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Journal of the New Zealand Medical Association, 02-April-2004, Vol 117 No 1191

Medical Discipline – Alternative Medicine

Charge:

The Director of Proceedings charged that Dr Richard Warwick Gorringe was guilty of three charges. Dr Gorringe denied all the charges.

Charge 1 – Mrs Short – Professional Misconduct:

Particulars 1.1 to 1.5 (Diagnoses)

It was alleged Dr Gorringe relied unduly on Peak Muscle Resistance Testing (PMRT) in diagnosing paraquat poisoning; and reached that diagnosis when it was not supported by Mrs Short’s history or clinical presentation; and failed to carry out any other diagnostic tests to confirm or exclude his diagnosis.

It was alleged that in diagnosing cytomegalovirus, Legionella infection and electromagnetic radiation sensitivity Dr Gorringe:

Failed to undertake an adequate clinical examination;
Relied unduly on PMRT to reach the diagnoses;
Failed to carry out any other diagnostic tests to confirm his diagnoses; and
Reached a diagnosis not supported by Mrs Short’s history or clinical presentation.

Particular 2 – (Informed Consent – PMRT)

It was alleged Dr Gorringe carried out PMRT without adequately explaining this diagnostic technique. In particular, he failed to advise Mrs Short of its advantages and disadvantages when compared to conventional and generally recognised diagnostic investigatory techniques; and/or failed to advise her of the degree to which PMRT had been scientifically evaluated for efficacy as a diagnostic tool; and in failing to give an adequate explanation he failed to enable Mrs Short to make an informed choice and therefore failed to obtain her informed consent to PMRT.

Particular 3 – (Informed Consent – other treatments)

It was alleged Dr Gorringe provided and/or arranged to be provided various treatments, namely, homeopathic paraquat injections, homeopathic drops, laser management, and spiritual healing, and also required Mrs Short to forego conventional medical treatment including topical steroid creams and Histafen without advising Mrs Short of the risks, benefits and efficacy of the treatment options; and in failing to give such treatment/management he failed to enable Mrs Short to make an informed choice, and therefore failed to obtain her informed consent to the treatment/management.

Particular 4 – (Documentation)

As an alternative to particulars two and three, it was alleged Dr Gorringe failed to adequately document any explanations given to or informed consent received from Mrs Short.

Particular 5 – (Exploitation)

It was alleged Dr Gorringe knew or ought to have known that the various diagnoses were not supported by Mrs Short’s clinical presentation and thus exploited Mrs Short for financial gain by:

continually advising and/or reassuring her that her condition was improving; and/or
by advising her to purchase homeopathic treatment from him; and/or
by advising her to attend follow up appointments for the monitoring of her condition and/or treatment.

Charge 2 – Mrs Short - Disgraceful Conduct in a Professional Respect:

It was alleged:

Dr Gorringe, in his management of Mrs Short knowing she had been previously diagnosed with chronic eczema and, having diagnosed her variously with paraquat poisoning, cytomegalovirus, Legionella infection and electromagnetic radiation sensitivity required her to cease her then current medication (including Histafen and topical steroid creams) which he knew, or ought to have known, were essential to the ongoing management of her condition; and/or
Dr Gorringe, in his management of Mrs Short when he knew, or ought to have known, of her severe continuing physical and psychological deterioration continued to advise and/or reassure her that her condition was improving and would continue to improve when he knew or ought to have known this was not correct; and/or
Dr Gorringe, when he knew, or ought to have known, that Mrs Short’s physical and psychological condition had deteriorated and was continuing to deteriorate:

failed to reinstate her former medication in a timely manner; and/or
failed to prescribe other medication appropriate to her condition in a timely manner; and/or
failed to advise her to seek further medical care or advice; and/or
failed to refer and/or consult with an appropriate specialist regarding her clinical condition at any time during this period.

Charge 3 -Ms Ghaemmaghamy – Professional Misconduct:

Particular 1- (Diagnosis)

It was alleged that during this period in diagnosing brucellosis, Dr Gorringe:

failed to undertake an adequate clinical examination; and/or
relied unduly on PMRT to reach his diagnosis; and/or
failed to carry out any other diagnostic tests to confirm his diagnosis; and/or
reached this diagnosis when it was not supported by Ms Ghaemmaghamy’s clinical presentation.

Particular 2 – (Informed Consent – PMRT)

It was alleged that Dr Gorringe carried out PMRT as a means of reaching the diagnosis of brucellosis without adequately explaining PMRT and in particular:

failed to advise Ms Ghaemmaghamy of its advantages and disadvantages when compared to conventional and generally recognised diagnostic/investigatory techniques; and/or
failed to advise her of the degree to which PMRT had been scientifically evaluated, for its efficacy as a diagnostic tool;

and in failing to give an adequate explanation regarding PMRT was alleged to have failed to enable Ms Ghaemmaghamy to make an informed choice and therefore failed to obtain her informed consent to PMRT.

Particular 3 – (Informed Consent - Homeopathic Medication and Spiritual Healing)

Based on his diagnosis of brucellosis it was alleged that Dr Gorringe provided/administered and/or arranged to be administered spiritual healing and homeopathic medication without advising Ms Ghaemmaghamy:

the manner in which the spiritual healing, as a treatment modality, would be conducted; and/or
whether antibiotics were available in conjunction with, or as an alternative to, homeopathic medication and/or spiritual healing; and/or
the purpose of risks, benefits and efficacy of the non-conventional treatment, and, in failing to give an adequate explanation to Ms Ghaemmaghamy it is alleged he failed to enable her to make an informed choice and therefore failed to obtain her informed consent to the treatment/ management.

Particular 4 – (Documentation)

As an alternative to particulars two and three, it was alleged that during the said period Dr Gorringe failed to adequately document any explanations given or informed consent received from Ms Ghaemmaghamy.

Particular 5 – (Exploitation)

It was alleged that during the said period when Dr Gorringe knew, or ought to have known, that the diagnosis of brucellosis was not supported by Ms Ghaemmaghamy’s clinical presentation and, on being advised she had tested negative for brucellosis, he exploited her for financial gain by advising her she had brucellosis of the intracellular form which would not be detected by conventional blood tests and advising her to purchase homeopathic treatment from him.

Finding:

Mrs Short

The Tribunal was satisfied that both the charge of professional misconduct and the charge of disgraceful conduct laid against Dr Gorringe in respect of Mrs Short in all the particulars, except particular four of the professional misconduct charge, both separately and cumulatively, were established. Particular four was laid in the alternative to particulars two and three. As the Tribunal found particulars two and three of the professional misconduct charge established, it did not consider it necessary to address particular four of the professional misconduct charge.

The Tribunal found:

That Dr Gorringe in respect of Mrs Short over a six month period of consultations made untenable diagnoses of paraquat poisoning, cytomegalovirus (CMV/CMV toxin), Legionella infection and electromagnetic radiation sensitivity by undue reliance on peak muscle resistance testing (PMRT) to the exclusion of conventional medical diagnostic methods and when not supported by Mrs Short’s clinical presentation.
That PMRT is not a plausible, reliable or scientific technique for making medical decisions and that there was no plausible evidence that PMRT had any scientific validity and that therefore reliance on PMRT to make diagnoses to the exclusion of conventional and/or generally recognised diagnostic/investigatory techniques was unacceptable and irresponsible.
That Dr Gorringe failed to obtain Mrs Short’s informed consent either to the diagnostic techniques or treatments used.
That he exploited Mrs Short.
That he failed to adequately/appropriately treat Mrs Short or refer her for care in the face of her deteriorating condition.

Ms Ghaemmaghamy

The Tribunal was satisfied that the charge of professional misconduct laid against Dr Gorringe in respect of Ms Ghaemmaghamy in all its particulars, except particular four, both separately and cumulatively, was established. Particular four was laid in the alternative to particulars two and three. As the Tribunal found particulars two and three established, it did not consider it necessary to address particular four of the charge.

The Tribunal found in respect of Ms Ghaemmaghamy:

Dr Gorringe made an untenable diagnosis of brucellosis of the intracellular kind by undue reliance on PMRT.
He failed to obtain her informed consent either to the diagnostic technique or treatments used.
He exploited her.

The Tribunal was of the view that where a registered medical practitioner practises “alternative” or “complementary” medicine, there is an onus on that practitioner to inform the patient not only of the nature of the alternative treatment offered but also the extent to which that is consistent with conventional theories of medicine and has, or does not have, the support of the majority of practitioners. The Tribunal recognises that persons who suffer from chronic complaints or conditions for which no simple cure is available are often willing to undergo any treatment which is proffered as a cure. As such, they are the more readily exploited. The faith which such persons place in practitioners offering alternative remedies largely depends on the credibility with which such practitioners present themselves. Where such remedies are offered by a registered medical practitioner, it is difficult to escape the conclusion that the patient derives considerable assurance from the fact that the practitioner is so registered. It follows, therefore, that a registered medical practitioner cannot discharge his or her obligation to treat the patient to the acceptable and recognised standard simply by claiming the particular treatment was “alternative” or “complementary medicine”.

It was satisfied that medical practitioners who practise both conventional and alternative medicine must be well aware of the possibility that patients consult them to get “the best of both worlds” and to avoid those aspects of alternative medicine which are extreme or incredible.

Penalty:

The Tribunal ordered:

Dr Gorringe’s name be removed from the Register of Medical Practitioners.
Dr Gorringe be censured.
Dr Gorringe pay $46,659.83 which represents 40% of the costs of the Director of Proceedings’ investigation and prosecution and $57,436.64 which represents 50% of the Tribunal’s costs, making a total payment of $104,096.47.
A report of the Tribunal’s Decisions be published in the New Zealand Medical Journal.

The full decisions relating to the case can be found on the Tribunal web site at http://www.mpdt.org.nz Reference No: 02//89D.