Health Practitioners Disciplinary Tribunal, 1298/Med22/554D, (17 March 2023)
The Director of Proceedings filed a charge of professional misconduct against general practitioner Dr Nelson Nagoor (Dr Nagoor) in the Health Practitioners Disciplinary Tribunal (the Tribunal).
The charge concerned Dr Nagoor’s failure to care for his patient, Mr Joshua Linder, adequately following the removal of a mole on Mr Linder’s back in April 2019. Dr Nagoor received a histology report advising that the lesion was an invasive primary melanoma. The report recommended a wider excision to extract the melanoma. However, Dr Nagoor did not act on this recommendation.
Instead, Dr Nagoor advised Mr Linder that the lesion was not cancer, did not advise that a wider excision was recommended, and failed to refer Mr Linder for further specialist assessment, management, and treatment in respect of the melanoma.
Mr Linder did not become aware of his diagnosis until almost six months after his first consultation with Dr Nagoor. Sadly, Mr Linder died on 28 June 2022 as a consequence of the melanoma.
The Tribunal was satisfied on the balance of probabilities that Dr Nagoor failed to take any steps to advise Mr Linder about the histology report. It found that there was no communication at all from Dr Nagoor to Mr Linder regarding the histology report, nor were there any arrangements made by Dr Nagoor to actively set up a consultation with Mr Linder to advise him about the diagnosis.
The Tribunal also considered that Mr Linder’s recollection of the 30 April 2019 consultation where Dr Nagoor informed Mr Linder that his mole was “not cancer” was reliable and accurate. The Tribunal found that Mr Linder was not told that he had an advanced aggressive melanoma requiring wider excision, and this was a significant departure from accepted standards. Further, the failure to act on the advice of the histology report or in accordance with the clinical guidelines was considered a severe departure from accepted standards.
Finally, the Tribunal considered that the consultation on 2 August 2019 when Dr Nagoor reviewed Mr Linder was a further missed opportunity of care. There was no record of Dr Nagoor examining Mr Linder’s lymph node basins, nor any evidence of a skin check being performed, at the three-month follow-up appointment. The Tribunal was satisfied that these failures to examine the patient for lymph node enlargement following the diagnosis of an advanced, aggressive melanoma was a significant departure from accepted standards of care.
Regarding penalty, the Tribunal found that Dr Nagoor’s omissions in Mr Linder’s care were a serious departure from professional standards reasonably to be expected of a medical practitioner working in general practice. The Tribunal was satisfied that the appropriate penalty in this case was censure, suspension from practice for a period of three months, conditions should Dr Nagoor resume practice, and a fine of $5,000.00.
The Tribunal’s decision can be found at: https://www.hpdt.org.nz/portals/0/1298Med22554D.pdf