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28 Sep 2017
A medical practitioner has been reprimanded and had conditions imposed on his registration for behaving in a way that constitutes unprofessional misconduct.
Dr Colin Duncan appeared before the Victorian Civil Administrative Tribunal (the tribunal).
The tribunal found that Dr Duncan, a general practitioner anaesthetist, had left an unconscious patient without direct medical supervision. The tribunal also found that he failed to adequately record his medical treatment of a patient prior, during or after a surgical procedure.
On 18 August 2011, prior to the arrival of the patient at the day surgery, Dr Duncan was shown the patient’s results of pathology tests from the previous day that confirmed that the patient was in renal failure and her liver function tests were markedly abnormal. Prior to the procedure, Dr Duncan observed that the patient was unconscious and jaundiced. He assessed that she was unfit for an anaesthetic at that time and should be transferred to a tertiary hospital. He informed the practitioner who was conducting the procedure of his assessment. However, Dr Duncan did not make any records or clinical notes of his pre-operative assessment of the patient.
Despite the patient’s condition, a decision was made by the other medical practitioner to continue with the procedure. During the procedure to evacuate the uterine contents Dr Duncan observed the patient to be unconscious and did not administer any anaesthetic. The patient was not intubated, although an oxygen mask was placed over her face. Dr Duncan did not make any record or clinical note about the patient’s condition during surgery.
After the procedure, Dr Duncan handed the patient over to recovery nurses in the recovery area and returned to the theatre to continue with the patient list. In doing so, he left the patient unconscious and without direct medical supervision from either himself or another medical practitioner present at the clinic. Dr Duncan did not make any records, clinical notes or otherwise, of his post-operative instructions for the patient.
The patient was then transported by ambulance to a tertiary hospital with Mobile Intensive Care Ambulance (MICA) paramedics in attendance.
The tribunal heard the matter on 27 March 2017 and handed down its decision on 27 June 2017. In making its decision, the tribunal stated that given the abnormal blood results and that the patient was jaundice and still unconscious, Dr Duncan had an obligation to ensure she was under direct medical supervision after surgery. By failing to do so, he placed her post-operative care at a substandard level. The absence of medical records compounded the situation because the nurses, ambulance officers and other practitioners were deprived of the benefit of Dr Duncan’s instructions on the patient’s care. However, the tribunal also noted that Dr Duncan had no previous history of such conduct and that it was unlikely that he would repeat the behaviour. He also readily acknowledged and recognised the errors that were made on that day and the serious consequences that could have followed.
The tribunal agreed that it was important to deter conduct of this kind. Accordingly it reprimanded Dr Duncan for unprofessional conduct and placed conditions on his registration requiring him to complete education:
Dr Duncan is also required to undergo an audit of his practice.
The decision is available on the tribunal’s website.