Charge Detail Summary

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File Number: Pod21/507P
Practitioner: Stephan Randall Edwards
Hearing Start Date:

Hearing End Date:

Hearing Town/City:
Hearing Location:
Charge Characteristics:

Conditions on scope of practice - failure to comply (Established)


Advertising inappropriate
(Established)


Legislation - breach of Health Practitioners Competence Assurance Act 2003
(Established)


Practising outside conditions or outside scope of practising certificate
(Established)


Title or scope - misrepresentation of
(Established)


Additional Orders:


Appeal Order:


Decision:

Full Decision 1211Pod20484 and 21507.pdf



Precis of Decision:

Charge

Between 15 to 26 March 2021 and 31 May to 1 June 2021, the Health Practitioners Disciplinary Tribunal (the Tribunal) considered two charges laid by a Professional Conduct Committee (PCC) against Mr Stefan Edwards, registered podiatrist of Auckland (the Podiatrist).

The Charges were laid under section 100(1)(a) and (b) of the Health Practitioners Competence Assurance Act 2003 (HPCA Act). The first charge alleges the Podiatrist was incompetent on several occasions relating to treatment he provided to six patients. The PCC alleged that the conduct amounted to malpractice or negligence in relation to the Podiatrist’s scope of practice and was likely to bring discredit to his profession. The second charge relates to the failure to observe the conditions of supervision placed on the Podiatrist after the first charge was laid.

The charge is summarised as follows:

  1. Over six surgeries from April 2013 to May 2016, the Podiatrist:
    1. Failed to obtain the patients informed consent for the procedure he was undertaking;
    2. Failed to make an informed diagnosis;
    3. Carried out inappropriate surgeries that harmed his patients;
    4. Failed to provide appropriate post-operative care;
    5. Used an unqualified member of staff to assist in a surgery; and
    6. Modified clinical records.
  2. Between September 2018 and July 2019, the Podiatrist breached the conditions imposed on his practice by the Podiatrist Board, by:
    1. Performing podiatric surgeries without supervision and deliberately omitting those surgeries in reports to the Podiatrists Board; and
    2. Describing himself as podiatric surgeon on his website, in breach of a condition on his scope of practice.

The PCC submitted that the Podiatrist’s conduct in respect of both the first and second charges when viewed either separately or cumulatively, amounts to professional misconduct in that it amounts to malpractice or negligence in relation to the Podiatrist’s scope of practice and has brought, or is likely to bring, discredit to the profession.

A detailed description of the charges against the Podiatrist can be found in the decision.

 

Background

The Podiatrist is, and at all material times was, a registered podiatrist. He was one of the few podiatrists in New Zealand with surgical training in foot surgery. The first charge relates to the Podiatrists practice undertaking foot surgeries across six complainants who all suffered varying degrees of chronic pain after their treatment by the Podiatrist. The complaints against the practitioner came to light after several patients made complaints to the Health and Disability Commissioner, which were subsequently referred to the Podiatrist’s Board.

Complainant A presented to the Podiatrist with a bunion deformity, an overlying second toe and a long second metatarsal. The Podiatrist undertook a surgery which resulted in an unstable joint, an overcorrection of the bunion, and a non-union of the second metatarsal. Complainant A suffered from chronic pain and deformity as a result.

Complainant B presented with pain in the central ball of her foot. The Podiatrist diagnosed a corn under the third metatarsal head, a bunion deformity of the big toe and excessively long third metatarsals. During the surgery problems arose with the torniquet, a decision was made to stop the surgery, and the Podiatrist was unable to complete the shortening of the second and third metatarsals. As a result, the Complainant suffered ongoing pain.

Complainant C presented with ingrown toenails. The Podiatrist additionally diagnosed them with congenital long second toes, recommending surgery to reduce their length as well as treat the ingrown toenails. The Podiatrist undertook a surgery intended to shorten the second and third toes which was unsuccessful and resulted in ongoing disfigurement, loss of normal function and pain.

Complainant D presented with painful arches in both feet and was diagnosed with a plantar fascia, and when the Podiatriast attempted to surgically release it he severed a nerve. The treatment left Complainant D with painful scarring, persistent pain, numbness in her foot when walking longer distances and severe pain stretching her foot.

Complainant E presented with a sore foot which was diagnosed as a Morton’s neuroma, or a thickening of the tissue around the nerve leading to the toes. Surgical decompression was performed on the same day. Complainant E was unhappy with the cost of the Podiatrist’s services and that she had not received conservative treatment of a cortisone injection. The surgery only provided temporary relief and the pain to her foot returned.

Complainant F presented with similar symptoms to Complainant D and the Podiatrist adopted the same course of action. The surgery was initially undertaken on the Complainants left foot using an endoscopic technique, but changed to open surgery when the camera lens became covered with fluid. Informed consent was not obtained for the endoscopic technique initially used. The practitioner undertook a second operation on the Complainants right foot also using an endoscopic technique, despite the difficulties encountered in the first surgery. The surgery resulted in nerve damage, causing the Complainant to suffer ongoing pain.

The second charge relates to Podiatrist Board imposed conditions on the practitioners scope of practice requiring supervision which were effective from 1 December 2017. Between 4 September 2018 and 6 December 2018, the practitioner performed unsupervised podiatric surgeries in breach of these conditions. These surgeries were not declared to the Podiatrist Board as required by a reporting condition. He failed to display on his website a notice that he was suspended from podiatric surgery as required and continued to describe himself as such. Subsequent to his suspension the practitioner continued to offer podiatric surgery services and display surgical patient testimonials on his website.

 

Finding

Charge 1 comprised 59 particulars, 51 of which the Tribunal found were established. The Tribunal found that this was conduct which amounted to professional misconduct. Mr Edwards had consistently failed to provide an adequate standard of care in respect of all six complainants. Mr Edwards failings pervaded most steps in the services he provided, from failing to obtain an informed diagnosis to managing post-operative care. In reaching this conclusion, the Tribunal did not accept that their finding meant that complications or adverse outcomes will automatically lead to a finding of negligence. Rather this was a case of consistently inadequate and negligent care at various stages falling well below a reasonable standard of care expected of registered Podiatrists. The Tribunal found that this was conduct requiring disciplinary sanction.

The Tribunal also found Charge 2 established, taking a very serious view on conduct that subverts professional obligations such as conditions on practice. The conditions were imposed to protect the public and aid the practitioner in further professional development, but they were subverted. The conduct was aggravated by the fact that the occurrence of these surgeries only came to light due to complaints made to the Health and Disability Commissioner. This was also viewed as conduct warranting disciplinary sanction.

 

Penalty

The Tribunal:

  • Censured the Podiatrist;
  • Cancelled the practitioners registration as both a podiatrist and podiatric surgeon,
  • Ordered the Podiatrist to pay 40% of the costs of the PCC and Tribunal, amounting to $195,000.00.

 

The Tribunal directed publication of the decision and a summary.

The full decision relating to this case can be found on the Tribunal website at www.hpdt.org.nz reference no: Pod19/465P.

 

Appeal

On 1 December 2022 Lang J delivered their judgment in the High Court on the appeal made by Mr Edwards of the liability decision made by the Tribunal. The Court upheld the majority of particulars and both charges finding professional misconduct. The Court largely agreed with the decision to cancel the practitioner's licence as he had already shown a propensity to subvert conditions on his license.

On 9 February 2023 the Court delivered their judgment as to penalty and costs. The Court set aside the decision of the Tribunal to cancel the practitioner's license, and instead made an order restricting the scope of the practitioner's license to podiatry, excluding podiatric surgery. The Court also reduced the imposition of costs from $195,000.00 to $172,000.00 to reflect the moderate decrease in the seriousness of the findings.