2. Report on performance
Final determinations
During the reporting period, 26 final determinations were issued, 26 became effective and the sanctions imposed as part of the effective final determinations included:
- reprimand and counselling on all 26 determinations
- repayment across 22 determinations totalling $1 626 909.24 (from $983.21 to $269 499.24 and averaging $62 573.31 per determination)
- full disqualification periods from two months to one year totalling 6.4 years over 12 determinations
- partial disqualification periods from one
month to two years and nine months totalling 5.5 years over 10 determinations.
When a practitioner has had two effective final determinations the Director must provide a written notice to the Medicare Participation Review Committee (MPRC). Pursuant to section 106X of the Act the Director wrote to the Chairperson of the MPRC in March 2005 providing information relating to a recent effective determination against a practitioner and an earlier effective determination from October 1998. The MPRC has a discretionary range of options available — from taking no further action against the practitioner to counselling and reprimand and full or partial disqualification from participation in the Medicare benefits arrangements for up to five years. As required under the Act the practitioner was notified of the correspondence to the MPRC.
As the Director is able to publish certain information on practitioners where a final determination comes into effect, details of those in date-of-effect order are given below:
Dr John Chung-Tsang Lai, General Practitioner, Bendigo Vic
Dr Lai was reviewed for his high level of prescribing under the Pharmaceutical Benefits Scheme. During the referral period Dr Lai wrote a total of 1003 prescriptions for benzodiazepines that comprised 28.9 per cent of his total prescribing.
The Committee examined Dr Lai’s item 54 surgery consultations and his item 173 acupuncture items. The Committee found Dr Lai had engaged in inappropriate practice in 100 per cent of consultations examined. The Committee’s findings included that Dr Lai:
- failed to use accepted medical criteria for selecting patients to whom antibiotic drugs were prescribed
- failed to monitor the quantities of drugs
being supplied to patients - failed to take an adequate history or make a proper physical examination
- failed to keep medical records that contained essential clinical information
- did not formulate clinically sound management plans for his patients.
In relation to Dr Lai’s use of acupuncture, the committee found he subjected patients to more treatments than were necessary.
The Committee formed the opinion that Dr Lai’s conduct was likely to cause a significant threat to the life or health of his patients. The Director referred Dr Lai to the Medical Practitioners Board of Victoria.
The Determining Authority directed that Dr Lai repay $65 483.41 in Medicare benefits and be fully disqualified from Medicare for three months.
Dr Anthony Tsamoglou, General Practitioner, Kogarah NSW
The Commission requested the Director to review Dr Tsamoglou’s practice for three reasons: his high average number of services per patient (6.58) which was above the 98th percentile, his high volume of level C consultations (2253) which was between the 95th and 99th percentile, and his high level of initiation of pathology. Dr Tsamoglou initiated more pathology services per patient (4.12) than 99 per cent of all active general practitioners in Australia.
The Director found, in relation to MBS item 24 (level B home visit) and MBS item 37 (level C home visit), that Dr Tsamoglou engaged in inappropriate practice in all services examined as he did not keep medical records containing all essential clinical information.
When examining many of Dr Tsamoglou’s level C surgery consultations, the committee again found Dr Tsamoglou’s record keeping deficient in essential information. In particular there was ‘little or no documented evidence of counselling, which Dr Tsamoglou stated occurred’. The committee considered that, ‘good clinical records of psychological consultations in a general practice form part of proper clinical care, assist in tracking key issues between consultations and also with the management of recurring difficulties in the long term’.
Another aspect of Dr Tsamoglou’s practice that caused the committee concern was his use of MBS items 18274 and 18276 (paravertebral, cervical, thoracic, lumbar or coccygeal nerves, injection of an anaesthetic agent). Based on the evidence, both oral and written, the committee concluded that Dr Tsamoglou injected soft tissue trigger points rather than performing nerve blocks. The Committee was of the opinion that this conduct would have been unacceptable to the general body of general practitioners.
The Determining Authority found that Dr Tsamoglou’s conduct constituted inappropriate practice. It directed that Dr Tsamoglou repay to the Commonwealth $12 762.58, and be disqualified for a period of three months from all services provided as a vocationally registered general practitioner.
Dr Frederico John Facchini, Medical Practitioner, Kogarah NSW
The Commission requested Dr Facchini be reviewed for his high services per patient (10.67) and the high volume of long and prolonged consultations: 68 per cent of all Dr Facchini’s consultations were long surgery consultations, and 21 per cent were prolonged. During the referral period Dr Facchini received $120 245 in Medicare benefits.
During the hearing Dr Facchini told the committee that he ran a ‘walk-in practice’ and that he did not have a receptionist nor did he keep a diary
or a daybook.
The Committee found that 96 per cent of Dr Facchini’s item 54 services were inappropriate. Dr Facchini was found not to have taken an adequate history and/or made an adequate physical examination and/or formulated an adequate management plan. Dr Facchini was found to have rendered services not medically necessary and to have kept records deficient in essential clinical information.
Eighteen of the 30 randomly-sampled services under examination involved issuing of a prescription for methadone. Dr Facchini repeatedly justified his failure to follow up clinical aspects of presenting complaints amongst his patients because he was a ‘methadone doctor’. The Committee did not accept this as an excuse.
The Determining Authority noted that, in relation to most services, the clinical input was deficient and Dr Facchini’s medical records adversely impacted Dr Facchini’s ability to provide care to his patient. The Authority directed Dr Facchini to repay to the Commonwealth $24 444.64 and to be fully disqualified from Medicare for one month.
Dr David Michael Gillman, Medical Practitioner, Airlie Beach Qld
Dr Gillman’s practice was reviewed on request by the Commission for his level of prescribing methadone, codeine phosphate and pethidine. Dr Gillman prescribed 7275 items under the PBS at a net cost of $143 375.93. Of the total number of prescriptions issued, 26.91 per cent were for narcotics or benzodiazepines.
The Committee was ‘very concerned regarding the overall quality of Dr Gillman’s medical records’. During the hearing the committee became concerned regarding Dr Gillman’s management of pigmented lesions some of which he had treated without histological conformation of their nature. It is possible that some of Dr Gillman’s patients received inadequate care as a result of his management.
The Committee expressed its concern regarding Dr Gillman’s prescribing of narcotics for non-clinically valid reasons, for not using accepted medical criteria for selecting patients to whom drugs were prescribed, and for not giving proper warning of the addictive properties of some drugs.
The Committee found that Dr Gillman’s
conduct constituted inappropriate practice in relation to 79 per cent of the class of MBS item
44 services and 15 per cent of the class of MBS item 30195 services.
The Determining Authority directed Dr Gillman to repay $11 640 to the Commonwealth and be disqualified from Medicare for six months from all services provided as a vocationally registered general practitioner.
Dr Wan Kum Chan, General Practitioner, Kingsford NSW
The Commission requested Dr Chan be reviewed for her high level of services. During the referral period Dr Chan provided 16 331 services to 5075 patients which put her well above the 99th percentile compared to all active general practitioners in Australia. Dr Chan gained benefits of $347 083.25 for these services.
The Committee concluded that all the 30 randomly sampled services would be considered unacceptable to the general body of general practitioners and would therefore constitute inappropriate practice.
Dr Chan’s medical records were found to be deficient in essential clinical information and, in all instances, the committee found Dr Chan had recorded information that was indecipherable. The Committee was not satisfied, by the oral and written evidence, that Dr Chan formulated and/or implemented an adequate management plan for a diagnosed complaint.
The Determining Authority directed Dr Chan to repay $101 382.71 and be disqualified for six months from Medicare for all services provided as a vocationally registered general practitioner.
Dr Jerzy Cywinski, General Practitioner, Bonnyrigg/Austral NSW
See summary under Federal Court and Full Federal Court, decisions handed down, later in this chapter.
Dr Peter Andrianakis, Medical Practitioner, Yarraville/East Kew Vic.
See summary under Federal Court and Full Federal Court, decisions handed down, later in this chapter.
Dr Kim Fatt Chan, General Practitioner, Reservoir Vic.
The Commission requested Dr Chan be reviewed for his high level of daily servicing and his overall high number of rendered services. During the referral period Dr Chan rendered 20 947 services to 5950 patients. This was well above the 99th percentile (15 515) for all active general practitioners in Australia. During the referral period Dr Chan rendered services for a total of $463 114.05 in Medicare benefits.
In almost every record examined, the committee noted that Dr Chan’s writing was mostly illegible. Dr Chan repeated information in patients’ records that he had obtained previously which made it difficult for him or any other treating practitioner to understand what had actually occurred during that particular consultation.
The Committee examined 61 MBS item 36 services and found that Dr Chan had engaged in inappropriate practice in 40 of the 61 services. Dr Chan was found not to have taken an adequate history, had failed to make an adequate examination, had failed to arrange necessary investigations and had failed to implement an adequate management plan in relation to one or more problems.
The Determining Authority required Dr Chan to repay to the Commonwealth benefits in the amount of $20 992.95 and be fully disqualified for two months from Medicare.
This was Dr Chan’s second referral to Professional Services Review. He had had an adverse determination in 1998 wherein he was required to repay $8255.90 and be disqualified for one month. As a result of the second adverse finding he was automatically referred to the Medicare Review Participation Committee.
Dr Jonathon Robert Turtle, General Practitioner, Deakin ACT
The Commission requested that Dr Turtle be reviewed for his rendering of a high proportion of long and prolonged consultations compared to standard consultations (1367 level B, 2458 level C and 502 level D). In addition, Dr Turtle’s rate of referral for pathology was above the 99th percentile for all active general practitioners in Australia ($61 524.70 in total pathology benefits).
The PSR committee found that Dr Turtle failed to collect and record an adequate history, failed to perform an examination of multiple systems, failed to arrange necessary investigations, and/or failed to implement a management plan.
The committee was of the opinion that, in some cases, Dr Turtle performed an examination that was inadequate for the presenting complaint. In other cases Dr Turtle failed to arrange the necessary investigations for the presenting complaint. This could have led to a misdiagnosis, resulting in the wrong treatment.
The committee’s conclusion was that Dr Turtle’s conduct would be unacceptable to the general body of general practitioners in connection with the services examined.
The Determining Authority found Dr Turtle’s inappropriate practice to be significant, and that it was of a serious nature. In light of submissions from Dr Turtle on the draft determination, the Authority reduced the severity of the sanctions because of Dr Turtle’s willingness to change and his acknowledgement that his records were inadequate.
The final determination directed that Dr Turtle repay to the Commonwealth Medicare benefits in the amount of $57 082.12. In addition, he was disqualified for six months from all services provided as a vocationally registered general practitioner.
Dr Chris Siamidis, Medical Practitioner, Brunswick Vic.
See summary under Federal Court and Full Federal Court, decisions handed down, later in this chapter.
Dr Mario Marchesani, General Practitioner, Geelong Vic.
Dr Marchesani was reviewed on request because of the high number of services per patient he rendered and the number of his level C consultations and home visits. Dr Marchesani rendered 338 level C home visits during the referral period -— well above the 99th percentile (170).
The committee examined Dr Marchesani’s long surgery (item 36) and long home visits (item 37). Dr Marchesani was found to have engaged in inappropriate practice because he failed to take a detailed history, failed to provide an adequate level of clinical input and kept medical records that were deficient in essential clinical information. Dr Marchesani visited patients with relatively straightforward single system problems, the committee considered these visits not clinically necessary. Dr Marchesani believed the time spent making specialist appointments for patients could be included when calculating the length of time of a consultation. The committee did not agree.
Dr Marchesani rendered many home visits to patients well known to him, sometimes at the request of the patient and sometimes on his own initiative. The committee found, in almost every instance, no evidence of any condition or new illness that would require Dr Marchesani to spend in excess of 20 minutes with the patient. The committee found that 100 per cent of Dr Marchesani’s long home visits were inappropriate.
The Determining Authority considered that Dr Marchesani failed to provide adequate clinical input to the services he provided.
The Authority directed that he repay to the Commonwealth $21 154.32 and be disqualified for a period of six months from all services provided as a vocationally registered general practitioner.
Dr William Crow Lyon, General Practitioner, McCrae Vic.
The Commission requested a review of Dr Lyon because of his excessive prescribing of benzodiazepines and codeine-containing compounds. In the referral period, Dr Lyon wrote 1431 prescriptions for benzodiazepines and 566 codeine compound analgesics to 274 patients.
The committee found that Dr Lyon ‘gave little or no consideration to whether some of his patients were drug dependent. He issued frequent repeat benzodiazepine prescriptions to patients, with little or no other clinical input’. The committee found a number of instances where Dr Lyon prescribed two benzodiazepines to patients during a consultation. When asked why he prescribed them in combination, Dr Lyon stated: ‘I don’t know why I do it really, to be honest with you’. He acknowledged that he sometimes prescribed drugs because the patient wanted them.
Dr Lyon’s progress notes generally consisted of single-line entries, with no history or evidence of an examination. The committee formed an opinion that Dr Lyon’s conduct was causing or was likely to cause a significant threat to the life or health of his patients. As a consequence he was referred to the Medical Practitioners Board of Victoria.
The Determining Authority directed that Dr Lyon be reprimanded and counselled and repay to the Commonwealth $1436.67. The Authority took into account that Dr Lyon was the subject of conditional registration supervised by the Medical Practitioner’s Board of Victoria.
Dr Jonathon Brent Sutton, General Practitioner, Doncaster/Fitzroy North Vic.
The Commission requested that Dr Sutton be reviewed because of his high level of services per patient (10.36 services per patient, total benefits $226 059.80), and the number of level C and D surgery consultations. Dr Sutton was above the 90th percentile for level C surgery consultations and above the 99th percentile for level D surgery consultations. He was also reviewed for the level of home visits and initiation of pathology and radiology. Dr Sutton’s total home visits made up 30 per cent of his total consultations compared with all active general practitioners in Australia (2.25%).
The committee found that, in those services it examined, Dr Sutton’s treatment ‘could not be described as accepted practice and was at best often superficial if not bizarre. Given the patients’ ailments his treatment also often appeared to be illogical, too frequent and without a sound clinical basis.’
The committee was concerned also that ‘Dr Sutton’s treatment of family members for psychiatric problems which, in the circumstances described, was inappropriate and demonstrated a lack of insight on his part’. The number of visits and consultations to his family members was extraordinary—85 to one and 45 to another.
The Determining Authority noted that Dr Sutton’s inappropriate practice was of a serious nature. It also noted that the Authority imposed lesser directions on Dr Sutton than it otherwise would have, because the Medical Practitioner’s Board of Victoria was dealing with him. The Authority based its decision on only the 19 services the committee had examined and did not extrapolate. The Authority directed that Dr Sutton repay $983.21 and be fully disqualified for six months.
Dr Ian Gordon Falconer, General Practitioner, Croydon South Vic.
The Commission requested a review of Dr Falconer due to his very high services per patient. During the referral period Dr Falconer had an average of 13.14 services per patient and rendered 1932 services to 147 patients. Despite having a very small patient base Dr Falconer was above the 99th percentile for emergency attendance after hours.
The committee found that Dr Falconer had engaged in inappropriate practice by failing to provide adequate clinical input into services, rendering services that were not necessary, managing chronic pain in a clinically unacceptable way, and prescribing narcotics and benzodiazepines when they were not clinically indicated.
During the hearing the committee became concerned that, due to Dr Falconer’s health and mental state, he was unfit to continue participating in the proceedings. Dr Falconer was referred to a consultant physician for an opinion. The physician advised that Dr Falconer was not fit to continue in practice. The committee was concerned that Dr Falconer’s conduct was causing or was likely to cause a significant threat to the life or health of his patients. The Director was advised of the committee’s concerns and Dr Falconer was referred to the Medical Practitioner’s Board of Victoria.
The Determining Authority directed that Dr Falconer be reprimanded and counselled by the Director. Dr Falconer agreed to retire from medical practice.
Dr Ian Lester Rafter, General Practitioner, Sydney NSW
The Commission requested that Dr Rafter be reviewed because of his high level of pathology initiation. In the review period Dr Rafter referred 939 patients for a total of 7290 pathology services at a total benefit of $164 684.20—
this was 968 services above the 99th percentile for all active general practitioners in Australia.
The committee found Dr Rafter had initiated pathology services that were not medically necessary. In addition, the committee found that many of Dr Rafter’s initiated pathology services were for health screening, as defined in the MBS book.
Dr Rafter ordered significant amounts of pathology in all consultations examined. The committee concluded that ‘many of the pathology tests initiated had no role in the diagnosis or management of patient symptoms’. Pathology services were often repeated within short intervals.
Dr Rafter used pathology services to explore patient symptoms without conducting a physical examination. Additionally, Dr Rafter initiated some pathology services to explore patient symptoms based on the assertions of unproven literature and theory.
The Determining Authority considered that a reprimand and counselling were both necessary and appropriate sanctions in Dr Rafter’s case.
Dr Lawrence Matthew Finley, General Practitioner, Culburra Beach NSW
The Commission requested that Dr Finley be reviewed for his high level of total services (16 710) and his prescribing of benzodiazepines. With a patient base of 4438 patients, Dr Finley prescribed 27 579 items under the PBS at a net cost of $512 494.95. On 1936 occasions he prescribed benzodiazepines (7.01 per cent of total prescriptions).
The committee found that 100 per cent of the sampled item 23 services were inappropriate. In particular the committee found that Dr Finley had failed to provide adequate clinical input into the services, had prescribed benzodiazepines when these were not clinically indicated, and failed to keep adequate and contemporaneous records. Dr Finley’s records were generally illegible.
The committee also examined Dr Finley’s conduct in relation to rendering items 18216 (intrathecal or epidural injection), 18242 (greater occipital nerve injection of an anaesthetic agent) and 39115 (percutaneous neurotomy). All of these services rendered by Dr Finley were found to be inappropriate. In particular the committee was very concerned about Dr Finley’s inadequate sterilisation methods. Dr Finley told the committee he had not used an autoclave for 10 years. Dr Finley initially asserted he had an autoclave until his wife reminded him he had given it away many years ago. He also told the committee it was his routine practice to reuse the same blade for (on average) 10 consecutive patients. The committee communicated their concerns to the Director who referred Dr Finley to the NSW Health Care Complaints Commission.
In view of the serious nature of Dr Finley’s inappropriate practice the Determining Authority directed that Dr Finley repay $269 499.24 and be disqualified for 12 months from all services provided as a vocationally registered general practitioner.
Dr Guy Claude Delcourt, General Practitioner, Mill Park Vic
The Commission requested that Dr Delcourt be reviewed because of concerns regarding his itemisation of deep skin repair. During the referral period Dr Delcourt rendered many more deep wound repairs than superficial repairs. Dr Delcourt’s profile was higher than the 99th percentile for these items than for all other vocationally registered general practitioners in Australia.
In addition to the Commission’s concerns, the Director was also concerned that Dr Delcourt’s conduct in rendering MBS item 36 services may have constituted inappropriate practice.
The committee investigated Dr Delcourt’s item 36 services and found that 100 per cent of the sampled services were inappropriate.
The committee then examined Dr Delcourt’s conduct in relation to deep wound repair (MBS item 30029). All of Dr Delcourt’s item 30029 and 30035 services were also found to be inappropriate. In particular he had not recorded essential clinical information as to wound location, tissue layer involved and tetanus immunisation status. The committee found Dr Delcourt had acted on his incorrect belief that if subcutaneous tissue was involved in any location it constituted a deep laceration, whether or not sutures were used. The committee also disagreed with Dr Delcourt’s opinion that a laceration on the fingertip constituted a deep laceration. On occasions Dr Delcourt used Steri Strips to treat wounds and claimed to have repaired a deep laceration.
The Determining Authority directed that Dr Delcourt be counselled and reprimanded by the Director and repay $16 435.26 in Medicare benefits.
Dr Neville Arthur Breitkreutz, General Practitioner, Biggera Waters Qld
The Commission requested that Dr Breitkreutz be reviewed because of his prescribing of benzodiazepines, narcotics and codeine compounds. During the referral period Dr Breitkreutz wrote 727 prescriptions for benzodiazepines, 268 for codeine compounds and 397 for narcotics. The Commission was also concerned that many doctor-shopping patients were attending Dr Breitkreutz’s practice.
The committee was concerned that Dr Breitkreutz prescribed drugs to his patients without adequate clinical indications. The committee concluded that he prescribed drugs of addiction to patients on demand. In the case of a patient suffering from spinal stenosis Dr Breitkreutz continued to prescribe large quantities of narcotics and benzodiazepines. For another patient suffering from back pain Dr Breitkreutz prescribed Physeptone (methadone) 10 mg tablets (pack of 20) every three days. The committee concluded that he failed to record an adequate history or formulate an adequate management plan. Dr Breitkreutz’s records at times consisted of only single-line entries.
The committee regarded Dr Breitkreutz’s disregard of Department of Health and Ageing advice that temazepam capsules should not be prescribed (due to the risk that addicts may inject the contents) as a serious threat to his patient. If injected into an artery, temazepam can cause tissue damage and gangrene.
The Determining Authority directed that Dr Breitkreutz be reprimanded and counselled by the Director. In his submission to the Determining Authority Dr Breitkreutz advised that he had retired from practice.
Dr Jack Freeman, General Practitioner, Nth Melbourne Vic.
See summary under Federal Court and Full Federal Court, decisions handed down, later in this chapter.
Dr Constantinos Perkoulidis, Medical Practitioner, Brunswick Vic.
See summary under Federal Court and Full Federal Court, decisions handed down, later in this chapter.
Dr Phillip John Chapman, General Practitioner, South Broken Hill NSW
The Commission requested that Dr Chapman be reviewed for his high level of services. Dr Chapman provided 16 521 services for a total benefit of $408 054.80; this put Dr Chapman above the 99th percentile when compared to all active general practitioners in Australia. Dr Chapman was also reviewed for prescribing under the Pharmaceutical Benefits Scheme. Dr Chapman prescribed 44 174 items at a net cost of $974 046.52.
The committee found inappropriate practice in 52 per cent of the exploratory sample of services. The committee found that Dr Chapman ‘did not provide an appropriate level of clinical input into the services and failed to satisfy the requirement of MBS item 23’. Dr Chapman’s medical records ‘were not sufficient to contribute to the quality and continuity of care received by patients’.
The committee found ‘there was no documented or oral evidence that Dr Chapman employed clinical management plans or strategies designed to provide comprehensive and continuing whole-patient care to patients who presented with long term chronic conditions’.
The Determining Authority considered that Dr Chapman’s inappropriate practice was serious and considerable. Applying the sampling methodology, 5189 MBS item 23 services involved inappropriate practice. The Authority directed Dr Chapman to repay $116 305.56 and be fully disqualified for three months and be disqualified for 12 months from all services provided as a vocationally registered general practitioner (concurrent with the full disqualification).
Dr Mohammed Amjad Hussain, General Practitioner, Airport West Vic.
The Commission requested a review of Dr Hussain because he had rendered 80 or more attendances on 22 occasions during the referral period.
The committee reached a finding that Dr Hussain had engaged in inappropriate practice by rendering 80 or more attendances on 22 days and that there was no suitably persuasive evidence of exceptional circumstances on any of the 22 days.
In his submission, Dr Hussain claimed there were exceptional circumstances that had led him to
be unable to render less than 80 attendances on the 22 days. His submission contained, inter alia, the following reasons:
- a relative shortage of GPs in the western suburbs of Melbourne
- Dr Hussain’s partner was unavailable during the referral period
- migrant groups comprise a loyal patient base
- all patients were bulk billed, while surrounding practices had reduced bulk billing
- no other clinics in the shopping area in which the practice was situated.
The committee considered these ‘reasons’ and rejected all of them as an explanation for Dr Hussain’s conduct. The committee was of the opinion that a practitioner should be able to proactively manage his practice so as to avoid a situation where he sees very large numbers of patients.
The Determining Authority directed Dr Hussain to repay to the Commonwealth $42 124.45.
Dr Khalid Aziz Qidwai, General Practitioner, Ashfield NSW
The Commission requested a review of Dr Qidwai because of his high level of rendering a level C consultation item with a procedural item. During the review period Dr Qidwai claimed 936 level C consultations and 919 procedural items.
The committee examined Dr Qidwai’s conduct in respect of 40 randomly sampled services and concluded that his conduct in connection with 36 of these services would be considered unacceptable to the general body of general practitioners. In particular 33 services were not medically necessary and the records of 35 services examined were considered to be deficient in essential clinical information and of a very poor standard.
During the hearing the committee became concerned that Dr Qidwai’s conduct was causing or was likely to cause a significant threat to the life or health of his patients for the following reasons:
- lack of understanding of autoclaving techniques
- lack of understanding of resuscitation facilities
- inadequately trained surgery assistants
- inadequate medical records
- inaccurate reading and assessment of histopathology reports
- lack of understanding of legal requirements for termination of pregnancies.
The committee communicated its concerns to the Director who was obliged to notify the Medical Board of New South Wales.
The Determining Authority viewed Dr Qidwai’s inappropriate practice as considerable. It determined that he repay $10 512.56, be fully disqualified for two months and be disqualified for four months from all services provided as a vocationally registered general practitioner (concurrent with the full disqualification).
Dr Michael Levenda, General Practitioner, Caulfield North Vic.
The Commission requested that Dr Levenda be reviewed for rendering of level C surgery consultations (item 36), for minor skin excisions, and use of nasendoscopy item 41764. Dr Levenda was above the 99th percentile for his level C consultations, skin biopsy item 30071, and nasendoscopy.
The committee found that Dr Levenda had engaged in inappropriate practice in all of the item 36 and item 41764 services examined. In addition, 10 of the 11 skin biopsy services the committee examined involved inappropriate practice.
The committee found numerous examples of Dr Levenda failing to provide adequate input: failure to determine the cause of a patient’s frequent falls, failure to consider the significance of the symptom of ‘numb toes’ in a diabetic patient, and failure to establish the source of infection prior to prescribing Doryx.
Dr Levenda’s use of a nasendoscope displayed grossly inappropriate conduct. He had used the instrument to examine simple problems such as a blocked nose, cough and allergic rhinitis. In some instances he failed to institute other, more appropriate investigations, such as X-ray, for a possible fractured nose.
Dr Levenda’s medical records were also found to be inadequate. The committee concluded that in all cases examined Dr Levenda’s records were not sufficiently clear and detailed so that another practitioner could safely and effectively undertake the patient’s ongoing care.
The Determining Authority found that Dr Levenda’s inappropriate practice was of a serious nature. The Authority directed that Dr Levenda repay $69 172.87 and be disqualified for six months from all services provided as a vocationally registered general practitioner.
Dr Albert Gerald Galea, General Practitioner, Liverpool NSW
Dr Galea was reviewed, on request by the Commission, because his total services were above the 99th percentile—17 416 services to 2974 patients for a total benefit of $406 739.30. He was also referred for his high level of diagnostic imaging that was also above the 99th percentile.
The committee considered that 25 of 30 randomly sampled services Dr Galea rendered were inappropriate. Dr Galea’s records were deficient in essential clinical information and there was generally a lack of appropriate clinical input. With respect to diagnostic imaging, the committee found that Dr Galea initiated services that were not necessary and failed to take an adequate history or carry out an adequate examination before initiating these services.
The committee also formed the view that Dr Galea’s conduct was causing or was likely to cause a significant threat to life or health of his patients. The reasons for this view included his inadequate pharmacological management and high prescribing levels and his poor patient management. The committee communicated its concerns to the Director who referred Dr Galea to the New South Wales Health Care Complaints Commission.
The Determining Authority agreed with the committee that Dr Galea had engaged in inappropriate practice in a large number of services (11 743 item 23 services). It directed Dr Galea to repay $267 547.50 and be disqualified for three months from all services provided as a vocationally registered general practitioner.
Dr Paul Joseph Ameisen, General Practitioner, Edgecliff NSW
The Commission requested a review of Dr Ameisen for his high level of services per patient. Dr Ameisen rendered 8751 services to 1402 patients (6.24 services per patient) for a total benefit of $263 733.50. He was also referred for the level of his initiation of pathology, his high level of prescribing Pethidine injections and benzodiazepines. Dr Ameisen was also above the 95th percentile in his rendering of level D surgery consultations.
The committee found that Dr Ameisen generally did not take detailed histories of patient’s presenting complaints and on several occasions did not examine the patient.
On the occasions Dr Ameisen did undertake an examination it was brief and was not of multiple systems, as required by the MBS descriptor. In all but two of the services examined, the clinical component of the service did not warrant use of MBS item 36. The entries in the medical records were generally insufficient to contribute to the quality and continuity of patient care.
On occasion, Dr Ameisen relied on results from a Lis Ten test, (a form of computerised electrodermal screening performed by another person who was not a medical practitioner), rather than the evaluation of clinical indications. In one example Dr Ameisen ‘intended to base the management plan for this patient, who had a history of chemical exposure, on the Lis Ten test rather than history and examination findings’.
The Determining Authority found that Dr Ameisen’s inappropriate practice was significant: ‘Dr Ameisen’s conduct in respect of 25 out of 26 MBS item 36 services sampled and 23 of the 25 MBS item 44 services sampled would be unacceptable to the general body of general practitioners.’
In most instances Dr Ameisen did not satisfy the requirements of the Medical Benefits Schedule, his clinical input was deficient, and his medical records adversely impacted his ability to provide care to his patients.
The Determining Authority directed Dr Ameisen to repay $63 525.20 in benefits and be disqualified for six months from all services provided as a vocationally registered general practitioner.