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DP v Patel

Health Practitioners Disciplinary Tribunal, 1 September 2006

On 1 September 2006 Dr Maheshkumar Patel, general practitioner, admitted one charge of professional misconduct arising out of a sexual relationship he had with his patient, Mrs X. The Tribunal found, on the basis of agreed facts, that Dr Patel had had a sexual relationship with his patient between 28 July 2004 and 10 February 2005. Further, he had failed to provide services with reasonable care and skill by failing to take appropriate steps to immediately terminate the relationship and refer his patient to another practitioner, and by continuing to treat her, including the ongoing care and management of a psychiatric illness.

Mrs X first consulted Dr Patel in September 2003 with insomnia and stress, for which he prescribed a sedative and an antidepressant. Between 6 October and 1 April 2004 she saw him a further six times, five of which were for anxiety and depression. During April she had a number of other appointments.

On 23 April 2004 Dr Patel made a referral to a psychiatrist, having previously offered a referral in October 2003. On 30 April 2004 a psychiatrist assessed Mrs X and diagnosed a major depressive episode with marked symptoms of anxiety. Dr Patel also referred Mrs X to a gastroenterologist because of gastric symptoms. The gastroenterologist reported that the main issue was anxiety and depression, that Mrs X had not been compliant with her medication, that she lacked insight into her mental health issues, and that she needed both medication and counselling. He emphasised the need for urgent contact with her psychiatrist.

In June 2004 Mrs X requested a further prescription of antidepressants and sedatives. She also resumed her career as a primary school teacher around this time.

On 16 June 2004 Mrs X presented with a variety of symptoms, namely gastroenteritis, tonsil pain, headaches and neck pain. Dr Patel explained that he was unable to help her and he suggested a second opinion from another GP, who saw her twice in June, initially considering that her depressive symptoms were likely to be secondary to her physical symptoms. After investigations returned normal results, he diagnosed psychosomatic illness.

On 28 July 2004 Mrs X presented to Dr Patel. Her antidepressant medication was changed. During the course of the consultation Mrs X became distressed and Dr Patel put his arm around her. She kissed him on his neck and this was reciprocated.

On 2 August 2004 Dr Patel made a further referral to the Cottage Mental Health Services. On 3 August 2004, with a chaperone present, Dr Patel conducted an intimate medical examination on Mrs X and made a referral to a general surgeon. On 4 August 2004 the Cottage advised that Mrs X had declined to be involved with the services.

In the meantime, Dr Patel and Mrs X visited each other at home and met in town. Emails and text messages of a romantic nature were sent between them. On occasions they had sexual intercourse. They had discussions about leaving their partners and living together.

On 8 November 2004 Mrs X consulted Dr Patel and discussed her insomnia and depression and he provided her with a sample and prescription of an alternative medication. The last time Mrs X consulted Dr Patel was on 20 December 2004 . He provided her with prescriptions on two further occasions as a result of telephone calls to the surgery.

At the end of January 2005 Dr Patel advised the CEO of his clinic that he was in a relationship with Mrs X. He was advised to cease seeing her in a professional capacity and arrangements were made for him to work from another Medical Centre. On 8 February Mrs X's records were transferred to another medical practitioner.

In imposing penalty, the Tribunal observed that the conduct complained of is the type that must be regarded as the most serious and meriting its condemnation, and that Dr Patel's misconduct was a breach of trust, misuse of power, and an exploitation of the vulnerability of Mrs X and her family.  While acknowledging that there were a number of aggravating features in the case, in particular that Mrs X was consulting Dr Patel regarding a psychiatric illness, and was very vulnerable, the Tribunal gave Dr Patel credit for making no attempt to evade the consequence of his actions, entering the earliest possible guilty plea, and indicating that intention throughout the HDC investigation, making endeavours to address why this may have occurred, contacting the Medical Council, and voluntarily giving up his practice of medicine.

Accordingly, Dr Patel was suspended for two years, commencing 1 September, censured, fined $10,000, ordered to pay 50% of the costs of the hearing and the prosecution, and had conditions imposed on his practice. The Tribunal also ordered publication of a summary of the decision in the New Zealand Medical Journal.