The Times Australia
The Times World News

.

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

  • Written by Christopher Rudge, Law lecturer, University of Sydney
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[1] by a special committee established under health practitioner law[2].

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[3]”.

And though the regulator may sometimes impose fines, it is rare. That’s because it may do so only when[4] it is “satisfied there is no other order, or combination of orders, that is appropriate in the public interest”.

In all state versions[5] of the national law, regulators may restrict doctors’ medical practices[6] 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[7] the “health and safety of the public” as the “paramount consideration.”

This can have unusual effects. As the Australian Health Practitioners Regulation Agency (AHPRA)[8] 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”.

Read more: Who is our health regulator, AHPRA, and does it operate effectively?[9]

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[10] (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[11].

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[12] 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[13] 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”.

Read more: Doctors may soon get official 'endorsements' to practise cosmetic surgery – but will that protect patients?[14]

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[15]. 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[16] and academic[17] studies[18] 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[19] too strict[20] and unsympathetic[21] 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[22] were coming to light[23], 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.

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[24] 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[25].

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.

Read more: How can the health regulator better protect patients from sexual misconduct?[26]

References

  1. ^ practice restrictions (www.austlii.edu.au)
  2. ^ law (legislation.nsw.gov.au)
  3. ^ protective jurisdiction (www.mcnsw.org.au)
  4. ^ when (legislation.nsw.gov.au)
  5. ^ versions (legislation.nsw.gov.au)
  6. ^ restrict doctors’ medical practices (www.legislation.qld.gov.au)
  7. ^ must regard (legislation.nsw.gov.au)
  8. ^ Australian Health Practitioners Regulation Agency (AHPRA) (www.ama.com.au)
  9. ^ Who is our health regulator, AHPRA, and does it operate effectively? (theconversation.com)
  10. ^ Health Care Complaints Commission (www.hccc.nsw.gov.au)
  11. ^ unsatisfactory professional conduct (legislation.nsw.gov.au)
  12. ^ apply the rules of evidence (legislation.nsw.gov.au)
  13. ^ record of “reprimand” is (www.medicalboard.gov.au)
  14. ^ Doctors may soon get official 'endorsements' to practise cosmetic surgery – but will that protect patients? (theconversation.com)
  15. ^ moral right to be wrong (jme.bmj.com)
  16. ^ reviews (www.ahpra.gov.au)
  17. ^ academic (papers.ssrn.com)
  18. ^ studies (pubmed.ncbi.nlm.nih.gov)
  19. ^ are (www.ama.com.au)
  20. ^ strict (www.ama.com.au)
  21. ^ unsympathetic (pubmed.ncbi.nlm.nih.gov)
  22. ^ Chelmsford psychiatric hospital (piac.asn.au)
  23. ^ coming to light (www5.austlii.edu.au)
  24. ^ inquiry (www.parliament.nsw.gov.au)
  25. ^ 2018 (doi.org)
  26. ^ How can the health regulator better protect patients from sexual misconduct? (theconversation.com)

Read more https://theconversation.com/what-happens-when-doctors-dont-act-as-they-should-and-whats-the-ruling-against-neurosurgeon-charlie-teo-209612

Times Magazine

Understanding ITIL 4 and PRINCE2 Project Management Synergy

Key Highlights ITIL 4 focuses on IT service management, emphasising continual improvement and value creation through modern digital transformation approaches. PRINCE2 project management supports systematic planning and execution of projects wit...

What AI Adoption Means for the Future of Workplace Risk Management

Image by freepik As industrial operations become more complex and fast-paced, the risks faced by workers and employers alike continue to grow. Traditional safety models—reliant on manual oversight, reactive investigations, and standardised checklist...

From Beach Bops to Alpine Anthems: Your Sonos Survival Guide for a Long Weekend Escape

Alright, fellow adventurers and relaxation enthusiasts! So, you've packed your bags, charged your devices, and mentally prepared for that glorious King's Birthday long weekend. But hold on, are you really ready? Because a true long weekend warrior kn...

Effective Commercial Pest Control Solutions for a Safer Workplace

Keeping a workplace clean, safe, and free from pests is essential for maintaining productivity, protecting employee health, and upholding a company's reputation. Pests pose health risks, can cause structural damage, and can lead to serious legal an...

The Science Behind Reverse Osmosis and Why It Matters

What is reverse osmosis? Reverse osmosis (RO) is a water purification process that removes contaminants by forcing water through a semi-permeable membrane. This membrane allows only water molecules to pass through while blocking impurities such as...

Foodbank Queensland celebrates local hero for National Volunteer Week

Stephen Carey is a bit bananas.   He splits his time between his insurance broker business, caring for his young family, and volunteering for Foodbank Queensland one day a week. He’s even run the Bridge to Brisbane in a banana suit to raise mon...

The Times Features

Metal Roof Replacement Cost Per Square Metre in 2025: A Comprehensive Guide for Australian Homeowners

In recent years, the trend of installing metal roofs has surged across Australia. With their reputation for being both robust and visually appealing, it's easy to understand thei...

Why You’re Always Adjusting Your Bra — and What to Do Instead

Image by freepik It starts with a gentle tug, then a subtle shift, and before you know it, you're adjusting your bra again — in the middle of work, at dinner, even on the couch. I...

How to Tell If Your Eyes Are Working Harder Than They Should Be

Image by freepik Most of us take our vision for granted—until it starts to let us down. Whether it's squinting at your phone, rubbing your eyes at the end of the day, or feeling ...

Ways to Attract Tenants in a Competitive Rental Market

In the kind of rental market we’ve got now, standing out is half the battle. The other half? Actually getting someone to sign that lease. With interest rates doing backflips and ...

Top Tips for Finding the Ideal Block to Build Your Home

There’s something deeply personal and exciting about building your own home. You’re not just choosing paint colours or furniture, you’re creating a space that reflects your lifes...

The Home Buying Process Explained Step by Step

Buying a home is a thrilling milestone, but it can also feel like navigating a maze without a map. With paperwork, finances, and decisions at every turn, understanding the home-b...