Australian Doctor 11th April 2025 | Page 11

ausdoc. com. au 11 APRIL 2025

NEWS 11

Surgeon fined for patient penis pic

Heather Saxena AN orthopaedic surgeon who photographed a comatose patient with a swastika tattoo on his penis and then shared the image with other doctors has been fined $ 10,000.

The patient was in ICU, intubated and ventilated after a homemade pipe bomb had exploded in his grasp in April 2019, said the Queensland Civil and Administrative Tribunal.

The surgeon, one of multiple treating doctors, said he was shocked to see the swastika given his lifelong experiences with racism.

“ The [ doctor ] has, throughout his life in Australia, been subjected to racism in various forms,” said the tribunal decision.

“ It has caused him significant distress, manifesting in him ultimately changing his name formally.

“ The appearance of a swastika, notoriously a Nazi emblem, on [ the patient’ s ] penis triggered feelings of shock and offence. He understood the swastika to represent racism and to be derogatory of people with his ethnic origins.”

The surgeon told the tribunal he had“ immediately

New first line for cystitis

FROM PAGE 1 empirical antibiotics for traveller’ s diarrhoea, unless patients had increased risk of complications or were having severe bouts.

Instead, supportive care and close follow-up should be prioritised for acute infections, the guidelines said.

Professor Collignon said this change was“ long overdue” and that many patients did not take precautions while travelling because they expected antibiotics would work.

“ Well, the antibiotic doesn’ t work anymore because there’ s so much resistance, and that attitude just engenders more resistance,” he said.

He added, however, that this move away from antibiotics did not apply to immunosuppressed or otherwise complex patients.

Therapeutic Guidelines: Update; 31 March 2025, bit. ly / 42cDU2o

Professor Peter Collignon.

regretted” taking the photo and sharing it via a messaging app.

He had resigned from his position at the Queensland public hospital and had been practising privately since, the tribunal heard.

“ Plainly, neither the photograph nor the sharing of it occurred with [ the patient’ s ] knowledge or consent,” it said.“ There was no clinical or medical purpose for either taking the photograph or sharing it.

“ The trust reposed by the

‘ He understood the swastika to represent racism.’

patient in his treating doctors can be seen to be particularly acute in those circumstances.”

The Medical Board of Australia was pushing for a sixmonth suspension; however, the tribunal deemed a $ 10,000 fine and a reprimand for professional misconduct sufficient.

It said the surgeon had taken the photo after 18 consecutive days of stressful work at the regional hospital.

“ It is not suggested that [ the doctor ] is at risk of committing like behaviour or other unethical behaviour in the

Reasons to consider LAGEVRIO

as the preferred * oral antiviral on the PBS for your patients aged ≥70 years who test positive for COVID-19 1, 2

* LAGEVRIO must be for use when nirmatrelvir-ritonavir is contraindicated. 1, 2

Proven

In MOVe-OUT, LAGEVRIO reduced the risk for hospitalisation or death vs. placebo through Day 29 by 30 %( adjusted relative risk reduction) in adult patients with mild to moderate COVID-19 4

( 95 % CI: 1 %, 51 %; 6.8 %( 48 / 709 ] vs 9.7 %( 68 / 699). Adjusted risk difference-3.0 %( 95 % CI-5.9 %,-0.1 %), p-value not available). Based on a planned interim analysis of LAGEVRIO vs placebo: The adjusted risk difference was-6.8 %( 95 % CI:-11.3 %,-2.4; 7.3 %( 53 / 377) vs 14.1 %( 28 / 385); p = 0.0024).

Real-world studies, 5-9 including the local Victorian study published in 2023, 5 also support the use of LAGEVRIO in treating older vaccinated patients with mild to moderate COVID-19.

Treatment-related adverse events ≥ 1 %( MOVe-OUT, LAGEVRIO vs placebo): 3 Diarrhoea( 2 % vs 2 %), nausea( 1 % vs 1 %), dizziness( 1 % vs 1 %)

No No to reduce risk of hospitalisation or death 3, 4

known drug interactions based on limited data available 3

dose adjustments required in patients with renal and / or hepatic impairment 3

future nor does the evidence point to any such conclusion,” it said.

After the doctor was reported to Queensland’ s Office of the Health Ombudsman in December 2019, the patient also pursued criminal charges, the tribunal said.

But it added that these were dropped after the surgeon and patient agreed to a“ private arrangement” at a restorative justice conference.

▼This medicine is subject to additional monitoring in Australia. This will allow quick identification of new safety information. Healthcare professionals are asked to report any suspected adverse events at www. tga. gov. au / reporting-problems.

SELECTED SAFETY INFORMATION 3 INDICATION: LAGEVRIO has provisional approval for the treatment of adults with COVID-19 who do not require initiation of oxygen due to COVID-19 and who are at increased risk for hospitalisation or death. The decision to approve this indication was based on efficacy and safety data from a Phase 3 trial. Continued approval of this indication depends on additional data. CONTRAINDICATIONS: Hypersensitivity to the active substance or any of the excipients. Hypersensitivity reactions have been reported with LAGEVRIO. If signs or symptoms of a clinically significant hypersensitivity reaction occur, immediately discontinue LAGEVRIO and initiate appropriate medications and / or supportive care. PRECAUTIONS: Pregnancy Category D: The use of LAGEVRIO is not recommended during pregnancy. In women of childbearing potential, health care providers should discuss the chance that they may be pregnant and consider the need for a pregnancy test. Contraception: Advise women of childbearing potential to use effective contraception for the duration of treatment and for 4 days after the last dose of LAGEVRIO. Sexually active men with a partner of childbearing potential should use contraception during and for 3 months after treatment. Based on animal data, LAGEVRIO may cause foetal harm when administered to pregnant women. Breastfeeding: Based on the potential for adverse reactions on the infant from LAGEVRIO, breastfeeding is not recommended during treatment and for 4 days after the last dose of LAGEVRIO. Paediatric patients: Use in patients under the age of 18 years is not recommended. ADVERSE REACTIONS: Common: nausea, diarrhoea, dizziness. The following have been reported in post-marketing experience: hypersensitivity, angioedema, erythema, pruritus, rash, urticaria, vomiting.

The doctor shared the photo with colleagues.

Scan to access study design for registration study 4

PBS information: Authority required( STREAMLINED): LAGEVRIO must be for use when nirmatrelvir(&) ritonavir is contraindicated. 1 The contraindications to nirmatrelvir(&) ritonavir can be found using the Liverpool COVID-19 Drug interaction checker or the TGA-approved Product

1, 10, 11

Information for nirmatrelvir(&) ritonavir. Visit www. pbs. gov. au for more information.

References: 1. Pharmaceutical Benefits Scheme. www. pbs. gov. au( accessed March 2024). 2. Pharmaceutical Benefits Scheme. Lagevrio ®( molnupiravir) Pharmaceutical Benefits Scheme Factsheet – Updated 1 December 2024. https:// www. pbs. gov. au / publication / factsheets / covid-19-treatments / PBS-Factsheet-lagevrio-molnupiravir-updated- December-2024. pdf( accessed December 2024). 3. LAGEVRIO Product Information, October 2023. 4. Bernal AJ et al. N Engl J Med 2022; 509 – 520. 5. Van Heer C et al. Lancet Reg Health West Pac 2023; 41:100917. 6. Gentry CA et al. J Infect 2023; 86( 3): 248 – 255. 7. Lin DY et al. JAMA Netw Open 2023; 6( 9): e2335077. 8. Park HR et al Infect Chemother 2023; 55( 4): 490 – 499. 9. Abu Ahmad W et al. Clin Microbiol Infect 2024; 30( 10): 1305 – 1311. 10. Paxlovid( nirmatrelvir-ritonavir) Product Information. December 2024. 11. University of Liverpool. COVID-19 Drug Interaction Checker. Available at https:// covid19-druginteractions. org / checker( accessed March 2024).

Before prescribing, please review the full Product Information available at www. msdinfo. com. au / lagevriopi or by scanning the QR code.

Copyright © 2025 Merck & Co., Inc., Rahway, NJ, USA and its affiiates. All rights reserved. Merck Sharp & Dohme( Australia) Pty Limited. Level 1 – Building A, 26 Talavera Road, Macquarie Park NSW 2113. MSDA0156 / 01. AU-ANV-00634 v1.0. Issued January 2025.