A Sydney neurologist has been found guilty of unsatisfactory professional conduct on consent and propriety grounds after taking images of a patient’s young daughter and videoing another patient on at least two occasions.
The NSW Health Care Complaints Commission brought several complaints against Dr Daniel Ghougassian, described as a long-standing neurologist and neuropathologist who has been in specialist practice for almost 20 years.
In the first complaint, the HCCC said Dr Ghougassian had improperly photographed “Person X”, the adolescent daughter of “Patient A”, who was in his care, and interviewed the girl about her mother’s health issues without arranging for a parent or another adult to be present.
A month later, in May 2018, it said he took a video of the 13-year-old’s shoulders and/or back after telling her to undo her bra and hold it in her hand.
In evidence, the tribunal heard that Patient A had been referred to Dr Ghougassian in 2017 after an axle fell on her head while she was putting out items for a council clean-up. She had suffered a brain injury, with an EEG showing paroxysmal features, and later suffered “violent outbursts”.
In his defence, Dr Ghougassian said he photographed bruises and scratches on the girl’s legs because of a possibility of undocumented trauma and domestic violence and to let the family know he was “keeping an eye on her”. He said he took the video of her back because of her apparent scoliosis.
As well as the alleged interview, he had also asked the girl to record a diary of her mother’s mood.
The NSW Civil and Administrative Claims Tribunal heard the second matter involved a female patient with Parry-Romberg Syndrome (PRS), who saw Dr Ghougassian on 28 occasions between 2003 and 2015, when she was aged between 17 and 29, at his rooms in suburban Sydney or at the epilepsy clinic at Prince of Wales Hospital.
“Patient B” provided evidence that the neurologist had videoed her on two occasions while she was wearing only underwear or a bra and jeans, the second time because he said he had lost the first recording.
On multiple visits he had also performed clinical examinations involving a pin-prick test for which he lifted up her bra.
Patient B said she had been asked to undergo the chest pin-prick test on more than 50% of visits, while Dr Ghougassian recollected only four occasions. On this point, the tribunal preferred the patient’s evidence that the exam was conducted “several times”.
“The respondent does not agree that there were 10 to 18 occasions when he undertook such an examination but rather estimates it was about four occasions; he asked Patient B to go behind the curtain and remove her shirt; he always asked Patient B if he could lift her bra to conduct a pinprick examination of the skin on her chest including part of the breast to which she verbally agreed. The respondent acknowledges that he did not ask Patient B whether she wished to have a chaperone present,” the tribunal transcript noted.
“The clinical notes are unclear and Patient B’s evidence was to the effect that it was more than 50% of the visits when she was asked to undergo such an examination. The tribunal accepts Patient B’s version that such conduct occurred on several occasions.”
The tribunal noted Patient B did not make any complaint about Dr Ghougassian’s treatment or filming of her until 2018, after she came to question whether his conduct was appropriate.
It said Patient B, who has now graduated as a medical scientist, was considered a truthful witness who related the events as she best recollected them.
Giving expert evidence, Professor Helen Dewey, director of neurosciences at Eastern Health in Melbourne, said PRS was a rare condition characterised by atrophy of skin, subcutaneous tissue and bone over one side of the face or head.
“It would be very reasonable to document that patient’s appearance with clinical photography at the time of presentation and to take further clinical photographs over time,” she said.
However, Dr Ghougassian’s notes “did not indicate any abnormality of gait pattern that might warrant video documentation”.
“The medical records indicate that the respondent had treated a range of symptoms, including symptoms that would generally be outside the respondent’s specialty,” Professor Dewey said.
There did not appear to be any clinical rationale for repeating a detailed sensory examination on each occasion of review, and Dr Ghougassian appeared to review Patient B more frequently and over a longer period than warranted by her clinical situation.
However, Professor Dewey reserved strong criticism for Dr Ghougassian’s inability to provide evidence that he had discussed the benefits and purpose of videotaping, and that he had obtained Patient B’s consent for doing so.
She also said his notes to referring practitioners were “sparse and included minimal documentation of any neurological examination conducted”, while his storage of patient videos was “disorganised and casual”.
With regard to Person X, Professor Dewey said scoliosis was not a condition normally managed by a neurologist and Dr Ghougassian’s explanation that he shot video of the adolescent girl for possible presentation to other doctors and medical students was unsatisfactory.
Dr Ghougassian “appears to have a lack of understanding of contemporary community expectations of interacting with minors. Such conduct invites strong criticism”, she said.
She noted his concern for the social and broader consequences of Person X’s condition, although she was not his patient, saying his approach to the girl and her mother was more in keeping with that of a general practitioner.
In its conclusion, the tribunal ruled the neurologist guilty on four complaints of unsatisfactory professional conduct, rejecting the HCCC’s recommendation for a harsher judgment of professional misconduct.
The tribunal denied a fifth complaint based on particulars of the cumulative reports. However, in relation to this the tribunal said it “…observes that the degree of inappropriate conduct in videotaping a 13 year old without a bra and without parental consent for an obscure reason and violating a host of boundaries with relation to Patient A and Person X is concerning; including the number of apparently unnecessary pin-prick testing of breast skin, inappropriate photography of Person X’s legs and not obtaining proper consent, not keeping records properly, inadequate consent for filming of Patient B, and the respondent’s general lack of awareness of potential distress to patients from such intimate exposures, compounded by the fact that a chaperone was not offered.”
Disciplinary measures are expected to be decided in December.