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Death of GP’s friend highlights conflict of interest, says coroner | Medical Observer

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Death of GP’s friend highlights conflict of interest, says coroner Paddy Wood (/author/paddy-wood) 4 March 2016 Michael Augoustinos (/author/michael-augoustinos)

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http://www.medicalobserver.com.au/professional-news/death-of-gp-s-friend-highlights... 6/03/2016

Death of GP’s friend highlights conflict of interest, says coroner | Medical Observer

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A GP’s failure to call an ambulance for a sleeping family friend who later died of a drug overdose should be used as a cautionary tale in the RACGP’s conflict of interest training, a coroner says. Yamini Patel died in a Melbourne hospital on 20 October, 2009, a day after her 48th birthday and 11 days after ingesting a deadly combination of tramadol and temazepam. In findings handed down on Monday, Victorian coroner Audrey Jamieson said Ms Patel’s family had arrived home on the night of 9 October to find her snoring on the sofa and unable to be woken. When her state was unchanged some 14 hours later, the family phoned Dr Uday Dixit, a GP and family friend. He suggested they check the house for medication wrappers and call an ambulance if her breathing changed. When she had still not woken by the late afternoon, they asked Dr Dixit to visit, showing him foil wrappers from tramadol suggesting eight tablets were missing. Dr Dixit found Ms Patel’s heart rate and blood pressure were normal and her pupils reactive to light, and advised the family that she needed to sleep the medication off, the inquest was told. According to Ms Patel’s husband, Bhadrayu Patel, he and Dr Dixit made “a joint decision” not to call an ambulance. “He did mention that in such cases if you do call the ambulance that it’s better,” he told the inquest. “But [that] these kind of medications are known to have people sleep quite a bit.

http://www.medicalobserver.com.au/professional-news/death-of-gp-s-friend-highlights... 6/03/2016

Death of GP’s friend highlights conflict of interest, says coroner | Medical Observer

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“He said, ‘OK, if we can monitor her and if things change we call the ambulance, we’ll go that path rather than distressing everyone and making everyone run around’.” Later in the evening, Mr Patel phoned Dr Dixit to report nothing had changed, and stayed up watching her overnight. The following morning Ms Patel’s daughter observed that her mother’s face had lost colour and that her lips had a purple tinge. Her breathing became erratic and an ambulance was called at 7.30am on 11 October. Ms Patel was taken to hospital and placed in intensive care and never awoke from her coma. An autopsy found the cause of death to be ischaemic brain injury from tramadol and temazepam toxicity. The RACGP’s Associate Professor Morton Rawlin told the inquest that it was impossible to know whether Ms Patel would have survived if she had been taken to hospital when Dr Dixit first visited the house. But he said it was inappropriate, given her prolonged unconsciousness, not to do so. In a statement made through his lawyer, Dr Dixit accepted the criticism. “In retrospect, he recognises in particular that it would seem that his judgement and conduct was affected by virtue of the close proximity of his relationship with the Patels. “He regrets that that’s interfered with his judgement and would like to convey to the court that he has in fact taken steps to ensure that none of his patients are in a similar situation.” In her findings, coroner Jamieson said the friendship with Ms Patel’s husband had influenced Dr Dixit not to have the “hard conversation” about taking her to hospital. “Dr Dixit’s failure to separate his professional standing from his personal relationship with the Patel family denied [Ms Patel] the most basic standard of care,” she wrote.

http://www.medicalobserver.com.au/professional-news/death-of-gp-s-friend-highlights... 6/03/2016

Death of GP’s friend highlights conflict of interest, says coroner | Medical Observer

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In her sole recommendation, she asked that the RACGP use the case — particularly how Dr Dixit’s relationship with the Patel family influenced his clinical decisionmaking — as part of its conflict of interest training. Dr Dixit was reprimanded over the case last year by the Victorian Civil and Administrative Tribunal and conditions were placed on his registration. More background: • GP didn’t call ambulance to avoid embarrassment (http://www.medicalobserver.com.au/professional-news/gp-didn-t-call-ambulance-toavoid-embarrassment)

• Finding with inquest into the death of Yamini Patel (http://www.coronerscourt.vic.gov.au/resources/aa8978ac-ffb5-45a1-981a39bbfce1336a/yaminibhadrayupatel_499609.pdf) Tags: Coronial Inquest (/tags/coronial-inquest), Legal (/tags/legal)

Author: Paddy Wood Digital Editor Paddy joined Medical Observer in 2015 from the Australian Associated Press, where he ran the agency’s technology coverage before joining the Sydney bureau to report on crime, politics and courts. His stories have appeared in The Guardian, The Sydney Morning Herald, The Korea Herald, The Australian, The Daily Telegraph, and others.