Medical Practitioner, Dr E New Zealand Men's Clinic - Health and ...

Health and Disability Commissioner
pressure on his usual medications prior to adding Phentolamine which is a
powerful hypotensive agent. It is my view that discussion with the cardiologist
was required before prescribing any agent to improve erectile function. The failure
of [Dr E] to provide studies to indicate the safety of Apomorphine-Phentolamine
nasal spray, could be interpreted to indicate irresponsible prescribing of two agents
with known powerful systemic effects. It is my view that the standard of care
provided to [Mr C] was a severe departure from expected standards because
of the failure by [Dr E] to obtain an adequate medical history, the failure to
undertake any clinical examination or clarify the cardiological status of [Mr C],
and the prescribing of powerful medications, one of which was contraindicated in
known coronary artery disease. I note that the records of [Dr E] indicated that he
intended to prescribe Apomorphine lozenges, but Apomorphine-Phentolamine
spray was dispensed.
No clinical assessment was documented. No telephone consultation with the
cardiologist was undertaken. Both were mandatory actions in the given clinical
context of [Mr C’s] known ischaemic heart disease. These were serious
omissions in care.
It is my view that Phentolamine, in particular, was contraindicated. It is unclear
whether the intended medication was dispensed by the clinic.
The standard that I have used in providing this advice is that of the New Zealand
Medical Council in their publication ‘Good medical practice’. The Council define
good clinical care as including, amongst other factors, ‘adequately assessing the
patient’s condition, taking account of the patient’s history and his or her views and
examining the patient as appropriate’. They also recommend ‘referring the patient
to another practitioner when this is in the patient’s best interests’. It is my view
that an inadequate history was taken and no clinical examination was documented.
Cardiological advice was also necessary.
[Dr E] has advised that some patients ‘will give me a clear impression that they do
not want to get into discussion about risks and so forth. This involves something
of a clinical judgement at the time’. It is my view that a doctor is more than just a
source of prescription medicines. Where a patient is unwilling to provide
reasonable information to substantiate a request for a specific treatment, a prudent
doctor should refrain from prescribing such medication.”
18 December 2008 32
Names have been removed (except the NZ Men’s Clinic) to protect privacy. Identifying letters are
assigned in alphabetical order and bear no relationship to the person’s actual name.