A doctor practising in Sydney has had his registration cancelled after he was found guilty of unsatisfactory professional conduct and professional misconduct. It was found that over several years, he engaged in deliberately deceptive conduct by altering entries in patient medical records, making non-contemporaneous records and creating false referral letters to specialists despite receiving multiple warnings about his behaviour.
In issue
Whether a general practitioner was guilty of professional misconduct for behaviour including altering patient records, making non contemporaneous records, creating false referrals, and failing to respond to warnings about his conduct.
The background
Dr Chin Ven Tan was registered as a medical practitioner in 1981 in NSW and began to work as a general practitioner shortly afterwards. Over the years, Dr Tan opened a number of GP medical practices across Sydney, including MediCentral, located in Sydney CBD. He worked there from 2017, where he individually determined the Medicare items to be billed.
Dr Tan regularly billed Medicare for items that involved him writing a detailed description of patients’ health problems, treatment methods and management plans. He also billed for attendances at consulting rooms and for documenting examinations that were conducted. For such Medicare items, practitioners are required to record and discuss any plans or arrangements with the patient and store it for at least two years.
Following a complaint from a patient in March 2018 regarding his lack of record-keeping, he was sent a warning letter from the Health Care Complaints Commission (HCCC), stressing the importance of maintaining accurate medical records. He also received a Medicare Practitioner Review Program (PRP) letter addressing concerns over his potentially inappropriate conduct, but Dr Tan failed to provide a response. Despite ongoing investigations of his conduct by the PRP, he continued to alter the dates of past consultations and added non-contemporaneous entries which allegedly confirmed that a patient had provided prior consent. Overall, the practitioner was found to have inappropriately altered over 4,000 patient record entries.
The decision at trial
The Tribunal found that Dr Tan had engaged in unsatisfactory professional conduct (s 139B(1) Health Practitioner Regulation National Law (NSW)) for inappropriately altering entries in patient records, creating fake specialist referral letters and making non-contemporaneous records. Dr Tan was also found guilty of professional misconduct (s 139E Health Practitioner Regulation National Law (NSW)) based on his intentionally deceptive reconstruction of patient records and lack of regard for the warning letters from the PRP. The Tribunal concluded that as a practitioner, he would have been well-aware of the standards and obligations expected of a medical practitioner and the need to keep accurate and contemporaneous medical records.
The Tribunal found that Dr Tan was motivated by self-interest to protect his own reputation and had no concern for the interests of his patients or the greater public. Given that Dr Tan’s problematic conduct spanned over 12 months despite numerous warnings, and the risk he posed to the medical profession, the Tribunal determined that his actions were so grossly serious to constitute professional misconduct.
Implications for you
This case serves as a reminder that it is essential for medical practitioners to keep contemporaneous medical records that accurately reflect discussions with the patient during consultations and any examinations that have been conducted. Such records should include all relevant details of the patient’s clinical history, diagnosis, medication and referrals in a way that can be understood by other health practitioners, to ensure continuity of care. We reiterate that the Code of Conduct requires medical practitioners to ensure that records are clear and sufficient to manage patient care and to date any changes made to records. Section 10.5 of the Code also provides that practitioners should store records for the period prescribed by the law and that they should be prompt in transferring health information when requested by the patient or another authority.
