The Background
Dr Benedicto, as an international medical graduate, had limited registration as a medical practitioner, requiring her to practise under supervision. During the period October 2015 to May 2017, Dr Benedicto was alleged to have provided substandard maternity care to 8 separate women by:
- failing to recognise an abnormal CTG;
- performing inadequate and poorly documented examinations;
- using ill-advised methods of forcep delivery;
- performing inadequate record keeping;
- making the decision to perform an emergency caesarean section without consulting her supervisor; and
- failing to arrange a CTG.
Dr Benedicto admitted that she engaged in the conduct described by the allegations and that the conduct was in breach of the relevant Guidelines and Codes.
The primary dispute concerned whether the suspension proposed by the Board was required.
The Board submitted that it was required, principally in the interests of general deterrence, because of the nature and gravity of the conduct and the need for deterrence.
Dr Benedicto submitted, in essence, that suspension would serve no protective purpose and would only be punitive.
The Outcome
Dr Benedicto was formally reprimanded. The Tribunal’s view was that a suspension was appropriate primarily in the interests of general deterrence and to protect the reputation of and confidence in the profession. However, with some reluctance, the Tribunal did not impose a suspension in addition to a reprimand because it found that Dr Benedicto was such an integral part of the maternity department at the Hospital, that her suspension had the potential to endanger the safety and continuity of care of current maternity patients.
The expert opinion indicated that Dr Benedicto’s performance was frequently associated with poor or absent documentation, examples of poor clinical judgment, lack of clinical skill and repeated failures to escalate concerns or to notify her supervisor.
In the expert’s view, Dr Benedicto’s performance was “well below” what would reasonably be expected of a practitioner of an equivalent level and her patients were entitled to expect better.
On the whole, the Tribunal found that Dr Benedicto had demonstrated insight into her own personal responsibility for the failures in the clinical care she provided and the inadequacy of the records she made.
However, one submission made about her personal responsibility concerned the Tribunal. She submitted that the conduct occurred in circumstances where the deficiencies in her practice were “obscured” from her and that she was not and could not reasonably be expected to be aware of those deficiencies.
The Tribunal agreed that Dr Benedicto’s supervision was undoubtedly inadequate, and her performance reviews did not identify that anything was amiss. However, the fact that there were significant adverse outcomes, including 4 stillbirths, in the care she provided “ought reasonably to have prompted, at the very least, some self-reflection”.
Being let down by her supervisor and working in an environment where poor practices were normalised, did not absolve the doctor from taking responsibility for deficiencies in her practice.
The Tribunal also noted that this Hospital had “an almost systemic complacency and misguided self-congratulation about the quality of the maternity service”.
The Implications
Although this case concerned a junior doctor under critically inadequate supervision, it highlights the personal responsibility every medical practitioner has, no matter how junior, to ensure that their own practice is safe, and consistent with the professional standards expected.
The Tribunal pointed out that “failing to recognise and work within the limits of one’s competence presents a danger in any field of patient care”.
The Tribunal also commented that Dr Benedicto’s inadequate record-keeping significantly limited the ability of other practitioners to provide continuity of care, including in emergencies. Poor documentation contributed to delays in recognising, managing, and providing urgent care to deteriorating patients.
To read the decision in Medical Board of Australia v Benedicto (Review and Regulation) [2022] VCAT 117, click here.
