Suspended after putting patient at risk

gavel court legal

A GP has been suspended after improper administration of morphine, Valium and lidocaine during a cosmetic procedure, which landed his patient in the emergency ward

A general practitioner has been found guilty of professional misconduct for what the NSW Civil and Administrative Tribunal characterised as “inadequate care” and “incompetence” in performing laser lipolysis cosmetic procedures.

The GP, who had been registered for 25 years at the time of the conduct and was principal and owner of a general practice in Western Sydney, began performing cosmetic procedures such as administering injectable fillers and Botox at his rooms in about 2010.

He began performing lipolysis – a procedure where laser is used to break down fat before it is suctioned out of the body – a few years later, in 2013.

In April 2016 a female patient attended the practice for a consultation about undergoing abdominal lipolysis.

However during the procedure performed the following month, the GP administered morphine as a substitute for his usual pethidine, which was not available on the day.

He administered the morphine at a higher dose than recommended for an opiate naïve patient of her weight, as well as Valium 20mg – a dosage higher than recommended in therapeutic guidelines – and lignocaine.

During the procedure, the patient fell into a deep sleep from which she could not be roused.

She began snoring and appeared cyanosed, with her lips blueish in colour.

The doctor concluded she had a reaction to morphine and administered naloxone. When he concluded that more naloxone was required, he found that none was available.

After observing her for a significant period, the GP noticed her blood pressure had dropped and her heart beat had become irregular.

It was then that he called an ambulance – two hours after the patient first appeared cyanosed.

The patient was subsequently hospitalised in the Emergency Department of a local hospital for a number of days, treated for inappropriate opioid and benzodiazepine administration and rapid atrial fibrillation.

An expert witness to the tribunal found the doctor’s conduct significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience.

He found the administration of Valium 20mg to be “excessively high”, and was strongly critical of the use of morphine as a substitute for pethidine, noting that a last-minute visit to the pharmacy next door betrayed a lack of planning in the practitioner’s clinical practice.

The expert said there was “no excuse” for administering a drug without being certain of the dose. 

Additionally it was found that the doctor did not have a defibrillator on the premises to use in case the procedure caused arrhythmia, and although he had access to a pulse oximeter he failed to use it to identify his patient’s decreasing oxygen saturation – a decision the expert labelled as “bizarre”.

It was “unforgiveable” to rely on observation only to monitor a patient’s vital signs during a long procedure such as liposuction using lignocaine, an agent known to cause cardiac arrhythmias, and opiates which are known to cause respiratory depression, the expert added.

“[The GP] had clearly underestimated the risks associated with this type of cosmetic practice and it was fortunate that his patients had not suffered more serious outcomes,” he told the tribunal.

He strongly criticised the two-hour period before the GP called the ambulance.

The tribunal accepted the evidence of the expert and the Health Care Complaints Commission (HCCC), agreeing that it “paints a picture of inadequate care or carelessness that strongly suggests incompetence in performing the procedure of laser lipolysis”.

Additionally the GP showed a “disastrously low level of understanding of the drugs he routinely used and those he chose to use in this particular case”.

“Here there was potential for serious harm to the patient and it appears to be more a case of sheer luck than professional competence that saved [the] patient from a much more serious outcome,” it said.

The tribunal ruled the GP’s actions constituted professional misconduct and ordered that his registration be suspended for six months.

The GP ceased to perform laser lipolysis procedurse immediately after the events of May 2016. When he returns to practice, he will be required to practise under supervision and is prohibited from performing any surgical procedures other than non-cosmetic minor procedures.

He was also ordered to pay costs to the HCCC.

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