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Medical Board of Australia v Jabbar (Occupational and Business Regulation) [2010] VCAT 1772 (5 November 2010)
Victorian Civil and Administrative Tribunal
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Medical Board of Australia v Jabbar (Occupational and Business Regulation) [2010] VCAT 1772 (5 November 2010)
Last Updated: 18 November 2010
VICTORIAN CIVIL AND ADMINISTRATIVE TRIBUNAL
ADMINISTRATIVE DIVISION
OCCUPATIONAL & BUSINESS REGULATION
LIST
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VCAT REFERENCE NO. B58/2010
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CATCHWORDS
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Health profession – disciplinary proceeding - unprofessional conduct
by medical practitioner – Health Professions Registration Act 2005
– reprimand – suspension of registration as medical practitioner
– restrictions on circumcision practice
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Medical Board of Australia
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Dr Mohammed Mateen Ui Jabbar
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BEFORE
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Member Dr B Clarke
Member Dr E Fabris
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HEARING TYPE
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DATE OF HEARING
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DATE OF ORDER
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CITATION
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Medical Board of Australia v Jabbar (Occupational and Business Regulation)
[2010] VCAT 1772
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ORDER
- Medical
Board of Australia is substituted as the applicant.
- Pursuant
to s101 of the Victorian Civil and Administrative Tribunal Act 1998 and
subject to further order the Tribunal orders that any information that might
enable the patient, the notifier and any of their
family members to be
identified must not be published.
Having conducted a hearing into allegations referred to the
Tribunal, the Tribunal finds pursuant to s77(1)(a) of the Health Professions
Registration Act 2005 (‘the HPR Act’) that:
- As
to allegations 1.1, 1.2 and 1.3 (as amended) Dr Jabbar has engaged in
unprofessional conduct within the meaning of s3(1)(a) and
(b) of the HPR Act,
and
- As
to allegation 1.4 Dr Jabbar has engaged in unprofessional conduct as defined in
s3(1)(a) of the HPR Act.
The tribunal makes the following determinations:
1. Dr Jabbar is reprimanded
- Dr
Jabbar’s general registration as a medical practitioner is suspended for a
period of three months effective from 22 November
2010
- Dr
Jabbar’s circumcision practice is limited to performing circumcision
procedures as follows:
- (a) On infants
up to the age of 4 months in his clinic; and
- (b) On children
5 years to 18 years in a hospital or approved day care facility with appropriate
anaesthesia under the supervision
of and as directed by a consultant
anaesthetist.
- Dr
Jabbar must not carry out any circumcision procedure on an infant between the
ages of 4 months and 5 years, with such children
to be referred to a paediatric
surgeon for circumcision procedures.
- There
are no restrictions on Dr Jabbar’s circumcision practice for adults 18
years and over.
- Dr
Jabbar must, at his own cost and expense, undertake remedial education and
counselling by a practitioner or practitioners approved
by the Medical Board of
Australia (approved practitioner/s). The approved practitioner/s is to
attend Dr Jabbar’s circumcision practice for not less than four sessions
to review his
medical records, notes and information provided to patients
undergoing circumcision procedures, and to conduct remedial education
and
counselling with Dr Jabbar about the appropriate performance of circumcision
procedures and techniques. The four sessions are
to be completed within three
months of the date of resumption of Dr Jabbar’s general registration as a
medical practitioner.
- The
approved practitioner/s shall provide a written report to the Medical Board of
Australia within two weeks of completing the review
of Dr Jabbar’s medical
records, notes and information provided to patients undergoing circumcision
procedures and the remedial
education or counselling. The approved
practitioner/s must report on the outcome of the review and the contents of the
remedial
education or counselling and address whether Dr Jabbar has met the
learning objectives (to be set by the approved practitioner/s)
to a level
expected of a registered medical practitioner undertaking circumcision
procedures. Dr Jabbar shall be responsible for
the costs and expenses of the
approved practitioner/s in providing the report.
- Dr
Jabbar must provide a written report to the Medical Board of Australia within
three weeks of completing the remedial education
or counselling. The report
must be written by Dr Jabbar in his own words and address the contents and
specific learning objectives
of the remedial education or counselling and
demonstrate how the remedial education or counselling has changed his
practice.
Presiding Member
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APPEARANCES:
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Mr K Armstrong of Counsel instructed by Minter Ellison, Lawyers
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For Respondent
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Mr P Halley of Counsel instructed
by TressCox, Lawyers
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REASONS
- On
1 March 2010 the former Medical Practitioners Board of Victoria referred a
number of allegations to the tribunal under s59(2)(g)
of the Health
Professions Registration Act 2005 (the Act), to conduct a hearing and make
findings and determinations about a number of allegations. On 1 July 2010 the
Medical
Board of Australia succeeded the Victorian Board: see Health
Practitioner Regulation National Law (Victoria) Act
2009.
Allegations
- That
on or around 29 January 2008, Dr Jabbar engaged in unprofessional conduct within
the meaning of paragraphs (a) and/or (b) of
the definition of
‘unprofessional conduct’ in s3(1) of the HPR Act in that he
inappropriately performed a circumcision
procedure on his patient at his private
clinical rooms.
PARTICULARS
Given the potential complexities associated with the patient’s type 1
diabetes and/or his age of 26 months, it was inappropriate
for Dr Jabbar to
perform a circumcision procedure on the patient at his private clinical rooms
rather than at a hospital sufficiently
equipped and/or able to safely
anaesthetise patients in the paediatric age group and/or with access to
appropriate diabetic specialists
and/or monitoring.
- That
on or around 29 January 2008, Dr Jabbar engaged in unprofessional conduct within
the meaning of paragraphs (a) and/or (b) of
the definition of
‘unprofessional conduct’ in s3(1) of the HPR Act in that he failed
to correctly perform a circumcision
procedure on his
patient.
PARTICULARS
(a) Dr Jabbar did not correctly apply the plastibell ring; and/or
(b) Dr Jabbar failed to ensure that the patient’s urethral meatus was
uncovered.
- That
between on or around 29 January 2008 and 30 January 2008, Dr Jabbar engaged in
unprofessional conduct within the meaning of paragraphs
(a) and/or (b) of the
definition of ‘unprofessional conduct’ in s3(1) of the HPR Act in
that he failed to appropriately
monitor, or ensure that another suitably
qualified person adequately monitored, his patient in the immediate
post-operative period.
PARTICULARS
(a) In the immediate post-operative period, Dr Jabbar failed to monitor, or
ensure that another suitably qualified person adequately
monitored, the
patient’s diabetes and/or blood sugar levels; and/or
(b) After receiving a telephone call from the notifier, the patient’s
father, in which the notifier disclosed to Dr Jabbar
that the patient had not
passed urine since the circumcision procedure, Dr Jabbar did not:
(i) adequately monitor, or ensure that another suitably qualified person
adequately monitored, the patient’s failure to pass
urine; and/or
(ii) make appropriate enquiries, or ensure that another suitably qualified
person had made appropriate enquiries, as to the patient’s
blood glucose
levels and/or insulin levels.
- That
in or around 29 January 2008, Dr Jabbar engaged in unprofessional conduct within
the meaning of paragraph (a) of the definition
of ‘unprofessional
conduct’ in s3(1) of the HPR Act in that he failed to make appropriate
clinical notes in respect of
his
patient.
PARTICULARS
Dr Jabbar’s notes do not make reference to the treatment and/or
management and/or control of the patient’s diabetes.
- Dr
Jabbar admits the allegations.
Background
- The
patient is a young boy who is now four years old. At the time of the procedure,
the subject of this referral, he was 26 months
of age. He had been diagnosed
with Diabetes Mellitus or Type 1 Diabetes in September 2007. From all reports
his diabetes was well
managed and controlled at the time of the procedure, and
continues to be well managed by careful attentive parents.
- The
boy’s parents wanted to have him circumcised. They say that although they
were given a referral by their GP they were advised
by staff at the Royal
Children’s Hospital (‘RCH’) that the hospital was unable to
perform elective circumcision
procedures. It is not relevant to the matters
before the tribunal that they are unable to recall who they spoke to at the
hospital
about this.
- The
boy’s parents were given Dr Jabbar’s details by a friend. His
father, who is the notifier, made an appointment with
Dr Jabbar for 29 January
2008. Although there is some dispute between Dr Jabbar and the family about the
time when the procedure
was carried out, we accept the notifier’s evidence
that the appointment was for 2 p.m. and not 6 p.m. as suggested by Dr Jabbar,
and that the procedure took place between 3 p.m. and 4 p.m. The appointment
time of 2 p.m. is consistent with the notifier’s
sworn evidence, the email
the notifier sent to himself on 14 January 2008 confirming the appointment
details and the entry in Dr
Jabbar’s appointment diary. We also note that
a further three appointments are recorded in Dr Jabbar’s appointment diary
following this one.
- The
notifier and his father-in-law observed the procedure whilst the boy’s
mother and brother waited outside the consultation
room. The notifier gave
evidence that they each held one of the boy’s arms, that the boy was
extremely distressed during the
procedure and the notifier was consoling
him.
- The
boy’s parents say they left the surgery approximately 5 minutes after the
procedure was completed. Dr Jabbar says he observed
the boy for approximately
half an hour during which time he observed urine in the child’s
pyjamas.
- On
his return home the child became increasingly distressed, and when he had still
not passed any urine the notifier telephoned Dr
Jabbar sometime between 10 and
11 p.m. The notifier’s evidence is that Dr Jabbar said it was likely the
boy’s inability
to pass urine was probably psychological (because of the
shock of the procedure), that the parents should give him more liquid and
he
should be ok.
- The
next morning, when the boy had still not urinated, and was not only very
distressed but suffering from a high temperature, his
parents called an
ambulance. He was taken to the emergency department at the RCH where he was
admitted to surgery, the initial plan
being to complete the circumcision
procedure. However, as recorded in the operation notes, the surgeon, after
finding gross swelling
of the penis and scrotum and evidence of infection, and
after consulting with a colleague, decided to abandon the circumcision procedure
and removed the plastibell ring. The surgeon found that a section of the
foreskin inner layer had been trapped across the plastibell
ring causing a
complete occlusion to the uretha meatus so there was no route for the passage of
urine.
- The
child subsequently developed Fournier’s Gangrene, and to date has had six
operations including plastic surgery. He suffered
severe scarring to his groin
and abdomen. He also lost part of his scrotal skin and required skin grafts.
Although the functional
prognosis is good it is probable that he will have
lifelong scarring, and a further two operations will be required. His right
testis
is normal.
The witnesses
- The
Board called both parents to give evidence, Mr McMullin the paediatric surgeon
responsible for the boy’s care whilst he
was a patient at the hospital,
and Dr O’Connell a paediatrician at the RCH who is the boy’s current
treating doctor for
his diabetes. It also called Dr Demeduik, a General
Practitioner who performs circumcision procedures on babies up to the age of
6
months, to give expert evidence. Witness statements were filed for all
witnesses except for Dr O’Connell.
- We
found the notifier’s evidence very persuasive. He was careful and
thorough in giving his evidence and made appropriate concessions
when he was
unable to recall exact details. He was very confident in his evidence about the
boy’s condition during and after
the procedure, and the telephone
conversation he had with Dr Jabbar that evening. He was adamant that Dr Jabbar
had not told him
to ring back if the boy had still not passed urine within one
to two hours. Noting that the notifier said he stayed awake during
the night
caring for the boy, and noting the parents’ obvious understanding of the
importance of following medical advice and
demonstrated by their careful
monitoring and management of his diabetes, we unhesitatingly accept the
notifier’s evidence about
his discussions with Dr Jabbar during the late
night telephone discussion.
Mr McMullin
- Mr
McMullin is a paediatric surgeon. At the time the boy was admitted to the RCH
he was Head of Urology at the hospital. He is clearly
concerned that the RCH is
declining to carry out elective circumcision procedures in line with Government
policy and said that he
considers it prudent and appropriate that where children
have serious health issues, such procedures should be performed in
hospital.
- Mr
McMullin noted that the boy was initially treated by Dr Stenman who was a
visiting paediatric surgical registrar from Finland and
who has since left
Australia.
- Although
he did not treat the boy when he was first admitted to hospital, Mr McMullin was
able to explain the notes made in the emergency
department, and the operation
notes. He said the boy was significantly unwell, and that had he been in a
country with a diminished
level of medical care available he might well have
died. He noted the boy progressed well and was discharged at the end of
February
2008, earlier than initially expected.
- Mr
McMullin confirmed the boy developed Fournier’s Gangrene which he said was
very unusual – the infection resulted in
skin and subcutaneous tissue loss
in the groin and foreskin area. He said he had not previously seen a case of
Fournier’s
Gangrene. Further, whilst there were apparently no
complications from the procedure directly attributable to the boy’s
diabetes,
his diabetes may well have impacted on the extent and gravity of the
infection.
Dr O’Connell
- Dr
O’Connell is a paediatrician at the RCH. Although she was working at the
hospital at the time of the boy’s admission
she did not start treating him
for his diabetes until some time after his discharge from hospital in 2008. She
gave evidence that
his diabetes is well managed by his parents who carefully
monitor his glucose levels. She confirmed the importance of appropriate
discussions with the parents and treating doctors before performing any surgical
procedure on a child suffering from Type 1 Diabetes
which she said requires
careful and particular management. She expressed concern that the procedure was
not carried out in a hospital
with appropriate post operative monitoring and
treatment.
Dr Demeduik
- Dr
Demeduik gave evidence that he regularly performs circumcision procedures in his
rooms on babies up to the age of six months, although
he said that his staff
would prefer him to limit the age to four months. He said that the older the
child the more likely he is
to be restless thus making the procedure more
difficult.
- Dr
Demeduik expressed concern that the procedure had been undertaken on the same
day that Dr Jabbar first saw the boy, particularly
because of the boy’s
age, and his Type 1 diabetes.
- Dr
Demeduik explained the circumcision procedure using a plastibell device in
detail and repeated the observations on the third and
fourth pages of his report
dated 21 October 2009:
The two main factors which concern me in this
case are the age of the patient and the presence of the Type 1 Diabetes
condition.
The age of the patient is relevant in that, notwithstanding the
application of a ‘perfect’ dorsal penile block with excellent
analgesia, the very likely distress in a child of this age would create marked
difficulties...Most paediatric patients require a
level of restraint ...and this
becomes increasingly difficult if the anaesthesia is incomplete and with the
increasing age and strength
of the child...I note that Dr Jabbar acknowledges
that the patient was distressed...The importance of a still patient is that
movement
significantly interferes with the application of any bell device and
the ultimate performance of a circumcision....The second factor
of concern was
the presence of Type 1 Diabetes and the risks such a procedure would pose to
[the patient’s] diabetic control
considering the stress on the patient and
interruption to normal feeding patterns...I would expect a practitioner to seek
specialist
advice as to the monitoring required and management of insulin on the
day or refer the patient to a centre where the practitioner
had access to
on-site specialist diabetic care for the patient.
- Further,
Dr Demeduik said he was most surprised that Dr Jabbar had not noticed the
foreskin blocking the uretha meatus. As he states
at the sixth page of his
report:
I assume the difficulties restraining a 26 month old child
caused or contributed to the misapplication of the bell but I am unable
to
explain the fact that the urethal meatus was covered and was not noticed at the
end of the procedure as this is a basic check along with ensuring there
is no bleeding (no matter the level of patient distress and movement) [emphasis
added]
- Dr
Demeduik also expressed concern about what he considered to be significant
inadequacies in Dr Jabbar’s clinical notes including
the lack of detail in
the boy’s medical history, details of the operation and the late night
call from the notifier. For instance,
whilst the boy’s Type 1 Diabetes is
noted there are no notes about how it is managed, or the advice given to his
parents about
monitoring and management following the procedure. Further,
although it is noted that Xylocaine was administered there are no details
about
the boy’s weight. Dr Demeduik explained that this was critical
information as Xylocaine is administered according to
weight because of possible
toxicity where the amount is too high.
- Dr
Demeduik confirmed that because of the boy’s age and medical issues the
procedure should have been performed in hospital
under a general
anaesthetic
with appropriate facilities and resources to monitor and manage his diabetes and
any complications.
Dr Jabbar’s position
- As
noted above, Dr Jabbar admits the allegations although he disputes some of the
detail provided by the notifier including the time
of the procedure, and the
nature of his discussions with the notifier during the late night telephone
call.
- Dr
Jabbar did not give evidence. His response to the record of interview between
Dr D’Cruz of the Board, and the notifier,
is set out in a letter from his
solicitors dated 6 January 2009 which has been included in the Tribunal Book.
Although the allegations
have now been admitted it is relevant that many of the
responses in that letter have been contradicted by the sworn evidence of the
boy’s parents which we have no hesitation in accepting.
Findings
- Mr
Halley of counsel submitted on behalf of Dr Jabbar that these allegations should
be regarded as one course of conduct in relation
to one patient, and not four
separate courses of conduct. We reject this. It is clear that Dr Jabbar has
failed this boy and his
parents at each step in the process resulting in what
can only be described as a tragic outcome. First, his patient selection was
poor. He failed to identify and appreciate the significant risk factors
associated with performing a circumcision procedure on a
boy of 26 months of age
suffering from Type 1 diabetes. It seems he failed to take a complete history
or, if he did so, he clearly
failed to record the details which Dr Demeduik has
confirmed one would expect to be recorded in a patient’s clinical notes
particularly in relation to the monitoring and management of the boy’s
diabetes. We note that all the medical practitioners
who gave evidence agreed
Dr Jabbar should have consulted with the boy’s treating doctors about the
management of his diabetes
and the appropriateness of conducting the procedure
in his rooms.
- Having
completed the procedure, Dr Jabbar failed to carry out the most basic of visual
checks to ensure that the urethal meatus was
clear, and not obstructed. When
the boy’s father rang him later that night he failed to ensure appropriate
follow up within
the next couple of hours to ensure the boy had passed
urine.
- Noting
that Dr Jabbar has admitted the allegations, and through his counsel has
proposed that certain determinations are appropriate,
and having considered the
evidence, we find:
(i) As to allegations 1.1, 1.2 and 1.3 (as
amended) Dr Jabbar has engaged in unprofessional conduct within the meaning of s
3(1)(a)
and (b) of the HPR Act, and
(ii) As to allegation 1.4 Dr Jabbar has engaged in unprofessional conduct as
defined in s3(1)(a) of the HPR Act.
Determination
- Mr
Armstrong submitted on behalf of the Board that the appropriate determination
would be:
- A reprimand;
and
- A period of
suspension of not less than 3 months; and
- A restriction on
Dr Jabbar’s circumcision practice such that he only be permitted to
perform circumcision procedures on babies
up to the age of 4 months; and
- Remedial
education or counselling from an approved practitioner over a period of 3 months
from the date of resumption of general registration,
with both the practitioner
and Dr Jabbar being required to report to the Board.
- Mr
Halley submitted on behalf of Dr Jabbar that a more appropriate determination
would be:
- A reprimand;
and
- He be required
to undergo remedial education or counselling as suggested by the Board; and
- Dr
Jabbar’s circumcision practice be restricted such that:
- (i) He be
permitted to perform circumcisions on babies up the age of 6 months in his
rooms;
- (ii) He be
required to refer infants from the age of 6 months to 5 years to a paediatric
surgeon for circumcision procedures;
- (iii) He be
permitted to perform circumcision procedures on children between the ages of 5
and 12 years of age providing such procedures
were performed in a day procedure
facility with a general
anaesthetic
under the supervision and direction of a
consultant anaesthetist;
- (iv) There be
no restriction on his circumcision practice where the patients are over 12 years
of age.
- Mr
Halley also submitted that in considering the appropriate determination we
should taken into account that having reflected on the
tragic circumstances of
this case Dr Jabbar has shown insight by admitting the allegations. However, as
Dr Jabbar did not give evidence
we have not been able to fully understand or
test his level of insight.
- The
principles to be applied by the tribunal in making a determination are clearly
set out in Medical Practitioners Board of Victoria v Naik [2009] VCAT
755 at [60 and 61]:
As has been observed before, the following
principles are relevant to our considerations of what determinations should be
made:
- The function of
a determination is protective, not punitive (see Healthcare Complaints
Commission v Litchfield [1997] NSWSC 297; (1997) 41 NSWLR 630). There are two objectives in
making a determination. They are the protection of the public and the
maintenance of the professional
standards of the profession in the eyes of the
public.
- The public
interest in the practitioner’s continuing to practice must be weighed
against the public interest in protecting clients
from any repetition of the
conduct exhibited (see Buttsworth v Walton (unreported NSW Court of
Appeal 19 December 1991 at p 15 per Samuels JA).
- The exhibition
of insight can be relevant.
- An aspect of the
maintenance of professional standards involves an imposition of a determination
that will deter both the particular
practitioner and others from like conduct
(see eg Craig v Medical Practitioners Board of South Australia [2001]
SASC 169; (2001) 79 SASR 545, Mullany v Psychologists Registration Board,
Supreme Court of Victoria (unreported) 22 December 1997; Skinner v
Beaumont (1974) 2 NSWLR 106 at 109 per Hutley JA and Buttsworth v
Walton (Court of Appeal of NSW, 19 December 1991 at 15); Health Care
Complaints Commission (HCCC) v Cox-May (No 1) [2007] NSWPST 6; Morris v
Psychologists Registration Board Supreme Court of Victoria (unreported) 19
December 1997; Honey v Medical Practitioners Board of Victoria [2007]
VCAT 526 at [14]- [16]; Wilks v Medical Practitioners Board of [2007] VCAT
2439 at [128]). (sic)
As this Tribunal has observed before, the
principles to be taken into account when considering what determination is
appropriate are
succinctly put in a decision of this Tribunal in Honey v
Medical Practitioners Board of Victoria [2007] VCAT 526. The same
principles apply in this case. Quoting from that decision -
Paragraph 1(a) of the Act provides that the main purpose of the Medical
Practice Act [and the HPR Act] is:-
“(a) To protect the public by providing for the registration of medical
practitioners and investigations into the professional
conduct, professional
performance and ability to practise of registered medical
practitioners.”
It is of prime importance in assessing the appropriate sanction that we bear
in mind that the purpose of the determination is not
to punish Dr Honey.
Rather, the purpose is to protect the public, by preventing persons who are
unfit to practice from practising
as medical practitioners, and by maintaining
proper professional standards.
This principle is referred to in cases such as Craig v Medical Board of
South Australia [2001] SASC 169; (2001) 79 SASR 545, Mullany v Psychologists Registration
Board, Supreme Court of Victoria (unreported) 22 December 1997 and Morris
v Psychologists Registration Board Supreme Court of Victoria (unreported )
19 December 1997.
Our aim must be to protect the public, and we achieve that aim by imposing
sanctions aimed at regulating professional performance
of the particular
individual under consideration and also by way of general deterrence to the
profession as a whole.
- In
considering the appropriate determination we have noted Mr Halley’s
instructions that Dr Jabbar has performed 1565 circumcision
procedures since
January 2008, all under local
anaesthetic
. The approximate numbers for each age
group are:
Up to 6 months 796
6 months to 4 years 232
4 to 18 years 191
Adult (over 18 years) 300 - 400
Previous disciplinary proceedings
- Mr
Halley provided two character witnesses for Dr Jabbar: one from Mr Abdul Rahman,
Consultant Surgeon/Medical Director at North West
Day/Werribee Day Hospitals who
has known Dr Jabbar professionally for approximately 20 years, and from Dr Mark
Attalla a General
Practitioner who has known Dr Jabbar on a professional basis
for two years. Both attest to the importance of the service he is providing:
circumcision procedures for cultural or religious purposes where these are no
longer performed in the public hospital system. Unfortunately
though, this is
not an isolated incident of Dr Jabbar having been found to have engaged in
unprofessional conduct.
- Dr
Jabbar has been the subject of disciplinary proceedings before the Medical
Practitioners Board of Victoria on three occasions.
Mr Armstrong, provided us
with copies of the Board’s decisions dated 11 February 2005, 26 February
2008 (following a hearing
on 23 October 2007) and 27 February 2009. In two of
the matters the Board found Dr Jabbar had engaged in unprofessional conduct,
and
in one of the cases that he had engaged in unprofessional conduct of a serious
nature. In the 2005 matter he was cautioned and
reprimanded, and in the other
two matters he was reprimanded. In the 2008 matter orders were made for
counselling by a senior medical
practitioner approved by the Chief Executive
Officer of the Board, or nominee, and in the 2009 matter he was directed to
change his
practices to address identified deficiencies in his informed consent
processes in relation to the circumcision of babies.
Reprimand and suspension
- We
have considered the submissions and being mindful that in making our
determination we must have regard to the public interest and
the maintenance of
professional standards we are satisfied that it is appropriate that Dr Jabbar be
reprimanded and his registration
be suspended for a period of three months.
Being concerned to minimise any immediate inconvenience to patients and their
families
who have impending appointments we consider it appropriate that his
registration be suspended effective 22 November 2010.
Restrictions on Dr Jabbar’s circumcision practice
- We
are satisfied that it is appropriate that there be certain restrictions imposed
on Dr Jabbar’s circumcision practice, and
consider a combination of the
suggested proposals appropriate.
- We
are not persuaded that Dr Jabbar should be restricted to performing circumcision
procedures on babies up to the age of 4 months
only although we are satisfied
that infants between the ages of 4 months and 5 years are particularly
vulnerable because of the difficulties
with keeping them calm and restrained.
Accordingly, we determine that Dr Jabbar be required to refer all infants
between the ages
of 4 months and 5 years to a paediatric surgeon.
- Although
Mr Halley urged upon us that it would be appropriate to require Dr Jabbar to
perform circumcision procedures on children
between the ages of 5 and 12 years
in a suitable day procedure centre under the direction of an anaesthetist, we
determine it appropriate
that this requirement apply to children to the age of
18 years.
- We
are not persuaded there should be any restriction on Dr Jabbar’s
circumcision practice for men 18 years and over.
Remedial education and counselling
- We
consider it appropriate that Dr Jabbar undergo some remedial education and
counselling by a practitioner approved by the Board.
We agree it is desirable
that the approved practitioner attend Dr Jabbar’s circumcision practice on
at least 4 occasions,
with the remedial education and counselling to be
completed within 3 months of Dr Jabbar’s resuming practice after the
period
of suspension of his registration as a medical practitioner.
- We
extend the matters suggested by the Board to be the subject of the remedial
education and counselling sessions to include not only
remedial education and
counselling about the appropriate performance of circumcision techniques and
processes, and a review of his
medical records and notes to also include a
review of the information provided to patients, and in the case of children,
their parents
or guardians as it seems the information provided to the
boy’s parents in this case was limited and somewhat lacking.
- We
find that four sessions, as suggested by the Board, are appropriate, and that
these are to be completed within three months of
the date of resumption of Dr
Jabbar’s general registration as a medical practitioner. Dr Jabbar is to
be responsible for the
cost of these sessions, and for the costs of the approved
practitioner in preparing the report. If the approved practitioner considers
it
necessary or appropriate, more than one practitioner may be approved by the
Board to carry out the remedial education and counselling.
The report should be
provided to the Board within two weeks of completing the remedial education or
counselling.
- We
also consider it appropriate, as suggested by the Board, that Dr Jabbar provide
a written report to the Board within three weeks
of the last session.
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DEPUTY PRESIDENT C AIRD Presiding Member
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URL: http://www.austlii.edu.au/au/cases/vic/VCAT/2010/1772.html