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\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12133937 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 
\par }\pard \ltrpar\qj \li5760\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin5760\itap0\pararsid1378419 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\ul\insrsid11668542\charrsid16401761 Application No}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\b\f39\ul\insrsid11668542 . 1 of 2015
\par }\pard \ltrpar\qc \li4320\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin4320\itap0\pararsid1378419 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542 
\par 
\par }\pard \ltrpar\ql \li5760\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin5760\itap0\pararsid1378419 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid8680791 IN THE MATTER}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid12133937  of a complaint by the Fiji Medical Council and pursuant to Section 74(1) (d) of the Medical and Dental Practitioners Decree 2010
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1378419 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12133937 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 
\par }\pard \ltrpar\qj \fi-3600\li3600\ri0\widctlpar\tx2880\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin3600\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542\charrsid11557166 BETWEEN}{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 \tab :\tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\insrsid11668542\charrsid16401761 Fiji Medical Council}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 \tab \tab \tab \tab \tab \tab 
\par \tab \tab \tab \tab \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\ul\insrsid11668542\charrsid16401761 Applicant
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542\charrsid12133937 
\par }\pard \ltrpar\qj \fi-2835\li2835\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin2835\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542\charrsid11557166 AND}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\b\f39\insrsid11668542 \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 :\tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\insrsid11668542\charrsid16401761 Litiana Browne}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid11557166 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11013868 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\ul\insrsid11668542\charrsid16401761 Respondent}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid11013868 
\par }\pard \ltrpar\qj \fi720\li6480\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin6480\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542\charrsid10029464 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542\charrsid11557166 BEFORE}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid11557166 \tab \tab \tab :\tab The Hon. Mr. Justice }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 David}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166  Alfred}{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542    \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\ul\insrsid11668542\charrsid16401761 President
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \caps\f39\insrsid11668542 D}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 r}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\caps\f39\insrsid11668542  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 Lisa Tikoduadua\tab \tab \tab \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542\charrsid16401761 MEMBER}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542 
\par }\pard \ltrpar\qj \fi720\li2880\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin2880\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 Dr Abdul Wahid Khan\tab \tab \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\b\caps\f39\ul\insrsid11668542\charrsid16401761 Member}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\ul\insrsid11668542 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \caps\f39\insrsid11668542 \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542 \tab \tab \tab \tab 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid11557166 Counsel}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 \tab \tab \tab :\tab M}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
s N Tikoisuva for the Applicant 
\par \tab \tab \tab \tab \tab Ms L Jackson for the Respondent}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 \tab \tab \tab \tab 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542 
\par 
\par Dates of Hearing\tab \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 :\tab 17, 18, 19, 24 and 26 February 2016}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid15104317 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid11557166 Date of }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542 Order}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 \tab }{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542 \tab :\tab 8 July 2016
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11557166 
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507\afs24 \ltrch\fcs0 \b\f39\fs24\ul\insrsid11668542\charrsid459130 ORDER OF THE MEDICAL AND DENTAL}{\rtlch\fcs1 
\af31507\afs24 \ltrch\fcs0 \b\f39\fs24\ul\insrsid11668542 
\par }{\rtlch\fcs1 \af31507\afs24 \ltrch\fcs0 \b\f39\fs24\ul\insrsid11668542\charrsid459130 PROFESSIONAL CONDUCT TRIBUNAL
\par }\pard\plain \ltrpar\s15\qj \li567\ri0\sa200\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af31507\afs24 \ltrch\fcs0 \f39\fs24\insrsid11668542 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 1.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The Applicant, the Fiji 
Medical Council (FMC) filed a Notice of Complaint against the Respondent, Dr Litiana Browne alleging the following:
\par }\pard \ltrpar\s15\qj \li1440\ri855\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin855\lin1440\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid6698546 
Unprofessional conduct contrary to section 55(1)(c) and section 2(2) (b) of the Medical and Dental Practitioners Decree 2010 (the Decree).
\par }\pard\plain \ltrpar\qj \fi720\li720\ri855\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin855\lin720\itap0\pararsid11668542 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid12652111 PARTICULARS
\par }\pard\plain \ltrpar\s15\qj \li1440\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1440\itap0\pararsid11668542\contextualspace \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent whilst being a registered medical practitioner, committed unprofessional conduct, that is, in the course of providing medical care and treatment to Shanta Wati Krishna (deceased) the said Respondent was negligent.
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid12652111 THE ALLEGATIONS AGAINST THE RESPONDENT 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 2.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Applicant contends that the Respondent is subject to disciplinary action, since:
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (i)\tab}}\pard \ltrpar\s15\qj \fi-720\li1287\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1287\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The deceased was first seen by the Respondent circa 19 April 2012, with a history of post-menopausal bleeding.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (ii)\tab}}\pard \ltrpar\s15\qj \fi-720\li1287\ri0\sa200\sl360\slmult1\widctlpar
\tx1457\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1287\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 That aft
er medical examination and consultation by the Respondent, the deceased underwent a Total Abdominal Hysterectomy (TAH) on 30 April 2012, at the Suva Private Hospital (SPH) without the benefit of endometrial sampling to confirm whether her conditions were 
cancer related.  She was discharged, post operation, on 3 May 2012.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (iii)\tab}}\pard \ltrpar\s15\qj \fi-720\li1287\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1287\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
During her care at the SPH, the Respondent was aware of the persistent abdominal pain, nausea, body pain and vomiting of the deceased, until her discharge.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (iv)\tab}The deceased was re-admitted to the SPH on 5 May 2012 with the same symptoms noted in (iii) above.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (v)\tab}
The deceased was subsequently transferred to the Colonial War Memorial Hospital (CWM) where she received medical attention until she died on 4 July 2012.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (vi)\tab}The endometrial tests revealed there was no cancer.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (vii)\tab}
That at all material times, the counseling documentation on management options noted and provided by the Respondent was substandard and contributed to medical decisions being made by the deceased which is not consistent with best practice principles.

\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (viii)\tab}
The failure of the Respondent to obtain endometrial sampling before providing medical treatment and care options was negligent and may have resulted in an unnecessary Total Hysterectomy.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (ix)\tab}The standard of intra-operative documentation is poor and the Respondent\rquote 
s failure to maintain such records is negligent.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (x)\tab}As a result of the Respondent\rquote s omissions and failures, the Respondent\rquote 
s conduct was below the standard of a reasonable medical practitioner in the circumstances.
\par }\pard \ltrpar\s15\qj \li1287\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1287\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 3.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Applicant therefore, prayed for, inter-alia, an order that the Tribunal exercise its powers under section 76(3) of the Decree.
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 4.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent in her Statement of Response to the Allegations alleged, inter-alia, as follows:
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (i)\tab}}\pard \ltrpar\s15\qj \fi-720\li1287\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin1287\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The Respondent denies that she committed any unprofessional conduct.

\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (ii)\tab}
The deceased informed the Respondent at the initial consultation on 19 April 2012 at Suva Bayview Medical Centre (Bay}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 view), }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
that she had been bleeding for about 3 weeks and wanted her baby bag removed. 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (iii)\tab}At the initial consultation the Respondent
 informed the deceased that she had to undergo a Dilation and Curetage (D & C) to rule out endometrial cancer.  This would cost $2,000.00.  The deceased said she did not have the money for this but only enough for the TAH which would cost $7,000.00.

\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid13722445 \hich\af39\dbch\af0\loch\f39 (iv)\tab}}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid13722445 A
t the initial consultation the Respondent conducted a thorough clinical examination of the deceased as well as ordering an ultra sound scan of her pelvis by Samabula Medical Centre.  After examining the ultra sound report and reviewing the clinical examin
ation, the Respondent concluded the chance of endometrial cancer in the deceased was low.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid13722445 \hich\af39\dbch\af0\loch\f39 (v)\tab}Therefore, based on the Respondent\rquote 
s clinical examination and the ultra sound report and the deceased\rquote s insistence the doctor performed a TAH on 30 April 2012 after the deceased signed a Consent Form for Surgical Operation Procedure which was witnessed by the Respondent.}{
\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\qj \li1287\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1287\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid13722445 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid459130 \hich\af39\dbch\af0\loch\f39 (vi)\tab}}\pard \ltrpar\s15\qj \fi-720\li1287\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin1287\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid459130 
The deceased wanted a TAH to be performed to treat her post-menopausal bleeding and not because of the possibility of cancer.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid13722445 \hich\af39\dbch\af0\loch\f39 (vii)\tab}}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid13722445 The mos
t effective cure for post \endash  menopausal bleeding is a TAH,  which would not only cure the deceased\rquote 
s post-menopausal bleeding but was also a preventative treatment against cancer developing in the future, and that was why the deceased had insisted on a TAH from the first consultation.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid13722445 \hich\af39\dbch\af0\loch\f39 (viii)\tab}
The Respondent contended that she kept thorough notes on the initial consultation at the Bayview Clinic.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (ix)\tab}}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent denied she was negligent and contended the operation cured the deceased from post-menopausal bleeding and was also a preventative treatment against uterine, cervical and ovarian cancers.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (x)\tab}The Respondent contended the operation was straight forward and absent any complications.
\par }\pard \ltrpar\s15\qj \li1287\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1287\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 5.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The Respondent therefore prayed that the Notice of Complaint and A
llegations be dismissed with costs.
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 6.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The hearing commenced with the President giving instruction on the procedure to be followed. 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 7.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The Applicant\rquote s first witnesses was }{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542 Dharmesh Bobby Prasad}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111  (PW1) the Chief Executive Officer of the FMC. He received a 
written complaint from Mr. Bal Krishna, the widower of the deceased.  As required, a copy of the letter of complaint was given to the Respondent for her response and her response was forwarded to Mr. Krishna who responded.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 8.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 All documents were then prese
nted to the Medical Professional Conduct Committee (MPCC).  After it deliberated it had 3 options }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid12652111 viz}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 :

\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af31507\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (i)\tab}}\pard \ltrpar\s15\qj \fi-360\li927\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin927\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
If there were a miscommunication, the MPCC would ask PW1 to talk to the parties.}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard\plain \ltrpar\qj \li0\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12015285 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af31507\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (ii)\tab}}\pard\plain \ltrpar\s15\qj \fi-360\li927\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin927\itap0\pararsid11668542\contextualspace \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 If there were no merits in the complaint, it is disregarded and both parties are notified.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af31507\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12015285 \hich\af39\dbch\af0\loch\f39 (iii)\tab}}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12015285 
If there is a prima facie case, the matter is referred to an investigator.
\par }\pard \ltrpar\s15\qj \li927\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin927\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 9.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The MPCC found there was a prima facie case and referred it to Dr James Fong who conducted an investigation.  The MPCC obtained a copy of the investigation report.  The secretariat of the FMC obtained the patient file from the SPH.
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 10.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
PW1 said the Respondent was a registered medical practitioner with a valid licence for 2012.  She p
racticed general and vocational medicine i.e Obstetrics and Gynaecology (O&G). He tendered a number of documents which were marked as Exhibits P followed by a number in running order.  The last of these was the Bundle of the SPH records, which after perus
al by Counsel for the Respondent, were confirmed to be in order and marked as Exhibit P8.  Some of the Exhibits were submitted by the Respondent.
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 11.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 PW1 was then cross examined by the Respondent\rquote 
s counsel on what transpired in the process towards this hearing.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 12.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
In re-examination, PW1 stated the FMC informs the practitioner of the outcome of the process.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 13.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The next witness was Bal Krishnan, the complainant (PW2).  He said his wife was the deceased.  He lodged a complaint against the Respondent becaus
e it seems to him his wife should not have died in a simple case of a hysterectomy performed by the Respondent.  His wife (then 49 years) was examined by the Respondent and she told PW2 that the Respondent advised her the best thing is to get rid of her b
a
by bag (uterus). If not, it could develop into cancer.  When PW2 questioned the Respondent, as to how she could tell her to go for an operation, the Respondent told him that his wife was healthy and there should not be any problem. The Respondent asked hi
m to come to the SPH with $8,000.00, on the following Monday.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid7275431 \hich\af39\dbch\af0\loch\f39 14.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid7275431 
After the operation the Respondent told him it was successful and everything was all right, and if the ovary had not been taken out it could develop into cancer.  
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Before the surgery there were no tests done.  After the surgery, tests were done and all were negative from the report from Australia.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 15.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent never told them of the risks involved or the complications that could arise.  The Respondent never advised of any tests to be d
one before the operation, and said the best option was to remove the baby bag.  The Respondent never gave a diagnosis before the surgery was done.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 16.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Under cross examination, 
PW2 said at the initial consultation at Waimanu Medical Centre, the deceased told the Respondent she had been bleeding  for the previous 3 weeks.  She did not tell the Respondent to remove her baby bag.  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\ul\insrsid11668542\charrsid12652111 She only said to remove the baby bag on the Respondent\rquote s advice}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
.  The Respondent said that this kind of bleeding could be cancerous.  The Respondent never told the deceased that to rule out cancer, a sample of her endometrium was needed.  The Respondent never told the deceased that the possibility of cancer was low.

\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 17.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent never said a D&C was necessary for the deceased.  The deceased never told the Respondent she had only enough money to cover the costs of the TAH. The deceased\rquote s decision to remove the baby bag was not their decision but was ba
sed on the Respondent\rquote s advice.  Everything the deceased did was based on what the Respondent advised.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 18.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid12652111 
In re-examination, PW2 said if they had been told by the Respondent that the risk of cancer was low they would not have gone for a hysterectomy}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 .
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 19.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
In answer to the President, PW2 said they totally relied on the Respondent and in answer to Dr Khan, PW2 said they did not consult any other doctor on the wife\rquote s problem.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 20.\tab}The next witness was Rachel Monika Krishna (PW3), the daughter of the deceased.
  She said she was with the deceased from the first consultation and was aware of the circumstances leading to the surgery.  The Respondent said after menopause, the ovaries and cervix have no purpose, and sent the deceased to get the scan done.  The Resp
o
ndent did not suggest a D&C and never explained any alternative operation and never told them what her diagnosis was.  At the first consultation, the deceased was not desperate but after the Respondent said if she did not get it done now then at some late
r date in her life she will have to have it done, the deceased decided to get it done.  The Respondent said there was a possibility it could be cancer.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542 \hich\af39\dbch\af0\loch\f39 21.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 She and her father }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid12652111 took the deceased to the SPH on 30 April 2012.  She, PW3, only wrote the deceased\rquote 
s name and address on the consent form, Exhibit P8A.  After the operation, the deceased was in pain.  On day 4 she was discharged.  On days 5 and 6 she was vomiting and in pain so her father and her had the deceased readmitted to the SPH.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 22.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The Respo
ndent and Dr Siti Vuniabola (Siti) came and the Respondent saw her and said she did not know what was happening.  After that, the deceased was transferred to and was given a transfusion in the CWM Hospital where she remained for 2 months.  Dr Siti said he
 did not know what was wrong with the deceased and he was going to operate on her to see what was wrong.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid13722445 \hich\af39\dbch\af0\loch\f39 23.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid13722445 After the surgery, Dr Siti said there were holes in the deceased
\rquote s intestine and all the intestinal matter was going into her abdominal cavity.  
Dr Siti said he cleaned the abdominal walls and did repairs but he had to wait and see if the repairs he did were holding.  Dr Siti said he did not know from where the holes came from.  The deceased had 2 or 3 more operations in the CWM Hospital.  The sur
geons kept saying there were leakages and after repairing they would start leaking again.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid8653608 \hich\af39\dbch\af0\loch\f39 24.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid8653608 
The deceased was unable to walk, unable to talk, unable to eat and remained in the Intensive Care Unit (ICU) in the CWM Hospital on her bed for 2 months until she died.  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid8653608 
The deceased never had any medical problem before the surgery (TAH) apart from bleeding}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid8653608 .
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 25.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
In answer to the President.  PW3 said the only things on Exhibit P8A, when she handed it to the SPH reception were the deceased\rquote s name and address.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 26.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Under cross-examination by Counsel for the Respondent, PW3 said she was with the deceased at the initial consultation and the deceased did not tell the doctor she wanted the baby bag removed.  The Respondent told the deceased that one of the causes of pos
t menopausal bleeding is cancer but the Respondent did not tell the deceased that she required a sample of her baby bag nor that the deceased required a D&C and it would cost approximately $2,000.00. 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid13722445 \hich\af39\dbch\af0\loch\f39 27.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid13722445 In re-examination, PW3 said the Respondent did not 
explain any other causes of the bleeding.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 28.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The next witness was Dr James Josefa Fong (PW4).  He stated he has been the head of the maternity unit, CWM Hospital for 12 years, had been working in the medical area for 25 years and is a specialist in O & G.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 29.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The FMC by letter submitted a complaint to the conduct committee to investigate.  He was part of this committee.  They asked for an analysis of the root cause from the CWM Hospital especially the ICU.  They said the injury to the inte
stine was iatrogenic, documented as induced by the treatment.  He was tasked to look through all the documents to ascertain if there were any substandard practice.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 30.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
PW4 then made a report and in it he detailed the instances of substandard }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid3168514 practices.  Taking all the resource material and the guidelines of affiliated 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid8653608 
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
colleges and the United Kingdom and Australia which are up to date, they base their opinion on the best clinical practice within the country. He tendered his report dated 1 July 2013 as Exhibit P10.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid8653608 \hich\af39\dbch\af0\loch\f39 31.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid8653608 
PW4 referred to Exhibit P8 and said there was evidence of a risk of intestinal injury.  Something sinister happened at the time of discharge that required further investigation.  This was indicated by the rise in }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542 the pulse rate}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid8653608 .  There was other evidence that the deceased\rquote s condition was deteriorating.  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\ul\insrsid11668542\charrsid8653608 The surgeons felt the hysterectomy was associated in one way or other with the bowel injury which occurred during the hysterectomy}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid8653608 . 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 32.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The risk of surgery depends on whether there is a plan
 to manage the risk.  Here there was no documentation of a plan.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 33.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Referring to the Consent Form, Exhibit P8A, PW4 said the Respondent
\rquote s signature is not in Part A.  It is conceivable that the patient may not have understood the consent form.  It would 
take 30 minutes to explain the consent form. Five minutes would not be adequate to cover 4 bullet points of Part B of Exhibit P8A.  From Exhibit P8, he noted the deceased arrived at 9:30 am in the Operating Theatre and the consent was signed at 9.20am.  H
e did not see in the initial consultation document that a D&C was requested but rejected. From the post operation notes the deceased had more complaints than usual related to the alimentary canal.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 34.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The tachycardia was persistently high and rising and ne
eded to be assessed.  PW4 would not have allowed the deceased to be discharged.  The best practice is for such a patient to remain in the hospital for further evaluation.  The Respondent discharged her.  On the next day after the surgery, the situation be
came worse.  The injury occurred in a very active part of the intestine and it was going to be difficult to repair.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid16282768 \hich\af39\dbch\af0\loch\f39 35.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid16282768 
Not having a sampling was a significant departure from best practice in the current day.  The management choice was not in keeping w
ith current clinical practice.  The patient should have been informed of the flow on consequences and it should have been documented.  The intra-operative documents should have shown what was done with the adhesions and bowels safely out of the way.  If y
ou appreciate there is a risk, it should be documented how you handled the risk.  In the absence of documentation of how the adhesions were managed, one cannot be confident in saying that the bowel was not injured while it was being dealt with.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 36.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 A doc
tor is duty bound to read the notes of the preceding 24 hours.  PW4\rquote s conclusions are based from the pre-operation to intra-operation and post-operation.  He had read the second opinion.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 37.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 In answer to the President, PW4 said his observations and conclu
sions are based on his O & G experience on the Respondent who is also a practitioner in O & G.  In answer to Dr Khan, PW4 said age is a factor in considering whether a doctor is up to date.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 38.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Under cross-examination by the Respondent\rquote 
s Counsel, PW4 said he was appointed as investigator under the Decree, by the FMC.  He did not interview anyone at all.  The Respondent\rquote 
s documents state she found adhesions but not what she did about them.  PW4 said he did not ask the Respondent for a cop
y of the initial consultation report.  The concern is cancer if there is post-menopausal bleeding.  Investigative procedures are carried out. Both a D&C and a biopsy are equally competent in detecting cancer.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid16282768 \hich\af39\dbch\af0\loch\f39 39.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid16282768 Both members of the Tribunal take PW4 as c
ompetent and possessing up to date data and concur with what he has said.}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid16282768 
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid16282768 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 40.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
PW4 did not ask the Respondent if she informed the deceased of risks of hysterectomy.  One of the risks is gastrointestinal complications.  On readmission the Respondent referred the deceased to a general surgeon.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid16282768 \hich\af39\dbch\af0\loch\f39 41.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid16282768 
After the hysterectomy, the deceased had persistent lower abdominal pain, body pain, nausea and occasional vomiting.  These symptoms persisted through day 1, day 2 and day 3.  In PW4\rquote s opinion, the symptoms appea
red to be on the upper limits of the normal and the only evidence of a sinister cause was the increasing heart rate.  On the notes, PW4 did not see the symptoms receding.  It is normal that they recede with time.  Pulse and heart rates were not normal thr
ough the 3 days.  In general, iatrogenic covers inadvertent injury.  On readmission to the SPH, the deceased had generalized abdominal tenderness. 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 42.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 PW4 said it does not reflect clinical concern and }{\rtlch\fcs1 
\af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid12652111 is not at all good practice to discharge on day 3 with a heart rate of 130 BPM}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
.  He did not agree that discharging the deceased on day 3 indicated an adequate level of clinical concern.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 43.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
In re-examination, PW4 said concern for cancer is what dictates investigation of post menopausal bleeding. An endometri
al sampling procedure of the lining is the best practice.  An ultra sound scan defines a risk but it does not make a pathological diagnosis of cancer.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 44.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The deceased\rquote s death should have been termed a coroner\rquote 
s death, as a death in the I.C.U.  General }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 G}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid16282768 ynaecologists}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid12652111  do not do lymph node dissection.  In Fiji there are only 3 who are skilled in doing lymph node dissections and the Respondent is not one of the 3.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 45.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 With this the Applicant closed its case.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 46.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The Respondent\rquote s Counsel made a submissio
n before calling the Respondent to the stand.  She said she had been a medical practitioner for more than 40 years and had provided medical treatment generally and specifically in O & G for women.  She met the deceased for her first consultation at the Ba
y
view Medical Centre.  The deceased was accompanied by her husband and daughter.  The Respondent created a folder.  The deceased asked for her baby bag to be removed.  The Respondent did not perform a D & C, as the deceased said she could not afford the ad
ditional cost for that.  She wanted a hysterectomy at the SPH.  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid12652111 
The highest concern to a gynaecologist is the possibility of cancer and the usual procedure is to advise the removal of the baby bag}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
.  The uterus and 2 ovaries have ceased operation but are sites for cancer.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 47.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent sent her for an ultra sound scan of the pelvis at the Samabula Medical Centre.  The ultra }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 sound }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
scan report is Exhibit P8 page 2.  If the lining of the uterus is thickened there may be possibility of cancer.  Here the lining is normal. The possibility of cancer is much much lower.  The Respondent performed an internal examination and advised a D & C
 so that she could sample the lining before proceeding to do a hysterectomy, because she needed to be sure there was no cancer before the hysterectomy.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 48.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
There was no evidence of cancer.  The Respondent saw the ultra sound scan which indicated the risk of cancer was very low.  The deceased was informed of the dangers of abdominal surgery }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\i\f39\insrsid11668542\charrsid12652111 i.e.}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
 heavy bleeding, organ injury and infection.  What transpired was recorded in her notes in the Waimanu Medical Centre made the day the deceased and family arrived.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 49.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 At this juncture, the Tribunal examined the suppositious }{
\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 note }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 produced for the first time a}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 t}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid12652111  the hearing.  The Respondent\rquote s Counsel informed she had it since 2015 and had not shown to the Applicant\rquote s Counsel. This was a sheet of A4 notepaper, blue in co
lour and in pristine condition.  It was not stamped with the name of the medical practitioner, which is the accepted practice.  The President therefore ruled that the note was not accepted as evidence.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 50.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The Respondent said the deceased refused an endometrial }{\rtlch\fcs1 
\af31507 \ltrch\fcs0 \f39\insrsid11668542 biopsy }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
and as the risk of cancer was low, opted for a hysterectomy.  The hysterectomy took place in the SPH.  The deceased was admitted on 30 April 2012 and she signed the consent form \endash  Exhibit P8A.  Part A is in the Respondent\rquote 
s handwriting and in Part B the signature at the right is the Respondent\rquote s, and the deceased signed at the left.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 51.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent wrote the date, the name and the address.  She did not sign at the signature of medical practitioner.  She did not sign Part A because it was n
ot necessary as the deceased spoke English.  The Respondent prepared the abdomen and moved the adhesions easily away and packed the bowels out of the surgery site, and proceeded with the hysterectomy which was straight forward.  Immediately after the surg
ery she wrote her report.    
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 52.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The deceased\rquote 
s ovaries and uterus were sent oversees and she saw the histological report Exhibit P4 which negated cancer.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 53.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The deceased was in hospital for 3 days post operation.  She was getting better all the time and was discharged on the 3}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\super\insrsid11668542\charrsid12652111 rd}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid12652111  day after surgery.  The Respondent was happy with her vital signs.  On the morning of 5 May 2012 the Respondent received a desperate call from the deceased\rquote 
s husband that she was vomiting and she told him to bring her right back to the SPH.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 54.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
There the Respondent said she looked different. Her abdomen was distended with tenderness.  The Respondent checked where the surgery was and it was healing.  The Respondent realized after examining her that the symptoms were of a gast
rointestinal nature, so she called the surgeon on call and he dictated her care in the SPH.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid6378315 \hich\af39\dbch\af0\loch\f39 55.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid6378315 
The Respondent said she was served with the complaint on 27 April 2015.  The FMC did not inform her they had appointed an investigator and that he had submitted a report.  She was not given an opportunity to discuss the matter with Mr Krishna.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 56.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Under cross-examination, the Respondent said she provided 2 responses to Mr Krishna\rquote s letter.  She is aware the investigator has powers under the Decree and can exerc
ise any of them.  It is true she was first aware of gastrointestinal complications on 5 May 2012.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 57.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid12652111 
It is correct the deceased was vomiting and nauseous and her pulse rate was high at readmission.  These were the same symptoms noted by the nurses immediately after the surgery}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
.  The Respondent saw the records.  The deceased was in her care.  For the first 24 hours after the operation, the Respondent would rely on the nurse\rquote s notes.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 58.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The nurses carry out the Respondent\rquote 
s plan.   Continuing to look after the patient is for the nurses who carry out the Respondent\rquote s instructions.  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid12652111 She is the decision maker for the deceased\rquote 
s care and after care.  On 1 May 2012 the symptoms after surgery are gastrointestinal.}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111   The symptoms were a lot worse when the deceased came back to the SPH.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 59.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent agreed that after the operation, the deceased had the same pain recorded by the nurses.  She said she did not review the nurse\rquote s notes.  She did not agree she failed to note the gastrointestinal problems on 3 May 
2012.  She said she did not discharge the deceased negligently on 3 May 2012.  The D & C is not an option but a prerequisite before a hysterectomy but the deceased refused.  She did not agree that she did not explain to them the options available.  It was
 not true they opted for a hysterectomy because she represented to them the removal of the baby bag was the only option.}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid3168514 
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid3168514 \hich\af39\dbch\af0\loch\f39 60.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid3168514  The Respondent said she is 73 years old.  She told the dece
ased the possibility of cancer was low.  She denied she told the deceased that cancer was a high risk and the only way to confirm that it is cancer is to remove the baby bag and have it tested.  She was made to understand money was an issue to them.  It w
as not true they wanted the best medical advice to address the problem.  At this point Dr Khan observed the deceased was asking for something which was not in her best interest.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 61.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Respondent said she did not sign Part A.  In Part B the deceased was not asked to consent to blood transfusion.  She did not explain all of Part B to the deceased before the deceased signed.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid10499327 \hich\af39\dbch\af0\loch\f39 62.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid10499327 
In re-examination, the Respondent said the symptoms when the deceased was readmitted were different from those when she went home.
  She said the deceased refused a D & C and told her she had collected enough money for a hysterectomy but could not afford the extra $2,000.00 for a D & C.  She said the deceased told her she wanted the baby bag removed to stop the bleeding.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 63.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The next
 witness for the Respondent was Dr Neil Sharma (DW2).  He said he was a medical doctor, whose specialty is O & G.  He had conducted in excess of 500 hysterectomies and treated hundreds of women with post menopausal bleeding.  
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 64.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 DW2 supplied a medical r
eport dated 2 February 2016.  At this juncture Counsel for the Applicant objected to any materials and evidence that will refer to the notes that the Tribunal has rejected.  Counsel for the Respondent said they were acceptable.  The President ruled that a
ll references to the initial Bayview notes are inadmissible as evidence, while the rest of the report }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 is, as }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
both members were of this view.
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 65.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
DW2 said before a TAH is considered there was a need to look at the patient holistically.  The discharge was satisfactory and within the guidelines of good medical practice.  The deceased\rquote 
s symptoms were within range and possibly acceptable in the deceased\rquote s case.  His opinion was based on the SPH\rquote s notes.  
\par }\pard \ltrpar\s15\qj \li567\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid14120299 \hich\af39\dbch\af0\loch\f39 66.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\ul\insrsid11668542\charrsid14120299 In answer to the Tribunal, DW2 said the train of eve
nts started with the operation (TAH) and ended with the deceased\rquote s death}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid14120299 .
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid8724833 \hich\af39\dbch\af0\loch\f39 67.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid8724833 
Under cross-examination, DW2 said he does not have a specialist licence from the FMC. His vocational registration ended in 2013 and he is in the process of obtaining accreditati
on from the FMC.  He said he gave this opinion as a general practitioner. With regard to the consent form \endash  Exhibit P8A \endash 
 he said this is the standard form.  Part A is a declaration by the Respondent that they have provided information to the patient regar
ding the nature and risks.  The signature of the Respondent provides certainty they have done their duty to provide information to the patient.  Part B is signed by the patient after she is provided with information.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 68.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 PW2 said a hysterectomy is major s
urgery and there are risks associated with any surgery.  In his experience all patients had consented to blood transfusion and were required to sign the consent forms by the Respondent.  He considered the nausea, vomiting and gastrointestinal problems com
bined with increased pulse rate over days 1, 2 and 3 were acceptable.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 69.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
In re examination, DW2 said the deceased was progressively getting better.  With that the Respondent closed her case.   
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 70.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sa200\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The President then directed both Counsel to lodge and se
rve their written submissions and the hearing would continue on 26 February 2016.  On that date both Counsel made their closing submissions.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 71.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Counsel for the Applicant said the case had to be decided on a balance of probabilities whether there was a cause for disciplinary action and whether it had been established that there was unprofessional conduct.  This was the first case of medical neglig
ence in Fiji, and there were 2 elements:  \tab }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 (1) \tab A duty of care.

\par }\pard\plain \ltrpar\qj \fi567\li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 (2)\tab A failing in the standard of care provided.
\par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid16599715 \hich\af39\dbch\af0\loch\f39 72.\tab}}\pard\plain \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542\charrsid16599715 Counsel submitted that the daughter had said the Respondent never told them of any other option than to remove the baby bag.  The Responden
t should have insisted on a D & C first.  The consent was signed at 9:20am and the deceased was in the Operating Theatre at 9:30am \endash  Could the consent have been full and informed?  The Respondent had said it was unnecessary to make the declaration.

\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 73.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 If
 the Respondent did not review the notes, how could she make her decision. Dr Sharma (DW2) is expressing an opinion after a 7 years lapse in practice and as a general practitioner and not as a specialist.  The Respondent knew there was no cancer and there
fore there was no need for a hysterectomy and therefore no fees for her.  There was no notation of D & C in the notes.  There was no record of post operation instructions.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 74.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Counsel submitted the Applicant had complied with the relevant sections of the Decree, and had proved the complaint of unprofessional conduct.  She said the object of the Decree was to protect the public\rquote 
s health and safety and asked if the complaint were proved, that the Tribunal would censure the Respondent impose a substantial fine and restrict the Respondent from practice for a specified time.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 75.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Counsel for the Respondent then submitted.  There were 2 issues: }{
\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid12652111 viz}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
 (1) Has the Applicant complied with the requirement for fairness.  (2) Did the Respondent depart from the standard and if so, does it warrant disciplinary action.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 76.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Counsel said only negligence was particularized, but the Decree does not particularize negligence.  Punishment is not the objective.  The Australian cases have persuasive value.  The test here was whether 
there was a deliberate departure?  The Tribunal must be reasonably satisfied.  The Applicant failed to keep the Respondent informed of the process and Counsel asked if there was procedural fairness here?  The Respondent was not given an opportunity to exp
lain to the widower.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid6949680 \hich\af39\dbch\af0\loch\f39 77.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid6949680 
There was bias by Dr Fong. Because of the lack of fairness and lack of impartiality, the complaint should be rejected.}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid6949680 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 78.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Counsel said the widower could pursue a medical 
negligence claim in the civil court against the Respondent.  She said the Respondent did not sign the declaration because she thought it only had to be signed if there was interpretation.  Counsel asked for the complaint to be dismissed.  In response to t
he President\rquote s request to Counsel for her response to the Applicant\rquote s Counsel\rquote 
s submission on what the Tribunal may order against the Respondent, Counsel said she did not want to say anything in mitigation in response to what the Applicant\rquote s Counsel had asked by way of sanction.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid4015604 \hich\af39\dbch\af0\loch\f39 79.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid4015604 Counsel for the Applicant i}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542 n}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid4015604  her reply said the cases of judicial review in Australian Courts were not relevant here.  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid4015604 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 80.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The President at the conclusion of the hearing, stated the Tribunal would give its decision in writing after taking time for consideration.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 81.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Tribunal before delivering its decision, has perused the written submissions, exhibits and authorities cited.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 82.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
At the outset, it is noted that this is the first Medical Tribunal hearing since the promulgation of the Decree.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 83.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The hearing has proceeded in a manner that is analogous to the conduct of a case in the civil court, as determined by the Tribunal.  The proceedings have complied with what has been laid down in section 75, section 76, section 79, se
ction 80 and section 81 of the Decree.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 84.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The only departure from the norm in a civil case being heard at first instance, is that here the decision of the Tribunal is either a unanimous or a majority one, except that questions of law or procedure are solely decided by the President.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid5847427 \hich\af39\dbch\af0\loch\f39 85.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid5847427 
The cases cited by Counsel for the Respondent do not assist her case.  In: }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid5847427 Dewan v Medical Board of Australia}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid5847427 
 (Occupational and Business Regulation) [2012] VCAT 1327, the Tribunal found on a balance of probabilities that Professor Dewan had failed to inform the parents that their child did not have Hirschsprung\rquote 
s disease, and this was professional conduct which was of a lesser standard than that which the public might reasonably expect of a registered medical practitioner. 
\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The case of: }{\rtlch\fcs1 
\af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid12652111 Prendiville & Anor v The Medical Council & Ors}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
 [2007] IEHC 427 was one for judicial review by the High Court of Ireland, of decisions of the Medical Council finding the doctors guilty of professional misconduct, and therefore has no relevance to the instant Tribunal hearing.}{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 86.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
This brings us to the alleged lack of fairness and impartiality raised by the Respondent\rquote s Counsel.  It is instructive to note that the Respondent had never at any time before the commencement of the hearing before t
he Tribunal or at all applied to the High Court for judicial Review to quash the complaint of the FMC and/or the report of the investigator.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 87.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Without expressing any opinion on these allegations, the Tribunal looks at section 76 of the Decree to ascerta
in whether these allegations, if true, could vitiate these proceedings.  As this is a question of law, the President has carefully considered the submission of the Respondent\rquote 
s Counsel and is of opinion the boundary lines of the province of the Tribunal ha
ve been laid down by the lawmaker in section 76(2) of the Decree and therefore the Tribunal must hear the complaint, unless it considers the complaint  frivolous or vexatious.  The Oxford Advanced Dictionary of Current English defines frivolous as \'93
not serious or important\'94 and vexatious as \'93annoying\'94
.  Again, this is a question of law, and the President is of opinion that the death of a patient of the Respondent is a matter that is both serious and important and not annoying.  The Tribunal is therefore enjoined to hear the complaint.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 88.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Tribunal now proceeds to give its unanimous decision on the complaint.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid949755 \hich\af39\dbch\af0\loch\f39 89.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid949755 
Section 55(1) of the Decree states that there is proper cause for disciplinary }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 a}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid949755 
ction against a registered person, which the Respondent is,   if \'93the person commits unprofessional conduct.\'94 Section 2(2) of the Decree states unprofe-ssional conduct\'94 includes:- (b) \'93
incompetence or negligence in relation to the provision of medical or dental treatment.\'94
\par }\pard\plain \ltrpar\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Since \'93negligence\'94
 is not defined in the Decree, the Tribunal is constrained to refer to the generally accepted test of professional negligence in Commonwealth countries known as the Bolam test.  In }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\i\f39\insrsid11668542\charrsid12652111 Bolam v Friern Hospital Management Committee}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111  [1957] 2 All E.R 118, McNair J said:}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 

\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 \'93}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid12652111 
But where you get a situation which involves the use of some special skill or competence, then the test whether there has been negligence or not is not the test of the man on the Clapham omnibus, because he }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\i\f39\insrsid11668542 h}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid12652111 as n
ot got this special skill.  The test is the standard of the ordinary skilled man exercising and professing to have that special skill.  A man need not possess the highest expert skill at the risk of being found negligent \'85
. It is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art.\'94
\par 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 90.\tab}}\pard\plain \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 This was further explained in: }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid12652111 Hunter v Hamley}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
 1955 S.C 204 by Lord President Clyde when he said:  \'93The true test for establishing negligence in diagnosis or treatment o
n the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary care.\'94
\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542 \hich\af39\dbch\af0\loch\f39 91.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 This }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 necessi}{
\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 tate}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 s the Tribunal closely examining the factual matrix of this complaint as revealed by the evidence produced on both sides.  

\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 92.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 We start with the Respondent\rquote s medical report on the deceased 
\endash  Exhibit P2 dated 27 August 2012.  This starts with describing her as \'93a very healthy lady.\'94  She was complaining of \'93post menopausal bleeding\'94
, bleeding for more than 3 weeks without stopping.  An ultra sound scan was done to exclude any other abnormality.  Blood tests were done too.  Next were discussions on treatment }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid16599715 
options and with the deceased were her husband and daughter.  They were advised that \'93for most gynaecologists we regard it as \'93cancer until proven otherwise.\'94  It is that serious regardless whether the bleeding is heavy or not.\'94
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 93.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The Tribunal pauses to note here that it is clear that the Respondent is telling the deceased and family that cancer is the source of the bleeding, unless the contrary }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 is}{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542\charrsid12652111  proved.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid13722445 \hich\af39\dbch\af0\loch\f39 94.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid13722445 This is confirmed by the Respondent stating in the report that \'93
It was to Shanta\rquote s advantage that we got on with the surgery since she was still bleeding and if our worst fears were confirmed that there was the beginning of abnormal changes then we would be \'93nipping it in the bud.\'94
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 95.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
These abnormal changes cannot be post-menopausal bleeding which may occur to women of the deceased\rquote s age who have final cessation of the menses.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 96.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Therefore the raison d\rquote 
etre for the hysterectomy was the possibility of cancer.  Consequently if there was any evidence that it was not cancer then any good doctor would have said that there was no need for the hysterectomy.  This evidenc
e became available when the ultra sound result showed the lining of the uterus is normal.  Only if the lining of the uterus is thickened then there may be a possibility of cancer.  Here the possibility of cancer is much much lower.  Then the Respondent sa
w the ultra sound report which indicated \'93cancer very low.\'94 \line 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 97.\tab}
With all these evidence at hand for the Respondent, a normal competent doctor would have come to the conclusion that the need for a hysterectomy no longer existed.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 98.\tab}Further it is hard to b
elieve that if the D & C option had been put to the deceased, she would not have accepted it as it was cheaper than a hysterectomy would have cost. This is shown by the Respondent\rquote s statement in her report \endash  Exhibit P2 \endash 
 where she said the options given were:
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid4082256 \hich\af39\dbch\af0\loch\f39 1.\tab}}\pard \ltrpar\s15\qj \fi-360\li927\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls6\adjustright\rin0\lin927\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid4082256 
D&C and if it shows there was malignancy then proceed to hysterectomy OR;
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 2.\tab}}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Go ahead with the Abdominal Hysterectomy.
\par }\pard\plain \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 99.\tab}}\pard\plain \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 It is as plain as a pikestaff that a hysterectomy would only be needed if there were malignancy.  This had been ruled out by the ultra sound scan. So on the Respondent\rquote 
s reasoning there was no need now for a hysterectomy.  Yet she went ahead with one.  Why?
\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid11826043 \hich\af39\dbch\af0\loch\f39 100.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid11826043 
The only plausible reason has to be that the Respondent was only interested in having a hysterectomy carried out.  And it is this hysterectomy that led to the death of the deceased.  This is confirmed by the Respondent\rquote s own witness, Dr Neil Sharma
, in his evidence when he said the train of events started with the operation (hysterectomy) and ended with the deceased\rquote s death.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid16132786 \hich\af39\dbch\af0\loch\f39 101.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid16132786 
Further, the Respondent failed to sign Part A of the consent Form.  The excuse she gave for not signing does not exculpa
te her.  On the contrary it inculpates her.  She is asking the Tribunal to conclude she has never performed any such operation in the past or she has an inadequate command of the English language, or because she is advanced in years she is not aware of th
e serious nature of what Part A connotes or, finally she is indifferent to the fate of the deceased.
\par }\pard \ltrpar\s15\qj \li1080\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1080\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 102.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Whatever the conclusion reached there }{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542 is }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 no escaping the necessary implication that the Respondent did not inform the deceased of the risks that atten
d such an operation as a hysterectomy.
\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 103.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
Thus she has fallen short of the standard of the reasonable medical practitioner in similar circumstances.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 104.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 This is unprofessional conduct which has to be }{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542 penalized in}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111  the interest of the public of Fiji.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid5785967 \hich\af39\dbch\af0\loch\f39 105.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid5785967 
The Respondent in her letter to the FMC also dated 27 August 2012.  Exhibit P3, in Para 5 & 6 makes it crystal clear that it was cancer that was the objective of the surgical intervention when she states \'93It was only in hind sight now that we now know 
there was no cancer \endash  we did not know that before.\'94
  The necessary implication of this must be if it was known that there was no cancer there would have been no hysterectomy.  But the truth of the matter is the Respondent did know and knew well before the 
hysterectomy, that the scan results showed in her own words \'93there was no cancer.\'94
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 106.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
So proceeding with an unnecessary operation for whatever reason, possibly for monetary reasons, an operation which was not in the best interest of the deceased was unprofessional conduct of a serious nature.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 107.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
The discharge of the deceased on day 3 when her medical condition was not of the best is yet another falling on the part of the Respondent from the standard of a reasonable  competent medical practitioner.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 108.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
What her witness Dr Sharma (DW2) said in his present position of an ordinary medical practitioner and not that of a specialist, that it was all right to discharge was not evidence of a compliance with the required standard of medical care.  In the opi
nion of the Tribunal this can be considered as evidence of a general and culpable complacency, born of a cavalier failure to exercise common sense.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid13722445 \hich\af39\dbch\af0\loch\f39 109.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid13722445 
Since there is no plausible evidence that the Respondent had advised the deceased of the risks associa
ted with a hysterectomy, the Tribunal finds the Respondent cannot exonerate herself from the flow on consequences of that operation. These are best described in the evidence of Dr Fong, PW4, when he testified, \'93
In absence of documentation of how adhesions were managed one }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid5382617 
\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid13722445 cannot be confident in saying that the bowel was not injured while it was being dealt with.\'94 He goes on to say that \'93the bowel injury occurred during the hysterectomy.\'94
  This would be considered as medical negligence anywhere.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid8939204 \hich\af39\dbch\af0\loch\f39 110.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid8939204 It 
is unhappy for Counsel for the Respondent to submit the hysterectomy was successful in stopping the bleeding.  Surely the unkindest cut of all was for the family to be told the operation was successful but the patient died thereafter.
\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 111.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 In: }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\i\f39\insrsid11668542\charrsid12652111 Sidaway v Royal }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542 Bethlehem }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \i\f39\insrsid11668542\charrsid12652111 Hospital Governors}{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid12652111  [1984] 1 All E.R 1018, the majority of the judges said the Bolam test applied to all aspects of the doctor\rquote s duty of care}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 :}{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542\charrsid12652111  diagnosis, advice and treatment.}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\qj \li567\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 112.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 In }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\i\f39\insrsid11668542\charrsid12652111 Reynolds v North Tyneside Health Authority}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111  [2002] Lloyd\rquote 
s Rep. Med. 459, the judge said a finding that it was negligent to ignore a small risk of catastrophic consequences (death or brain damage)  was neither unfair nor unrealistic.}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid3224253 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542 \hich\af39\dbch\af0\loch\f39 113.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 H}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
ere the certificate of death of the deceased states the cause of death as }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 \'93}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 Multi Organ dysfunction, abdominal catastrophic.
\'94
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid15559429 \hich\af39\dbch\af0\loch\f39 114.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid15559429 Thus the negligence of the Respondent}{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \f39\insrsid11668542 ,}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid15559429  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 her unprofessional conduct and her falling from the requisite standard have all }{
\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid15559429 been proved and on the balance of probabilities }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 the Tribunal is satisfied }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\f39\insrsid11668542\charrsid15559429 that there is proper cause for d}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 isciplinary action against the R}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid15559429 espondent.
\par }\pard \ltrpar\s15\ql \li720\ri0\sa200\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin720\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 115.\tab}}\pard \ltrpar\s15\qj \fi-567\li567\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin567\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 The Tribunal therefore orders:
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (1)\tab}}\pard \ltrpar\s15\qj \fi-360\li927\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin927\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 That the Respondent be censured.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (2)\tab}That the Respondent pay the Fiji Medi}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
cal Council a fine of $5,000.00, within 30 days from the date of this order.
\par }\pard \ltrpar\s15\qj \li927\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin927\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par 
\par 
\par 
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (3)\tab}}\pard \ltrpar\s15\qj \fi-360\li927\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls7\adjustright\rin0\lin927\itap0\pararsid11668542\contextualspace {\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 That the Respondent\rquote 
s registration be canceled, her licence be revoked and the Respondent be disqualified from being registered generally for a period of ten (10) years with effect from the date of this order.
\par {\listtext\pard\plain\ltrpar \s15 \rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f39\fs22\insrsid11668542\charrsid12652111 \hich\af39\dbch\af0\loch\f39 (4)\tab}Each party to bear their own costs of these proceedings.
\par }\pard\plain \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 \rtlch\fcs1 \af31507\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542 Dated and }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid12652111 Delivered at Suva, this }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542 8}{\rtlch\fcs1 \af31507 
\ltrch\fcs0 \b\f39\super\insrsid11668542\charrsid4733110 th}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid12652111 day of }{\rtlch\fcs1 \af31507 \ltrch\fcs0 
\b\f39\insrsid11668542 July }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid12652111 2016.
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542 
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \f39\insrsid11668542\charrsid12652111 
\par }\pard \ltrpar\qj \fi720\li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85
\'85\'85\'85
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\insrsid11668542\charrsid4733110 mr Justice David Alfred}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110 \tab -  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542 \tab }{
\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110 PRESIDENT
\par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\ul\insrsid11668542\charrsid4733110 
\par 
\par 
\par }\pard \ltrpar\qj \fi720\li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85
\'85\'85\'85.
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\insrsid11668542\charrsid4733110 Dr Lisa Tikoduadua}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110     \tab -  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542 \tab }{
\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\insrsid11668542\charrsid4733110 Member
\par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110 \tab 
\par 
\par 
\par 
\par }\pard \ltrpar\qj \fi720\li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110 \'85\'85\'85\'85\'85\'85\'85\'85\'85\'85\'85
\'85\'85\'85
\par }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\insrsid11668542\charrsid4733110 Dr Abdul Wahid Khan}{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110  \tab -  }{\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542 \tab }{
\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\caps\f39\insrsid11668542\charrsid4733110 Member
\par }\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\f39\insrsid11668542\charrsid4733110 
\par }\pard \ltrpar\qj \li0\ri0\sl480\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11668542 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \b\insrsid11668542\charrsid4733110 
\par }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af31507 \ltrch\fcs0 \insrsid12869491 
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