27 Aug 2018
A medical practitioner has been reprimanded and fined $20,000 for professional misconduct relating to his treatment of two patients.
The Medical Board of Australia (the Board) referred Dr Alfredo Noches Garcia to the State Administrative Tribunal in Western Australia (the tribunal) in March 2018 after receiving allegations about the care he provided to two patients. Dr Garcia has specialist registration in general surgery and practised as a consultant general surgeon.
Patient 1 had a past history that included an open radical total gastrectomy, cholecystecomy, small bowel resection and feeding tube insertion following a diagnosis of stomach cancer. He attended an emergency department by ambulance in July 2015 with generalised abdominal pain and was diagnosed with a small bowel obstruction following an abdominal CT scan.
The tribunal heard that Dr Garcia failed to diagnose acute afferent limb syndrome after reviewing the CT scans and did not operate immediately. He failed to arrange for a naso-gastric tube to be inserted, and failed to arrange for surgery to be performed after a subsequent abdominal X-ray demonstrated progression of a small bowel obstruction. Dr Garcia also failed to suspect sepsis and start antibiotics, and did not seek advice or support from the treating gastrointestinal surgeon in relation to the appropriate management of the patient.
Three days after arriving at the hospital, the patient’s condition deteriorated further and the patient was attended to by the hospital’s medical emergency team, before being transferred to the hospital’s intensive care unit.
The tribunal found Dr Garcia’s conduct in relation to Patient 1 breached section 2.2.1 the Good medical practice: a code of conduct for doctors in Australia (the code) in failing to recognise and work within the limits of his competence and scope of practice. He breached section 2.2.7 of the code in failing to formulate and implement a suitable management plan, and section 2.2.9 for failing to consult and take advice from colleagues in relation to management of Patient 1.
Patient 2 was referred to Dr Garcia by the patient’s general practitioner in 2016. The patient had symptomatic gallstones with reported episodes of biliary colic since 2010.
The patient was scheduled to undergo a laparoscopic cholecystectomy (gall bladder removal) and had blood tests ordered by no investigations to determine whether there were stones in the common bile duct.
During the operation, the laparoscopic procedure had to be converted to an open procedure due to multiple adhesions. An intra-operative cholangiogram demonstrated multiple gallstones blocking the common bile duct and Dr Garcia unsuccessfully tried to extract the stones. He did not undertake a formal choledochotomy to clear the common bile duct and he did not leave a T tube to decompress the biliary system and reduce the risk of ascending cholangitis post operatively.
The patient developed sepsis associated with ascending cholangitis and was transferred to a tertiary hospital.
Dr Garcia failed to seek advice from a more experienced general surgeon upon realising that his surgical approach had not removed the stones.
The tribunal found that Dr Garcia’s conduct in relation to Patient 2 breached section 2.2.1 of the code by failing to properly assess Patient 2 and take account of the patient’s previous surgical history and appropriate examination. He breached section 2.1.2 of the code by failing to formulate and implement a suitable management plan, and section 2.2.2 by failing to ensure that he had adequate knowledge and skills to provide safe clinical care. He breached section 2.2.9 of the code in failing to consult and take advice from colleagues in relation to the management of Patient 2.
The matter was settled at mediation in June 2018. Dr Garcia admitted that he had engaged in professional misconduct. The tribunal recorded he has demonstrated insight into the limitation of his practice and had since taken steps to address issues including further education.
The tribunal ordered that Dr Garcia be reprimanded and fined $20,000. He was ordered to pay a contribution of $12,000 towards the Board’s legal costs.
The decision is published on the eCourts Portal of Western Australia website.