A Canberra doctor failed to assess a patient and obtain informed consent for an invasive laser skin treatment that left the patient in pain and discomfort at her son's first birthday party three days later.
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The ACT Civil and Administrative Tribunal has published its decision on an application from the Medical Board of Australia, which sought disciplinary action against Canberra Laser Biotherapy Clinic owner Dr Nathem Al-Naser, alleging five breaches of the doctors' code of conduct.
The tribunal found each of the five grounds for the application had been proven. The case has been listed to return to the tribunal on Monday for further orders and directions.
The medical board's application followed a complaint made by a patient who underwent a procedure at Canberra Laser Biotherapy Clinic in 2014.
The woman, who was given the pseudonym Patient K by the tribunal, consulted Dr Al-Naser's clinic on March 3 that year to seek treatment for blemishes on her face that were thought to have been the result of acne scarring.
The decision says she was attended to by clinician Annie Page and given a treatment plan that proposed one treatment per week, using a relatively low-intensity dual laser. This was to be reviewed after six weeks, with the possibility of using a higher-intensity Erbium profractional laser after the review.
However, the decision says that when Patient K returned to start treatment on March 6, she received treatment using the high-intensity laser "in circumstances about which there is great controversy".
"During and after the treatment she said she was in pain and was concerned about the appearance of her face," the decision says.
Dr Al-Naser gave evidence that he made a visual assessment of Patient K on the day she received the treatment and that he attended to her in the clinic for 15 minutes that day. He also said she signed consent forms and that his standard practice would have been to tell the patient they would experience pain, redness and some bleeding after the procedure.
But Patient K denied signing the forms and said she never saw Dr Al-Naser before or during her treatment, and that there was no communication with him until the day after the treatment.
In the decision, Special Member Graeme Lunney SC said the tribunal had "little confidence" in the reliability of the evidence given by Dr Al-Naser and Sarah Larkin, a clinician and part-owner of the clinic.
"On the other hand the tribunal has confidence in the veracity of Patient K," the decision says, noting that her claim for compensation had been settled before she gave evidence in the tribunal proceedings.
The tribunal found Dr Al-Naser did not make any assessment of Patient K, and that communication with her was "limited in the extreme without any care taken to ensure that she understood what was going on".
There was also a failure to obtain informed consent from Patient K and to explore less invasive treatment options.
"The information passed to Patient K was so inadequate that when she went into the treatment room she thought she was going to see the doctor and when the laser started it was commencement of the procedure to take a test patch," the decision says.
"She says the treatment wasn't what she had expected. The tribunal has accepted her evidence."
The tribunal also ruled there had been "a substantial failure" to provide adequate aftercare instructions and treatment to Patient K, and that record-keeping had been inadequate.
It is not the first time Dr Al-Naser has earned the ire of the medical board. In 2015, he was banned from supervising a practice for two years after he failed to report a sexual relationship between a doctor he employed at the Belconnen Medical Centre, Dr Maged Khalil, and a patient.
Dr Al-Naser treated the patient for the effects the relationship had on her health, but did not take any action and allowed Dr Khalil to continue working at the surgery until the patient and her psychologist reported the relationship to the medical board.