What happens when doctors don’t act as they should? And what’s the ruling against neurosurgeon Charlie Teo?

After several years of controversy, and both praise and blame for his willingness to perform high-risk surgeries, neurosurgeon Charlie Teo has been subject to practice restrictions by a special committee established under health practitioner law.



So how does the process of restricting doctors’ medical practice work? And what did this mean for Teo?



How are health practitioners regulated in Australia?​

Health practitioner regulators in Australia aren’t generally empowered to make punitive decisions about health professionals’ conduct.

Instead, Australia’s health practitioner regulations (the so-called “national law”) require decision-makers to exercise their powers to protect patients. They operate in what is often called a “protective jurisdiction”.


And though the regulator may sometimes impose fines, it is rare. That’s because it may do so only when it is “satisfied there is no other order, or combination of orders, that is appropriate in the public interest”.

In all state versions of the national law, regulators may restrict doctors’ medical practices only if it’s “necessary to ensure health services are provided safely and of an appropriate quality”.

But the NSW national law includes additional wording. In all its decisions, the regulator must regard the “health and safety of the public” as the “paramount consideration.”

This can have unusual effects. As the Australian Health Practitioners Regulation Agency (AHPRA) acknowledges, requirements to protect the public may sometimes result in “a determination that is harsher on the practitioner than if punishment were the sole purpose”.



What happened in the Teo case?​

In late 2022, proceedings commenced against Teo via two complaints by the New South Wales Health Care Complaints Commission (HCCC).

The complaints concerned two brain surgeries on two patients. Both involved “radical resections” (“en bloc” removals) of these patients’ brain tumours. Tragically, neither patient regained consciousness after the operations and both patients died – one just ten days after.

In legal terms, the complaints were based on a provision of the national law that defines certain categories of wrongdoing as unsatisfactory professional conduct.

The HCCC alleged Teo had engaged in two categories of this wrongdoing: conduct below the standard reasonably expected of a doctor of his training and experience, and unethical conduct.

The HCCC alleged Teo’s decisions to operate were inappropriate and substandard because the risks of “neurological morbidity” (so-called brain death) outweighed the (potential) benefits of the interventions. There was no allegation that Teo’s surgical skills were substandard.

The surgeries were also unethical, it was alleged, as informed consent had not been obtained from the patients and one patient was required to pay an expensive upfront fee in circumstances of clear vulnerability.



What were the findings and consequences for Teo?​

The Professional Standards Committee, made up of an experienced judge, two expert neurosurgeons and a lay member, applied the civil standard of proof – the balance of probabilities – to the evidence. Though the committee is not legally bound to apply the rules of evidence applied in criminal courts, it decided, broadly for procedural fairness reasons, to receive and consider all of Teo’s unchallenged evidence.

In a decision of more than 100 pages, the committee found Teo guilty of unsatisfactory professional conduct. It determined to “reprimand” Teo (this means a record of “reprimand” is noted on the public copy of his practitioner licence) and to impose four conditions on his practice.

Three conditions involve increased oversight of his practice records. But a more restrictive condition will require Teo to obtain written support from a neurosurgeon approved by the Medical Council of New South Wales for any neurosurgery involving “recurring malignant tumours in the brain or brain stem”.

While this order was hotly contested in the proceedings, the committee determined that, for reasons including Teo’s evidenced “isolation from his peers”, the condition was “necessary to protect the health and safety of the public”.



What about patient autonomy or clinical freedom?​

Difficult ethical questions arise in medical regulation. Here, the committee had to balance the practitioner’s right to practise medicine against the paramount consideration of patient health and safety and against the patient’s right to exercise autonomy.

This last right is sometimes seen as a patient’s moral right to be wrong. On these considerations, the committee relied on accepted evidence from ethical experts that proposed that, as a matter of ethics,

a surgeon does not have a licence to undertake any conceivable procedure even with the agreement or acquiescence of the patient.

Is medical regulation strict in Australia and NSW?​

Many reviews and academic studies find the national law to be fair and appropriate, or not strict enough.

However, some scholars and representative groups including the Australian Medical Association (AMA) find some aspects are too strict and unsympathetic to practitioners.

But a potted history of NSW medical history showcases how successive medical scandals have tended to drive strong regulatory reform. In 1984, when the tragic impacts of the shocking and unethical treatment at Chelmsford psychiatric hospital were coming to light, NSW was the first jurisdiction globally to establish a complaints body for health consumers. Known as the Complaints Unit, this body is now the HCCC.


file-20230712-18-klms7x.jpg

Teo performed two neurosurgical procedures on patients when other neurosurgeons had recommended against it. Unsplash



Another milestone occurred in the early 2000s following several scandals, including the so-called “Butcher of Bega” episode. An inquiry into these events prompted the NSW government to introduce laws permitting medical practitioners to be immediately suspended if the regulator considered it was in the “public interest”.

This was the first power of its kind in Australia and was only adopted into the broader national law of other states in 2018.



What next for Teo?​

Teo may appeal the orders of the committee to the NSW Civil and Administrative Tribunal or seek a review of the conditions. But as the conditions are not subject to an end date, it appears they will otherwise continue indefinitely.

This article was first published on The Conversation, and was written by Christopher Rudge, Law lecturer, University of Sydney

 
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Nobody is doubting he did a lot of positive outcomes with surgery. From what I've read, it was his pattern of behaviour they had to stop.
He's not the lone ranger of having a God complex either.
Took the words right out of my mouth Penny.
Over the years, I have read of many successful outcomes with Teo's treatments.
Unfortunately, brain surgery comes with such a high possibility of adverse conditions. I suppose when a surgeon is sought out by desperate people the way he probably was, he may well develop a huge ego and as Penny puts it "God Complex".
I have listened to surgeons when they have explained risks to us for various things. They put things on the table and definitely spell out the risks. I feel everyone would be aware that any surgery comes with a risk, and more so something like brain surgery. When a surgeon or doctor is upfront and very clear on what may happen, it is scary, but necessary.
Teo might just have believed in himself too much.
 
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Reactions: Penny4
Took the words right out of my mouth Penny.
Over the years, I have read of many successful outcomes with Teo's treatments.
Unfortunately, brain surgery comes with such a high possibility of adverse conditions. I suppose when a surgeon is sought out by desperate people the way he probably was, he may well develop a huge ego and as Penny puts it "God Complex".
I have listened to surgeons when they have explained risks to us for various things. They put things on the table and definitely spell out the risks. I feel everyone would be aware that any surgery comes with a risk, and more so something like brain surgery. When a surgeon or doctor is upfront and very clear on what may happen, it is scary, but necessary.
Teo might just have believed in himself too much.
Yes, that's very true. As we know, Teo is operating overseas, so wealthy Australians can get the surgery there now.
My late father suffered with debilating migraines with the side effect of temporary paralysis on one side of his body, as well as other harsh symptoms. Over the years, he saw 7 different Neurologists. Didn't help him one iota. A handful of these had the 'God Complex' ... which was unfounded in our regard.
 
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Reactions: Gsr
Most likely get me banned from SDC but on a personal decision I do not have a lot of confidence in some members of the medical profession .The rush for the Covid Vax has affected a number of close family members and friends deaths and medical side affects.Thought a bit more research would have been carried out but now to late in some cases .Watch the pile on but that is my experience not anyone elses that cannot be rectified.
 
  • Like
Reactions: DLHM
After several years of controversy, and both praise and blame for his willingness to perform high-risk surgeries, neurosurgeon Charlie Teo has been subject to practice restrictions by a special committee established under health practitioner law.



So how does the process of restricting doctors’ medical practice work? And what did this mean for Teo?



How are health practitioners regulated in Australia?​

Health practitioner regulators in Australia aren’t generally empowered to make punitive decisions about health professionals’ conduct.

Instead, Australia’s health practitioner regulations (the so-called “national law”) require decision-makers to exercise their powers to protect patients. They operate in what is often called a “protective jurisdiction”.


And though the regulator may sometimes impose fines, it is rare. That’s because it may do so only when it is “satisfied there is no other order, or combination of orders, that is appropriate in the public interest”.

In all state versions of the national law, regulators may restrict doctors’ medical practices only if it’s “necessary to ensure health services are provided safely and of an appropriate quality”.

But the NSW national law includes additional wording. In all its decisions, the regulator must regard the “health and safety of the public” as the “paramount consideration.”

This can have unusual effects. As the Australian Health Practitioners Regulation Agency (AHPRA) acknowledges, requirements to protect the public may sometimes result in “a determination that is harsher on the practitioner than if punishment were the sole purpose”.



What happened in the Teo case?​

In late 2022, proceedings commenced against Teo via two complaints by the New South Wales Health Care Complaints Commission (HCCC).

The complaints concerned two brain surgeries on two patients. Both involved “radical resections” (“en bloc” removals) of these patients’ brain tumours. Tragically, neither patient regained consciousness after the operations and both patients died – one just ten days after.

In legal terms, the complaints were based on a provision of the national law that defines certain categories of wrongdoing as unsatisfactory professional conduct.

The HCCC alleged Teo had engaged in two categories of this wrongdoing: conduct below the standard reasonably expected of a doctor of his training and experience, and unethical conduct.

The HCCC alleged Teo’s decisions to operate were inappropriate and substandard because the risks of “neurological morbidity” (so-called brain death) outweighed the (potential) benefits of the interventions. There was no allegation that Teo’s surgical skills were substandard.

The surgeries were also unethical, it was alleged, as informed consent had not been obtained from the patients and one patient was required to pay an expensive upfront fee in circumstances of clear vulnerability.



What were the findings and consequences for Teo?​

The Professional Standards Committee, made up of an experienced judge, two expert neurosurgeons and a lay member, applied the civil standard of proof – the balance of probabilities – to the evidence. Though the committee is not legally bound to apply the rules of evidence applied in criminal courts, it decided, broadly for procedural fairness reasons, to receive and consider all of Teo’s unchallenged evidence.

In a decision of more than 100 pages, the committee found Teo guilty of unsatisfactory professional conduct. It determined to “reprimand” Teo (this means a record of “reprimand” is noted on the public copy of his practitioner licence) and to impose four conditions on his practice.

Three conditions involve increased oversight of his practice records. But a more restrictive condition will require Teo to obtain written support from a neurosurgeon approved by the Medical Council of New South Wales for any neurosurgery involving “recurring malignant tumours in the brain or brain stem”.

While this order was hotly contested in the proceedings, the committee determined that, for reasons including Teo’s evidenced “isolation from his peers”, the condition was “necessary to protect the health and safety of the public”.



What about patient autonomy or clinical freedom?​

Difficult ethical questions arise in medical regulation. Here, the committee had to balance the practitioner’s right to practise medicine against the paramount consideration of patient health and safety and against the patient’s right to exercise autonomy.

This last right is sometimes seen as a patient’s moral right to be wrong. On these considerations, the committee relied on accepted evidence from ethical experts that proposed that, as a matter of ethics,


Is medical regulation strict in Australia and NSW?​

Many reviews and academic studies find the national law to be fair and appropriate, or not strict enough.

However, some scholars and representative groups including the Australian Medical Association (AMA) find some aspects are too strict and unsympathetic to practitioners.

But a potted history of NSW medical history showcases how successive medical scandals have tended to drive strong regulatory reform. In 1984, when the tragic impacts of the shocking and unethical treatment at Chelmsford psychiatric hospital were coming to light, NSW was the first jurisdiction globally to establish a complaints body for health consumers. Known as the Complaints Unit, this body is now the HCCC.


file-20230712-18-klms7x.jpg

Teo performed two neurosurgical procedures on patients when other neurosurgeons had recommended against it. Unsplash



Another milestone occurred in the early 2000s following several scandals, including the so-called “Butcher of Bega” episode. An inquiry into these events prompted the NSW government to introduce laws permitting medical practitioners to be immediately suspended if the regulator considered it was in the “public interest”.

This was the first power of its kind in Australia and was only adopted into the broader national law of other states in 2018.



What next for Teo?​

Teo may appeal the orders of the committee to the NSW Civil and Administrative Tribunal or seek a review of the conditions. But as the conditions are not subject to an end date, it appears they will otherwise continue indefinitely.

This article was first published on The Conversation, and was written by Christopher Rudge, Law lecturer, University of Sydney


This needs to be put in the same place as climate change. The rubbish bin!
 
  • Like
Reactions: Heather J Doubleday
A friend of ours , a very well known sports person will support Dr Charlie Teo and will support him all the way.

Our friends Wife needed brain surgery and a very delicate surgery at that and her surgeon was Charlie Teo and our friends believe if it wasn't for Dr Teo's expertise she wouldn't be here today.
 
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Reactions: midgemills and Gsr
He’s a truly gifted surgeon but I was truly truly shocked to hear of him refusing patients who couldn’t pay his up front fees. I would have thought,with brilliance,comes compassion. Apparently not. Only greed and a God complex.
 
  • Like
Reactions: Gsr
Charlie Teo is a neurosurgical groundbreaker. He was hounded by lesser members of the medical fraternity with an agenda. He's not perfect, who is?
I'd let him operate on me in a heartbeat.
Awork collegues partner had surgeries with Charlie. They gave him quite a few years of extra quality time.
 
Most likely get me banned from SDC but on a personal decision I do not have a lot of confidence in some members of the medical profession .The rush for the Covid Vax has affected a number of close family members and friends deaths and medical side affects.Thought a bit more research would have been carried out but now to late in some cases .Watch the pile on but that is my experience not anyone elses that cannot be rectified.
You won't get banned for saying what you did.
Omg I have said worst, as have a number of other people.

I don't trust doctors full stop,

1. I have had negligent surgery.

2. My 20 year old niece was Recently diagnosed with a rare cancer which has spread. She had been complaining to a doctor for 4 years of pain in her back and was told straight out it was growing pain. It took for her not to be able to walk for further testing to be done. Now every Thursday it's chemo for her.

As for the vaccine, I don't know, I agree it was produced to quick but I think there would have been more deaths.

I have lost a few friends unexpectedly both this year. A 59 year old healthy female , she had the flu for 5 days , went to bed early and never woke up. That was 6 months ago. Then one of our closest friends came home from work and told his wife he was going to lay down as he felt really tired , he never woke up. He was just 63 he would have been 64 last Thursday. We just found out it was a heart attack. He didn't have any heart problems. He went to the gym, he surfed every weekend . He did smoke.

My son reconds Shane Warne's heart attack was from the vaccine
 
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After several years of controversy, and both praise and blame for his willingness to perform high-risk surgeries, neurosurgeon Charlie Teo has been subject to practice restrictions by a special committee established under health practitioner law.



So how does the process of restricting doctors’ medical practice work? And what did this mean for Teo?



How are health practitioners regulated in Australia?​

Health practitioner regulators in Australia aren’t generally empowered to make punitive decisions about health professionals’ conduct.

Instead, Australia’s health practitioner regulations (the so-called “national law”) require decision-makers to exercise their powers to protect patients. They operate in what is often called a “protective jurisdiction”.


And though the regulator may sometimes impose fines, it is rare. That’s because it may do so only when it is “satisfied there is no other order, or combination of orders, that is appropriate in the public interest”.

In all state versions of the national law, regulators may restrict doctors’ medical practices only if it’s “necessary to ensure health services are provided safely and of an appropriate quality”.

But the NSW national law includes additional wording. In all its decisions, the regulator must regard the “health and safety of the public” as the “paramount consideration.”

This can have unusual effects. As the Australian Health Practitioners Regulation Agency (AHPRA) acknowledges, requirements to protect the public may sometimes result in “a determination that is harsher on the practitioner than if punishment were the sole purpose”.



What happened in the Teo case?​

In late 2022, proceedings commenced against Teo via two complaints by the New South Wales Health Care Complaints Commission (HCCC).

The complaints concerned two brain surgeries on two patients. Both involved “radical resections” (“en bloc” removals) of these patients’ brain tumours. Tragically, neither patient regained consciousness after the operations and both patients died – one just ten days after.

In legal terms, the complaints were based on a provision of the national law that defines certain categories of wrongdoing as unsatisfactory professional conduct.

The HCCC alleged Teo had engaged in two categories of this wrongdoing: conduct below the standard reasonably expected of a doctor of his training and experience, and unethical conduct.

The HCCC alleged Teo’s decisions to operate were inappropriate and substandard because the risks of “neurological morbidity” (so-called brain death) outweighed the (potential) benefits of the interventions. There was no allegation that Teo’s surgical skills were substandard.

The surgeries were also unethical, it was alleged, as informed consent had not been obtained from the patients and one patient was required to pay an expensive upfront fee in circumstances of clear vulnerability.



What were the findings and consequences for Teo?​

The Professional Standards Committee, made up of an experienced judge, two expert neurosurgeons and a lay member, applied the civil standard of proof – the balance of probabilities – to the evidence. Though the committee is not legally bound to apply the rules of evidence applied in criminal courts, it decided, broadly for procedural fairness reasons, to receive and consider all of Teo’s unchallenged evidence.

In a decision of more than 100 pages, the committee found Teo guilty of unsatisfactory professional conduct. It determined to “reprimand” Teo (this means a record of “reprimand” is noted on the public copy of his practitioner licence) and to impose four conditions on his practice.

Three conditions involve increased oversight of his practice records. But a more restrictive condition will require Teo to obtain written support from a neurosurgeon approved by the Medical Council of New South Wales for any neurosurgery involving “recurring malignant tumours in the brain or brain stem”.

While this order was hotly contested in the proceedings, the committee determined that, for reasons including Teo’s evidenced “isolation from his peers”, the condition was “necessary to protect the health and safety of the public”.



What about patient autonomy or clinical freedom?​

Difficult ethical questions arise in medical regulation. Here, the committee had to balance the practitioner’s right to practise medicine against the paramount consideration of patient health and safety and against the patient’s right to exercise autonomy.

This last right is sometimes seen as a patient’s moral right to be wrong. On these considerations, the committee relied on accepted evidence from ethical experts that proposed that, as a matter of ethics,


Is medical regulation strict in Australia and NSW?​

Many reviews and academic studies find the national law to be fair and appropriate, or not strict enough.

However, some scholars and representative groups including the Australian Medical Association (AMA) find some aspects are too strict and unsympathetic to practitioners.

But a potted history of NSW medical history showcases how successive medical scandals have tended to drive strong regulatory reform. In 1984, when the tragic impacts of the shocking and unethical treatment at Chelmsford psychiatric hospital were coming to light, NSW was the first jurisdiction globally to establish a complaints body for health consumers. Known as the Complaints Unit, this body is now the HCCC.


file-20230712-18-klms7x.jpg

Teo performed two neurosurgical procedures on patients when other neurosurgeons had recommended against it. Unsplash



Another milestone occurred in the early 2000s following several scandals, including the so-called “Butcher of Bega” episode. An inquiry into these events prompted the NSW government to introduce laws permitting medical practitioners to be immediately suspended if the regulator considered it was in the “public interest”.

This was the first power of its kind in Australia and was only adopted into the broader national law of other states in 2018.



What next for Teo?​

Teo may appeal the orders of the committee to the NSW Civil and Administrative Tribunal or seek a review of the conditions. But as the conditions are not subject to an end date, it appears they will otherwise continue indefinitely.

This article was first published on The Conversation, and was written by Christopher Rudge, Law lecturer, University of Sydney


Doctors are governed by the Hippocratic Oath. Politicians are governed by the Hypocritic Oath
 

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