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GP's involvement as friend where patient cared for by another GP (00HDC08647)
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00HDC08647, 27 June 2002
Right to services of an
appropriate standard ~ Reasonable care and skill ~
Right to make an informed choice and give informed consent
~ General practitioner ~ Mental illness ~
Welfare guardian ~ Rest home ~ NZMA Code of
Ethics ~ Protection of Personal and Property Rights Act
1988 ~ Right 4(2) ~ Right 7(1)
A complaint was made by the General
Manager of a rest home and hospital about the services provided to
the consumer by a general practitioner. The complaint was on the
basis that the general practitioner consulted with the consumer
without the permission of her son, who holds a Power of Attorney,
and without the approval of the regular general practitioner, and
that this resulted in the consumer being advised that she is not a
paranoid schizophrenic; being given a change in her medication
without consultation with her regular general practitioner; and
being encouraged to move to another town to receive treatment there
from the general practitioner.
The facts were that the consumer had
a history of paranoid schizophrenia. Her son had been appointed as
her welfare guardian. The GP, who considered herself a friend of
the consumer through their common ethnic background and church
associations, declined a request to be the consumer's general
practitioner but assisted in developing the consumer's trust in
another practitioner. Subsequently the GP continued to visit the
consumer as a friend but also acted in a professional capacity on
at least two occasions without the prior knowledge of the other
practitioner. The other practitioner found the GP's interference in
the care of the consumer slightly irritating but, as the consumer
was a difficult patient to care for, the GP's assistance was, on
the whole, considered helpful.
The Commissioner reasoned, after
receiving independent expert advice from a general practitioner,
that:
(1) the New Zealand Medical
Association "Code of Ethics" requires that a doctor not interfere
with another doctor's established relationship with his or her
patient without compelling reasons to do so;
(2) the GP's actions, which resulted
from a degree of role confusion, were helpful, and she kept the
consumer's GP informed;
(3) the Protection of Personal and
Property Rights Act 1988 emphasises the importance of promoting the
independence and best interests of the individual; and
(4) there was nothing to support the
allegations that the GP encouraged the consumer to believe she was
not suffering from schizophrenia, or that the GP encouraged the
consumer to move, and these allegations seemed to be based on
conjecture.
The Commissioner held that the
general practitioner
(1) did not breach Right 4(2) in
that she did not unreasonably interfere in the agreed GP's
relationship with the consumer; and
(2) did not breach Right 7(1) as the
evidence suggested that she provided care to the consumer only when
acting with her full knowledge and concurrence.