A doctor who recommended a 22-year-old with an eating disorder to "self-pleasure" has been found to have "breached sexual boundaries".
In a judgement released today, the Health and Disability Commissioner investigated a complaint from the patient, who had battled eating disorder bulimia for a number of years.
Recently moved to the area, the woman sought the help of a doctor at a local medical centre in late 2007, coming frequently for blood tests and weigh-ins.
The woman said the doctor repeatedly made inappropriate comments of a sexual nature, frequently leading the conversation to masturbation.
Her complaint said the doctor advised her "she should be doing [it] often, for self pleasure". This would "make [her] smile...make [her] more happy or in a more pleasant state", the patient said.
The complaint said the doctor also told her that he would like "to lock [her] in a closest [sic] with something pleasurable", and on another occasion "examine every inch of [her] body - he would be able to locate every organ, every bone etc".
After her request for sleeping pills, the doctor prescribed two drugs, dothiepin and zopiclone. He continued to prescribe zopiclone after the patient accidentally overdosed on it, mistaking it for a bottle of laxatives, in 2010.
He also prescribed her glycerol suppositories, despite knowing she abused laxatives, and suggested low-pressure water enemas and abdominal massage.
Despite his notes stating that he felt "a little out of [his] depth" in treating the patient, the doctor did not follow up his 2010 referral of the patient to a psychologist.
The doctor's faxed letter was not received by the specialist, and the woman only began seeing the psychologist when she self-referred two years later.
The doctor denied he had made any sexually suggestive or otherwise inappropriate comments to his patient in the five years he saw her. He said he mentioned to the woman other patients with self-destructive behaviours had replaced these with alternate habits and "this did include reference to other forms of self-pleasure, sexual or otherwise".
He could not recall the number of times he broached the topic of self-pleasure, though from his notes it might have been two or three times, he said. He said, in hindsight, the recommendation of self-pleasure was "not well judged".
The commissioner found the therapeutic use of sexual behaviours as treatment for the patient were "clinically inappropriate and not supported by medical evidence" and a "breach of sexual boundaries".
The findings also concluded the doctor made "ill-judged" comments that made his patient feel uncomfortable.
The continued prescription of sleeping pills and suppositories and suggestions of enemas and massage as treatments were also inappropriate, the commissioner found.
The doctor's failure to follow up the referral of his patient to a psychologist was also found to be a breach of the Code of Health and Disability Services Consumers' Rights.
The doctor was ordered to undergo a competency review and be mentored by two senior GPs until the end of 2015.
His details will also be given to the District Health Board, Medical Council of New Zealand and Royal New Zealand College of General Practitioners.
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