A NSW GP whose family developed a close relationship with an elderly patient and allowed her to pay for his child’s school fees, buy him expensive medical equipment and build a small dwelling on his property for her care, and then benefited from her substantial will when she died, has had his registration cancelled.
Dr Michael Cleary, who had been a GP for 40 years with an unblemished record before his treatment of an elderly woman known as Patient A, had his registration as a medical practitioner cancelled last month by the NSW civil and administrative tribunal.
Cleary was found by the tribunal, which was ruling on NSW health care and complaints commission (HCCC) allegations, to have “exploited” and committed “longstanding” and “recurrent” unsatisfactory professional conduct during his 15-year treatment of Patient A, who died aged 87 in January 2019.
Guardian Australia reported last month on the case of Peter Alexakis, another NSW GP which the HCCC alleges breached professional boundaries with an elderly patient shortly before their death, something Alexakis denies.
In the Cleary case, the tribunal found the conduct related to “boundary issues”, care and treatment issues and record-keeping issues dating back to 2009.
The tribunal found the “boundary issues” included allowing Patient A to buy him a $40,000 device Cleary used for homeopathy, pay almost $140,000 for his children’s school fees, and provide $36,000 in other amounts, sometimes seemingly in the form of loans.
Patient A, who Cleary described as like a grandmother to his children, made the payments to Cleary, his wife, and children. They visited each other’s houses for social visits, and he admitted inviting her to school functions and on family holidays.
The tribunal also found she once lent Cleary her car for six weeks, which he and his wife used, but did not pay for the road tolls they incurred.
According to the tribunal, Cleary told the HCCC that Patient A had wanted to become involved in paying the school fees, and had mostly discussed it with his wife, but he knew that she had been generous to his family in this, and other ways.
“The real issue was that for many years she was part of the family and I accept I should have ceased providing her with medical treatment in these circumstances,” Cleary told the HCCC.
The tribunal found that Cleary had given no indication of why he did not stop treating Patient A when it became clear the nature of the relationship had changed.
He was represented at the hearing by senior lawyers but did not give evidence, instead providing two statements, with the tribunal characterising this as engaging “in the most superficial” way.
“Nothing … implies that the respondent regrets that he allowed his family to benefit from Patient A to the extent and for as long as they undoubtedly did, or reveals any insight into the inappropriateness of his conduct in continuing his professional relationship with Patient A in those circumstances,” the tribunal found.
“In the absence of any explanation from the Respondent [Cleary], it can reasonably be inferred that only the death of Patient A terminated the Respondent’s family’s receipt of financial benefits from Patient A.”
The tribunal also found that in 2013, Patient A arranged to have a small dwelling built on Cleary’s property, which would enable him to care for her if she became too frail or unwell to live on her own. It heard evidence the dwelling cost about $100,000 for Patient A to build, and “constitutes a not insignificant … benefit” to Cleary and his wife, but there was no evidence they had “any intention of reimbursing the estate of Patient A”.
Cleary was also found by the tribunal to have failed in providing adequate treatment to Patient A, including by prescribing homeopathic remedies in place of other evidence-based treatment, failing to treat recurrent nausea and urinary tract problems, and prescribing oxycodone, a powerful opioid, without any clinical indication she needed it.
The tribunal found he then failed to manage long-term opioid addiction concerns, despite her suffering numerous side-effects that could be attributed to chronic opioid use, and knew (or ought to have known) that she was at risk of becoming dependent on the drug and was likely to abuse it.
After Patient A was found dead in the bath by Cleary, the doctor then signed her death certificate and cremation certificate, stating that the cause of death may have been due to natural causes, or from a stroke-like attack or uncontrolled hypertension.
The commission alleged that in doing so Cleary had failed to observe proper professional boundaries because other causes of death were plausible, and Cleary should have sought a second opinion from a medical colleague, given his close personal relationship with patient A.
There is no suggestion the death was suspicious. But Prof Vicki Kotsirilos, an experienced GP who acted as an expert on behalf of the HCCC, found Patient A may have suffered from natural causes of death, including those stated by Cleary, but other plausible causes had not been ruled out, such as overdose of oxycodone or another drug, pregabalin, which could have been accidental or intentional.
Cleary also said he did not know he or any member of his family would benefit under patient A’s will until after she died, and the tribunal found there was no evidence to the contrary. No findings of misconduct were made regarding the 2015 will, under which Cleary’s family received four-fifths of her residuary estate.
Guardian Australia understands the estate was worth about $1m.
Cleary did not object to his registration being cancelled and the tribunal heard that he planned to retire. He will not be able to reapply for registration for five years. No orders were sought with respect to his ability to continue practising homeopathy.
