Australian Doctor Australia Doctor 18th August 2017

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GP’s ordeal over
Missed melanoma led to court battle over notes
PAUL SMITH
A FIVE-year legal ordeal appears to
be over for a GP who misdiagnosed a
melanoma as a plantar wart that later
metastasised and led to the patient’s
death.
Dr Steven Kelly, a GP in Newcastle,
NSW, was originally sued by Malcolm
Coote for misdiagnosing the wart after
Mr Coote found a growth on his foot
about 3mm wide and 1-2mm thick,
which felt like a pebble in his shoe.
The negligence claim went through
two trials before ending up before the
NSW Supreme Court of Appeal.
At the heart of the case was whether
the lesion, when Mr Coote first pre-
sented in 2009, had pigmentation or a
black spot suggestive of a melanoma.
Dr Kelly recorded in his notes simply
‘If the case highlights
anything, it is that just
because you think it is
a wart, it may not be.’
— Gemma McGrath,
medical negligence lawyer at
Panetta McGrath, Perth, WA
that it was a plantar wart and treated it
with cryotherapy.
Mr Coote also consulted two other
doctors about the lesion over the fol-
lowing months.
But none of the doctors — includ-
DOCTORS ARE HUMAN TOO
ing Dr Kelly — having looked at what
they believed was a wart, documented
a detailed observation in their notes.
A biopsy was eventually performed
in March 2011, and it was discovered
that the lesion was in fact an acral len-
tiginous melanoma that had metasta-
sised.
Mr Coote died in 2012.
The fact that the doctors had not
documented the appearance of the
lesion became significant in the court
case.
Mr Coote’s wife later claimed she
had seen “on the sole of his foot …
a little black mark about the size of a
match head” when her husband first
spoke to her about the lesion.
She said she had initially thought
it was a piece of tar and had tried to
remove it with her fingernail.
She also claimed that, in her experi-
ence, the lesion looked nothing like a
plantar wart.
However, this month, the Supreme
Court of Appeal found in favour of Dr
Kelly.
Justice John Basten wrote in his
judgement: “Neither [Dr Kelly or Mrs
Coote] measured the lesion, nor took
notes of what they had seen. There was
no reason to expect Mrs Coote to do
so, but there was reason to expect Dr
Kelly to do so in the course of his pro-
fessional practice.
“He said he would not record
[observations in his medical notes]
consistent with his diagnosis, but only
unusual [clinical] matters.”
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page 11
cont’d page 6
Mandatory reporting victory welcomed
GEIR O’ROURKE
A DOCTOR who delayed
seeking help for depression
because he feared
mandatory reporting has
welcomed the commitment
by state and federal health
ministers to revamp the laws.
Australia’s health ministers
will consider changing the
current reporting rules in
November, following a spate
of doctor suicides and a
high-profile campaign by the
medical profession.
Since 2010, the National
Law has required treating
health practitioners to report
impaired doctors when they
could be seen as a risk to
public safety.
But at a COAG meeting
this month, health ministers
accepted that doctors
“should be able to seek
treatment for health issues
with confidentiality”.
“A nationally consistent
approach to mandatory
reporting provisions will
provide confidence to health
practitioners that they can
feel able to seek treatment for
their own health conditions
anywhere in Australia,” it said
in a communiqué.
The pledge was welcomed
by Dr Geoffrey Toogood
(pictured), a Melbourne
cardiologist and doctors’
mental health campaigner
who has opened up about
his personal battle with
depression.
“When I was ill, I never
understood the nitty-gritty
of the law, and there was
a concern that I would be
reported, at the back of my
mind, which meant that I
delayed treatment,” he told
Australian Doctor.
The AMA and the RACGP
have also welcomed the
pledge to reform the laws.
Both have been pushing the
council to adopt a version
of the exemptions from
mandatory reporting for
health practitioners currently
in place in WA.
COAG has agreed to
commission a discussion
paper and seek the opinions
of patient and practitioner
groups before considering
a detailed proposal in
November.
The pledge comes just
two years after COAG told
doctors that mandatory
reporting was here to stay.
Victorian Doctors Health
Program medical director
Dr Kym Jenkins said that
cont’d page 6
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