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DP v Dr Krishnayya

Health Practitioners Disciplinary Tribunal, 6 June 2007

Following a hearing on 6 - 8 June 2007, Dr Gornoori Krishnayya was found guilty of professional misconduct as a result of a breast reduction procedure he performed on a patient who then developed post-operative complications, resulting in significant tissue loss and disfigurement.

Dr Krishnayya performed a Lejour breast reduction, which is a technique better suited to small reductions or mastopexy (breast re-shaping). The Tribunal found that the surgeon's choice of procedure was not appropriate for his patient, who was obese. This factor increased the risk of ischaemia (inadequate flow of blood to a part of the body), which in turn may lead to necrosis (death) of tissue. Furthermore, the patient had very large breasts, with a sternum to nipple distance of 49cm. The procedure entails maintaining the blood supply from the nipple to the chest wall via a pedicle (a tube of tissue). When the breast was reduced, the pedicle was shortened to 22cm, as a result of which the pedicle would have been folded or rotated, thereby compromising the blood supply. Because of Dr Krishnayya's limited understanding and knowledge of the Lejour technique and any other procedures, the Tribunal concluded that the surgeon was not well placed at all to determine that the Lejour procedure was appropriate for his patient.

The Tribunal found that there was inadequate information pre-operatively, in that Dr Krishnayya failed to advise his patient that because of her height to weight ratio and her smoking, there was a significantly increased chance of major tissue loss post-operatively, (because of the risks of ischaemia) and also that he failed to tell her that it was possible that she would be unable to breast-feed post-operatively.

Dr Krishnayya's failure post-operatively to explain to his patient the cause of the necrosis and infection, the likelihood of nipple loss, the possibility that antibiotics might not be effective in treating the infection, and that re-operation under general anaesthetic might be required, when considered along with the other shortcomings were found to amount to professional misconduct.

In imposing penalty, the Tribunal observed that Dr Krishnayya had "a lack of knowledge of essential procedures which he should have been aware of when undertaking breast reduction surgery". It imposed extensive conditions, including that he practise under supervision for three years, not undertake any new procedures, not undertake or advertise any plastic, reconstructive or cosmetic surgery, and that he undertake education in communication, risk factors and post-operative complications. An urgent and full competence review by the Medical Council of New Zealand was recommended. He was fined $5000 and ordered to pay costs of $15,000. The Tribunal declined permanent name suppression. Dr Krishnayya's appeal to the High Court in relation to name suppression was unsuccessful.

A full copy of the Tribunal's decision may be found at http://www.hpdt.org.nz/Default.aspx?tabid=155