Is this the reason the VAD Review Board had to throw Dr Nick Carr under the bus?

The Voluntary Assisted Dying Review Board in Victoria is saying nothing. And that is a surprise. For many doctors, it should be answering questions over its treatment of Dr Nick Carr.

This month, the Melbourne GP was found guilty of professional misconduct — one of the most serious charges that can be made against a doctor — for stuffing up the paperwork for a terminally ill patient accessing the Voluntary Assisted Dying (VAD) scheme back in January 2020.

As was made clear in Dr Carr’s tribunal hearing, the patient’s signature was missing on the second page of one of the forms, which had been completed in front of two witnesses, as required by law.

The review board flagged the omission with him, he got the patient to return and sign. The issue was the review board failed to make clear to him that the patient needed to sign the form in the presence of the two witnesses.

It reported him to the Medical Board of Australia for the stuff-up anyway.

Dr Carr says he felt totally unsupported.

“I thought, ‘Why on earth am I working multiple hours of either minimally paid or non-paid time?’

“The thanks I got for it was for the Voluntary Assisted Dying Review Board to report me for a mistake that I fixed the way it told me to.”

He says, over the following three years, as the notification made its way through the system, he spent a lot of time stressed and anxious, fearing he was going to be suspended, trawling through mountains of paperwork trying to justify what he did and did not do.

This week, AusDoc approached the review board for comment. Why did it report him for an omission that was partly its fault? Was his treatment harsh? Is it concerned about deterring doctors from becoming involved with the VAD scheme?

In its statement, it referred to the Victorian Civil and Administrative Tribunal ruling and said it had nothing further to add.

There are good arguments in its defence for throwing him under the bus.

Dr Carr’s terminally ill patient was one of the first to go through the VAD scheme.

The eyes of the world were watching how it was operating, and given the deep ethical controversies surrounding it, all those involved had to be seen to follow the processes laid down.

And the patient’s signature was important: it was to acknowledge that they understood they were being prescribed a lethal drug and that they expected to die following its administration. It was not for a footnote.

You could argue it would have been a very bad idea, given the politics, for the review board simply to say, “Do not worry about the witnesses; it is all fine; we will fix it up.”

The optics would not look good.

So on that basis, maybe the medical board needed to be called in. Ultimately, it was the medical board’s, not the review board’s, decision whether or not to pursue Dr Carr and bring him before a tribunal. Ultimately, it was the tribunal to decide whether or not he was guilty of professional misconduct.

And that is where the failure lies. It seems very hard to argue that the failures involved where not slight.

It was not a question of the patient not knowing what was happening (the tribunal made it clear they did); it was not a question of them being ineligible for the scheme (the tribunal said it was clear they were).

It was simply one of those miscommunication bungles between the review board and Dr Carr that happens to all of us. There was no malign intent by anyone and no actual harm.

That is why many feel Dr Carr did not deserve being processed through the regulatory sausage machine and why they feel that the review board should be accepting some responsibility.

The treatment of Dr Carr is likely to deter some doctors from getting too involved with the VAD scheme.

Of course, there are doctors who would see that as a good thing given their ethical views on the medical profession’s involvement with voluntary euthanasia.

But for VAD supporters, that will have material consequences. There have been long-running concerns that the system is struggling to meet the demand for VAD by terminally ill patients.

The latest annual report by the Voluntary Assisted Dying Review Board states that, since its launch, some 1344 deaths have occurred among patients who have secured VAD permits, with 912 dying from the administration of the VAD substance.

It adds that around 208 doctors (mainly GPs) have been involved in at least one case as a consulting or co-ordinating practitioner.

More detailed figures showing the number of doctors most involved in cases would be slightly more informative on the extent of the pressure.

But the point is that Dying with Dignity Victoria, of which Dr Carr is a board member, says there are many anecdotal reports that patients are struggling to find doctors to access the scheme.

If true, you can feel that the review board’s silence on Dr Carr’s case is not helping.