Fine, censure for cancer fail

Former Invercargill doctor’s actions amounted to clinical negligence and professional misconduct

A former Invercargill doctor who failed to tell his patient he had cancer has been handed his penalty, but he wasn’t there to hear it.

In October, the Health Practitioners Disciplinary Tribunal found Dr Nelson Nagoor failed to inform his patient Joshua Linder that he had an aggressive melanoma skin cancer. The tribunal found that Nagoor’s actions amounted to clinical negligence and professional misconduct.

Linder later died of the cancer. Evidence was given that his lesion was advanced when he presented to Nagoor, and an earlier referral would not have changed the ultimate outcome.

Following the removal of a lesion on Linder’s back, Nagoor sent a histology request to a laboratory. Despite receiving a histology report confirming that the lesion was an invasive superficial spreading primary melanoma, and that the report recommended a wider excision, Nagoor did not act, and did not inform Linder of the histology results. Neither did he refer Linder to a specialist.

The tribunal moved to the penalty hearing yesterday.

Nagoor was not present because he had moved back to South Africa and retired, tribunal members were told.

The tribunal suspended his registration for three months. He was also censured, fined $5000, and ordered to pay $26,000 towards the $73,000 costs in the disciplinary process.

If he returned to work in medicine in New Zealand, Nagoor would be required to practise under supervision for 18 months at his own cost, and to undertake a performance assessment to determine his competency. In addition, he would not be able to practise as a sole practitioner for three years.

The director of the proceedings, Jane Herschell, had earlier argued that Nagoor’s registration should be cancelled, and if not,

then suspended. She also pushed for a fine, censure, and payment of costs.

Nagoor’s lawyer, Adam Holloway, had argued against cancellation of his registration for a charge of clinical negligence, saying that such a penalty was reserved for the most serious of cases. ‘‘This is a one-off clinical error.’’

Nagoor was working at the Nga¯ Kete Ma¯ tauranga Pounamu Charitable Trust’s He Puna Waiora Wellness Centre in Invercargill and providing care to Linder between April and May 2019. The care related to a melanoma skin cancer on Linder’s back.

Nagoor filed an affidavit for the original hearing from South Africa, and, through his lawyer, accepted that his conduct amounted to professional misconduct, and apologised.

Tribunal chairwoman Alison Douglass said patient records and Linder’s own evidence clearly established that Nagoor failed in his care of Linder by not contacting him about the histology report or arranging an in-person consultation to advise him of the findings.

She said the tribunal was satisfied that between about April 17, 2019 and August 2, 2019, Nagoor failed to adequately communicate to Linder that he had an advanced aggressive form of melanoma cancer.

‘‘The charge will be established as negligence for the omissions in Mr Linder’s care by Dr Nagoor, that fell well below accepted reasonable standards of the medical profession.

‘‘This was an opportunity for an earlier intervention which was missed.’’