24 Sep 2018
A medical practitioner who ordered blood tests for Essendon football players has been reprimanded and fined for unprofessional conduct.
The Medical Board of Australia referred Dr Robin Willcourt to the Victorian Civil and Administrative Tribunal (the tribunal) on 6 December 2016. Dr Willcourt is a registered medical practitioner with general registration and specialist registration in obstetrics and gynaecology.
Dr Willcourt had an interest in athlete health and injury prevention and in November 2011 was introduced to Mr Stephen Dank who he was told was a sports scientist working with the Essendon Football Club. At that meeting Mr Dank told Dr Willcourt he was involved in a study to monitor players to assess the effects of their training program. The study involved cardiovascular assessments and blood tests.
The sports scientist asked Dr Willcourt if he would be interested in participating by authorising blood analysis of the players at his request. Mr Dank claimed the club doctor was involved but was overburdened by his usual workload and Dr Willcourt’s role would be to assist him. Dr Willcourt would become more involved with the study after the initial blood analysis.
Dr Willcourt agreed to participate by authorising blood tests for seven Essendon players. The process involved completing pathology requests so blood tests could be performed. Dr Willcourt was not present at the time samples were collected and did not assess the players himself.
The tests he ordered included measurement of serum gonadotrophins, testosterone, sex hormone binding globulin, calculated free testosterone, red blood cell folate, vitamin B12, serum electrolytes, kidney and liver function, iron studies, serum glucose, thyroid function, full blood examination, erythrocyte sedimentation rate and C-reactive protein. Dr Willcourt received test results at his practice, made notations and highlighted abnormalities before providing the results to Mr Dank.
Dr Willcourt agreed that he did not take any clinical histories, conduct clinical examinations or establish a clinical need for the blood tests. He did not ensure that the players had provided informed consent for testing or that any other registered health practitioner had obtained informed consent.
After receiving the results of the blood test, Dr Willcourt did not provide any direct patient follow up for any of the players, including where results were abnormal. He also did not ensure that the players were followed up by another medical practitioner. He did not keep records of their clinical history, findings, investigations and other medical management.
Dr Willcourt claimed he was told tests were sanctioned by the club doctor and saw his role as assisting him in assessing the impact of the players’ physical workload and dietary regime. In his view, player examinations were unnecessary given the aim of the study was to identify the effects of the training and nutrition program and explore improvements, with his role limited to authorising and analysing blood tests and results. Dr Willcourt claimed he was told the purpose of the study was discussed with the players who participated voluntarily, and he expected further medical management to be carried out by the club doctor.
After carrying out the blood testing Dr Willcourt was not invited to join the study, contrary to his earlier discussion with the sports scientist.
In its decision dated 3 July 2018, the tribunal found Dr Willcourt’s conduct to be at the ‘highest end’ of unprofessional conduct. The tribunal agreed with an expert assessment that his clinical care of the players was ‘non-existent’, and while it accepted he may have been ‘conned’ by the sports scientist, this did not release him from his full clinical responsibilities.
The tribunal noted that Good Medical Practice: a code of conduct for doctors in Australia (2009) required Dr Willcourt to:
a. assess patients, taking into account the history, the patient’s views, and an appropriate physical examination (paragraph 2.1.1)
b. formulate and implement a suitable management plan (including arranging investigations and providing treatment and advice) (paragraph 2.1.2)
c. consider the balance of benefit and harm in all clinical-management decisions (paragraph 2.2.4)
d. inform patients of the nature of, and need for, all aspects of the clinical management, including examination and investigations, and giving them adequate opportunity to question or refuse intervention and treatment (paragraph 3.3.3)
e. keep patients informed about their clinical progress (paragraph 3.3.7)
f. obtain informed consent or other valid authority before undertaking any investigation (paragraph 3.5.2), and
g. keep accurate, up-to-date and legible records, report relevant details of clinical history, clinical findings, investigations and other management (paragraph 8.4.1).
The tribunal found Dr Willcourt failed to act in accordance with the code and his actions amounted to unprofessional conduct. This included authorising pathology requests where no doctor-patient relationship existed and at the request of an unregistered practitioner, and his failure to provide clinical care, keep accurate clinical records and follow up on results or arrange further management.
The tribunal reprimanded Dr Willcourt and fined him $7,000. As he is currently employed in the United States of America and does not intend to return to practise in Australia, the tribunal decided against placing conditions on his registration requiring further education and supervision noting this could ‘make a mockery of the disciplinary process’.
The decision is available on the Austlii website.