Rob Kidd reports on how the man continues to practise while many of his patients remain oblivious to his past.
For a doctor who had sex with a patient, The B-52s’ Love Shack was probably not his choice of soundtrack as his career hung in the balance.
Its tinny notes jangled through the Dunedin motel’s PA system in the wood-panelled conference room as the man slumped in his chair, as though he was trying to disappear.
The music was abruptly cut as the five stern-looking members of the Health Practitioners Disciplinary Tribunal took their seats and outlined the case.
Dr X faced disciplinary charges in four areas.
He had sex with his patient during two consultations, paid her money when she was struggling, prescribed her increasing doses of opiates and lied to the Medical Council about his conduct.
Unsurprisingly, given the doctor did not dispute it, the charge of professional misconduct was found proven.
His behaviour was "likely to bring discredit to the medical profession", tribunal chairwoman Alison Douglass said.
The man was censured and his registration was cancelled but it came with a hefty caveat in his favour.
REPRIEVE
He was allowed to continue seeing patients until a written decision was released (likely at the end of this month).
The only proviso was that he complete a sexual misconduct assessment test, administered by a psychologist and psychiatrist over a couple of months.
If the results satisfy the Medical Council he will be able to apply for re-registration immediately.
Dr X might barely miss a day of work — and his patients may never know his identity.
Ms Douglass imposed an interim name suppression order at the conclusion of the April hearing, for written argument to be filed.
Earlier this month, after a hearing conducted by video-link, she lifted the ban on publication.
The public interest outweighed the doctor’s private concerns, Ms Douglass said.
But, again, suppression would only lapse following the release of the tribunal’s judgement and a 21-day appeal period on top of that.
Counsel Anne Stevens KC said a decision was yet to be reached on whether the decision would be challenged.
STUFFED UP
While Dr X was labelled "predatory" by lawyers representing the Medical Council’s Professional Conduct Committee (PCC), he had not struggled to find work.
He left the Otago practice where he was employed after details of the indiscretions arose, but had since found work at two rural health providers.
The names of all three workplaces were permanently suppressed.
Despite the requirement that he be chaperoned during all consultations and the cost that incurred, his current boss told the tribunal of his unwavering faith in the doctor.
"[He] has an enormous amount of compassion and empathy with his patients ... the standard of care his patients are receiving is exemplary," he said.
"I certainly don’t see him as a predator."
Such was his trust that he had chosen the man as his own family physician, the employer said.
He said Dr X had been up front about his problems from the outset and they spoke regularly about his transgressions.
"I can remember his exact words [when he told me]: ‘Boss, I’ve fallen in the honey pot. I’ve really stuffed up’," said the employer.
"He’s a bit of a broken man."
DEPENDENCY
Before he was a broken man, Dr X took over the care of the near-broken Patient Z in 2012 when her regular GP left the practice.
She had a persistent depressive disorder, a history of anxiety, drug and alcohol dependence issues, physical injuries which resulted in chronic pain.
"[She] had been a victim of violence for a significant period of her life, and as a result she suffered from bad head injuries and concussions," a summary of facts said.
Patient Z was being prescribed benzodiazepines and opiates when Dr X inherited her file.
Over more than four years, he escalated her treatment, prescribing her with stronger opiates even as she showed up to the medical centre with physical injuries from her inebriation.
The woman would run out of medication early, a clear sign she was exceeding the recommended dosage.
The doctor failed to review Patient Z’s treatment plan, and there were no medical notes recording discussions with colleagues about her management.
Among the seven medications he prescribed were morphine sulphate, codeine and oxycodone hydrochloride — known in the US as "hillbilly heroin".
An expert who subsequently reviewed Dr X’s prescribing called it "an accident waiting to happen".
Mrs Stevens argued it was not ethical oversight on her client’s part but the trappings of inexperience.
"He accepts his knowledge at the time was inadequate to deal with such a high level of dependence," she said.
Patient Z was eventually referred to Community Drug and Alcohol Services in 2015 but that was initiated by social services because of increasing concerns around her caring for her grandchildren.
HAND-OUT
Around that time, Dr X made two payments totalling $507 to the woman.
He used his wife’s account to make the transaction but neglected to inform her, the tribunal heard.
She was one of the only members of the public who observed the day-long hearing, parked on the edge of her seat, sporting a growing look of anguish and distaste.
Mrs Stevens stressed the money had nothing to do with the sexual contact that later occurred and that it only came about because of the man’s "compassion".
The doctor explained his generosity had been guided by his Christian upbringing, but he admitted he had never given a client cash before.
"[The patient] was in dire financial straits and requesting assistance on an urgent basis in terms of her accommodation and food. It was only on that basis that payments were made," Mrs Stevens said.
PCC lawyer Kate Feltham said it mattered little why the money had changed hands.
"It’s the fact of the payments — particularly a patient as vulnerable as [her] — it leads to the blurring of boundaries between an appropriate doctor-patient relationship," she said.
SEX
In June 2016, the boundary was most significantly breached.
Dr X twice had sex with Patient Z during routine consultations at the medical centre.
PCC co-counsel Tom Wheeler said there had to be a zero-tolerance approach to such relationships.
The doctor’s behaviour was aggravated, he said, because of the earlier payments and the gradual erosion of professional boundaries.
"[He] was in an extremely high-trust environment. Her dependence on him was significant," he said.
"Dr X engaging in sexual conduct can only be described as opportunistic, predatory behaviour."
Details of the affair only emerged when Patient Z informed her psychotherapist several months later.
The Medical Council wrote to the doctor the following year, seeking a response to the allegations.
He responded a couple of weeks later denying any wrongdoing.
He had treated the patient, just like his others, "with the utmost care and respect", he said.
For more than two years Dr X maintained the lie.
It was only when he was informed his DNA had been detected inside the woman’s underwear that he finally came clean.
INSIGHT
Mr Wheeler said the doctor had an established pattern of denials.
When confronted with the allegations, Dr X at first only admitted one payment had been made, he only conceded sex had occurred in the face of irrefutable evidence and acceptance for his deficient prescribing came once a comprehensive report had been compiled.
The man’s conduct was "deficient, unethical and completely devoid of consideration", the PCC said.
Mrs Stevens rejected that characterisation but was further grilled by tribunal members who demanded to know why it had taken her client so long to admit culpability.
"Insight is not an instant quality," she said.
"His wife said for the first year he was in a state of shock, frozen in disbelief of what he’d done — whether he would ever practise again — coming to terms with the awfulness of what occurred, that only he was responsible for."
Dr X’s treatment of Patient Z was a one-off, Mrs Stevens said, something that had never occurred before and would never be repeated.
"He did not go out to and find [her]. She had been his patient for a number of years before these two instances. She continued to be his patient with no further sexual relations afterwards. It demonstrates a weakness on his part."
She told the tribunal Dr X has been seeing a psychologist, had a medical mentor and had engaged with a church pastor.
And the seven-year saga had come at a massive cost.
He served a suspension from work for more than a year, was charged $140,000 by his medical indemnity insurance provider, ordered to pay tribunal costs of about $50,000 and still had an outstanding legal bill.
Dr X only spoke once during the disciplinary tribunal hearing, to explain he could no longer afford to see a psychologist, choking back tears.
He did not respond to the Otago Daily Times’ requests for comment.
Repeated attempts to contact Patient Z were also fruitless but friends said she was struggling.
Timeline
Jul 2012: Dr X starts seeing Patient Z, gradually increases her prescribed opiates
Jan 2015: The woman is referred to alcohol and drug counselling by social services over concerns about her state
Apr 2015: Dr X makes $100 transfer to Patient Z’s account
May 2015: Transfers another $407
Dec 2015: Patient Z sees another doctor who records concerns over ongoing opiate prescription
Jun 2016: Dr X has sex with his client twice in his consultation room
Nov 2016: Patient Z’s counsellor informs Medical Council of sexual conduct
May 2017: Medical Council asks Dr X about relationship with her
Jun 2017: Doctor denies any wrongdoing
Jul 2019: Dr X admits having sex with Patient Z after being confronted with DNA evidence
Nov 2020: It is determined the case should go before Health Practitioners Disciplinary Tribunal
Apr 2023: Tribunal censures Dr X and cancels his registration
Jun 2023: Name suppression refused for the doctor, order remains in place for at least three weeks after written ruling released
