Charge

On 12 - 16 March 2018 the Health Practitioners Disciplinary Tribunal considered a charge against Dr Rui Mendel, medical practitioner of Auckland (the Doctor).

The particulars of the Charge referred to:

• dishonest and unethical behaviour in misleading a patient’s mother in relation to changes to medication for a patient;
• dishonest and unethical behaviour in relation to the direction of administration of haloperidol decanoate to a different patient;
• dishonest and unethical behaviour in statements to two registrars concerning inclusion of detail in notes;
• unprofessional behaviour by the Doctor towards two registrars the Doctor was supervising;
• other alleged unprofessional behaviour towards other colleagues on three occasions; and  
• refusal or failure to keep adequate patient notes in relation to seven specified patients.

   

Background and Finding on Individual Particulars

The Doctor graduated as a physician overseas in 1987 and was vocationally registered in New Zealand in the scope of psychiatry in 2001.  He became a consultant on the Inpatient Psychiatric Unit at Rotorua Hospital (the Unit) in January 2014. 

When the Doctor commenced as a consultant two young female doctors were working as registrars in the Unit.

Dishonest and Unethical Behaviour in Misleading a Patient’s Mother

This patient had been committed under the Mental Health Act 1992.  She had a long history of severe bipolar affective disorder and intellectual disability.  She did not have the capacity to make decisions regarding her welfare and her mother was her welfare guardian and enduring attorney. 

The patient had been receiving sodium valproate for around 15 years alongside maintenance electro-convulsive therapy. 

The Doctor reviewed the patient and the Tribunal found the Doctor decided to change the patient’s regime which included taking her off the sodium valproate.  The change in medication was not successful.  The patient relapsed and the decision was made to revert back to the sodium valproate. 

At a meeting with the patient’s mother to discuss why the change in medication had not been successful, the Tribunal found the Doctor denied to the mother that he made the change to the patient’s medication and he said the community mental health team was to blame for the change in medication.

The Tribunal further found the Doctor admitted to one of the registrars that he had lied to the patient’s mother and directed the registrar not to document what he had said.

The Tribunal found this Particular established. The Tribunal found the Doctor’s conduct was malpractice and conduct bringing discredit to the profession, and was sufficiently serious to warrant a disciplinary sanction. 

Dishonest and Unethical Behaviour in Relation to the Administration of Haloperidol

This Patient was admitted to the Unit following an overdose. She had a significant previous psychiatric treatment history.

There was no dispute that the Doctor did prescribe and direct the administration of haloperidol.

This Particular to the Charge had five sub-particulars.

1.  The Tribunal was satisfied the Doctor failed to adequately assess the patient. The Tribunal found the Doctor’s conduct was negligent and conduct bringing discredit to the profession, and was sufficiently serious to warrant a disciplinary sanction. 

2.  The Tribunal was satisfied that the dose of haloperidol was inappropriate and was potentially harmful to the patient. The Tribunal found the Doctor’s conduct was, negligent, malpractice, and conduct bringing discredit to the profession. The misconduct was sufficiently serious to warrant a disciplinary sanction. 

3.  The Tribunal did not accept there was sufficient evidence that the Doctor knew the medication was not in his patient’s best interests; but it found that he ought to have known. The Tribunal found the Doctor’s conduct was negligent and conduct bringing discredit to the medical profession and was sufficiently serious to warrant disciplinary sanction. 

4.  The Tribunal found the Doctor failed to explain the effect and potential adverse effects of the medication to the patient and also that he failed to gain the informed consent of the patient. The Tribunal found the Doctor’s conduct was, negligent, malpractice, and conduct bringing discredit to the profession. The misconduct was sufficiently serious to warrant disciplinary sanction.

5.  The Tribunal was not satisfied there was sufficient evidence the Doctor administered or directed administration of a medication in an attempt to discipline or punish the patient.

The Tribunal found sub-particulars 1-4 above separately and cumulatively to be misconduct warranting disciplinary sanction.  However, they were not found by the Tribunal to be dishonest and unethical.  Overall therefore, this Particular was not established.

Dishonest and Unethical Conduct Concerning Inclusion of Detail in Notes

The Tribunal accepted the submission for the Doctor that the PCC did not discharge the onus of establishing to the necessary standard that he used the alleged words.  In addition, the words he did use, did not exhibit any dishonesty and unethical conduct on his part.  This Particular was therefore not established.

Unprofessional Behaviour to Registrars

A number of allegations were made regarding comments and a gesture made by the Doctor to the registrars.  Some of the allegations were found to be established and the Tribunal found that cumulatively the conduct was sufficiently serious to warrant disciplinary sanction.

Unprofessional Behaviour to Other Colleagues

It was alleged the Doctor stood over a junior doctor and shouted at her.  The Tribunal found there was evidence of the Doctor having shouted but there was inconclusive evidence of his having stood over her at the same time.  This sub-particular was not made out on the facts.

It was alleged the Doctor made a threatening phone call to a colleague. The Tribunal accepted that the words referred to in the sub-particular were used by the Doctor and found that these were not appropriate.  However, the Tribunal did not consider they were sufficient to establish professional misconduct. 

It was alleged the Doctor confronted a different colleague in an intimidating and/or threatening manner. The Tribunal found there was not sufficient evidence that there was intimidation or a threatening manner as to amount to professional misconduct.

This particular was not established.

Inadequate Patient Notes

The Tribunal considered notes of seven patients and it accepted that the notes for all seven patients were inadequate. The Tribunal found the Doctor’s conduct was negligent and conduct bringing discredit to the profession. The Tribunal found it was cumulatively sufficiently serious to warrant disciplinary sanction.

Overall Finding

The Tribunal found professional misconduct was established in relation to some of the Particulars of the Charge.

Penalty

On 4 December 2018 the Tribunal issued a Penalty Decision after receiving penalty submissions from the parties.

The Tribunal:

• censured the Doctor;
• ordered that he pay a fine of $5,000;
• placed conditions on his practice; and
• ordered him to pay costs of $71,000.

The Tribunal further directed publication of its decision and a summary.