The doctor has surrendered to his accusers but I don't think he needed to. Imunotherapy can work miracles and it can be argued that is should be tried first before leaping into surgery.
His decision to use ipilimumab is perhaps questionable. It is an older drug that can have severe side effects. Since Keytruda has now been approved for use with melanoma, that would have been a better choice. But it may not have been available under any protocol in 2018
But, as his colleagues say, he should have recognized the side-effects of ipilimumab as they emerged and gone straight into surgery at that point. So there was a degree of negligence there. But as a busy chief oncologist in a public hospital, such omissions can happen. It was probably his workload that was principally to blame
A top Queensland oncologist has been found guilty of professional misconduct, after a melanoma patient died “unnecessarily” due to the doctor’s multiple failures in diagnosis and treatment.
Paul Norman Mainwaring is a former director of oncology at the Mater Hospital and more recently practised at Canossa Private Hospital in Oxley.
He is now co-founder and chief executive of cancer diagnosis biotech company XING Technologies.
In a decision published on Tuesday, the Queensland Civil and Administrative Tribunal member John Robertson found that the 57-year-old’s “multiple failures” and, in particular, his initial treatment decision by immunotherapy for the melanoma patient in 2018 was “very serious”.
“The expert evidence against (Mr Mainwaring) is overwhelming, (his) multiple failures and, in particular, his initial treatment decision are therefore very serious,” Mr Robertson states in his decision.
Mr Mainwaring admitted during the tribunal hearing on September 15 that he “acted in a manner that was substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training and experience”, the decision states.
He also accepted his various failures in treatment decision-making including failure to seek other specialist opinions, and failure to keep notes amounted to professional misconduct.
He has surrendered his medical registration.
The decision states that a 76-year-old patient, known as PB, lost 11kg in weight and “tragically died” in Brisbane on 25 May 2018 after he developed an infection from severe diarrhoea and a perforated gastrointestinal wall which was a “known complication” of the immunotherapy called ipilimumab, with four doses by infusion between January and March 2018.
“Ipilimumab was not the appropriate treatment for the patient given the patient’s melanoma was either a stage IIB or stage IVa; has known side effects due to its high toxicity, including colitis and diarrhoea,” Mr Robertson wrote in his decision.
“The appropriate approach to the patient’s condition was to “wait and see”,” Mr Robertson wrote.
The tribunal heard that three experts in the field - Benjamin Brady, a specialist oncologist at the Peter MacCallum Centre in Victoria, Victoria Atkinson a medical oncologist at the Princess Alexandra Hospital and Brian Bell, the executive director of medical services at the same hospital - concurred that the choice of ipilimumab as a treatment was not clinically appropriate.
Dr Brady and Professor Atkinson told the tribunal that the patient “had an avoidable and unnecessary death” with Professor Atkinson stating that PB “had at worst, a completely resected stage IVa melanoma and had a very high likelihood that he would be cured from his cancer”.
Mr Mainwaring’s diagnosis of the man with a more serious metastatic melanoma “was neither clinically appropriate nor accurate”, when he was more likely to have a less-serious form of melanoma.
Dr Brady also considered that the risks and benefits of the treatment were not adequately emphasised to PB by Mr Mainwaring and that he failed to ask a colleague for a second opinion or for any help in managing PB’s treatment.
Mr Mainwaring has not practised for over three years and surrendered his registration in February 2019.
Prior to surrendering his registration, he had permanently retired as medical oncologist at Canossa Private Hospital and he told the QCAT hearing that he had no intention to return to practice.
“But for his voluntary cessation of practice in 2019, the seriousness of the conduct would ordinarily warrant the respondent be disqualified from practice for a lengthy period to send an appropriate message of denunciation to the medical profession and the community at large,” Mr Robertson wrote.
Mr Mainwaring told the tribunal he deeply regretted the tragic circumstances surrounding PB’s death and offered his sympathies to his family, and he was remorseful for his conduct.
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