6 NEWS
6 NEWS
15 SEPTEMBER 2023 ausdoc . com . au
‘ I did what they said but they still reported me to AHPRA ’
Dr Nick Carr describes the emotional toll of his paperwork error .
Sarah Simpkins
“
I
WOULD almost forget about the investigation . And then another email would come through , my blood pressure would drop to the floor and I would freeze , with the horrible gut-sinking realisation that , yes , this is still going on .”
Dr Nick Carr is talking about the emails he received from AHPRA updating him on its investigation into his paperwork bungle .
In 2020 , he became the subject of a formal notification about his role helping a terminally ill patient access Victoria ’ s voluntary assisted dying ( VAD ) scheme .
As Australian Doctor readers will know , last month , he was found guilty of professional misconduct . The charge sounds serious — and it is . But it all related to one of the forms he had to fill in .
It turned out that , while the patient had added their name to the declaration form in the presence of two witnesses , they had failed to sign the second page next to a written statement acknowledging that , through the scheme , they would be prescribed a drug that would end their life when administered .
It was picked up by the Victorian Voluntary Assisted Dying Review Board , which emailed Dr Carr alerting him to the omission .
So he asked the patient to come back to his practice and add their signature . What he did not realise was that this second signature also needed to be signed before two witnesses .
The patient ended their life through the VAD scheme as they had planned .
Although there was never any question over their eligibility , the review board alerted the Medical Board of Australia about the lapse in the paperwork . The medical board decided to take action , with Dr Carr brought before the Victorian Civil and Administrative Tribunal ( VCAT ).
Dr Nick Carr .
The tribunal noted that Dr Carr showed “ clear remorse and insight ” for his mistake .
But speaking after the verdict , Dr Carr also describes the emotional toll .
“ I was working full-time , I was doing my VAD work and , honestly , it went on so long that there would be months at a time when nothing would happen .”
But then emails would arrive in his inbox , and his heart would sink into his stomach .
“ I have advocated for a long time for the right for people to end their lives as they wish through VAD , but I did consider quitting the scheme .
“ I thought , ‘ Why on earth am I working multiple hours of either minimally paid or non-paid time ?’
“ The thanks I got for it was for the Voluntary
When the AHPRA emails arrived , his heart sank into his stomach .
Assisted Dying Review Board to report me for a mistake that I fixed the way it told me to .
“ I felt so unsupported by the system because it reported me for an error I made in good faith . To me , it just felt absolutely gutting .” At this point , it is worth repeating the key fact . The original email sent to Dr Carr by the review board pointing out the missing signature never made it clear that he needed to assemble another two witnesses for the patient to add their missing signature . If it had , you would assume Dr Carr would have been happy to avoid his subsequent miseries , going through a three-year complaints process , which frequently involved him reading hundreds of pages of documents about what he did and did not do .
FAIRFAX
Dr Carr says his legal team made a deal with the medical board to ensure the sanction would remain a reprimand and mitigate the risk that VCAT might consider suspending him .
“ I guess it was also possible that , if we had just thrown ourselves on VCAT ’ s mercy , it might have gone for a lesser sanction than professional misconduct .”
But he stresses that the deal meant he could not challenge the final outcome when it was delivered .
The existence of VAD and the involvement of the medical profession obviously still divide doctors .
But there has been sympathy for Dr Carr , with a general view that his treatment has been harsh . However , the tribunal argued it needed to ensure “ general deterrence ”, and it also stressed that “ scrupulous compliance ” with the VAD Act was essential .
Dr Carr also acknowledges that the judgement against him was influenced by his previous encounter with the board nearly 10 years ago — when he was cautioned following the death of a patient by suicide after taking pentobarbital .
Dr Carr had written on the death certificate that her cause of death was MI at the patient ’ s request to avoid any “ fuss ”, including an autopsy .
“ It was helping a patient prior to the VAD legislation being available ,” he says .
“ In a way , that probably was not very smart , but it was entirely for the patient ’ s best interest and involved no gain for me .
He says the VAD case distresses him because it sends a message to doctors working in the field that they could be “ hauled over the coals for honest errors ”.
The complexity of VAD paperwork needs to be fixed , he says , arguing it has been a “ bugbear of the system since the very beginning ”. But he will continue to be involved in VAD . “ It is such an important piece of work , and the thing that kept me doing it is knowing what the demand is and the comfort that we give people by doing it , so that is why I stayed .”
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