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DP v Johri

Health Practitioners Disciplinary Tribunal, 25 July 2006

On 21 July 2006 a general practitioner, Dr Ajit Johri appeared before the Health Practitioners Disciplinary Tribunal and admitted a charge of professional misconduct in relation to the care he provided to his patient, Ms Vicki Wilson.

On 22 November 2004 Ms Wilson, at that time 40 years old and 21 weeks pregnant, visited her midwife for a routine check-up.  The midwife's notes document Ms Wilson having a lump in her left breast and that she advised Ms Wilson to see her general practitioner.

On 24 November 2004 Ms Wilson and her partner attended a consultation.  Dr Johri's notes recorded a three-day history of a painful lump in Ms Wilson's left breast.  On examination there was a 3cm lump and Dr Johri considered it was that it was most likely a blocked duct with infection or a tumour.  It was Dr Johri's intention to refer her to a breast surgeon if the lump did not respond to a 10-day course of antibiotics and panadol.  A further appointment was made for one week's time.  No issue was taken with the quality of the advice and service provided by Dr Johri to his patient at this consultation.

On 1 December 2004 Ms Wilson attended a second consultation and was again accompanied by her partner.  She advised Dr Johri that there had been some reduction in the size of the lump and that it was not as sore as previously.  There was no discharge.  There was a dispute as to whether or not he examined the breast lump or make a follow-up appointment.  No referral was made to a specialist.  Dr Johri's record of this consultation was:

"… the lump has gone down in size not as sore also no discharge, wait and see in March when baby is due"

In February 2005 Ms Wilson and her partner moved to Dunedin where she told her new midwife that she had a lump in her breast.  Ms Wilson was immediately referred to the breast screening service in Dunedin Hospital.  She was seen by a house surgeon on 15 March 2005, and upon examination a fixed hard solid lump measuring 6cm by 4cm was recorded.  Following a mammography and fine needle cytology, within a few days a diagnosis of left breast carcinoma was confirmed.

After induction, Ms Wilson gave birth by caesarean section to a baby girl on 25 March 2005.  On 14 April 2005 she underwent a left mastectomy and axillary dissection.  A CT on 18 April 2005 confirmed likely metastatic disease.  Ms Wilson died on 15 November 2005.

Breast cancer in pregnancy is particularly aggressive and needs urgent management.  Dr Johri accepted that he should have recorded whether an examination occurred on 1 December 2004 and that he should have insisted on some review in the next week, as well as alerting her midwife to make sure that her progress was monitored.  The Tribunal noted that if there had been an appointment made for 6 December 2004 which Ms Wilson did not attend, then Dr Johri should have left no stone unturned and made sure that Ms Wilson was again seen and examined or a referral made to a specialist.

The Tribunal determined that Dr Johri's conduct constituted professional misconduct and that he should be censured and ordered to pay 30% of the costs of the Director of Proceedings and Tribunal.