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Dr Helen Tsigounis is an experienced medical doctor unable to work in Australia. Managing editor David Donovan continues the story of her lonely battle against the Australian medical and legal establishment to secure registration in her homeland.
 
Dr Helen Tsigounis


Part One ended as follows:
In 12 May 2003, after beginning work in Cardiology as a second year resident, but while still awaiting word on her application to the Medical Board, Dr Tsigounis resigned from the Townsville Hospital to return to Melbourne to attend to her father, who was then suffering from a serious heart condition. Two days later, on 14 May, the Queensland Medical Board sent Dr Karen Yuen to the Townsville Hospital to inquire about Dr Tsigounis’ performance. On 11 June 2003, Helen Tsigounis received a notice from the Queensland Medical Board asking her to Show Cause why she should not be barred from the medical profession.
[Read Part One of ‘Keeping the Doctor Away’]

Keeping the doctor away Part 2


In Part Two, we look at Dr Tsigounis' battle both in and out of Australian courts to gain registration in Australia — and even decent legal representation.

The Dreyfus affair

 
Mark Dreyfus, QC


In June 2003, Dr Helen Tsigounis needed a lawyer to conduct her appeal against the Queensland Medical Board’s surprising moves to bar her from the profession. Coming highly recommended was top Melbourne silk Mark Dreyfus QC, (who is now a senior MP in the Federal Government). Unknown to Dr Tsigounis at the time, Mr Dreyfus had, in fact, represented the Victorian Medical Board against doctors in several cases. Tsigounis engaged Dreyfus along with another junior barrister he requested, Jane Dickson. Dr Tsigounis’ legal team, at that time, also included a local solicitor, Leone Brassier.

Dr Tsigounis says she spent considerable money securing the services of this team.

“Mr Dreyfus wanted a percentage of the costs of the future court hearing paid upfront as well as continual payment of his tax invoices for the preparation of the case,” wrote Dr Tsigounis in her book ‘Red Back Web’.

She said she met with the entire legal team at Dreyfus’ office in central Melbourne over a 10 month period from mid-2003 to 2004.

The Medical Board was obliged by legislation to issue what was known as an “Information Notice” within 6 months of issuing a “Show Cause” notice. However, instead of doing this, the Board continued to issue more Show Cause notices, to which Dr Tsigounis’ and her legal team provided detailed responses.

In a memorandum dated 12 February 2004, Dr Tsigounis asked Dreyfus:
“Can we stop The Board from issuing one show cause notice after another in their attempts to delay the process while they search for more evidence against me?”
 
The Queensland Medical Board issued a series of Show Cause notices.


In his memorandum of reply, dated 17 February 2004, Mr Dreyfus wrote, “in short, no”.

Then he added:
“The Board is incompetent in the manner they are dealing with your issue and there are numerous errors in the process by the Board.”
After receiving Dr Tsigounis’ reply to the November show Cause notice, and seven months since her application to be registered, the Board took a different tack — issuing a letter headed “Reasons for Decision”, in which they stated they had finally made a decision to cancel Dr Tsigounis’ registration.

The letter did not appear to meet the requirements of an “Information Notice” as prescribed under the relevant legislation, and Dreyfus described the move in a memorandum dated 12 February 2012 as “outrageous, extraordinary, bizarre and crazy”.

Nevertheless, he filed a notice to appeal it in the Brisbane District Court on December 2003.

In a farcical twist, the Board then stated their own November decision was invalid, claiming Dr Tsigounis’ annual registration fees had not been paid by September when they had apparently been due. Dr Tsigounis alleges that she showed Mr Dreyfus documentary evidence she had paid these fees – in fact, twice – but Dreyfus did not accept this as fact and allegedly told her to pay the fees and continue to “play the game”. So, she paid her fees, seemingly for a third time, and a month later the Board duly issued her with a “Restoration of Previous Registration Notice”.

While the Medical Board delayed and obfuscated, Dr Tsigounis was unable to earn income and was rapidly accumulating tens of thousands of dollars in legal fees.

The Medical Board wasn’t finished playing their cat and mouse game yet, however, because in February 2004, they issued Dr Tsigounis with yet another Show Cause notice, which included new complaints from the Cardiology Department — where she had promoted by the Townsville Hospital to resident and so were entirely irrelevant to her performance as an intern. In any case, Dr Tsigounis and her legal team prepared another detailed, expensive, 50 page response.



Finally, on the 26 March 2004, the Board issued an Information Notice; Dreyfus lodged an appeal against it on the same day, declaring the following:
‘Dr Tsigounis has satisfactorily completed internship requirements in accordance with her conditional registration in that she has reached the necessary level of competence to practice unsupervised.

‘The Appellants probationary registration (in this case being conditional registration or registration with internship conditions) be reinstated and extended for a further period or that the Appellants probationary registration be reinstated but that the probationary conditions be removed.’
At that point, there followed a significant dispute between Dr Tsigounis and Mr Dreyfus. It seems that despite repeated requests, the affidavit was not prepared to her satisfaction, leaving out numerous items Dr Tsigounis felt were critical to her case, and including irrelevant items that did not appear to support her cause — including details of her dispute with Frankston Hospital. And despite her instructions, no supplementary affidavit was prepared to correct the record. In addition, Dr Tsigounis’ also asked her legal team to seek expert opinion from overseas and from a list of local doctors she supplied — experts she felt were less unlikely to be adversely influenced, or cowed, by the Australian Medical establishment. Instead, Dreyfus proceeded to obtain expert opinion from a local doctor who was highly entwined in the local medical fraternity — Associate Professor Rodney Judson from the Royal Melbourne Hospital. Helen Tsigounis alleges she specifically told Dreyfus that Judson was unlikely to look favourably upon her cause, yet still he proceeded in using him as the appeal’s only expert.

Curiously, the report prepared by Professor Judson was allegedly provided to the Medical Board by Dreyfus before being seen by Dr Tsigounis herself.
From Dr Tsigounis' subsequent complaint to the Bar and Ethics Committee.


“When the Judson Report was presented to me during a conference on the 23rd of July 2004, it had already been given to Phillips Fox, the solicitors acting for the Medical Board,” said Dr Tsigounis.

“During the conference, I described the report as biased and ordered my solicitors to exclude it from the evidence.

Dreyfus refused.

As Dr Tsigounis had apparently anticipated, the “Judson report” was ultimately used as evidence by the Medical Board to support their case against Helen Tsigounis.

Furious, Dr Tsigounis began to do much of the legal work herself and proceeded to get expert opinions from the local experts she had asked Dreyfus to contact: Professor Paddy Dewan, Dr Arthur Rosenblum and Dr Arthur Papagelis.

After a preliminary hearing in Brisbane on 29 March 2004, the case was set down to be heard in Townsville in the District Court. A month before the set hearing, Dr Tsigounis' solicitor Leone Brassier withdrew from the case, despite allegedly having already received $50,000 from her. Then, decisively, a week before the hearing, Mark Dreyfus and Jane Dickson also withdrew, having also allegedly received a similar amount from the doctor.

The reason given for the withdrawal was that Dr Tsigounis had instructed them to apply for full registration, something Dr Tsigounis had insisted was her goal from the start. In the last memorandum, Dreyfus stated his reasons for returning the brief:
'…the current state of evidence did not support the argument for unconditional registration and … there was not compelling expert or other independent evidence supporting Dr Tsigounis’ quest for full registration.'
Dreyfus, however, was almost certainly well aware that there were several opinions favourable towards the doctor's quest for full registration; opinions, moreover, that Dr Tsigounis had secured without any assistance whatsoever from her so-called legal "team” — including expert witnesses Prof Dewan, Dr Rosenblum and Dr Papagelis.

Dr Tsigounis alleges categorically that Mark Dreyfus was engaged by her on the specific and very clear basis that he would seek full registration for her. His abandonment of her at her most needful time critically damaged her chances for success in the appeal.



The resignation of her entire legal team so close to the trial was a terrible blow to Dr Tsigounis’ chances of success. A complaint was duly made about Dreyfus’ legal representation to the Victorian Bar and Ethics Committee on 22 November 2004, which was unsuccessful. Interestingly, Dreyfus was a member of that very Committee at the time the complaint was made, although according to the correspondence received from the Committee dismissing Dr Tsigounis’ complaint, he had resigned from it as the complaint was received. A subsequent complaint by Dr Tsigounis to the Victorian Legal Ombudsman was also ignored.

Coming up against a brick Wall

Within days of her appeal, Dr Tsigounis desperately hired Mr Prospero Franzese to conduct the 5-day court hearing in Townsville — and spent a week with him in his South Yarra office discussing the case. Dr Tsigounis prepared a supplementary affidavit to include all the information Dreyfus had left out and had it sworn, but Franzese declined to lodge it with the court, allegedly telling Dr Tsigounis:
“They don’t want it in, and anyway your case is strong enough without it.”
 
Judge Clive Wall (sometimes called "The Great Wall" by online legal magazine Justinian).


On 23 August 2004, Dr Tsigounis walked into the Townsville District Court with Franzese. One of the first of many seemingly callous acts performed by Clive Wall, the presiding Judge, was to prevent Prospero Franzese from appearing for Dr Tsigounis. He did this on the grounds Franzese had no professional legal indemnity insurance in Queensland. The judge, in fact, had the discretion to allow an “agent” to appear for Dr Tsigounis under the District Court Act but declined to exercise this after asking the advice of the Medical Board barrister Mr David Tait.

From a transcript of the proceedings:
His Honour: Section 52 of the District Court Act provides that “a party to an action or other proceeding under this Act may appear in person or by a barrister or solicitor … or by any person allowed by special leave by the judge in any case” …. Well, what do you say Mr Tait about whether I should grant special leave to Mr Franzese?

Mr Tait: I have no instruction to the point, but my submission as bearing in mind my obligation to the court as counsel would be that it is inappropriate to grant such leave….
Was it that Judge Wall may have wanted Dr Tsigounis to drop her case, before hearing any of the arguments?
His Honour: No, well I don’t think that special leave should be granted… what do you say Mr Franzese?

Mr Franzese: Oh, Your Honour, I really can’t say much to that except accept it. What we’d require is a short break so that the appellant can prepare herself to represent herself.

His Honour: Yes, alright. Yes, well, I’ll give you leave to do that. But, Ms Tsigounis, do you realise that you’ll have to conduct the case yourself?

Dr Tsigounis: Well, I have no choice?

His Honour: Well, I don’t think you do. I don’t think you do have a choice.

[Note: emphasis inserted.]
Instructed that she would be without counsel, Dr Tsigounis was at 11.55am given a short adjournment to, as Franzese said, “prepare herself to represent herself” and, after a brief hug, he hurried out of the court to find Helen some local legal support. At 12.20pm, the court resumed, with Dr Tsigounis representing herself, entirely alone, unprepared and terrified.

Dr Tsigounis conducted the court case herself for the first and second day. After the second day Franzese invited her to meet a local barrister he said would take on the case, Paul Dillon. When he came to court the following morning, Judge Wall asked to see Dillon privately in his chambers. After coming back out, Dillon told Dr Tsigounis he would not take on the case — and immediately walked out.
 
Townsville courthouse - with a banner for an unrelated, yet pertinent, protest.


Finally, after the 3rd day of hearings, the Judge adjourned the case for a month, because it had become clear to him that the case would take more than the 5 days set down for the hearing — not through any concern about Dr Tsigounis’ lack of legal representation.

In yet another blow, before any more hearings were heard, her dogged ally Franzese withdrew from the case. Dr Tsigounis alleges Mr Franzese has claimed to be have been subjected to "ongoing pressures" and was frightened. Again, Dr Tsigounis engaged a new lawyer. His name was Tony Hargreaves and he came on board on 22 September 2004. But before any further hearings had been commenced, Hargreaves also withdrew, apparently also retaining not only the money Dr Tsigounis had paid him up front, but also both copies of her vital court documents. The Law Institute of Victoria later also dismissed Dr Tsigounis’ complaint against this legal practitioner, also. Despite engaging even further legal representation, Dr Tsigounis was, almost inevitably in the end, obliged to represent herself at the 2nd part of the hearings, which commenced on 31 January 2005 and which went on for another tormentuous fortnight.

The conduct of the case seemed designed to confuse and frustrate any self-representing litigant, with the transcript showing witnesses were consistently called by the Medical Board out of the order they were listed down — making it almost impossible for Dr Tsigounis to prepare, alone, for cross examination. The judge cheerfully allowed this without brooking any complaint, regularly chastising Dr Tsigounis if she dared complain. There is not enough time to discuss the conduct of the case, except to say that virtually no assistance or encouragement was given to Dr Tsigounis by the judge, who appeared eager to look favourably upon virtually all the Medical Board’s arguments and tactics.

After a week of hearings, Dr Tsigounis said she was completely exhausted.

“By the Friday, the fifth day of the second part of the hearing, I had only slept 16 hours in five nights and felt exhausted and dazed, like I was suffering a hangover.”

“My hands were trembling and I had difficulty coordinating even to hold a pen.”

Despite telling the judge her case would be adversely affected by her state, and tendering an article on sleep deprivation to him, Clive Wall refused to allow an adjournment and the case continued on for several more nightmarish days.

Dr Tsigounis was, of course, unsuccessful in gaining registration, with the judge ruling that Dr Tsigounis needed to do a further year as an intern under probationary conditions at a hospital other than Townville Hospital.
 
Dr Cooksley's evidence regarding the so-called "meningitis patient", which explains that he got all his information from the registrar, did not see the clinical notes, described Dr Tsigounis' treatment inaccurately — and even had the patient's sex wrong! Still, he was dogmatically convinced the patient had meningitis and somehow was believed by the Judge over several other expert opinions.
Flawed judgement

The arguments put by the Medical Board, which were ultimately accepted almost in full by Judge Wall, clearly contain significant discrepancies and apparent inaccuracies, which must lead to a real concern about a miscarriage of justice having occurred in this case.

The main source for the Medical Board’s case came from Dr Karen Yuen, who visited Townsville Hospital for two days soon after Dr Tsigounis had left, and was, it seems, expressly sent to find reasons not to allow Tsigounis to be registered. Much of Yuen’s evidence appears to be based on hearsay rather than any concrete facts, as she alleges that after verbally interviewing Dr Tsigounis’ colleagues, she discovered the doctor’s progress had been limited and not of the standard required by someone who had successfully completed an internship. This claim, however, is at odds with the progress shown in Dr Tsigounis’ written internship assessment reports, as the Medical Board’s states itself in its own Show Cause notice of 11 June 2003:
‘A report was received from Dr Keary, Director of Clinical Training, The Townsville Hospital, on 20 May 2003. In this report, Dr Keary indicated that the formal reports show a pass ….

‘Notwithstanding the fact that satisfactory assessment reports had been received, a number of verbal complaints, some in writing, had been made against you….

‘As there was concern regarding the fact that the intern assessment provided which are satisfactory did not reflect the discussions Dr Yuen had held with your colleagues on 15 and 16 May 2003, Dr Keary was requested to elaborate on his comments in his correspondence of 20 May 2003.’
Apparently, the written reports were not worth the paper they were written on, while the gossip was compelling.
 
Document omitted by the Medical Board from their affidavit, showing Dr Tsigounis had completed her internship satisfactorily IN ALL repects. Curiously, complaints only seemed to appear after she'd left Townsville.


As stated by Dr Tsigounis in a written submission:
“It appears extraordinary that none of the persons who filled out intern assessment forms expressing positive conclusions in respect of our client were interviewed or considered by Dr Yuen.”

Of course, not registering a doctor based on the “vibe” picked up on a 2 day-trip north would not usually be sufficient to debar a doctor in most courts of law, and so the June 11 show cause notice also included a negative written assessment by Dr Sharmula Balanathan from the Vascular and Plastic Surgery Unit, dated 28 May 2003, which said that:
‘Helen has required substantial supervision during the time she has worked for this unit. I have not found her to be a reliable and dependable resident.’
The veracity of this “assessment”, however, appears dubious at best. Firstly, because it was the only negative written intern assessment report Helen Tsigounis had received out of ten and was, moreover, dramatically at odds with the others. Secondly, it was dated several weeks after Dr Tsigounis had resigned from Townsville Hospital and more than two months after she had worked in Balanathan’s unit. It was, indeed, written after Dr Keary’s May 20 report stating Helen Tsigounis had received nothing but favourable assessments. Tellingly, the report was only received after Dr Yuen had invited Dr Balanathan to comment, following Yuen’s visit to Townsville on May 15-16.

The Board also sought to downgrade the other uniformly favourable assessments. For instance, Dr Coley was Dr Tsigounis’ appointed mentor during her stint in the Townsville Hospital Emergency Department, and gave Dr Tsigounis an excellent internship assessment report on 16 December 2002. In fact, after completing a full term of 10 weeks in Emergency by mid-December, she was promoted from intern to Resident Medical Officer by the Hospital and continued to work in the Emergency Department under this new title until the first week of February 2003. Yet it appears that sometime during the following 14 months, Dr Coley changed his mind — because in a statement dated 13 February 2004, whilst residing in the United States, Dr Coley saw fit to revise his internship report from over a year before from the excellent marks he had initially given Helen to “just adequate”. Suffice to say, this report must also be viewed with decided scepticism.
 
Intern assessments don't get much better than the one Dr Coley wrote about Dr Tsigounis at the time they worked together. In America, 14 months later, he had a radical change of heart.


To support the hearsay and post-dated “reports”, the Board also tried to allege Dr Tsigounis had made specific “mistakes” such that her competence as a medical practitioner could be drawn into question.

Closer examination shows that most of these allegations appear to be entirely without basis.

In the February 2004 Show Cause notice, the Board alleged that Dr Tsigounis had made errors writing orders for drugs to be administered by nurses to patients while working in the Cardiology Department where, as mentioned earlier, she had been promoted to resident, and did not work as an intern. Again, the complaints were made some 10 months after Dr Tsigounis had worked there. They were described by expert witness Professor Paddy Dewan as “frivolous”. Expert witness Dr Papagelis went further, describing a claim as a “…a silly complaint, that sort of nurse needs to taking to; I mean how could you even think that was the case”. Nonetheless, Judge Wall used this as evidence of Helen's “mistakes” in his judgement.

There were three other alleged “mistakes” relied upon by the Judge to allow Dr Tsigounis’ deregistration to stand. The first concerned an unidentified child patient’s cannulation going wrong, and relied on statements by Dr Mark Elcock and two paediatric nurses dated February 2004 — some 12 months after the incident was alleged to have taken place.

During the court hearing, Nurse Maloney said:
“I am not aware whether the Townsville Hospital has any specific guidelines in relation to the number of attempts that should be made to cannulise a child, however in my experience, if the cannula cannot be inserted within 3 attempts, someone more experienced should be approached to insert it…. From the marks on the child’s hand, I could tell that a number of attempts had been made to insert the cannula. While I was in the room, Helen made at least one further attempt. I estimate that about 5 or 6 attempts were made to insert the cannula in the child’s arm.”
This testimony was contradicted by nurse Buldo, who said that Dr Tsigounis had successfully inserted the cannula on her third attempt. However, she still damned Dr Tsigounis by saying that the hospital policy was for only two unsuccessful attempts before finding a more experienced practitioner to insert the cannula.
 
Deputy Director of Medical Services at Townsville Hospital, Dr Barry Hodges, signed a completion of internship form, having no concerns about Dr Tsigounis and recommending full registration. After Helen left, he too changed his mind.

Dr Elcock, in his affidavit, said that Helen Tsigounis may have had up to four attempts to insert the cannula, but said that having up to three attempts was not unusual and declined to mention any policy on the number of attempts the Hospital allowed. In fact, no documented policy was ever produced by the Medical Board about cannulation.

Despite this confusing, contradictory, unsupported, and really rather incoherent, testimony, the Medical Board maintained in court that Helen Tsigounis had breached a hospital policy of not exceeding three attempts to insert a cannula. This was accepted by Judge Wall, who declared in his judgement that Dr Tsigounis had attempted to cannulate the child “five or six times” — the outlying estimate.

In court, expert witness Paddy Dewan said:
“It is a common event to have more than three attempts to put in a cannula …. I have certainly seen residents who have had seven or eight goes at putting in a cannula.”
Dr Papagelis concurred, saying:
“Three of four attempts to cannulate a child is not unusual … And sometimes the priority is to find a vein.”
Dr Rosenblum said:
“When cannulating, three or four attempts is not bad.”

*****

The second alleged “mistake” related to a complaint about Dr Tsigounis included in the November 2003 Show Cause notice.

The allegation appeared in a statement by Dr David Cooksley, dated 22 October 2003:
“Dr Tsigounis attended a female patient who required a high vaginal swab…. Whilst attempting to take the vaginal swab, Dr Tsigounis inserted the swab into the woman’s rectum before using the same swab for the high vaginal specimen….”
Dr Cooksley stated that he had not actually seen the patient to confirm the facts, but had been told about the incident by a nurse.


The nurse who made the initial complaint may have been nurse Ruth Struthers, whose statement was incorporated into the February 2004 Show Cause notice.

She said she recalled an incident when a female patient came in complaining of abdominal pain. She said Helen examined her alone in the paediatric area with the curtains drawn around the bed. She claims she heard the patient say through the curtains “you’ve got it in the wrong spot”.
‘When the procedure was finished, Helen drew back the curtains and left soon after. After Helen had left, the patient asked me whether Helen was qualified and whether she knew what she was doing. I asked the patient “why did you say this?”

She replied, “cause she stuck it up my bum”.’
When giving oral evidence, Nurse Struthers said she could not identify who the patient was, nor produce any documentation to support her allegation.

Numerous other doctors, despite not being on duty at the time nor even sighting, let alone speaking to, the alleged victim, made various statements declaring that such as “incident” had indeed occurred. Dr Niall Small claimed in his evidence that a speculum (not a swab) has been placed into a patient’s anus and that this “was witnessed by an emergency department enrolled nurse”. Of course, this seems to contradict nurse Struthers, who never claimed to have seen the incident, but was allegedly lurking outside while Dr Tsigounis had examined the patient with the curtains drawn. Another one, Dr Elcock, also claimed the offending instrument was a speculum, not a swab. Hedging her bets was Dr Julia Ashley, who claimed in her affidavit the incident was a swab, but then said in her court appearance that she was “absolutely sure” that Dr Tsigounis had inserted a finger — and not a swab.

Of course, Dr Ashley cheerfully admitted in Court that her allegation was really nothing more than gossip she had heard in the wards:
“This is a second hand report I got from the nursing staff.”
Unsurprisingly, Dr Tsigounis denied the allegations in their absolute entirety and asked for any evidence that it was ever brought to her attention, or written on any patient record.
Dr Keary's reply to the Medical Board

Indeed, the allegation had already been dismissed by the Townsville Hospital in a letter from Dr Peter Keary dated 29 August 2003, who at the request of the Medical Board had sought to find any evidence of such malpractice:
‘In respect to the woman taken to the paediatric room…. I have no idea whether these allegations were drawn to Dr Tsigounis’ attention when she was employed and I have no patient record in relationship to this and therefore cannot say if it’s supported by that.

‘There is another report, which refers to the use of a speculum in the rectum. However, this is also totally hearsay and I have no patient record of this.’
Despite being dismissed as “totally hearsay”, the Townsville Bulletin duly reported, on the first day of the hearing, that Dr Tsigounis had performed “… an examination in the tea room where a speculum was placed in a patient’s anus.”

Throughout the trial, the Board continued to mischievously insist there was a “cervical/rectum” incident.

In one of the very few areas in which he differed from the Medical Board, Judge Wall refused to accept the cervical/rectal incident as fact in his judgement — describing it as exactly what it was: hearsay. He did not, however, classify the complaint as malicious, which it also appears to have been.

*****

The final and, according to the Board, most damning clinical mistake Dr Tsigounis was alleged to have made was the mistreatment of a patient with meningitis — a very serious and potentially life threatening condition. The Medical Board and the judge regarded this as the key piece of evidence they used to decline Dr Tsigounis’ registration.

Dr David Cooksley expressed the Board’s opinion in a statement dated 22 October 2003:
‘Dr Tsigounis attended a patient with acute bacterial meningitis. She correctly diagnosed this condition and performed a lumbar puncture.

‘One dose of intravenous antibiotic was administered but Dr Tsigounis then discharged the patient from the emergency department without discussing the case with the emergency registrar. The patient was subsequently recalled to the emergency department and fortunately suffered no harm from this incident.
The emergency consultant that recalled the patient after reviewing his chart was Dr Julia Ashley, who claimed that Helen had arrived at a diagnosis of probable meningitis and then sent the patient home, though without a lumbar puncture as Dr Cooksley alleged Dr Tsigounis had performed.

In fact, the clinical notes tell an entirely different story from those of either of these two doctors.

Firstly, laboratory tests performed for meningitis when the patient was recalled, the morning after being seen by Dr Tsigounis, all came up either negative or within normal ranges — indicating the patient almost certainly did not have meningitis.

This is supported by Dr Niall Small from Townsville Hospital, who when asked whether JY suffered from meningitis:
“No. Following the lumbar puncture results it was revealed he did not have meningitis.”
Furthermore, the clinical notes show Dr Tsigounis had specifically excluded meningitis in her diagnosis before sending the patient home.
 
Dr Tsigounis had specifically excluded meningitis.


In short, Dr Tsigounis appears to have made a correct diagnosis and the patient suffered absolutely no harm or damage from her care.

Despite all that, the Medical Board continued to refer to the “meningitis patient” throughout the trial. In fact, on the first day of the District Court hearing (23/8/04), Malcolm Weatherup reported in the Townsville Bulletin that Dr Tsigounis had sent home a patient who had been suffering from “acute bacterial meningitis”.

Astoundingly, unlike the “cervical/rectal” incident, the “meningitis” campaign was successful because, in making his final judgement, Judge Wall made the following surprising statement:
“I am satisfied from the evidence of Dr Cooksley that JY had meningitis. Dr Small thought he did not but I think he is mistaken; Dr Cooksley’s examination of the patient’s records was much more detailed than Dr Small’s and I felt he had a better understanding of the overall picture.”
Astounding, because the thought process the Judge could possibly have used to reach this conclusion is an almost unfathomable mystery. Firstly, Cooksley had never once examined the patient “JY” and was not even in the hospital when the patient presented. Secondly, Dr Cooksley openly admitted that he knew very little about the facts of the so-called “meningitis patient”. For instance, when he appeared in court and was asked whether his diagnosis of meningitis agreed with the clinical notes, he replied:
“I don’t know, I haven’t looked.”
Despite having apparently never looked at any laboratory results, clinical notes, or patients, and having wrongly thought Dr Tsigounis had administered a lumbar puncture – as well as somehow gotten the sex of the patient in question wrong – Dr Cooksley was still  adamantly about his diagnosis — the patient definitely had meningitis. Symptoms, sex or pathology were superfluous.

It seems unlikely, reading the testimony of the numerous doctors, that the patient had, in fact, been suffering from meningitis.

Lab results indicated JY never had meningitis.
Nevertheless, Judge Wall believed Dr Cooksley.

Based on this evidence, and much more that this piece does not have space to cover, there is little alternative but to hold very grave reservations about the conduct of the case and the judgment made. Much of the evidence against Dr Tsigounis appears to be flimsy, based on personality and hearsay, and derived from allegations made well after she had finished working as an intern at Townsville Hospital, in Queensland.

Throughout their action, the Board chose to include negative reports when they could find or solicit them, and hearsay when they couldn’t — but no favourable assessments appeared at all, though numerous of those existed. In addition, no weight was given to the fact Dr Tsigounis was already an experienced and registered medical practitioner in Greece. In all, a misleading and one-sided picture of Dr Tsigounis’ clinical aptitude appears to have been presented to the Court by the Board — and was accepted by the judge apparently entirely without question.

This summation appears to be supported by expert evidence given during the hearing by various witnesses. For instance, Dr Rosenblum stated during the hearing:

“It seems that obviously someone who perhaps didn’t like you or perhaps was collating and trying to collect as many errors as possible to put them to a submission. Because, I mean, I think myself about the number of times in my own intern year that I made errors and usually when I made errors … one of the staff would correct me. So, it seems they’ve obviously been compiling a list … I wonder whether I made more errors in my intern year than you made in your intern year.”

Dr Papagelis agreed with this, saying:
“It is my assessment that there is nothing here that cannot be attributed as part of the learning curve for hospital residents and interns …. She appears to have accumulated extensive experience therefrom than your average intern prior to registration.”
Professor Paddy Dewan said there was no reason Dr Tsigounis should be disallowed registration:
“Her training seems adequate for registration…. The remainder of the allegations against are trivial or vexatious … Helen appears to be the scapegoat for a system under stress.”
(In part 3, we will look at Dr Tsigounis’ appeals all the way to the High Court and bring the story up to the current day.)

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