Tribunal restricts practice, finds unprofessional conduct

25 Feb 2016

The ACT Civil and Administrative Tribunal (ACAT) has found an orthopaedic surgeon engaged in unprofessional conduct.

The ACT Civil and Administrative Tribunal (ACAT) has found an orthopaedic surgeon engaged in unprofessional conduct and unsatisfactory professional performance in his treatment of a number of patients and restricted his practice to protect patients.

The Medical Board of Australia had referred Dr Richard Hocking, an orthopaedic surgeon, to the ACAT because of concerns about his clinical judgement and performance.

In April 2013, the Board had taken immediate action to protect patients and manage risk to the public, and had suspended Dr Hocking’s registration, pending other inquiries. Dr Hocking had appealed this decision and the ACAT ordered a stay of the Board’s decision.

In September 2013, ACAT considered this appeal and handed down its decision in March 2015. ACAT decided Dr Hocking’s ongoing practice posed an immediate risk to patients but that suspension was not necessary. Instead ACAT imposed a condition on his registration prohibiting Dr Hocking from treating paediatric patients who have Perthes Disease with platelet rich plasma (PRP), unless he does so under the supervision of a specialist orthopaedic surgeon approved by the Board. In the intervening period the Board had imposed other conditions on his registration in response to further notifications.

In March 2015, ACAT considered submissions related to three separate matters - two disciplinary actions by the Board and one appeal by Dr Hocking. At the time of the hearing Dr Hocking had three Board-imposed conditions on his registration preventing him from performing unsupervised open elective hip or pelvic surgery, other than routine primary adult hip replacement and requiring him to retrain in elective open hip or pelvic surgery. An earlier ACAT decision had imposed a condition on Dr Hocking not to perform any elective paediatric surgery.

The first matter related to allegations that Dr Hocking had removed bone from the rim of the hip socket of a 13 year-old patient who suffered from a congenital hip dysplasia, while he was performing a hip arthroscopy.

The Board alleged that three or four months after the operation, after Dr Hocking knew there had been complications post-surgery, he had created a second more detailed operation report that purported to be a contemporaneous account of the operation. The ACAT found that there were errors in Dr Hocking’s first report and that his second report was deliberately produced for use in possible disciplinary proceedings and aimed to present his actions during the arthroscopy in a more favourable light. The ACAT found the preparation of the second report amounted to unprofessional conduct.

The Board also alleged that Dr Hocking failed to disclose to the patient and her family the restrictions on his registration, when those restrictions would have prevented him from performing the second stage of the patient’s treatment plan. ACAT found that Dr Hocking’s belief that those restrictions would have been lifted by the time of the second stage of the treatment plan was not reasonable. The Tribunal was satisfied that Dr Hocking had a legal, ethical, and professional obligation to inform the patient of the restrictions on his registration and his failure to do so amounted to unsatisfactory professional performance.

The second matter related to allegations of Dr Hocking’s experimental and novel injection of Platelet Rich Plasma (PRP) inter-articularly into the hip of a nine year-old patient with Perthes’ disease.

ACAT accepted evidence that PRP was a novel therapeutic treatment for Perthes’ disease in paediatric patients but that there were no adverse effects for the patient in this case, that PRP is used to reduce inflammation in conditions not dissimilar to Perthes’ disease, and that PRP is increasingly being used to replace treatment with steroids to reduce inflammation.

ACAT noted that Dr Hocking was not, at the time, working within the public hospital system and was thereby not required to seek hospital ethics committee approval of his use of this novel technology to treat a child. For these reasons, ACAT found Dr Hocking had no case to answer about his use of the PRP treatment.

The Board’s allegation that Dr Hocking misrepresented to the patient’s parents the prior use of PRP injections to treat children with Perthes’ disease, and that he failed to gain the parent’s informed consent for its use on their daughter, were not proven. However, ACAT found Dr Hocking engaged in unsatisfactory professional performance by failing to refer the patient to another paediatric orthopaedic surgeon, when this was warranted.

The third matter related to the Board’s refusal in December 2013 to remove the three conditions imposed on Dr Hocking’s registration requiring supervision and retraining. ACAT decided to set aside the three conditions but replace them with new conditions.

Overall, ACAT found Dr Hocking had engaged in one count of unprofessional conduct and three counts of unsatisfactory professional performance. It applied a global response to the three matters by imposing conditions on Dr Hocking’s registration requiring him to discuss all complex cases pre-operatively with suitably qualified surgeons, highlight his athroplasty audit as part of his professional development and peer review process, practise within a department in the public hospital sector and with a group in the private sector and arrange his operating theatre bookings to make sure his major cases are performed only where and when a second surgeon is available to provide clinical back-up when needed.

The decision is published on ACAT.