Tribunal finds medical practitioner engaged in professional misconduct during consultation

17 Jul 2017

A medical practitioner’s consultation with a 10-year-old girl with a malignant tumour has resulted in a tribunal finding of professional misconduct.

Dr Alastair Nuttall saw the patient with her parents during a consultation in September 2009. She had been diagnosed with a malignant tumour of her liver in August.

Doctors at Princess Margaret Hospital for Children (PMH) had previously recommended that the patient be treated with chemotherapy. The parents had been treating the girl with natural therapies and did not wish to have their daughter treated with chemotherapy. There was a hearing listed to take place in a court the day after they consulted Dr Nuttall, that could have resulted in the patient being treated with chemotherapy as a result of an order, and without the parents’ consent. The parents intended to have the patient travel overseas to avoid this.

The parents told Dr Nuttall they wished for her to be treated with natural therapies, including the application of mud or clay to her body.

At the parents’ request, Dr Nuttall provided a fitness to fly certificate and on the day of the consultation, the girl and her mother left for South America. The girl died in November 2009.

The Medical Board of Australia (the Board) referred Dr Nuttall to the Western Australia State Administrative Tribunal (the tribunal) alleging, among other things, that he should have:

• advised the parents that he did not have sufficient expertise or experience in the treatment of childhood hepatoblastoma
• consulted the oncology team at PMH to better inform himself about the patient’s clinical state
• not given advice that he was not qualified to give; advice which misled the parents about the efficacy of the alternative treatments, and
• not interpreted the ultrasound report or serial alpha fetoprotein (AFP) blood level measurements.

In April 2017, the tribunal found that Dr Nuttall behaved in a way that constituted professional misconduct in relation to all of the Board’s allegations.

It found, among other things, that:

• at the time of the consultation, Dr Nuttall did not have sufficient expertise or experience and did not inform the girl’s parents that he did not have expertise or experience in the treatment of childhood hepatoblastoma to enable him to properly interpret the ultrasound scan or the AFP test result; and should not have given any advice in relation to either of those tests
• Dr Nuttall should not have given advice in relation to a comparison between an ultrasound and CT scan
• Dr Nuttall expressly or impliedly approved of the parents providing alternative therapies to the patient and/or expressly or impliedly recommended they continue to administer natural therapies to the patient, and
• Dr Nuttall ought to have contacted a member of the oncology staff at PMH to better inform himself about the patient's clinical state and/or the likely efficacy of the proposed chemotherapy treatment before offering any medical advice to the parents concerning their intention to have their daughter travel overseas in order to avoid undergoing chemotherapy pursuant to a potential order of a court.

The tribunal ordered in June that Dr Nuttall be reprimanded and that his registration be suspended for 12 months from 19 July 2017. He was also ordered to pay the Board’s costs.

The reasons for the tribunal’s finding delivered on 10 April 2017 and the tribunal’s decision as to penalty and costs delivered on 19 June 2017 will be published on the Austlii website.