Medical Board of Queensland v Tarvydas
[2010] QCAT 246
•3 June 2010
| CITATION: | Medical Board of Queensland v Tarvydas [2010] QCAT 246 |
| PARTIES: | Medical Board of Queensland (Applicant) |
| v | |
| Dr Harvey Martin Tarvydas (Respondent) |
APPLICATION NUMBER: HPF015-09
| MATTER TYPE: | Occupational regulation matters |
HEARING DATE: 28 April 2010
HEARD AT: Brisbane
| DECISION OF: | Judge Kingham (Deputy President) Assisted by: Dr John North, Dr Bernadette Dutton, Mr Graeme Lawrence |
DELIVERED ON: 3 June 2010
DELIVERED AT: Brisbane
ORDERS MADE: 1. Dr Tarvydas has engaged in unsatisfactory professional conduct.
2.Dr Tarvydas’s registration as a medical practitioner in Queensland is cancelled.
3.Dr Tarvydas is not eligible to apply to be re-registered as a medical practitioner in Queensland until:
a. 3 years have elapsed from the date of this order; and
b. He has successfully completed, at his own expense, a course approved by the Board about treatment regimes for conventional and unconventional medical treatment.
4.Details of the disciplinary finding and sanction imposed must be recorded in the register for 6 years from the date of this order.
| CATCHWORDS : | UNSATISFACTORY PROFESSIONAL CONDUCT, where the registrant did not comply with the policy on Unconventional Medical Treatment, where the registrant showed disregard for the patient’s wellbeing. SANCTION, where prior disciplinary sanction, where the registrant failed to co-operate in the investigation or participate in the proceedings. Health Practitioners (Professional Standards) Act 1999 ss 123, 241, 242, sch Health Practioner Regulation National Law Act 2009 s83 Queensland Civil and Administrative Tribunal Act 2009 s.256 |
APPEARANCES and REPRESENTATION (if any):
| Applicant | Mr Allen for the Medical Board of Queensland |
| Respondent | No appearance |
REASONS FOR DECISION
The Medical Board of Queensland commenced disciplinary proceedings against Dr Tarvydas.[1] Dr Tarvydas has not participated in any stage of the proceedings and did not attend the hearing. Notice of the proceedings was served on him care of his sister, pursuant to an order for substituted service. This was necessary because Dr Tarvydas was elusive about his whereabouts and how material could be provided to him.
[1] The referral was made to the former Health Practitioners Tribunal. It is taken to be a proceeding before QCAT and QCAT has jurisdiction to deal with the matter. Queensland Civil and Administrative Tribunal Act 2009 s.256
In February I directed the Board to send a text message to the last known mobile phone number for Dr Tarvydas confirming that all further correspondence about these proceedings would be sent to his sister’s address. Material subsequently sent there by both the tribunal and the Board was returned to sender.
I directed the Board to send Dr Tarvydas the text message because the solicitor for the Board had, not long earlier, had two conversations with Dr Tarvydas on that phone number. The solicitor ensured he was well aware of these proceedings and sought information on how to provide documents to Dr Tarvydas.
In an earlier conversation between the tribunal’s case manager and Dr Tarvydas’s sister, our case manager told the sister what the proceedings were and also sought direction about how to make direct contact with her brother.
I am satisfied Dr Tarvydas understood what proceedings had been commenced and chose not to actively advocate his interests. That behaviour is consistent with the approach he took during the Board’s investigation of the complaint that led to these proceedings. Dr Tarvydas’s failure to engage is no reason to delay proceedings properly brought in the public interest. Some time has elapsed since the hearing and Dr Tarvydas has still not made contact with the tribunal. I am satisfied that it is now appropriate to proceed to determine the matter.
The proceedings against Dr Tarvydas arise out of his treatment of a patient in 2007 which, the Board alleges, was in contravention of its policy with respect to unconventional medical practice. The Board submitted the tribunal would be satisfied Dr Tarvydas’s conduct amounts to the following aspects of unsatisfactory professional conduct:[2]
[2] Defined in the schedule to the Health Practitioners (Professional Standards) Act 1999
(a) Professional conduct that is of a lesser standard than that which might reasonably be expected of the registrant by the public or the registrants professional peers; and/or
(b) Professional conduct that demonstrates incompetence or a lack of adequate knowledge, skill, judgement or care in the practice of the registrants profession; and/or
(c) Providing a person with health services of a kind that are excessive, unnecessary or not reasonably required for the person’s wellbeing.
Dr Tarvydas treated the patient with what he described as “stem cell treatment.” The patient was introduced to Dr Tarvydas through the President of Adhesive Arachnoiditis Sufferers Queensland (the AASQ).[3] Members of the group suffered chronic and debilitating pain. The President of the AASQ believed Dr Tarvydas had a cure for their condition. He had been contacted by one of Dr Tarvydas’s patients in Western Australia. The President then invited Dr Tarvydas to address the group. He and other members of the AASQ later commenced treatment.
[3] Arachnoiditis is inflammation of the arachnoid, membrane, one of the membranes that cover the brain and spinal chord. (Black’s Medical Dictionary, 42nd ed, A&C Black Publishers Ltd 2010)
Dr Tarvydas held out to members of the AASQ the hope of relief they were not getting from conventional medical treatment. He told them he was conducting a trial and that his treatment would stimulate the growth of their stem cells and revitalise them.
It is hardly surprising his claims of a breakthrough treatment raised concerns for some members. Apparently, the promotion of Dr Tarvydas to the group caused a schism in the AASQ. It was not long before there was a complaint to the Board. The first complaint came from a member of the group who did not undertake the treatment. She had doubts about what Dr Tarvydas proposed and was suspicious because of something she had read about him on an internet site.
Another AASQ member consulted Dr Tarvydas on 7 occasions in 2007. This was the patient upon whose complaint the proceedings commenced.
The treatment commenced with one injection a day over 3 consecutive days. Thereafter, booster shots were administered monthly. The patient was told to take a nightly dose of 2 tablets. The cost of the treatment was $200 per month which, the patient was advised, could not be claimed from Medicare. Dr Tarvydas told her the treatment would be for life.
It seems Dr Tarvydas, who apparently resided in Western Australia, did not have any consulting rooms in Queensland. Initially treatment occurred at the home of the President of the AASQ. Later, it took place in a hotel room in the Legends Hotel, Surfers Paradise.
At each consultation, the patient received injections and tablets. After some time she began to notice significant changes in her appearance. She experienced growth of facial hair, bloating and significant weight gain. She described herself and other patients of Dr Tarvydas as “moonfaces” who looked like “rolypolies”.
Dr Tarvydas did not reveal to her the content of the injections. The substance injected was drawn from unmarked phials. Nor did he disclose the content of the tablets, which he dispensed directly and which were, likewise, unlabelled. He described the treatment as “his secret”.
Although he gave her a form to fill out to describe her past medical history and current medication, Dr Tarvydas did not perform a physical examination of the patient. He did not provide her with any information about the trial he said he was conducting. Nor did he provide her with any scientific evidence about the treatment. He did not inform her of any associated risks. He did not ask her to sign a document consenting to the treatment or to participating in a trial. He did not monitor her health to assess the effects of the treatment.
The patient’s suspicions, aroused by her physical changes, were heightened by Dr Tarvydas’s unwillingness to reveal the substance he was injecting or the name of the tablets. The patient consulted her general practitioner and complained to the Health Quality and Complaints Commission (HQCC), which referred the matter to the Board.
Around the same time as that patient approached the HQCC, the Board received a complaint from an AASQ member, also a patient, and her husband. Later, they withdrew that complaint, but the information they provided corroborated that provided by the first patient to the HQCC and, later, to the Board, in important respects.
That couple also persuaded the producers of Channel 7’s current affairs program, Today Tonight, that there was a story in it. Masquerading as a new patient, a journalist recorded Dr Tarvydas in action and managed to secure from Dr Tarvydas’s room some tablets and a syringe filled with an unidentified substance. Both were analysed by the Victorian Institute of Forensic Medicine. The tablets were identified as a restricted drug, Prednisolone, a corticosteroid. The substance in the syringe was identified as another restricted drug, Dexamethasone, an anabolic steroid.
The Board received the referral from the HQCC in November 2007 and suspended Dr Tarvydas’s registration on 11 December 2007. Despite being afforded ample opportunity, both before and after his registration was suspended, Dr Tarvydas made no submissions to the Board about the allegations made against him. The evidence gathered by the Board was uncontested in these proceedings.
On the material amassed by the Board’s investigators, I am satisfied that Dr Tarvydas treated the patient on 7 occasions in contravention of the Board’s policy entitled Unconventional Medical Practice in the following ways:
(a) The registrant purported to treat his patient with “stem cell treatment,” an unconventional medical practice (“the treatments”); and
(b) The registrant failed to properly assess his patient to receive the treatments by failing to sufficiently investigate her medical history or condition so as to make or confirm a generally recognised diagnosis; and/or
(c) The registrant failed to properly assess his patient to receive the treatments by failing to perform any, or any adequate physical examination of his patient, sufficient to make or confirm a generally recognised diagnosis; and/or
(d) The registrant failed to properly assess his patient to receive the treatments by failing to make it clear that unconventional medical practice was being recommended or used in the treatments and failed to obtain her informed consent to the treatments; and/or
(e) The registrant administered injections and supplied oral tablets (‘the medications’) to his patient during the treatments, and the registrant failed or refused to divulge to his patient the composition or identification of the medications at any time; and/or
(f) The registrant failed during the treatments to note in a record whether his patient was advised that the purported treatments were unproven and unconventional; and/or
(g) The registrant failed during the treatments to advise his patient of the conventional treatment options, including their risks, benefits and efficacy, as reflected by current knowledge.
It is not simply a question of Dr Tarvydas failing to comply with the Board’s policy in those respects. The purpose of those guidelines is to ensure medical practitioners practise safe medicine. Dr Tarvydas did not assess or monitor his patient’s condition. He provided no information about his treatment, conventional options, and the risks associated with both. He made no attempt to obtain informed consent. His cavalier disregard for core requirements of patient care fundamentally challenges his professionalism. I am satisfied the Board has made out its case that Dr Tarvydas has engaged in unsatisfactory professional conduct.
In order to protect the public and uphold professional standards of practice and public confidence in the profession,[4] Dr Tarvydas’s registration should be cancelled.[5]
[4] Health Practitioners (Professional Standards) Act 1999 s123 – these are the purposes of disciplinary proceedings
[5] Health Practitioners (Professional Standards) Act 1999 s241(2)(i)
Given his failure to engage in the investigation and these proceedings, I have no basis for confidence that he is aware of or accepts the Board’s policy and guidelines about unconventional medical practice. He will not be entitled to apply to be registered as a medical practitioner until he has successfully completed, at his own expense, a course approved by the Board about treatment regimes for conventional and unconventional medical treatment.[6]
[6] Health Practitioners (Professional Standards) Act 1999 s241(2)(j)(i)
I accept the Board’s submission that it is not necessary to set conditions that should apply if Dr Tarvydas is registered to practice in the future.[7] The Board will have ample power to set such conditions.[8] This is best done in the light of circumstances as they then appear. That is particularly so in this case because there is an unresolved disciplinary matter involving Dr Tarvydas under investigation by the Medical Board of Western Australia. It is more appropriate to consider conditions that might apply once those proceedings are determined.
[7] Health Practitioners (Professional Standards) Act 1999 s241(2)(j)(ii)
[8] Health Practioner Regulation National Law Act 2009 s83
Further, the Board submitted he should not be allowed to apply to be registered in the next 2 years. Dr Tarvydas has not been able to practice in Queensland since December 2007, when his registration was suspended, some two and a half years ago. Nevertheless I consider a longer period of cancellation is called for in this case, for the reasons which follow.
Dr Tarvydas demonstrated his contempt for regulatory processes designed to protect the public by his decision not to co-operate in the Board’s investigation. His choice not to participate in the tribunal proceedings suggests a lack of remorse and inspires little confidence about his future practice.
Dr Tarvydas has been the subject of previous disciplinary sanction in Western Australia. He was suspended for 12 months, reprimanded and fined $2,500 for improper and infamous conduct arising from his prescription of pethidine and anabolic steroids to patients. Further details about those proceedings are not before the tribunal, but it is concerning that they also involved the use of steroids.
Dr Tarvydas apparently targeted a group of people who, because of their chronic and debilitating pain, were vulnerable and likely to respond to the hope his so-called stem cell therapy treatment offered. He made no attempt to properly inform the patient of the treatment and any associated risks. Nor did he take the basic step of assessing her condition and monitoring the impact of his treatment. In so doing he put her health at risk. In short, he demonstrated no concern at all for his patient’s welfare.
Dr Tarvydas will not be eligible to apply to be re-registered for a further 3 years.[9] The details of this disciplinary finding and sanction will be recorded in the register for 6 years.[10]
[9] Health Practitioners (Professional Standards) Act 1999 s241(4)
[10] Health Practitioners (Professional Standards) Act 1999 s242(1)(d)
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