Consent key in chemo case


tribunal hearing legal case

The days of doctors deciding what patients should know or consent to are “long gone,” a tribunal has noted in imposing protective orders on a former pharmacist

A former pharmacist has been precluded from reapplying to practise medicine for two years, and told that if he was still registered, his licence would have been cancelled.

The Health Care Complaints Commission has issued a statement about Dr John Joseph Grygiel, a medical practitioner who practised as a specialist medical oncologist until 2016. Dr Grygiel relinquished his registration in 2020.

He had originally been a pharmacist, graduating in 1967 from the University of Sydney, and then graduating with his Bachelor of Medicine/Bachelor of Surgery in 1974.

Dr Grygiel worked as the Senior Staff Oncologist at St Vincent’s Hospital, Darlinghurst, from 2012 to 2016, and between 2010 and 2012 – which on leave from St Vincent’s – at Macquarie University Hospital. Between 1989 and 2012 he was employed as a Visiting Medical Officer and/or as Honorary Medical Officer and treated cancer patients at Bathurst and Orange through the Greater Western Area Health Service.

The majority of the patients he treated suffered from head or neck squamous cell carcinomas (HNSSC).

In 2015, an investigation was conducted into his prescribing practices at St Vincent’s, particularly on the prescribing of carboplatin in a flat dose of 100mg for a number of patients receiving definitive or adjuvant chemoradiotherapy as part of their treatment for cancer.

An investigation into his practices at Macquarie soon followed, and its executive officer lodged a complaint with the HCCC.

After a series of amendments to the complaints, in which some were removed, and delays due to COVID-19, a hearing took place at the NSW Civil and Administrative Tribunal.

The chemotherapy drugs Cisplatin and Carboplatin were at the centre of the majority of the complaints.

The treatment issues raised were decisions regarding chemotherapy does, the adequacy of consent from patients, and record keeping.

At the March 2021 Tribunal hearing, it was found that Dr Grygiel had failed to obtain adequate and informed consent from 52 patients, and failed to make and keep adequate records of their care and treatment by him.

He was also found to have provided care and treatment of 11 identified patients that was significantly below the expected standard.

The Tribunal found that he had adopted a standard practice of prescribing the carboplatin at a flat 100mg dose, for 33 HNSCC patients.

In doing this, he demonstrated that he held firm views in relation to the treatment of the cancers, in which there was a risk these patients, treated with carboplatin, did not receive chemotherapy they were otherwise eligible to receive, and the efficacy of which was evidence-supported.

Also as a result of his views on treating HNSCC, he did not give comprehensive advice to the 33 patients to enable them to give informed consent, the Tribunal found.

“While it would be unrealistic to ignore the constraints of time and resources facing practitioners, these proceedings highlight the need, particularly where patients are treated in a multi-disciplinary setting, for proper consent and recording processes rather than the reliance on generic consent forms,” the Tribunal noted.

“The vast majority of patients should be afforded an explanation where treatment proposed is non-standard with unknown efficacy and/or not supported by published data, and there should be sufficient place in pro forma consent forms for annotation of relevant information provided to the patient including particularly any material risk.”

The Tribunal further commented that the, “days of the practitioner determining what the patient should or should not know or consent to about their treatment are long gone… it is a patient’s fundamental right to make their own choice about undergoing treatment if that treatment involves a material risk.”

In one case, that of a relatively young male patient, the Tribunal noted that Dr Grygiel’s rejection of prescribing cisplatin was “difficult to accept”.

“Rather than individualised clinical judgment, the practitioner followed a practice he had adopted in the 1980s without consideration of prescribing based on an evidence based regime,” it said.

The doctor’s conduct amounted to unsatisfactory professional conduct and professional misconduct, it found.

It decided that if Dr Grygiel was still registered, his registration would have been cancelled, and ordered that he not be able to seek reinstatement for two years.

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