Medical practitioner cautioned for unsatisfactory professional conduct

22 Jul 2016

A tribunal has found that Dr Indunil Shiranth de Silva, a physician, had behaved in a way that constituted unsatisfactory professional conduct.

The Medical Board of Australia (the Board) commenced disciplinary proceedings against Dr de Silva in July 2015. The allegations against Dr de Silva related to his post-operative care of a patient at the Mater Hospital Mackay in early January 2009.

The patient had undergone laparoscopic surgery, performed by a surgeon. During the procedure, the duodenum was perforated and while two perforations were repaired, it appears that one was left unrepaired. The patient appeared to have developed peritonitis and while the treating surgeon considered it was resolving, the patients’ husband requested a second opinion. It was at that point that the surgeon consulted Dr de Silva. Dr de Silva was acting as a consultant physician, to assist with the patient’s postoperative care.

Dr de Silva reviewed and treated the patient over two days, including ordering blood tests and treating an episode of atrial fibrillation. Dr de Silva accepted that he was aware that the patient had unresolving peritonitis and a small bowel leak. He also accepted that he should have brought the patient’s clinical signs, symptoms, diagnostic results and the findings reported in a CT scan to the attention of the surgeon, though he did note these in the patient’s notes and instructed nursing staff to bring these matters to the surgeon’s attention.

The patient eventually developed life threatening peritonitis and was transferred to the Mackay Base Hospital for emergency surgery.

During the proceedings, expert reports were obtained about Dr de Silva’s treatment of the patient. The expert reports largely supported Dr de Silva’s treatment of the patient and advised that, at most:

1. earlier intervention by Dr de Silva would have had a bearing on the outcome suffered by the patient;
2. Dr de Silva should have telephoned the patient’s surgeon to inform him of her condition; and
3. it would have been preferable for Dr de Silva to have attended at the hospital on the evening of 11 January 2009 when requested to do so by the nursing staff.

Although it was agreed between the parties that the care of the patient was the primary responsibility of the surgeon, Dr de Silva accepted that the delay in addressing the patient’s condition by her health care team, of which he was a part, compromised the patient’s health.

Dr de Silva conceded that he had engaged in unsatisfactory professional conduct but he did not believe his conduct demonstrated he was incompetent or had a lack of knowledge, skill, judgment or care. The Board did not press for a finding in that regard.

In its decision on 30 May 2016, the Queensland Civil and Administrative Tribunal made orders approving an undertaking which Dr de Silva provided to the Board to complete an education course on professional communication and that Dr de Silva be cautioned.

The full reasons for the tribunal’s decision are published on the AustLII website.

Background

The surgeon in this matter, Dr William Fitzgerald, was reprimanded and had conditions imposed on his registration as a medical practitioner in Australia. Read the media release.