Anaesthetist reprimanded and fined for publishing book containing confidential patient information

The Queensland Civil and Administrative Tribunal (Tribunal) has emphasised that the disclosure of patient information through either self-publishing or commercial publishing platforms is fundamentally incompatible with the obligations of a medical practitioner.

Background

Dr Rathie was a specialist anaesthetist employed at Toowoomba Base Hospital between 1995 to his resignation in January 2024. Between 2015 and 2022, Dr Rathie commenced authoring several books. In approximately 2022, Dr Rathie decided to author The Anaesthetic Picture Book (book), depicting his day-to-day life as an anaesthetist. Over the course of 2023, he regularly photographed patients, clinical records, and surgical procedures on his mobile phone without patient consent. He self-published the book on Amazon in September 2023.

Eight copies were sold online and a further 15 ‘author copies’ were distributed to family, colleagues, and friends. The book was also promoted in the hospital's theatre tearoom and anaesthetist staffroom, and copies were made available for purchase to employees.

On 5 October 2023, the Office of the Health Ombudsman (OHO) received a complaint in relation to the book. Dr Rathie was suspended from his employment on 26 October 2023 and subsequently resigned on 10 January 2024.

Two allegations were referred to the Tribunal, being that Dr Rathie:

1. breached patient confidentiality and privacy by photographing and publishing clinical records, surgical procedures, and images of patients undergoing treatment; and
2. published inappropriate and insensitive commentary about patients' weight, personal features, and medical conditions, including attributing patients’ nicknames.

Decision

The Tribunal was satisfied that Dr Rathie’s conduct constituted professional misconduct under section 5 of the Health Practitioner Regulation National Law. It found the conduct was not an isolated lapse in judgement, had continued over approximately two years, was undertaken deliberately for the purpose of publication, and there was no evidence Dr Rathie reflected on his actions or sought advice before publishing the material. The Tribunal also found the risk of patient identification was materially heightened because Dr Rathie practiced in a small regional centre and there were repeated references to the hospital within the book.

In reaching a decision as to the appropriate sentence for Dr Rathie, the Tribunal accepted that Dr Rathie demonstrated genuine remorse, cooperating fully with the investigation, immediately removing the book from sale, attempting to recover copies, voluntarily completing ethics and privacy education, and undertaking mentoring on his professional obligations.

Ultimately, the Tribunal has chosen to use this decision to deter other practitioners and found Dr Rathie had behaved in a way which constituted professional misconduct, reprimanded Dr Rathie and imposed a fine of $30,000 payable within 28 days.

Key takeaways

The decision reinforces several important principles for medical practitioners and their insurers:

• Photographing patients, clinical records, or procedures without consent, even without direct identifying information, can constitute professional misconduct.
• Attempted de-identification of patients may be insufficient, particularly in regional settings where contextual details materially heighten the risk of identification.
• The availability of self-publication platforms does not diminish a practitioner's confidentiality obligations.
• Amusement is not a valid defence to breaches of patient confidentiality. The Tribunal reinforced that motivation is irrelevant and any unauthorised disclosure of patient information breaches professional standards.

As avenues for personal publication continue to expand, particularly social media platforms, medical practitioners and their insurers must be aware that the disclosure of patients' personal information without consent is fundamentally incompatible with the obligations of a medical practitioner, regardless of the motivations for disclosure or attempts to de-identify material.