In Re Dr David Charles Lindsay and the Medical Practice Act 1992 - [2004] NSWMT 8

No judgment structure available for this case.

New South Wales

Medical Tribunal

CITATION: In Re Dr David Charles Lindsay and the Medical Practice Act 1992 [2004] NSWMT 8

TRIBUNAL: Medical Tribunal

PARTIES: Health Care Complaints Commission
Dr David Charles Lindsay

FILE NUMBER(S): 40009 of 2003

CORAM: - - -

CATCHWORDS: Unsatisfactory professional conduct

LEGISLATION CITED: Medical Practice Act 1992

CASES CITED: Reffek v McElroy (1965) 112 CLR 517 ;
Bannister v Walton (1993) 30 NSWLR 699 ;
Briginshaw v Briginshaw (1938) 60 CLR 336;
Dawson v Law Society of NSW (Court of Appeal, 21 December 1989, BC8901279);
Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 ;
Gill v Walton (1991) 25 NSWLR 190;
Jago v District Court of New South Wales (1989) 168 CLR 23;
Herron v McGregor (1986) 6 NSWLR 246

DATES OF HEARING: 27/04/04 (findings entered)

DATE OF JUDGMENT: 12 August 2004

ORDERS: 1. Dr Lindsay is severely reprimanded; 2. Pursuant to s61(l)(c) of the Medical Practice Act the following conditions are imposed upon Dr Lindsay's registration: ; (a) Dr Lindsay is to submit to a random audit of his medical records by a person or persons nominated by the Board ; (b) Dr Lindsay is to accept supervision by a person nominated by the Board to provide support and to monitor Dr Lindsay's capacity to practise medicine safely

JUDGMENT:

REASONS FOR FINDINGS

27 April 2004

Deputy Chairperson: Judge D J Freeman DCJ

Tribunal Members: Dr D Glenn

THE TRIBUNAL ORDERS THAT THE NAME OF THE PATIENTS OR ANY MATTER CAPABLE OF IDENTIFYING THE PATIENTS BE NOT PUBLISHED

These proceedings were instituted by a complaint of the Health Care Complaints Commission (HCCC) apparently filed in 2003. Details of the originating complaint are not before this Tribunal. The hearing proceeded on the basis of a Further Amended Complaint dated 3 March 2004, that is a few days before the hearing commenced on 8 March 2004.

That Further Amended Complaint was in the following terms:

"David Charles Lindsay, being a Medical Practitioner registered under the Act, has been guilty of unsatisfactory professional conduct within the meaning of Section 36 of the Act, in that the Practitioner has demonstrated a lack of adequate knowledge, skill, judgment or care in the practice of medicine.

PARTICULARS OF COMPLAINT PATIENT A

1. The practitioner failed to provide adequate information to Patient A prior to excising a lesion from his lower leg on 14 February 2000, in that the practitioner:

(a) failed to discuss adequately the possibility that further surgery may need to be performed;

(b) failed to explain adequately the procedure;

(c) failed to inform Patient A that he was sending the specimen to pathology for further investigation.

2. The practitioner provided inadequate post-operative care in that he:

(d) failed to adequately explain Patient A's pathology results to him;

(e) wrote an inappropriate letter dated 12 April 2000 to Patient A;

(f) the practitioner failed to discuss the option of referral to a specialist to Patient A.

3. The practitioner failed to maintain adequate and legible medical records in relation to Patient A.

PATIENT B

1. The Practitioner failed to obtain permission and/ or informed consent to excise a lesion from Patient B's face , on 3 April 2000

2. The Practitioner failed to provide adequate information to Patient B prior to excising the lesion on her face in that he:

(d) failed to explain the risks of the procedure and possible sequelae

3. The Practitioner provided inadequate post-operative care to Patient B in that he:

(a) failed to discuss adequately her pathology results with her; and

(b) failed to adequately explain the need for further surgery .

4. The Practitioner failed to maintain adequate and legible medical records in relation to Patient B.

There is no dispute about the law applicable in these proceedings and it is convenient to adopt the summary provided in counsel for the complainant's written submissions:

Reffek v McElroy

Bannister v Walton

"2. The Tribunal must have regard to the gravity and importance of the matters which it is deciding in accordance with the principles stated in Briginshaw v Briginshaw (1938) 60 CLR 336 at 360 to 363 per Sir Owen Dickson CJ:

"4. The purpose of the jurisdiction which is exercised by the Medical Tribunal is not the punishment of the former practitioner. The Tribunal's jurisdiction is for the protection of the public: Dawson v Law Society of NSW (Court of Appeal, 21 December 1989, BC8901279) per Kirby P at 9, Mahoney JA at 34; Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 at 637."

"5. The jurisdiction is intended to maintain proper ethical and professional standards, primarily for the protection of the public, but also for the protection of the profession: Litchfield, above, at 637-E."

THE COMPLAINT CONCERNING PATIENT A

A man, now aged in his late thirties, Patient A had a place of work not far from the Mid City Skin Cancer Clinic at 403 George Street Sydney which had been operated by Dr Lindsay for the past seven years.

In early 2000 Patient A was recommended by one of his customers (who had had a skin lesion treated by Dr Lindsay) to attend this Clinic. He did so because he was concerned about a mole on his lower left leg. Patient A arrived at the Clinic in the mid-afternoon of 14 February 2000. He was examined all over by Dr Lindsay. He told Dr Lindsay that he was concerned about a mole which had, to his notice, been getting darker over the preceding six or seven months.

Dr Lindsay told him that the mole was "abnormal" or perhaps even that it "looked like a melanoma" although there is some dispute about the use of this term at that stage. Whatever the details of this observation might have been, Patient A certainly remembers that the conclusion expressed by Dr Lindsay was that the mole "had to be cut out" and that that procedure could be done there and then. He consented to this course.

Patient A claims, however, that Dr Lindsay did not fully explain to him how he was going to cut out the mole or anything else about the procedure.

For reasons which will be enlarged later in this judgment the Tribunal had some difficulty in accepting everything Patient A has said. In this case the fact is that he was able to agree, in cross-examination, that he had been given instructions on wound care and scarring - information which he previously claimed not to have been given, meaning that his recollection of the totality of this conversation is flawed. The Tribunal would accept that Dr Lindsay, in accordance with his usual practice, would have described the procedure to be undertaken. It is likely that this explanation was somewhat perfunctory and either did not register with Patient A or has since been forgotten.

Thereafter Dr Lindsay did perform excision of the suspect lesion which was sent to the pathologist Dr Gal for examination.

For completeness that report is set out hereunder:

MACROSCOPIC EXAMINATION

The specimen consists of an oval piece of skin measuring .15x14x5mm bearing on its surface a brown lesion measuring 9mm in diameter.

MICROSCOPIC EXAMINATION

Sections show a superficial spreading type intraepidermal malignant melanoma with no foci of dermal invasion seen at multiple levels examined

Excision appears complete by a minimum margin of about 2mm from the nearer vertical resection edge and by larger margins elsewhere

SUMMARY

SKIN OF LOWER LEG: INTRAEPIDERMAL MALIGNANT MELANOMA; MARGINS COMPLETE Reported by Dr Andrew Gal Verified by Dr Andrew Gal."

Patient A claims that he was not told that the specimen removed from his leg would be sent for such testing. Consequently, he says, it came as a complete surprise to him when the contents of this report became the subject of discussion between himself and Dr Lindsay at the next consultation which occurred on 1 March 2000. In the meantime Patient A had made and broken appointments on 28 and 29 February.

Certainly Dr Lindsay likes to manage his patients and the time he spends with them in what appeals to him as the most efficient and economical fashion. Whether this is because of the pressures of time in what was clearly a very busy practice (with four fully operational surgeries conducted solely by Dr Lindsay) or because that is a reflection of the Doctor's personality is unclear and in any event immaterial. His style, as honed by repetition in many thousands of consultations, would appear to be controlling with little heed for whether his well-rehearsed "patter" was in fact being understood and the information he was attempting to convey was being digested by his patients.

Of course, it behoves all medical practitioners to remember the phenomenon that patients sometimes do not absorb all the information being directed at them and that some require repetition and simplification. In the case of Patient A, in Dr Lindsay's own words, he "was dealing with a very difficult patient. It appeared that he could not understand even the most basic information. He seemed to be very confused by what I was telling him." It must be said, however, that the conversation the effect of which Dr Lindsay purports to reproduce in paragraphs 8 and 9 of his affidavit does not support this assessment.

There was on this occasion apparently a failure of communication or a later failure of recollection. In relation to communication one submission put by senior counsel for Dr Lindsay troubles the Tribunal. It was put:-

in his iudgment

The Tribunal doubts that the correct test can be expressed in such subjective terms. It must be objectively evaluated whether the practitioner's efforts were reasonable in the circumstances.

As already indicated, however, because of concerns about the completeness and reliability of Patient A's recollection the Tribunal is not satisfied that there was an inadequate explanation for the procedure undertaken on 14 February 2000.

It also appears likely to the Tribunal that Dr Lindsay, as was his wont, would have made some references to the specimen being sent for testing. In the opinion of Dr Quinn such a reference would need to have been only fleeting. It is likely that Patient A's concentration was on Dr Lindsay's repeated assurances that removal of the mole means "you will have no further problems with it" and, later, that "I've got it early. I know you are going to be fine. I've got it out." These are the things that a patient is likely to register with other qualifying clauses not being appreciated.

Similarly with regard to the need to discuss the possibility of further surgery no real criticism of Dr Lindsay can be sustained. He himself says that he did not dwell on this for the obvious reason that he did not want to dissuade Patient A from having the original excision which was clearly in his best interest. Dr Quinn expressed the view that he would not touch on the question of further possible surgery until he had the histopathology diagnosis in front of him. He would use a phrase like "further management may be required".

Minds may differ, then, about the extent to which a patient should be advised " and possibly alarmed about future treatment options. This particular is, in any event, specifically limited to the situation which obtained prior to excising the lesion. Sufficient but understandably muted reference to the possibility of future surgery at this point is a requirement that would be easily satisfied. The Tribunal is not persuaded that there was a total absence of any indication to the patient that future treatment was possible. This Particular accordingly is not made out.

In summary the Tribunal finds in relation to Complaint 1:

(a) Not proven;

(b) Not proven;

(c) Not proven.

COMPLAINT 2

The particulars of this complaint refer to the events which followed the original excision performed on 14 February 2000 and it is proposed to deal with them chronologically rather than in the order in which they are numbered.

When Patient A did return to see Dr Lindsay on 1 March 2000 there was a discussion about the contents of the pathologist's report. Patient A claimed to have been bewildered by this. The accounts of this consulation given by the two participants vary widely.

In summary, Patient A claims that Dr Lindsay told him that the report indicated that the lesion that had been removed was "not dangerous". He was, therefore, unable to comprehend why a second operation was necessary. He claims that he was confused by a metaphor used by Dr Lindsay to the effect that if the lesion was 10, five had been cut out and it was necessary to cut out the other five. Dr Lindsay said that this is a reference to a metaphor (which, to the Tribunal, is equally confusing) which he used only on the last encounter between him and Patient A on 12 April 2000. It appears to the Tribunal that Dr Lindsay is mistaken. The events of 12 April 2000, on either account, did not allow much room for further discussion about re-excision. They are, as will be seen, much more concerned with possession of the pathology report and further "explanation" of its contents.

On either version of the events of 1 March 2000 it is apparent that Dr Lindsay failed to get through to Patient A the reasons for a proposed re-excision. This is hardly surprising. Both parties agree that Dr Lindsay told Patient A that the lesion was "not dangerous". Patient A claims that he was told that the lesion was not a melanoma although he conceded in cross-examination that the doctor could have told him it was "like a melanoma". Dr Lindsay's explanation, reproduced from paragraph 19 of his affidavit was to this effect:-

This to a man described as having the shortcomings Dr Lindsay had ascribed to him can barely be thought to be intelligible. It may well have been understood by some patients but not by the man Dr Lindsay says he was dealing with.

It was met, predictably enough, by the question, "If you've already cut it out why do you have to cut it out again?"

Dr Lindsay's reply was a little more forthcoming but relied for explanation of the need for re-excision on "the rules" saying that neither he nor Patient A had any say in the matter. In fact this is not correct. The patient, provided he understood his options, did have a say in whether the re-excision was performed. It was in fact quite wrong for Dr Lindsay to seek to manipulate his patient by telling him that he had no choice.

With the benefit of hindsight it seems that some simple, more informative form of words could have been devised. For example:-

This criticism of Dr Lindsay, however, might be seen to have more to do with his inadequacy in explaining the need for further surgery and there is no such complaint made, in those terms, against him.

It is at this point that consideration may perhaps have been given to raising the question of a second opinion for Patient A. There was clearly a difficulty in communication. Patient A says that he had lost faith in Dr Lindsay. He declined to have the further procedure done there and then. He told Dr Lindsay that he would call later to arrange a time. He said in evidence that he had no intention of doing so.

In all the circumstances Dr Lindsay's acceptance of Patient A's offer to ring and make an appointment was a little unrealistic. Counsel's submissions are, in part, based on the proposition that Patient A is wholly unreliable. He had demonstrated some unreliability by failing to keep two appointments. He had failed to understand repeated "explanations" of the need for further surgery. This was probably because Dr Lindsay kept answering him "in the same or similar terms".

According to Dr Lindsay the patient was "distracted", he was agitated and concerned about other things. What weight should have been placed on his vague offer to call? If at any time it was then, before he left, that Dr Lindsay should have raised the idea of a second opinion to see whether somebody else could manage to make clear to Patient A the necessity for further excision.

The point is taken, however, that the complaint is framed specifically as a failure to discuss referral to a specialist. Dr Mann does not say that Dr Lindsay should have offered Patient A referral to a specialist, only that "he could have offered a second opinion from another skin cancer doctor" of which failure she is, in any event, only mildly critical. Since there is no criticism of -to perform the further surgery (as distinct, perhaps, from his inability to explain the necessity for it) this Particular is not made out. No other realistic opportunity for discussing referral to a specialist existed. No complaint is made that such a referral should have been discussed prior to the excision on 14 February 2000. The next exchange between Patient A and Dr Lindsay occurred on 5 April 2000 by telephone. The patient's name had been entered on a "follow up" record because of his need for re-excision.

When there had been no contact from him after 1 March, Dr Lindsay, on 5 April 2000, telephoned Patient A's number. It is common ground that the phone was answered by the patient's brother who purported to inform Dr Lindsay that the patient would be having no further treatment. Apparently the brother had had two minor lesions dealt with by another practitioner by way of biopsy rather than total excision. For whatever reason, Patient A and his brother appeared to believe, in consequence, that this should have the form of treatment adopted by Dr Lindsay. This was obviously an ill-founded belief and its expression generated a clash between Dr Lindsay and the patient's brother. Ultimately, as requested, Patient A did return Dr Lindsay's ca11later on 5 April 2000.

Their respective accounts of this conversation vary widely as well. According to Patient A he was still questioning the need for a further excision. On his version he asked Dr Lindsay what would happen if he did not have the further operation and Dr Lindsay said, "You're going to die. There I've said it. You're going to die". Dr Lindsay testified that Patient A had asked him (as he had a number of times during the discussion of 1 March) "am I going to die?" to which the doctor had replied, "No, you're going to be fine but you (sic) got to have the operation done".

Accurate reconstruction of this conversation is impossible. Patient A has been shown to have a flawed recollection. For example, in relation to mentioning Professor Milton, he says that he did not tell Dr Lindsay of his intention to consult the Professor until the meeting of 12 April 2000. Dr Lindsay's recollection differs and his records note, "Skin & Cancer Foundation -Milton" at the time of this conversation on 5 April. It is likely that the Professor's name was mentioned in this telephone call. Patient A is unreliable in other respects but the fact is that, in his evidence, he conveyed his absolute conviction that Dr Lindsay told him he was going to die. Of course sincerity in giving evidence is not a guarantee that the evidence is correct.

On the other hand Dr Lindsay presents as an extremely rigid personality convinced of the rectitude of his own practices and behaviour. He reacts very badly to any criticism, express or implied, even when some criticism is justified in relation to eg., his record keeping. Any questioning of his decisions seems to be met with overly vigorous defence. He considered, as he said a number of times, that Patient A was very disrespectful of him as a doctor. He had an unshakable belief that he knew what was best for Patient A and that this patient required the excision "under the rules". It is likely that he was forceful in attempting to convey his plan of treatment to Patient A. In those circumstances it is more than possible that, in an attempt to convey the seriousness of the situation and the strength of his own belief, he may have been driven to convey the idea that Patient A could die if he did not have further treatment. This, in the Tribunal's view, is the most probable reconstruction, ie., that Patient A asked whether he could die and Dr Lindsay told him forcefully that he could.

The Tribunal would regard this as something of an overstatement by way of simplification. Even in the circumstances of believing that he was obliged to somehow galvanise a difficult patient into action, this statement would still have been inappropriate. Whilst this version is the most probable there are many different ways in which the conversation could have developed. The Tribunal is not prepared to find, to the necessary level of comfortable satisfaction, that this version does represent the true content of this somewhat heated exchange. In any event, even on this basis, the complaint that Dr Lindsay "told the patient he was going to die" is not made out.

The second half of this Particular also requires some consideration, ie., the words "when there was no clinical indication that Patient A had a life threatening condition".

The Tribunal doubts that, as at April 2000, it could fairly be said that Patient A had a life threatening condition. He was in no immediate or short term danger. If he had the re-excision within 10 weeks of the original excision then he would be guaranteed to have no reduction in his life expectancy. If he did not (as turned to be the case) then his chances of survival were lessened. To bring about his demise, however, would require a chain of developments. Thus, if he did not have the re-excision and if there was further or new growth in the area surrounding the original site and if he did not seek attention and if enough time was allowed to pass for that further melanoma to metastasise then his situation would be dire. If any competent medical practitioner had been asked by Patient A in early April 2000, "could I die?" the answer, bearing in mind the possible chain of developments outlined above, would have to have been "yes". No practitioner would have been able to answer the question in the negative.

Overall, however, because of the Tribunal's view of the unconvincing state of the evidence this Particular (a) is not made out.

THE CONFRONTATION OF 12 APRIL 2000

Certainly something had happened in the course of the telephone conversation on 5 April 2000 to bring about Patient A's appearance, in an agitated state, in Dr Lindsay's rooms on 12 April 2000. Patient A was there, he said, to see his pathology report. He already understood that he would not be getting a copy of the report because Dr Lindsay had told him this in the telephone call of 5 April. There is no doubt, in the Tribunal's mind, that at a later point in the consultation Patient A did attempt to seize his file or the report. Both Dr Lindsay and Ms Glynne (the doctor's mother who, as office manager, occupied a desk outside the surgery in which the confrontation took place) gave evidence of some form of physical approach by Patient A to Dr Lindsay. There are significant differences in their evidence but even Patient A admits in cross-examination that he "could have" tried to grab the file. This is, of course, an extraordinary answer unless his recollection of the events of that day is so poor that he could not be certain of anything. His response is taken as a grudging admission that he did so act.

Before this physical act the doctor and the patient had been behind a closed door in one of the surgeries. Ms Glynne's attention had been drawn to Patient A before they entered the room because he had rudely told her son that the identity of the general practitioner referring him to Professor Milton was "none of his business". Whilst they were in the room, with the door closed, she could report only what she heard, which was periods of silence with episodes of the patient speaking very loudly and using swear words.

Of the versions given by Patient A and Dr Lindsay as to what transpired in the room, neither is wholly convincing. Patient A says that the doctor, sitting opposite him, held the report out facing him but closed the file before he had had a chance to read the report fully. This happened, he said, twice. Dr Lindsay claims that he had sat alongside his patient and taken him through the report. According to Dr Lindsay the patient claimed the report did not relate to him. According to Dr Lindsay the patient raised his voice and the doctor removed the file and placed it behind him. At this point, so his evidence went, Patient A lunged at him and struck him on the chest, the impression being given that the patient was attempting to get at the file behind him while the assault was directly on the doctor.

This is not what Ms Glynne said she saw. She described the file as being held by Dr Lindsay against his chest between his body and his folded arms so that when Patient A lunged at Dr Lindsay with both hands (which she thought were closed) his actions were consistent with him attempting to grab the file.

Doubtless there was a physical incident initiated by the patient. The evidence is unclear, however, even on what happened next. According to Ms Glynne she offered to copy the pathology report for Patient A. She said he refused saying, "No. I don't want the report. It's wrong." According to Dr Lindsay when this reply was made, he, Dr Lindsay, intervened and said, "No, he's not getting the report." Ms Glynne has no recollection of this.

To further complicate matters Patient A claims that he and Dr Lindsay went into the surgery or consulting room twice whilst Dr Lindsay and Ms Glynne insist that they only went into and out of that room once. There is evidence supporting Patient A's version in the uncontested statement of Ms Dawes.

All that can be said with certainty is that Dr Lindsay did not give a copy of the pathology report to Patient A. To that extent, Particular 2(c) is made out.

Should criticism of Dr Lindsay's decision not to give a copy of the pathology report to his patient be sustained? It is obviously an area in which minds may differ. Dr Mann opined that it would have been a good idea to appease the patient and could have done him no harm since, according to Dr Lindsay, the full contents of the report had already been made kown to Patient A.

Dr Mann originally expressed herself, as a peer reviewer, as being "moderately" critical of Dr Lindsay (or any doctor) "who did not provide pathology results to a patient in a timely fashion". That formulation obviously involves explanation as well as provision of a copy. The Tribunal has already expressed its view about the adequacy of explanation given by Dr Lindsay. The question here is whether criticism is justified for Dr Lindsay failing to provide a copy of the report, having already revealed (and "explained") its contents.

Dr Mann had this to say -[T.140]:-

DR MANN: "I thank that that's a personal and controversial issue. I do think that the ability to provide written information to every patient is a reflection of the skill of the doctor. Some doctors can manage to do that. Some doctors don't have the skill to do that.

Q. Views within the profession legitimately and honestly held on that issue differ, don't they? A. They do.

Q. And there's a respectable body of opinion which you wouldn't criticise which says that it's better to explain it and not to give the written document to the patient, isn't that right?

A. I don't think that respectable body would put their view in that.

Q. How would they put it?

A. They might put their view by saying there's a minority of patients who will be injured by being given a physical copy, because they will misunderstand the words and those patients would be better explained rather than given a physical copy.

Q. Ultimately it's a matter for clinical judgment for doctors as to whether a patient falls into that category or not? A. Yes.

Q. And some of the behavioural characteristics of patients who might qualify for that category would be persons, would they not, who had apparently wilfully misunderstood advice given to them in the past?

A. No, in fact those patients do much better if you actually give them everything that they're looking for and you explain in excruciating detail, every word, if necessary, providing them with back-up information from textbooks or the internet so that should they come back to you, you can quote back to them your explanatory words. Those patients do particularly poorly if you try and, you know, cover over the top and not give them full explanations.

Q. What kind of patients in your experience are those that sometimes it is better to give them the explanation, rather than the document?

A. People with intellectual disability, I don't know if I can think of too many others, I suppose people who have an untreated florid paranoid schizophrenia, perhaps. I don't know that I can immediately think of anyone else."

A fair interpretation of that exchange would be that Dr Mann herself and the majority of her fellow practitioners would be critical of a failure to provide a copy of the report. A respectable body of opinion would hold the view that it is appropriate to withhold the report from a minority of patients who would be injured by being given the document. That group of patients would include those who were suffering from intellectual disability or a florid paranoid schizophrenia. There is no evidence that Patient A falls into this category. This is so despite Dr Lindsay's repeated attempts by way of unqualified psychiatric opinion to categorise Patient A as being "mentally ill".

Dr Quinn was taken to that excerpt from Dr Mann's evidence and asked this question [T.353]:

A. I'd say in the 15 years of clinical practice, I've probably given five pathology reports probably because they were leaving the area and to allow their notes to be easily transferred to the new practitioner. My standard practice with pathology reports is to actually display the pathology report in front of the patient and to underline specifically on that pathology report the important features, such as the depth of the melanoma, if it's a melanoma, if it's a skin cancer, the fact that it has been completely excised and its diagnosis such as a BCC.

It is important to note that Dr Quinn was restricting himself to "fellow practitioners in my particular milieu", that is, Specialist Master Surgeons to whom patients are referred by their primary treating doctors, usually General Practitioners. His position is not to be equated with that of Dr Lindsay at all. Indeed, as ultimately emerged in cross-examination [T. 367-368] if Dr Quinn were ever confronted with a patient who was adamant in his demands for a copy of the pathology results then he, Dr Quinn, would probably send the patient back to the referring General Practitioner and let that practitioner make the decision as to whether to provide such a copy.

In the circumstances of this matter Dr Lindsay's position is on all fours with the position of a general practitioner such as Dr Mann. Dr Mann speaks for the body of opinion relevant to that position. Outside the exceptions she described criticism is valid, then, of Dr Lindsay for not providing a copy of the report. It is instructive, in addition, to examine Dr Lindsay's reasons for withholding the report. In his affidavit Dr Lindsay says:-

to

.

In cross-examination Dr Lindsay was asked [T .445]:

A. Not a chance. That was my immediate response, there was obviously a level of emotional response in there, but I think it is still the correct response. You don't condone that kind of behaviour, especially if the patient is a severely irrational, severely dangerous individual. You don't go providing stuff to escalate again. You just get the person out of your premises as quickly as you can. What my mother chooses to do at this point is her choice, she is a little more calm than I am at the end of that. I have just been assaulted and I don't know what's going to happen next and I don't know if the individual is carrying a weapon.

Q. There was no indication he was carrying a weapon, was there? A. Well, he had clothing on, so how would I know.

Q. Well, there is no indication that he had any form of weapon on him?

A. I don't know.

Q. Well, it was a [supposition] on your part?

A. He assaulted someone, the next step is to be [wary] that the person might be carrying a weapon, that would be normal response in that circumstance, to make sure that no physical altercation occurred again and that no physical violence occurred again and you remove him from your premises as quickly as you possibly could in the interests of the safety of the staff. Now, I let it wheel around a bit, but not for too much longer. I let him wheel around and say what he wants to say and he is out the door. I'm not concerning him, he knows where the door is, okay?

Q. Your giving him a report would reward that behaviour, is that your attitude?

A. Is it the HCCC's attitude that a doctor can be violently assaulted in their premises? Is that the HCCC's standpoint? That's what I would like to know first.

Q. Is that your answer, sir? A. If the HCCC approves of that behaviour, that's what I would like to know first, before we go any further. I'm not condoning violent behaviour in my premises. That is a sensitive area that I work in. It is a medical practice, it's not open for violence and whatever choices we made from that point, would be ours. The fact that we tried to be more conciliatory after is our choice, measured according to what we saw of [Patient A].

Q. Is it your interpretation of what happened on that day, that to give him the pathology report would have rewarded his, on your account, violent behaviour?

A. It would have brought me closer in the vicinity of [Patient A] and I wanted to stay a good five to 10 feet away from him, because I would be the one handing him the report."

This is an illuminating exchange. The Tribunal's conclusion is that Dr Lindsay was in fact seeking to punish (or at least not reward) Patient A for his behaviour and to maintain his "position of power" as Dr Mann puts it. There would have been no physical danger to Dr Lindsay in allowing Ms Glynne to do what she wanted to do, ie., physically transfer a copy of the report to Patient A.

Dr Lindsay's claim to have been acting only in the best interests of the patient cannot be reconciled with his later decision to have his solicitors send a copy of the report direct to Patient A in a letter of 30 May 2000. It is not without significance that it was only after receipt of this document that Patient A eventually did consult another doctor.

The conclusion is that this Particular is made out and that it attracts criticism of a mild degree.

The remaining Particular under this complaint (e) refers to the letter of 12 April 2000.

That letter reads as follows:-

If you do not follow my instructions this could have severe adverse results to your health and well being. However, if you seek appropriate treatment within the next month we would reasonably expect you to have a 100% cure rate of your current problem."

The criticism of this letter by Dr Mann was that it was couched in very severe language, was uncompromising and could be considered to be intimidating.

There is, as emerges from the cross-examination of both Drs Mann and Quinn no argument that the sending of a letter to Patient A was a proper step for Dr Lindsay to take. Dr Quinn's view was that the terms of the letter were quite appropriate in the circumstances. His evidence carries additional weight because of his understanding of the dangers which Patient A could face and the nature and timing of the treatment he should receive.

Dr Mann's view, on the other hand, is somewhat weakened by an apparently inadvertent misunderstanding of the precise terms of the letter. She expressed her opinion based on the understanding that the letter had warned of "severe adverse effects" on Patient A's life. Such phraseology carries, in the Tribunal's view, more sinister connotations than the actual words of the letter would convey.

This is basically a dispute about the tone of the letter. It is a dispute conducted on terms that Dr Lindsay had undergone a disturbing physical confrontation with Patient A earlier that same day. In all the circumstances the Tribunal is satisfied by the evidence of Dr Quinn that the letter is not inappropriate and is, given the forgoing circumstances, balanced and reasonable. This particular is not made out.

In summary, under Complaint 2 the findings of the Tribunal are:

a. not made out;

b. not pressed;

c. established;

(d), (e) and (f) not made out.

Complaint 3 relating to the inadequacy of Dr Lindsay's records will be dealt with separately. There is a different approach taken by Dr Lindsay through his counsel to this allegation in respect of both Patients A and B.

PATIENT B

A woman now in her mid-seventies complained, basically, that she had been operated on by Dr Lindsay without explanation, warning or the giving of her permission. She said, in her statement dated 27 July 2000 to the HCCC that she attended the Mid City Skin Cancer Clinic on 3 Apri12000:-

I showed him a spot on the right side of the bridge of my nose near my eye. I thought that it was a spot caused by my spectacles rubbing the area but I thought I would show it to Dr Lindsay anyway.

He checked the spot. He told me to lie down on the examination couch and then covered the rest of my face. He did not explain what he was going to do. I thought he covered the rest of my face because he had decided to bum the spot off. However he started to inject the area with anaesthetic."

Patient B said she asked what he was doing and was told only to "be quiet". The spot was then cut out.

This sequence was consistent with that outlined in her original letter of complaint dated 31 May 2000. A fair reading of those two documents would indicate that all of the procedures undertaken by Dr Lindsay were done on the same day, namely 3 April 2000.

In a subsequent statement, this time dated 3 December 2000, however, Patient B indicated that she had first gone to Dr Lindsay's clinic on 20 March 2000 and had then been told by Dr Lindsay that she could have the two sun spots on her arms burned off. In this statement she claimed that:-

(b) that she did not have the sun spots burned off that day because this would have made her late for the afternoon tea she was attending.

Patient B's recall of the events of her consultations with Dr Lindsay is hopelessly astray .

What the evidence establishes may be briefly summarised as follows:-

one

2. Prior to the burning off of her sun spots Dr Lindsay had explained this procedure but this was unnecessary because she had had similar treatments in the past.

3. On 3 April 2000 "the growth" on the bridge of her nose was removed under local anaesthetic.

4. On 4 April 2000 Patient B re-attended Dr Lindsay for the wound to be cleaned.

5. On 7 April 2000 she went to Dr Lindsay who had been her general practitioner for five years previous to this.

6. On 10 April 2000 she re-attended Dr Lindsay for the removal of the stitches and there was a discussion about further surgery being required on that site because of the report from the pathologist

In this connection it is accurate to say, as counsel's submissions put it, that [Patient B] gave "remarkable evidence about growths". Whilst initially positive that she had not been told by Dr Lindsay that she had a growth (or cancer as she would have interpreted this term) she later conceded that she had been so told and that her evidence on this was unreliable.

Her evidence is not really credible. Having asserted that she was operated on without her consent, that she was "terrified" by this and that after the operation she wanted nothing more than to get away from the doctor who had assaulted her, she apparently made no complaint to her trusted general practitioner whom she consulted four days later.

At one stage she expressed the belief that Dr Lindsay had removed all three of the "spots" on her face on this one occasion when it is abundantly clear that the revision of the surgery on the bridge of her nose and the removal of the other two spots were all done months later by Dr Muller.

The fact is that deep confusion in her recollection is not only evident in her testimony but was present when she made her original complaint, a matter of weeks only after the events of April 2000.

Whilst nobody suggests that Patient B is being deliberately dishonest it is clear to this Tribunal that her testimony cannot bear sufficient weight as to engender "comfortable satisfaction". Further examples of her genuine confusion are perhaps unnecessary. The conclusion is that, although she attended on 3 April without a companion, that is, without a prior realisation that surgery would render her vulnerable in the sense that she would not be able to wear her glasses and would need assistance in making her way home, this was not because she had not been informed of or agreed to surgery. It may have been because she had either forgotten somehow or had become confused about the impact of this surgery upon her. That the impact of this particular surgery was rather more than she would have anticipated is quite clear. This is partly because of her admitted insistence that this lesion on the bridge of her nose be treated in an order different from that preferred and recommended by Dr Lindsay.

On her evidence the Tribunal could not be persuaded that she was operated on without her informed consent or that there was any failure to explain the procedure, the nature of the lesion or the risks of the procedure and possible sequelae.

There cannot, either, be sustained any criticism of Dr Lindsay for failure to refer Patient B to a specialist. Dr Quinn, whose expertise in this field is undoubted, would not have expected Dr Lindsay to discuss such referral because Dr Lindsay's competence to undertake the initial excision is not in question. This disposes of the various heads under Complaint 2.

As to Complaint 3 there seems no doubt that Dr Lindsay did discuss the cancerous nature of the lesion originally but incompletely removed. Patient B's testimony to the effect that on leaving his surgery she immediately told her friend that "Dr Lindsay said I had a growth" together with her understanding of this term puts this issue to rest.

That she needed further surgery is common ground. That she understood his reasons for advising this course is also clear.

In summary then, in relation to Patient B, none of the Particulars of Complaints 1,2 and 3 is made out.

As to Complaint 4 - the failure to keep legible and adequate medical records, this falls to be dealt with alongside the similar complaint made in relation to Patient A.

THE STAY APPLICATION

There can be no doubt that the records kept by Dr Lindsay in relation to both of these patients were grossly deficient. Dr Lindsay does not agree, claiming that, for his purposes, his records are entirely adequate. In this he is wrong for a number of reasons to which we will come.

Instead of attempting to defend the indefensible Dr Lindsay's legal advisers took, on this aspect, a different tack. An application was made at the end of the evidence for the Tribunal to stay the proceedings in respect of these complaints, that is, to not proceed with the hearing on these matters on the basis that the proceedings were oppressive and represented a species of double jeopardy.

Some background is obviously necessary.

In evidence before this Tribunal is, by agreement, the fact that there was a Professional Standards Committee hearing in early 2001 in relation, at least, to a patient named in those proceedings but who should be referred to here as "Patient 0".

On 22 July 2001 the Professional Standards Committee (PSC) found, inter alia, that (Dr Lindsay) failed to maintain adequate medical records of his consultations with Patient O. Conditions were then imposed on Dr Lindsay's registration.

On 22 November 2002 a Medical Tribunal rejected Dr Lindsay's appeal against the findings of this PSC and confirmed the conditions. An appeal to the Court of Appeal from that Tribunal decision is pending.

The terms of these conditions, insofar as they are known to this Tribunal, are as follows:-

2. Dr Lindsay submit to a random audit of his medical records by the person or persons nominated by the Board to monitor compliance with Schedule 2 of the Medical Practice Act Regulations 1998 within 3 months from 29 November 2002 and subsequently as required by the Board.

3. That Dr Lindsay authorise and consent to the release of information between the Health Insurance Commission and the Board where necessary to facilitate monitoring of compliance with these conditions."

Senior counsel's argument in favour of a stay proceeded, briefly, on the following lines:-

2. The complaint made about alleged shortcomings in Dr Lindsay's records relating to Patients A and B were known to the HCCC before the PSC hearing in 2001. There appears to be no good reason why, at least insofar as medical record keeping was concerned, these complaints could not have been dealt with at the same time as similar complaints in relation to Patient O.

3. "The repetition of allegations about the particular conduct over the same or a similar period of time, and in any event before the hearing of the first charges brought, does not serve the purpose of disciplinary proceedings. If it were permissible then the HCCC could bring any number of separate proceedings in the Tribunal for medical record defaults by Dr Lindsay for other patients for the period 1998 to 2000. Not only is there no proper purpose served by conducting such prosecutions (as Dr Lindsay has already received his remedial sentence) it is oppressive and therefore amounts to a form of abuse of process." [Counsel's written submissions paragraph 122].

4. Whilst not strictly double jeopardy the Court of Appeal in Gill v Walton (1991) 25 NSWLR 190 had expressed a caution against re-litigating similar alleged offences and had decried such repeated proceedings as "oppressive".

The exact details of the Tribunal hearing involving Patient 0 are not before the Tribunal. It is noted that the complaints made in relation to Patients A and B, are not in the exact terms of the complaint previously made concerning the records of Patient O.

An applicant for a stay carries the onus of establishing the grounds for such intervention and this is a heavy onus having regard to the extraordinary nature of such a remedy [Jago v District Court of New South Wales (1989) 168 CLR 23]. The purpose of the Tribunal is not punitive but predominately protective. The Tribunal exists and its orders are designed to protect the integrity of the medical profession and to ensure the safety and well being of the community. If it appeared to the Tribunal that its orders had not been understood or were being ignored by a practitioner the Tribunal would be recreant to its duty if it did not act to ensure both comprehension and compliance.

The judgment in Gill v Walton (supra) make clear that situations such as this where the charges are similar but not identical to the original charges do not "fall squarely within any of the settled particular instances of specific legal rules informed by the principles against double jeopardy." In that case the unfairness and oppression involved in a proposed repeated hearing of similar charges was compounded by:-

.(c) the interposition of a lengthy Royal Commission in which the same or similar matters had been ventilated;

(d) the passage of a further five years of delay; and

(e) the need, according to Kirby P, or at least the desirability, according to Gleeson CJ, of acting conformably with the previous Court of Appeal decision to grant a stay. [Herron v McGregor (1986) 6 NSWLR 246].

It is noted that there is no evidence before the Tribunal about the extent to which the relevant conditions on Dr Lindsay's registration have been monitored. Dr Lindsay said in evidence that the Medical Board is now "quite happy with the way I do notes at the moment". However, Dr Lindsay did not recognise and, indeed, sought to question the validity of the very regulation [Schedule 2 of the Medical Practice Act Regulations (1998)] which is cited in the conditions of his registration.

The standard of his record keeping, as illustrated by the notes in relation to Patients A and B in these proceedings, is entirely inadequate. This is established both by the evidence of Dr Mann and by the expertise of the Tribunal's members. Indeed, in the final analysis, Dr Lindsay demonstrated that he could not decipher his own notes, let alone have them interpreted properly by any other practitioner called upon to take over treatment of his patients. Yet he continued to claim that his records in this case were legible and adequate.

In those circumstances the Tribunal would be recreant to its duty to grant a stay and refuse to consider the evidence of these complaints.

Accordingly the stay is refused and the Tribunal determines that Complaint 3 in respect of Patient A and Complaint 4 in respect of Patient B is made out.

Pursuant to the agreement reached between counsel, the Tribunal will now receive written submissions on whether the findings made amount to unsatisfactory professional conduct and, if so, what orders should be made consequent upon that finding. Seven days is prescribed for written submissions from the HCCC and a further seven days for any response on the part of Dr Lindsay.

_____________________

REASONS FOR DETERMINATION AND ORDERS
12 August 2004

Deputy Chairperson: Judge D J Freeman DCJ

Tribunal Members: Dr D Glenn

THE TRIBUNAL ORDERS THAT THE NAME OF THE PATIENTS OR ANY MATTER CAPABLE OF IDENTIFYING THE PATIENTS BE NOT PUBLISHED

On 27 April 2004 the Tribunal published its findings and its reasons for those findings in relation to certain particulars of the complaint made against Dr Lindsay.

Found to be established were the facts that Dr Lindsay failed to provide Patient A with a copy of his pathology report and that Dr Lindsay had failed to maintain adequate and legible medical records concerning both Patients A and B.

The consequences of these findings were the subject of further written submissions from the HCCC, these being dated 5 May 2004 and from Dr Lindsay, those bearing date 14 May 2004. These submissions were made in compliance with the Tribunal's orders of 27 April 2004. In addition, on 25 May 2004 the Tribunal received further submissions from the HCCC to which a response on behalf of Dr Lindsay was received on 15 June 2004.

Finally, on 30 June 2004 Dr Lindsay's solicitors forwarded a further submission based on the fact that the Court of Appeal had dismissed Dr Lindsay's appeal against orders made by the Tribunal in the matter involving Patient O.

It is common ground in those submissions that the failure of Dr Lindsay to provide Patient A with a copy of his pathology report does not ground a finding that this action constituted unsatisfactory professional conduct. It is probably accurate to say, and the Tribunal finds, that this single act does not, by itself, justify a finding of unsatisfactory conduct.

However, it is the Tribunal's view that the practitioner's actions in this regard fall well short of the ideal because his failure to communicate satisfactorily with Patient A is regarded as but an example of a more widespread failure to appreciate his patients' emotional and intellectual requirements.

For example, in the case of Patients A and B this Tribunal was prepared to give the benefit of the doubt to Dr Lindsay concerning two people who might fairly have been regarded as patients resenting with reasonably difficult personalities in the circumstances. Both patients, especially Patient B, had demonstrably flawed recollection and on the basis of this evidence the Tribunal felt unable to come to that degree of satisfaction which would support a finding of misconduct or even unsatisfactory conduct. Since the Tribunal has now had access to the summary of evidence and findings of the PSC in relation to Patient 0 there has arisen a real concern about the similarities which are there demonstrated when compared with the practitioner's version of events with regard to Patients A and B.

It is apparent that Dr Lindsay has a somewhat rigid approach to the practice of medicine in his chosen sphere. Clearly he believes that he knows what is for the patient and he will not easily tolerate questioning, let alone dissent. At times, as demonstrated with Patient A, he will give the patient advice which is wrong (eg., the patient having no choice) if it serves to advance the course which he has chosen. Complaints about this rather high handed approach are met with the assertion that it is the patient's fault because of emotion, mental instability or the like.

In relation to the failure to maintain adequate and legible medical records the same "blinkered" approach on the part of Dr Lindsay is evident.

In its original determination the Tribunal noted that it did not have access to information about the Medical Board's monitoring of Dr Lindsay's record keeping in terms of the condition on his registration imposed by the PSC following the matter of Patient O. The Tribunal was concerned only with the fact that Dr Lindsay did not recognise and appeared to dispute the validity of regulation which obtained in this respect.

The evidence given by Dr Lindsay on this monitoring program can now be seen to be either deliberately untruthful or, at the least, completely out of touch with reality. For example, at page 507 of the transcript there appeared the following exchange: -

A. Look, an expert doctor - and we are talking about expert doctors, we are not talking about doctors who wander from practice to practice, or locum here there and there and dabble in everything. I'm talking about focussed doctors who dedicate to skin, dermatologists, plastic surgeons and doctors, just like me, who have being doing it for 11, 12 years. One hundred per cent. We know what we are doing.

We keep records, we know what dates the patient came in and we keep the pathology file. We know 100 per cent what we are doing. Why add to the confusion by adding information that's not relevant to what you're doing? I've got in my head, I've got a very good memory, I think - I have been told I have and I remember things and I know each intimate detail about the surgery. I remember things. I visualise the surgery I did. I mean, that's my ability. You write notes according to what you need and people can't invade your privacy as a professional to the point that they're looking over your shoulder and saying "I don't like your notes". They don't like it. I like it and it works for me and it has saved people's lives. Okay? That's why I do it, and if it's in the interests of the safety of the patient and the care of the patient and that suits me, my personality type and how I order my world, then that's how I do it.

Now, I will take advice and I will improve things and I have and the Medical Board is quite happy with the way I do notes at the moment. You know, they like these things. They say "That looks good, we like the way you do it now, that's good, you use a stamp, that's good. No one else does that, you've got a stamp for your antibiotics, that's good." They like those things. A lot of those things I've had for ages. There's no perfect note taking. There's no such thing."

Medical Practice Act Regulations

A second audit was conducted on 13 June 2003, limited to surgical cases recorded in 2003. A copy of this report was also provided to Dr Lindsay's solicitor. Without rehearsing the full report it is sufficient to say that it did not support Dr Lindsay’s view that “the Medical Board is quite happy with the way I do notes at the moment".

The auditor commented on the difficulty of the task "due almost entirely to the nearly complete lack of legible and contemporaneous notes on the clinical files". It is true, as submitted by senior counsel for Dr Lindsay that the practitioner was found to be keeping, as required, a clear complete and legible surgical logs, thus making him compliant with condition 3(a) imposed by the PSC in November 2003 for a period of two years. However the keeping of this log is of very little, if any, assistance in safeguarding the well being of the individual patients. The auditor concluded that Dr Lindsay's records "are of extremely poor quality, posing a risk to both Dr Lindsay and his patients" (emphasis added).

The auditor expressed the view that it was not possible to comment on Dr Lindsay's surgical skill particularly as the auditors were denied access to patient photographs (this was an intervention on the part of Dr Lindsay's solicitor who, for whatever reason, had been present during these audits and, indeed, had insisted on video taping the first of them).

The final conclusion of the auditor was that, based on his records, it appeared that Dr Lindsay:-
· "Undertakes a large number of surgical procedures, including complex closures. Does not routinely refer patients with melanoma or non-melanoma skin cancer for specialist review or opinion.
· Does not have an adequate system to ensure that patients are not lost to follow up.
· Has not adequately documented adherence to guidelines for the excision of malignant melanomas.
· Does not adhere to accepted guidelines for the follow up of patients with malignant melanomas.
· Does not attend to matters of patient information or consent."

The HCCC concedes that Dr Lindsay may do some of the foregoing matters but the state of his records is such it is simply impossible to say whether he follows the proper procedures or not.

It is apparent that Dr Lindsay has learnt little from the two audits which have been conducted to date. He apparently fails to understand the overarching requirement of the Regulation that he keep records, in a legible fashion, of the patient's history, examination findings, treatment and further proposed management so as to allow another medical practitioner to continue managing the patient's case. This is a fundamental requirement of good medical practice. This failure represents a lack of adequate knowledge, judgment and care. It is unsatisfactory professional conduct.

The fact that the records of Patients A and B were prepared in 2000 would ordinarily answer the case if it appeared that Dr Lindsay had completely reappraised his attitude on this aspect since that time. He has not. He continues to defend the indefensible. This, in the mind of the Tribunal, raises the question as to whether he may fairly be regarded as "impaired".

For his failure to keep records even approaching the minimum required in relation to Patients A and B the practitioner is to be severely reprimanded. The question of what conditions should be imposed in order to protect future patients of Dr Lindsay (and indeed Dr Lindsay himself) remains to be considered.

Senior Counsel for Dr Lindsay has submitted that his client's compliance with the requirement that he keep a log of surgical records demonstrates that such a condition is no longer necessary. The HCCC appeared to agree with this. It is not necessary to require this condition to be reimposed. The situation is different, however, with regard to the practitioner's continuing failure to understand the necessity to keep adequate records in respect of individual patients. It is true that since the dismissal of his appeal the original orders requiring ongoing audit of his performance on this aspect will continue in force. Senior Counsel for Dr Lindsay has submitted that, therefore, repetition of such conditions is unnecessary.

The Tribunal finds that, on the material placed before it, some revision of this condition is necessary. For one thing the nominated Regulation has been superseded.

Most debate in the submissions has been on the subject of whether a mentor selected by Dr Lindsay or a supervisor appointed by the Board (or both) should be required to ensure that Dr Lindsay no longer practises in such an isolated fashion and to expose him to peer influence to assist him in both dealing with patients with whom he has difficulty and in recording properly those patients' history and treatment.

The Medical Board has a policy or protocol for supervision but not for the rather more amorphous concept of a mentor relationship. It is preferable, in the Tribunal's view, that the protocol be followed.

Finally in respect of costs the HCCC has been unsuccessful in the majority of the particulars of which it complained. It has, however, been successful in illustrating the failure of Dr Lindsay to understand and to comply with the existing hearing conditions of his registration with regard to record keeping. The hearing was in any event unnecessarily prolonged by Dr Lindsay's unwillingness or inability to respond briefly and directly to any questions. The Tribunal considers that the complainant should pay the major part of Dr Lindsay's costs but this is in relation only to the defence of the further amended complaint, that is the complaint which was heard and determined by the Tribunal. The Tribunal determines that the complainant should pay 75 per cent of Dr Lindsay's costs on this restricted basis.

The full orders of the Tribunal are:-

1. Dr Lindsay is severely reprimanded.

2. Pursuant to s61(l)(c) of the Medical Practice Act the following conditions are imposed upon Dr Lindsay's registration:
(a) Dr Lindsay is to submit to a random audit of his medical records by a person or persons nominated by the Board to monitor compliance with Schedule 2 of the Medical Practice Act Regulations 2003 within six (6) months of today's date and subsequently as required by the Board. Dr Lindsay is to authorise the said person or persons to prepare for the Board a report of his/her findings. Dr Lindsay is to meet all costs associated with the audit programme.
(b) Dr Lindsay is to accept supervision by a person nominated by the Board to provide support and to monitor Dr Lindsay's capacity to practise medicine safely. The supervisor is to be appointed within six months and to provide supervision to the third level nominated in the Board's policy PCH 7.1 dated August 2002. The costs of such supervision and reporting to the Board at least annually is to be borne by Dr Lindsay. It is an element of this condition that Dr Lindsay cooperate fully with his supervisor.

COSTS

The complainant is to pay 75 per cent of the practitioner’s costs of the further amended complaint dated 3 March 2004.

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Citations

In Re Dr David Charles Lindsay and the Medical Practice Act 1992 [2004] NSWMT 8

Cases Citing This Decision

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Cases Cited

11

Statutory Material Cited

1

Briginshaw v Briginshaw [1938] HCA 34

Prothonotary of the Supreme Court of New South Wales v Nikolaidis [2010] NSWCA 73

CITATION:	In Re Dr David Charles Lindsay and the Medical Practice Act 1992 [2004] NSWMT 8
TRIBUNAL:	Medical Tribunal
PARTIES:	Health Care Complaints Commission Dr David Charles Lindsay
FILE NUMBER(S):	40009 of 2003
CORAM:	- - -
CATCHWORDS:	Unsatisfactory professional conduct
LEGISLATION CITED:	Medical Practice Act 1992
CASES CITED:	Reffek v McElroy (1965) 112 CLR 517 ; Bannister v Walton (1993) 30 NSWLR 699 ; Briginshaw v Briginshaw (1938) 60 CLR 336; Dawson v Law Society of NSW (Court of Appeal, 21 December 1989, BC8901279); Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 ; Gill v Walton (1991) 25 NSWLR 190; Jago v District Court of New South Wales (1989) 168 CLR 23; Herron v McGregor (1986) 6 NSWLR 246
DATES OF HEARING:	27/04/04 (findings entered)
DATE OF JUDGMENT:	12 August 2004
ORDERS:	1. Dr Lindsay is severely reprimanded; 2. Pursuant to s61(l)(c) of the Medical Practice Act the following conditions are imposed upon Dr Lindsay's registration: ; (a) Dr Lindsay is to submit to a random audit of his medical records by a person or persons nominated by the Board ; (b) Dr Lindsay is to accept supervision by a person nominated by the Board to provide support and to monitor Dr Lindsay's capacity to practise medicine safely