30 Jan 2020
A medical practitioner with specialist registration in obstetrics and gynaecology has been reprimanded and had conditions imposed on her registration for unprofessional conduct.
Dr Shipra Gaur was referred to the Western Australian State Administrative Tribunal (the tribunal) in December 2018 following an investigation by the Medical Board of Australia (the Board).
The matter brought to the tribunal focused on a patient who had an urgent referral to the outpatient clinic and was seen by Dr Gaur in March 2017. The patient was aged in her 50s and had experienced post-menopausal bleeding over several months. She had pelvic pain requiring high doses of Panadeine Forte and anti-inflammatory medications, and a suprapubic lump which was firm and mobile with a uterus size equivalent to a gravid uterus at 18-20 weeks. While her ultrasound confirmed multiple fibroids and an ovarian cyst, it did not explain the cause for her continuous pelvic pain. The patient could not recall when she last had a pap test.
Dr Gaur inappropriately managed the patient by obtaining her consent for a total abdominal hysterectomy and bilateral salpingectomy and placing her on the elective waiting list for those procedures as a non-urgent ‘category 3’ patient. She also referred the patient back to her general practitioner with a request that the doctor perform a pap test in circumstances where Dr Gaur ought to have ordered and acted on diagnostic procedures undertaken.
According to the agreed facts of the matter, Dr Gaur failed to triage the patient as an urgent or ‘category 1’ patient. She failed to perform a full pelvic examination of the patient, including speculum examination of the vagina and cervix and inspection of the vulva. She also failed to arrange urgent or category 1 diagnostic procedures such as an examination under anaesthesia, dilation and curettage with hysteroscopy, cervical and vaginal biopsies and/or endometrial biopsy.
In April 2017 the patient was diagnosed with Stage 4 squamous cell carcinoma of the cervix with widespread metastasis. Despite Dr Gaur’s error resulting in a delayed diagnosis and management of the patient’s condition, it was accepted that the delay did not negatively affect the patient’s outcome.
It was submitted by way of mitigation that Dr Gaur had no prior disciplinary history and admitted her error in her management of the patient’s care. She participated in a review of her records and discussion of cases relating to post-menopausal bleeding and cooperated fully with the Board’s investigation.
Dr Gaur arranged mentoring and auditing of her records relating to these cases and assured the Board she has made changes to her practice and documentation to address issues identified in her management of the patient.
In its decision dated 29 April 2019, the tribunal found Dr Gaur had engaged in unprofessional conduct. She was reprimanded and had conditions imposed on her registration which require her to undergo mentoring by another registered medical practitioner with specialist registration in obstetrics and gynaecology. She was also required to have her practice audited over period of six months.
Dr Gaur was ordered to contribute $12,500 to the Board’s costs of the proceedings.
The decision is available on the eCourts Portal of Western Australia website.