A DOCTOR has denied professional misconduct in his treatment of a man who died from cancer more than a year after he had a mole removed.
Dr Peter Peng-Cheng Ting, a GP in Artane, Dublin, faces two complaints: that mole tissue excised by him from William Cashell’s back in February 2007 was not sent for analysis, and that he never recorded the excision.
Dr Ting failed to mention the excision in letters referring Mr Cashell (37) to Beaumont Hospital in Dublin after he developed lumps under his arm and in his groin, a Medical Council fitness-to-practise committee heard yesterday.
Early diagnosis was a central factor in the treatment of cancer, said Prof Colin Bradley who lectures in general practice in University College Cork.
The failure to send the excised material for analysis amounted to a serious falling short of professional standards, he said. Beaumont’s lack of knowledge of the mole affected its perception of the urgency of the matter, he believed.
A father of one from Rush, Co Dublin, Mr Cashell developed a lump under his arm in March 2007 which doubled in size by July. He also developed a lump in his left groin and suffered weight loss.
Dr Ting saw him in April 2007 and in May referred him to Beaumont. He was given an appointment to see a consultant on August 17th, 2007.
Dr Ting also arranged for a chest X-ray and an ultrasound scan. Blood tests subsequently carried out appeared mainly normal.
In a letter to Beaumont on July 5th, 2007, Dr Ting referred to the underarm lump having doubled in size and said Mr Cashell was experiencing considerable pain. The matter was urgent and he sought an earlier appointment.
The August 17th consultation date remained unchanged after which Beaumont indicated it would proceed with urgent procedures and review the results with Dr Ting.
Mr Cashell attended D Doc, an out-of-hours service, on September 3rd, 2007, in pain and was referred to Beaumont, which admitted him. A biopsy on September 6th disclosed terminal cancer.
Mr Cashell came under the care of the oncology team in Beaumont but he died on May 31st, 2008.
The fitness-to-practise committee is conducting an inquiry into allegations of professional misconduct against Dr Ting (51) arising from his treatment of Mr Cashell.
Dr Ting, who is to give evidence today, denies the allegations. His counsel Leesha O’Driscoll said he accepted he did not record the excision but did not accept that amounted to professional misconduct.
Dr Ting would say he removed a “skin lesion” circular in shape, regular in colour and intact, and which Mr Cashell described as “itchy”, she said.
Lorraine Coady, Mr Cashell’s partner, said she first noticed a mole on his back about December 2006. By February 2007, it had grown, changed colour from light brown to dark brown, it was coming away from the skin and was itchy.
After it was removed by Dr Ting, Mr Cashell complained it was sore, she said. He developed lumps under his arm and groin and was “back and forth” between Dr Ting and Beaumont.
He went to D Doc in September 2007 after being sent home from work because he was in so much pain. It sent him to Beaumont and told him not to leave until it “sorted him out”.
In his evidence, Prof Bradley said Dr Ting’s medical notes were inadequate in that they failed to record the excision. He also said his referral letters also contained a paucity of information. He accepted there were also inadequacies in notes from Beaumont concerning Mr Cashell and that Dr Ting had endeavoured to act in Mr Cashell’s best interests.
Prof Bradley agreed it was “broadly true” the standard of care across the health system was not always what it should be. While GP notes could be “very succinct” and “not ideal” concerning details recorded, he said the absence of a note of a surgical procedure was “more exceptional”.
