certainly in those cases where dishonesty is conceded, is a genuine and comprehensive approach to reflection, insight and remediation.
Dr Z’s period of reflection and insight spanned some three years. Dr Z had reflected in depth on the likely causes of the underlying conduct. She had been open to supervisers and peers about the incident, delivering presentations on how the issues in the case engaged the fundamental tenets of good medical practice. Dr Z had also attended a number of professional courses that targeted the issues in the case.
The extent of Medical Protection guidance and support took nothing away from the fact that this was an ardent professional committed to her profession and to maintaining standards; this, for the hearing, was plain to see.
New Zealand commentary
In New Zealand, the complaint would have been made to the Medical Council of New Zealand (MCNZ), specifically the Professional Conduct Committee (PCC). The PCC is made up of three members – two doctors and one individual who is not a doctor. The PCC would have gathered information on the case and requested Dr Z to submit a summary of her practice including her pattern of work, her supervisors and her continuing medical education activities. This summary would also ask about any illnesses or stressors in her life.
From this point, the PCC may request to meet Dr Z and determine its next steps. The PCC may recommend the Medical Council should:
• review the doctor’s competence
• review the doctor’s fitness to practise medicine
• review the doctor’s scope of practice
• refer the subject matter of the investigation to the police
• counsel the doctor.
The PCC may also make a determination that:
• no further steps be taken in relation to the notification or conviction
• in the case of a notification, the notification should be submitted to conciliation
• a charge should be brought against the doctor before the Health Practitioners Disciplinary Tribunal.
1
Each case presenting before the PCC will be unique and so it is important that members work closely with Medical Protection throughout the process. In this particular case, the outcome of the investigation would likely be more favourable if Dr Z could provide confidence that she was able to learn from this incident and commit to maintaining future integrity in her professional practice. Dr Z’s insight, reflection and willingness to remediate would likely contribute reassuringly.
1Meeting with a Professional Conduct Committee. Medical Council of New Zealand