Medical Board of Australia v Karam
[2012] QCAT 198
•11 May 2012
| CITATION: | Medical Board of Australia v Karam [2012] QCAT 198 |
| PARTIES: | Medical Board of Australia (Applicant) |
| v | |
| Dr Thamir Karam (Respondent) |
| APPLICATION NUMBER: | OCR144-10 |
| MATTER TYPE: | Occupational regulation matters |
| HEARD AT: | Brisbane |
| DECISION OF: | Judge Fleur Kingham, Deputy President Assisted by: Dr Harpreat Moudgil Ms Emma Robertson Dr John Waller |
| DELIVERED ON: | 11 May 2012 |
| DELIVERED AT: | Brisbane |
ORDERS MADE: | 1. Dr Karam’s registration is subject to the conditions set out in the schedule to the decision; 2. Those conditions must be recorded in the public register for the term of the conditions; 3. Dr Karam must pay the Board’s costs of and incidental to these proceedings as agreed or as assessed on the standard basis against the District Court scale. |
| CATCHWORDS: | PROCEDURE – OCCUPATIONAL REGULATION – HEALTH PRACTITIONER – DISCIPLINARY – where the practitioner conceded that he had engaged in unsatisfactory professional conduct – where the practitioner did not admit to all conduct alleged by the Board – where the parties have made joint submissions on sanction – whether the Tribunal should make findings on disputed facts OCCUPATIONAL REGULATION – HEALTH PRACTITIONER – DISCIPLINARY – SANCTION – where unsatisfactory professional conduct established – whether sanction sufficient to protect the public, uphold standards of practice and maintain public confidence in the profession OCCUPATIONAL REGULATION – HEALTH PRACTITIONER – DISCIPLINARY – COSTS – where the parties have reached agreement on costs Queensland Civil and Administrative Tribunal Act2009, s 32 Medical Board of Australia, Recency of Practice Registration Standard requirement 1(c) |
APPEARANCES and REPRESENTATION (if any):
This matter was heard and determined on the papers pursuant to s 32 of Queensland Civil and Administrative Tribunal Act2009 (QCAT Act).
REASONS FOR DECISION
The Medical Board of Australia brought disciplinary proceedings against Dr Karam, alleging unsatisfactory professional conduct when he temporarily held an acting appointment as Training Registrar in Obstetrics and Gynaecology at Mackay Base Hospital from late 2006 to early 2007. Queensland Health did not extend his contract because of complaints from patients and staff, largely about his attitude and poor communication skills.
Queensland Health initiated a clinical review of ten patients managed by Dr Karam in that position. In these proceedings, the Board alleged unsatisfactory professional conduct in relation to 5 of those patients.
Dr Karam conceded that he had engaged in unsatisfactory professional conduct in relation to his communications with colleagues, his record keeping and, to a limited extent, his care of 2 patients. Otherwise he denied the remaining allegations made by the Board about his clinical competence. Although the Board has provided the Tribunal with expert evidence in relation to those allegations Dr Karam denied, the Board has asked the Tribunal not to make findings about them.
It submitted that Dr Karam had admitted sufficient facts to establish unsatisfactory professional conduct, without the need for a hearing about the disputed allegations.
Further, Dr Karam has agreed with the Board that the Tribunal should impose conditions on his registration which the Board submits are adequate to protect the public, and maintain professional standards and confidence in the profession.
The Tribunal accepts there is little utility in a hearing about the matters in dispute. The parties have made a joint submission on sanction. If the Board were able to prove the disputed allegations it would not seek additional or different orders. The Tribunal is satisfied it should proceed on Dr Karam’s admissions and make the orders jointly proposed.
Findings on conduct and sanction
Dr Karam has made admissions about a pattern of communicating with colleagues that reflects very poorly on his professionalism. Dr Karam’s communications with colleagues on a number of occasions were argumentative and disrespectful. During one incident he argued with two registered nurses in the presence of a patient about to undergo an emergency caesarean section for foetal distress. He also argued with anaesthetist colleagues about patient matters or clinical procedures.
He communicated poorly with colleagues responsible for the care of two patients he treated. He failed to give a full account of the condition of one patient; for the other, he failed to provide the relevant practitioner with any account at all. Dr Karam failed to keep appropriate clinical records for two patients. Finally, he breached the confidence of a patient, who overheard him doing so, by disclosing a matter to a member of staff.
These are not isolated incidents. Dr Karam has conceded they demonstrate a pattern of inappropriate communication. As well as suggesting contempt for his colleagues, they reveal a lack of concern for patients.
[10] Dr Karam will be required to complete a course on professional responsibility and communication within six months. Although training may assist, the Tribunal apprehends a risk that Dr Karam will continue to communicate inappropriately unless he addresses the attitudes that underlie his conduct.
[11] As for his clinical competence, Dr Karam has made limited admissions relating to only two patients. For one patient he failed to commence syntocinon in a timely fashion after a post-partum haemorrhage. For the other, he failed to use continuous foetal monitoring. These go to his competence to perform procedural obstetric and gynaecology.
[12] Dr Karam has conceded unsatisfactory professional conduct. The Tribunal finds that his conduct is of a lesser standard than his colleagues and the public might reasonably expect.[1] It also demonstrates a lack of adequate knowledge, skill, judgment or care in the practise of his profession.
[1]Health Practitioners (Professional Standards) Act 1999, Sch def of unsatisfactory professional conduct para (a).
[13] The orders will prevent Dr Karam from performing any procedural obstetric and gynaecology work except in a genuine emergency, when there is no other medical treatment available. Dr Karam must report to the Board if this occurs. Dr Karam must inform his employer of the conditions, notify the Board of each change in his clinical position and authorise his employer and Medicare to provide information to the Board so it may monitor his practice.
[14] The parties propose that these conditions remain in place until 2 May 2013. These matters occurred more than 5 years ago. Dr Karam has not practised in procedural obstetrics and gynaecology for some two and a half years, having undertaken to the Board to do so only under direct supervision. When the conditions expire, Dr Karam will not have practised in the field for more than 3 years. He will have to provide a plan for professional development and re-entry to practise if wants the Board to register him to practise in that field again.[2] That will provide the Board an opportunity to assess his clinical competence and impose necessary requirements at the time, if at all, he seeks to re-enter the field.
[2]Medical Board of Australia, Recency of Practice Registration Standard requirement 1(c)
Costs
[15] The parties have agreed that Dr Karam will pay the Board’s costs of and incidental to the proceedings fixed at $32,000, such sum to be paid within 2 years of the order.
Schedule
Within six months of the date of the Tribunal orders Dr Karam must undertake and satisfactorily complete a course which incorporates professional responsibility and communication, such course to be approved, in advance, by the Board.
Other than in the case of a genuine emergency, Dr Karam must not perform any procedural obstetric and gynaecology work, i.e. he can perform shared antenatal care and non-procedural general practitioner gynaecology.
Within seven days of commencing such a position, Dr Karam must notify the Board of the location and nature of his employment and duties whilst in any clinical medical position.
Dr Karam must notify these conditions, in writing, to the District Manager, the Executive Director of Medical Services and/or the Chief Executive Officer of each hospital and/or his employer in any clinical medical position in which he applies for employment and/or clinical privileges, during the currency of these conditions.
Within seven days of making the application for employment and/or clinical privileges Dr Karam must provide the Board with a copy of the correspondence referred to in the preceding paragraph.
Dr Karam must authorise Medicare Australia to provide information about his practice of medicine to the Board, at its request.
Dr Karam must authorise a representative of the Board to contact and exchange information with each hospital/employer where he holds employment/clinical privileges, at such time or times as the Board determines.
Dr Karam must keep a log book recording the details of any pregnant patient for whom he provides consultation or treatment, including the patient’s details, condition treated and treatment provided and provide a copy of this log book to the Board every three months.
In the event that Dr Karam performs any obstetric and gynaecology work in a genuine emergency when no other medical treatment is reasonably available, Dr Karam must advise the Board in writing within seven days of treatment of the details of the patient and treatment, attaching the relevant clinical record.
10. The conditions to Dr Karam’s registration will apply until 2 May 2013.
11. Dr Karam must bear all cost of compliance with the conditions.
12. The conditions must be recorded on the public register maintained by the Australian Health Practitioners Regulation Authority.
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