Med­i­cal im­pos­tors

The pros­e­cu­tion of a fake doc­tor this week raises the ques­tion: what makes im­per­son­ators tick? Health ed­i­tor Adam Cress­well re­ports

The Weekend Australian - Travel - - Health -

JU­LIANNE Radley knows ex­actly what it feels like to find out the per­son you looked up to as ‘‘ Doc­tor Mark’’ — a man who heard her most in­ti­mate de­tails, and treated her chil­dren’s ill nesses — was noth­ing of the sort. Even with her own health train­ing, Radley — an acute care nurse — hadn’t seen it com­ing. She and her chil­dren had been go­ing to see ‘‘ Dr Mark’’ Dal­las on and off for six or seven years. He was so con­vinc­ing, it never oc­curred to her there was any­thing wrong when he pre­scribed medicines, vac­ci­nated her chil­dren, treated a rash or pal­pated a breast lump. He even con­ducted an in­ter­nal vagi­nal ex­am­i­na­tion, us­ing a specu­lum.

So it was only when she opened Syd­ney’s Sun­day Tele­graph that she re­alised ‘‘ Dr Mark’’ in fact pos­sessed no med­i­cal qual­i­fi­ca­tions be­yond a first-aid cer­tifi­cate.

‘‘ On the day it was in the Sun­day Tele I was work­ing in the emer­gency de­part­ment, and ev­ery­one was talk­ing about it in the tea­room,’’ she re­calls. ‘‘ I said I had been see­ing him, and they all said, ‘ How could you not know?’. I felt so hu­mil­i­ated — I didn’t know why I didn’t know ei­ther, but I didn’t.

‘‘ I felt to­tally vi­o­lated, and there was very lit­tle sup­port. They (oth­ers I spoke to) couldn’t see how psy­cho­log­i­cally dev­as­tated I felt — that I had trusted this man, that I had trusted him with my chil­dren’s health and my own health.’’

Mark Dal­las, to­gether with his brother Rick, a gen­uine med­i­cal doc­tor, had been see­ing pa­tients to­gether at their surgery in Syd­ney’s west for up to six years, be­fore the prac­tice was raided in 1998.

Each of the brothers was fined $45,000 in 1999 for de­fraud­ing Medi­care, and the fol­low­ing year Rick — the one en­ti­tled to call him­self a doc­tor — was struck off the med­i­cal reg­is­ter for aid­ing and abet­ting his brother’s de­cep­tion. In 2003 Mark Dal­las, who pro­vided ‘‘ treat­ments’’ to an un­sus­pect­ing Ju­lianne Radley, was jailed for 18 months in con­nec­tion with the case.

Even sev­eral years later, Radley is feel­ing the con­se­quences.

‘‘ I didn’t go to a GP for a long while,’’ she says. ‘‘ I would go into surg­eries and if they didn’t have their cer­tifi­cates (of qual­i­fi­ca­tion) on the wall, I would want to know where they were.’’

The co­nun­drum of med­i­cal fak­ers and what mo­ti­vates them was in the news again this week, af­ter a tra­di­tional Chi­nese medicine prac­ti­tioner, Yao Guo Lin, also known as David Lin, pleaded guilty in the NSW Supreme Court to 31 breaches of the NSW

still Med­i­cal Prac­tice Act, in­clud­ing hold­ing him­self out as a doc­tor and pro­vid­ing false med­i­cal cer­tifi­cates.

The court heard Lin was trapped by two NSW Med­i­cal Board in­ves­ti­ga­tors, who se­cretly filmed him telling the wo­man he could per­form an abor­tion and sup­ply­ing the abor­tion drug RU-486 — which can cur­rently only be law­fully im­ported by one doc­tor in Queens­land, the only one who has so far suc­cess­fully ap­plied for per­mis­sion to do so.

Next week, an­other fake doc­tor, Lor­raine Brooke-Smith, will ap­pear for sen­tence be­fore Syd­ney’s Down­ing Cen­tre Lo­cal Court in re­la­tion to a string of sim­i­lar of­fences.

She was con­victed of 27 counts in 2003, in­clud­ing one in which she made her­self out to be a car­di­ol­o­gist and ad­vised a pa­tient of an­other car­di­ol­o­gist to stop tak­ing a num­ber of medicines.

That spe­cial­ist doc­tor later tes­ti­fied that had his pa­tient taken the ad­vice, it could have killed the pa­tient by trig­ger­ing angina and a heart at­tack.

Fol­low­ing her con­vic­tion she was made sub­ject to a two-year good be­hav­iour bond — but later ad­mit­ted com­mit­ting fur­ther of­fences dur­ing the bond pe­riod.

Th­ese re­lated to her suc­cess­fully ap­ply­ing in 2004 for a job with Life With­out Bar­ri­ers, a char­ity that pro­vides sup­port to peo­ple with in­tel­lec­tual dis­abil­i­ties. She was hired partly on the ba­sis that her med­i­cal ex­pe­ri­ence would al­low her to cope with sce­nar­ios be­yond the skill of other car­ers, in­clud­ing a client who ex­pe­ri­enced about 17 ‘‘ grand mal’’ seizures per day.

Pa­tients have come to very real harm in plenty of other sim­i­lar cases. And pa­tients who have suf­fered harm at the hands of im­pos­tors may be left with­out re­course to com­pen­sa­tion, as fake doc­tors will not be mem­bers of a med­i­cal in­sur­ance com­pany that usu­ally foots the bill in neg­li­gence suits.

In an­other case just last year, Nancy Xiao was found guilty of breach­ing the Med­i­cal Prac­tice Act af­ter try­ing to re­move haem­or­rhoids from a pa­tient who be­lieved she was a doc­tor. The pa­tient ended up in Con­cord Hospi­tal af­ter the area be­came in­fected and necrotic, and re­quired surgery to re­move the dead and in­fected tis­sue.

The mag­is­trate fined Xiao $3000 and or­dered her to en­ter into a good be­hav­iour for three years, say­ing she was ‘‘ care­less and in­dif­fer­ent’’ as to whether she obeyed the leg­is­la­tion or not.

NSW Med­i­cal Board regis­trar Andrew Dix says part of the prob­lem in pur­su­ing sus­pected im­pos­tors is that un­der the leg­is­la­tion, it has to be proved be­yond rea­son­able doubt that the ac­cused falsely rep­re­sented them­selves as a doc­tor, ei­ther di­rectly or by their con­duct.

This was the point that stymied the board’s at­tempted pros­e­cu­tion 10 years ago of ki­ne­si­ol­o­gist Ian Yde, fol­low­ing the death of 22-year-old Robert Romero, who had tes­tic­u­lar can­cer. It was al­leged Yde per­suaded Romero to es­chew can­cer treat­ments rec­om­mended by his doc­tors in favour of al­ter­na­tive prac­tices, in­clud­ing jump­ing on a tram­po­line. But a mag­is­trate threw out all charges in 1997 af­ter ac­cept­ing that Yde had not promised he could cure can­cer.

But of those who are guilty of pass­ing them­selves off as doc­tors, what makes them tick?

Syd­ney foren­sic psy­chi­a­trist Stephen All­nutt says ‘‘ not much is known’’ about the mo­ti­va­tions of peo­ple who pass them­selves off as doc­tors. Far from be­ing a phe­nom­e­non that is pe­cu­liar to medicine, peo­ple have also been known to pass them­selves off as lawyers and other pro­fes­sion­als who are ‘‘ seen by so­ci­ety as hav­ing some sta­tus’’.

With­out re­fer­ring to any par­tic­u­lar case, All­nutt says peo­ple who im­per­son­ate doc­tors ‘‘ keep pop­ping up’’ and prob­a­bly fall into one of four cat­e­gories.

One would be the delu­sional men­tally ill per­son, who might be­lieve them­selves to be a doc­tor in the same way as an­other delu­sional pa­tient might think they are Je­sus Christ. All­nutt be­lieves this cat­e­gory is rare and eas­ily spot­ted.

The next two cat­e­gories he thinks are less eas­ily de­tected, par­tic­u­larly if they have some med­i­cal knowl­edge that can cam­ou­flage their de­ceit. One is the ‘‘ frag­ile per­son­al­ity’’ who wants to be more than they are, and con­vinces them­selves they are a doc­tor in or­der to get the re­spect and sta­tus they crave. Al­though deep down they are not truly delu­sional, their adopted per­sona is of­ten ce­mented in with years of lies, which can prove dif­fi­cult to pen­e­trate — and be dif­fi­cult for the per­pe­tra­tor to re­verse.

The third cat­e­gory would what he calls ‘‘ the true char­la­tans’’ who know per­fectly well they are not doc­tors, but pre­tend to be for fi­nan­cial or other gain. The fourth cat­e­gory would be some­one who mis­rep­re­sents him­self as a doc­tor through some mis­un­der­stand­ing of what is per­mit­ted, ei­ther be­cause they have an in­tel­lec­tual prob­lem or some other rea­son.

‘‘ The pro­fes­sions that are reg­u­lated are the ones (in which cases) will come to the Con­tin­ued inside, Page 19

Pic­ture: Gra­ham Crouch

Pros­e­cuted: Yao Guo Lin pleaded guilty to 31 breaches of the NSW Med­i­cal Prac­tice. Insets, ma­te­rial pro­duced in ev­i­dence

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