A surgeon is still working despite failing a patient by not telling her she might have cancer until it was terminal.
Amro Labib Mahmoud Ahmed Shanab was found guilty of professional misconduct over his treatment of the 29-year-old woman at Fiona Stanley Hospital in Perth in 2016.
The State Administrative Tribunal found he failed the woman by not recognising the risk of her malignant tumour, not acting with urgency and not offering early surgical intervention.
“The treatment failings between 22 July, 2016 and 11 November, 2016 as described were clearly very significant,” the SAT said.
“In our view, they were such a serious departure from the standard reasonably expected of a practitioner of an equivalent level of training or experience as to amount to professional misconduct.”
Working under the name of Dr Labib, he is currently a visiting medical officer at St John of God Murdoch Hospital in Perth.
His online profile describes him as a specialist endocrine, breast and general surgeon.
“His vision is to provide his patients with the best medical care possible, in a friendly and relaxed environment, ensuring they always have been informed with all the details and possible options in regards their treatment,” the profile reads.
The SAT noted the patient was first referred in November 2015 to Fiona Stanley Hospital, where Dr Labib was an endocrine surgery consultant at the time.
A CT scan showed a mass above her right adrenal gland, which was consistent with a haematoma or an adrenal tumour, although the latter was rare for her age.
Another scan in April 2016 showed the mass had shrunk, but also an adrenal washout, which was slow and suggested a malignant tumour.
An ultrasound a month later showed the mass had increased.
The Medical Board of Australia said the scans should have alerted the doctor that the mass was likely to be a tumour and urgent surgery was required.
Instead, Dr Shanab ordered further imaging, but did not request it be done urgently and it was not completed until October that year, showing an increase in the size of the tumour.
A CT scan the following month showed a further significant increase in the size of the mass, suggesting metastases in the liver.
Dr Shanab did not inform the patient until November, when her condition was terminal.
She died about two months later.
The Medical Board of Australia alleged the failings in the treatment of the woman were of such gravity as to amount to professional misconduct.
Dr Labib accepted he failed, but said it only dated from July 22, 2016 when he claimed to have first seen the April 2016 CT scan and the May 2016 ultrasound report.
The SAT was not satisfied on the available evidence that Dr Labib did see the reports earlier than July 22.
“The fact that the practitioner did not discuss the obvious possibility of a malignancy with (the patient) and raise the option of urgent surgery, but rather merely ordered further imaging without any appropriate urgency, was a very significant failing,” the SAT said.
“To the extent that, as the practitioner put it, he became ‘fixated’ on the mass being a haematoma, his clinical judgment was seriously impaired.
“Any doubt about the appropriate course of action could have been resolved by seeking a second opinion. The reasons he gave for not seeking a second opinion were plainly inadequate.
“When other imaging results were brought to the practitioner’s attention in October 2016, his response was again inadequate.
“The results served to reinforce the likelihood of a malignancy and the need for urgent action.”
The SAT is yet to hand down its penalty for Dr Shanab, with the matter returning on October 18.
Following the incident, the hospital undertook a review of its report distribution system and improvements were made.
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