VAD doctor’s fine paid by fundraiser

4 minute read

When a voluntary assisted dying GP was fined $12,000, advocacy groups raised $20,000 in support.

In August 2023, Victorian GP Dr Nicholas Carr was reprimanded and fined $12,000 after an error involving an absent signature on voluntary assisted dying paperwork.

Fears that news of the error would result in a loss of trust from the public, though, appear to have been misplaced.

While the ruling was “harsh”, GP and CEO of the VAD advocacy charity Go Gentle Australia Dr Linda Swan hoped GPs would not be discouraged.

“GPs should be reassured that Dr Carr’s case is an isolated one,” Dr Swan told The Medical Republic.

“Of around 4000 VAD applications across Australia to date, this is the only one that has resulted in a fine.”

Dr Swan added that over $20,000 was raised within a week through a crowdfunding campaign to cover Dr Carr’s fine.

The remaining money will be donated to Voluntary Assisted Dying Australia & NZ.

“This shows that Australians want this end-of-life choice and are prepared to support doctors who act in good faith to provide VAD services,” she said.

In 2020, the VAD review board notified Dr Carr of an oversight he made when submitting VAD paperwork for one of his patients.

In an application for a self-administration permit, the “written declaration” was erroneously missing the patient’s signature, despite including signatures from two witnesses.

When made aware of his mistake, Dr Carr arranged for the patient to sign the original form and backdate it, rather than signing a new document in front of witnesses.

He was not made aware of the need to sign a new form in the presence of witnesses when he was contacted about the missing signature, which was a requirement of the VAD Act.

The patient accessed VAD and died on 1 April 2020.

A review of the backdated form prompted an investigation by the VAD review board, which found that although Dr Carr didn’t intend to mislead, and didn’t stand to gain anything, the error was “too serious to be ignored”.

As part of the application, Dr Carr certified that the VAD request and assessment had been performed in accordance with the VAD Act.

Given the lack of a signature, the review board found Dr Carr’s certification to be “incorrect”.

The Victorian Civil and Administrative Tribunal found Dr Carr’s behaviour amounted to “professional misconduct” and ordered the doctor be reprimanded and pay a hefty $12,000 fine.

According to the tribunal’s verdict, it needed to enforce “strict compliance” with the VAD Act.

“Compliance with all [VAD] requirements is vital, not only to protect the rights of patients, but also to ensure that public confidence in the VAD process is not eroded,” the ruling read.

“Medical practitioners have a key role as gatekeepers.

“They have an obligation to ensure that the processes for which they are responsible under the Act are carried out to the letter.”

The tribunal outlined the importance of “general deterrence” of the “reasonably high” fine.

Speaking to TMR, Dr Swan said that while Go Gentle Australia supported “thorough scrutiny of the VAD process” to identify and improve upon the process, the tribunal’s decision was “harsh”.

“There seems to be a contradiction between the acknowledgement that the error was unintentional on one hand and the severity of the fine on the other,” she said.

“There was never any question about Dr Carr’s medical professionalism or the eligibility of the patient for VAD.

“We hear from other states that their boards have taken a far less punitive approach, preferring education rather than fines.”

Dr Swan said that measures that may discourage GPs from engaging in what some have called “the most rewarding work they have ever done … is a loss for dying and suffering Australians and for those health professionals who want to be involved”.

“GPs represent 60% of the VAD workforce in Victoria,” she said.

“We will have to wait for the next VAD Review Board report to see if the tribunal’s decision has had any impact on GP involvement.”

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