When deviant doctors dodge detection
Christchurch GP Rakesh Chawdhry has been jailed for sexually assaulting 10 patients. He abused several of his victims when he should have been under the watch of a chaperone. Are we being kept safe from errant doctors? Michael Wright reports.
How would you feel about this: You’re a guy and you need to go to the doctor for an intimate sort of reason. Maybe you’re after a check for a sexually transmitted infection. It turns out the doctor you see is the subject of a police complaint, having allegedly asked another male patient to obtain an erection and ejaculate during a consultation, before attempting to perform oral sex on him. This doctor has been charged with sexual violation. You know nothing about any of this when you walk into the room.
This was the situation faced by several of the victims of Rakesh Chawdhry, who was convicted of 12 sex offences against patients at a recent judge-alone trial. They should have been aware that something was up, because Chawdhry was under orders to ensure a chaperone was present for any intimate examination of a male patient, but they weren’t. Chawdhry ignored the order. It was, as Patient L, one of Chawdhry’s other victims, said, a pretty significant oversight in the system: ‘‘It’s trusting the wolf with the sheep, really.’’
Chawdhry first came to the attention of the authorities in December 2012, when a patient lodged a complaint, alleging the assault described above. Police investigated, and charged him with sexual violation by unlawful sexual connection in February 2014.
Within days, Chawdhry informed the Medical Council and the Riccarton Clinic in Christchurch, where he was working as a contractor. On March 5, he signed a voluntary undertaking with the council agreeing to the chaperone conditions.
‘‘Whilst it has the word voluntary in it we regard it as absolutely binding,’’ Medical Council chairman Andrew Connolly said, ‘‘If there’s any breach we see that as serious as breaching a condition.’’
The prosecution, however, was dropped that July, meaning Chawdhry was acquitted of the charge. The Crown had decided not to proceed for reasons including lack of evidence and the ‘‘significant credibility issues’’ of the complainant. The chaperone order was duly rescinded on August 14, however Riccarton Clinic senior doctor Angus Chambers said it was agreed by ‘‘verbal instruction’’ that a similar arrangement continue:
‘‘[We] decided that the best protection for Dr Chawdhry and our patients and our clinic was to ask him to have a mandatory chaperone policy for male patients and Dr Chawdhry agreed to that.’’
At least three of Chawdhry’s victims were abused while the chaperone conditions were in place – one during the Medical Council period, two when the verbal agreement with the clinic was in place.
There could have been more. Connolly said Chawdhry was obliged to tell the Medical Council he was under scrutiny as soon as he knew himself, not just after he was charged with a crime. Police could not confirm when Chawdhry first learned of the complaint against him (they now have a memorandum of understanding with the council, so it is informed of any investigation against a doctor as early as possible), but had it been before February 2014, the chaperone conditions could have been imposed earlier.
‘‘He had a professional obligation to tell us, but his judgement is clearly out the window.’’
When, as Connolly acknowledged, ‘‘the onus in [Chawdhry’s] agreement was all on him doing the right thing’’, this is clearly a problem.
‘‘I’m familiar with cases from New Zealand, Canada, United Kingdom and Australia where chaperoned doctors have managed to evade the conditions and to harm patients,’’ Auckland University law professor Ron Paterson, a world expert on patients’ rights and the practice of chaperoning, said. ‘‘That is unacceptable.’’ Requirements for doctors under chaperone orders have changed markedly since 2014, mostly due to the work of Paterson. Last year he reviewed the practice of chaperoning for the Medical Board of Australia and recommended it dispense with them. The board complied.
The Medical Council here made changes as a result too. Now, if a doctor is subject to chaperone conditions, all other doctors and nurses at the practice must be aware of the fact, and why. Patients cannot be told why, but must be informed of a doctor’s chaperone status if they make an appointment with them. They must be given the opportunity to see another doctor or, if they agree to see the original doctor under watch, sign a consent form, which is entered into the medical notes, along with the chaperone’s name. Notes are subject to audit.
On top of that, the council now favours other protective measures, Connolly said.
‘‘I think we’ll see [chaperones] used far less often. We’ll see a lot more gender restriction, and if that’s not appropriate then we’ll see suspension.
‘‘All of that has come out very much from what Ron Paterson taught us and based on some anxiety we already [had with] chaperones.’’
Paterson applauded the Medical Council’s changes, with the obvious caveat that he preferred ditching them altogether. Connolly demurred on the allor-nothing approach, mostly because of the fallibility of the more serious sanctions. Doctors have contested suspensions in court and won.
‘‘I’ve got exactly this problem at the moment,’’ Connolly said, ‘‘We suspended a doctor for a single patient complaint. We debated, ‘Could we protect the public by having a chaperone?’, and the nuances of this guy’s case was we didn’t think we could. The District Court said, ‘The police haven’t finished their inquiry, they haven’t laid any charges, you have to go back to a chaperone’.’’
The same thing happened in the case of former Hastings doctor David Lim, Connolly said. The council moved to suspend, the court ruled chaperone. Lim was eventually convicted of stupefying and indecently assaulting four patients, all prior to the suspension appeal, and jailed for five years.
‘‘Chaperones still have a position in patient safety,’’ Connolly said, ‘‘But I think we also need to talk with the criminal justice side about just what we’re trying to achieve. Because at the moment we have real trouble getting overturned at times.’’
Scrapping chaperones altogether would not solve this, as courts outrank medical boards. Paterson recalled a suspension appeal case in Australia from the day his report was released: ‘‘A judge in Queensland . . . said we still think suspension would be overkill here and we’re putting in place a chaperone.
‘‘I accept that there are cases where the courts and tribunals will continue to order that a chaperone condition be in place,’’ Paterson said, ‘‘But I would expect that to decrease over time as authorities change their own policy and practice.’’
Connolly conceded the new system isn’t foolproof, but is better than the old one, which Chawdhry sidestepped simply by ignoring a rule no-one was checking up on. The council will review his case now the court process is over.
‘‘It comes down to why on earth wasn’t there a chaperone there? That has to be a failing both of the system and of Chawdhry. If you’re facing things like this you do not practice one centimetre outside the rulebook.’’
Chawdhry did not observe such caution. As Patient L wrote in his victim impact statement, read aloud by Judge Jane Farish in court at sentencing:
‘‘Your actions were untrustworthy, unprofessional and undignified. You abused [the doctor-patient] relationship and you abused me.
‘‘You are a doctor only in name, but not for much longer.’’