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15 Oct 2019
A medical practitioner from Canberra had conditions placed on his registration after he failed to obtain adequate informed consent, failed to adequately document a consultation and procedure, and failed to provide adequate follow up care.
On 2 August 2019, the ACT Civil and Administrative Tribunal (Tribunal) found that because of his conduct, Dr Al-Naser poses a ‘serious risk’ and it is necessary to take immediate action to protect public health and safety.
In December 2018 the Medical Board of Australia (the Board) took immediate action in the form of imposing conditions on Dr Al-Naser’s registration, after he performed a circumcision on a male child. The child suffered complications and required a blood transfusion and further surgery.
Dr Al-Naser appealed against the Board’s decision to impose conditions on his registration not to undertake any circumcision procedures and various ancillary conditions.
The question before the Tribunal was the same as that considered by the Board; whether because of Dr Al-Naser’s conduct, performance or health, he poses a serious risk to persons and it is necessary to take immediate action to protect public health or safety.
The Tribunal commented that there was a significant dispute about some of the facts relating to the matter, specifically the communication between the patient’s parents and Dr Al-Naser prior to the procedure and afterwards, the obtaining of informed consent, and the after care provided by Dr Al-Naser to the patient.
Dr Al-Naser provided a consent form to the mother of the patient. However, there was no information in the consent form of the risks and potential complications associated with the procedure, nor were the risks and potential complications explained verbally to the patient’s mother.
The Tribunal accepted the evidence of an expert witness that indicated Dr Al-Naser’s documentation of the consultation and procedure was inadequate in that he did not describe the physical anatomy or examination done prior to the procedure. Dr Al-Naser outlined the information he would ordinarily include in a clinical record but admitted he did not enter that information into the clinical record in this case.
The father of the patient contacted Dr Al-Naser after the procedure as the child had ongoing bleeding. At Dr Al-Naser’s request, the father sent the doctor photos of the patient that evening. Dr Al-Naser reassured the father that there was no need to worry. He further instructed the father to apply the prescribed antibiotic cream, administer Panadol and see how they go overnight. Further photos of the patient were sent to Dr Al-Naser the day after the procedure. Dr Al-Naser called the patient’s father immediately after and said that the patient looked ‘fine’ and although the bleeding was just ‘a little more than usual’ it was ‘totally normal’. The patient’s parents decided to get a second opinion from their local general practitioner. After examining the patient, the GP referred them to the hospital emergency department where the patient was diagnosed with a post circumcision haemorrhage.
The Tribunal revoked the condition imposed by the Board as it did not form the reasonable belief that Dr Al-Naser’s conduct in assessing and performing the circumcision poses a serious risk to persons. The Tribunal had access to expert evidence that was not available to the Board when it made its decision to take immediate action in December 2018.
However, the Tribunal decided that it was necessary to take immediate action to protect public health and safety on the basis that that Dr Al-Naser poses a serious risk to persons in relation to his conduct in obtaining inadequate informed consent, his inadequate documentation of the consultation and procedure and his inadequate follow up care of the patient. The Tribunal imposed a condition on Dr Al-Naser’s registration requiring him at the end of each month to provide details to AHPRA of surgical procedures, including circumcisions (and various ancillary conditions), performed during that month and to include the informed consent, the medical notes documenting each procedure and his notes of the follow up care in each case.
In forming its decision, the Tribunal had regard to Dr Al-Naser’s disciplinary history, noting some of the conduct the subject of the present appeal has been of concern to the Board since 2015.
The decision is published on the Austlii website.