The background
Dr Constantin Jigau self-notified to the Medical Board of Australia (the Board) in October 2018 after he received a determination from the Professional Services Review Committee on 24 October 2018 which related to his rendering of services under 9 MBS item numbers.
The Board referred this matter to the Victorian Civil and Administrative Appeals Tribunal (the Tribunal) under section 193 of the Health Practitioner Regulation National Law (Victoria) Act 2009 (the National Law) on the basis that Dr Jigau’s conduct amounted to professional misconduct.
Dr Jigau was a general practitioner aged in his early 70s. He was a sole practitioner who eventually had other allied health practitioners working with him, but no other health practitioners.
The allegations made were, broadly, as follows:
- Dr Jigau inappropriately utilised MBS items;
- Dr Jigau prescribed medications (including benzodiazepines, opiates and Duromine) without adequate documented clinical justification and/or appropriate patient monitoring;
- Dr Jigau ordered pathology tests and/or investigations without adequate documented clinical justification;
- Dr Jigau failed to keep accurate, current and complete records of the relevant patient history, examination, procedures performed, differential diagnoses, management plans and correspondence.
Dr Jigau admitted the allegations and the parties submitted an agreed statement of facts.
The outcome
The Tribunal reprimanded Dr Jigau and imposed conditions on his registration that he must be audited and engage in mentoring. The factors the Tribunal weighed when considering whether the Tribunal should suspend Dr Jigau’s registration were:
- Reasons for suspension:
- Dr Jigau engaged in the conduct over 12 months; and
- it had significant implications for the safety and efficacy of patient care.
- Reasons against suspension:
- the conduct occurred 6-7 years before the decision and since then, Dr Jigau had put in place measures or built upon existing ones to improve his practice;
- Dr Jigau made complete admissions (which showed insight);
- Dr Jigau had repaid $357,000 to Medicare; and
- Dr Jigau had been carrying out COVID-19 vaccinations.
The primary difficulty the Tribunal had with Dr Jigau’s conduct was his inadequate record keeping. Their view was that, by reason of his poor records, his patients were at risk because other practitioners could not pick up their care in a fully informed manner, with confidence that all issues had been identified and/or dealt with.
In fact, the expert evidence from Dr Gillian Singleton indicated that a number of chronic conditions were missed and health conditions were not managed due to Dr Jigau’s poor record keeping.
The Tribunal did note (as part of the factors weighing against the imposition of suspension) that Dr Jigau had taken the following steps to improve his practice:
- obtained assistance with computer systems and learned to touch type;
- undertaken training in MBS item numbers;
- reduced his working hours; and
- employed a nurse, assistant and psychologist.
Part of the Tribunal’s reasons for making its determinations related to deterring others from repeating the conduct engaged in by Dr Jigau. This wider deterrence was a heavy determining factor in the Tribunal’s decision.
The implications
Lessons learned from this decision are practical and oft-recited.
The Tribunal was unequivocal that clinical record keeping is an integral part of the safe effective practice of medicine. Any reliance on a practitioner’s memory is a dangerous practice that is contrary to the requirements of the Code of Conduct.
Secondarily, the Tribunal pointed out that practitioners benefit from the counsel of others. Not regularly engaging with peers is a real risk. Medical professionals can gain valuable knowledge, support and insight from each other, avoiding systemic failings such as those in this case.
To read the decision in Medical Board of Australia v Jigau (Review and Regulation) [2022] VCAT 30, click here.