Dr John Grygiel – Oncologist - Unsatisfactory Professional Conduct and Professional Misconduct

12 April 2021

The Health Care Complaints Commission prosecuted a complaint before the NSW Civil and Administrative Tribunal against Dr John Joseph Grygiel,  a medical practitioner who practiced as a specialist medical oncologist until 2016. Dr Grygiel relinquished his registration in 2020.

The complaint related to the care and treatment provided by Dr Grygiel in a number of roles:

• In the period 2012-2016, in his capacity as Senior Staff Oncologist and Associate Professor of Medicine, Dr Grygiel treated cancer patients at St Vincent’s Hospital, Darlinghurst.
• Between 2010 and 2012, Dr Grygiel treated cancer patients at Macquarie University Hospital.
• Between 1989 and 2012, Dr Grygiel was employed as a Visiting Medical Officer and/or as Honorary Medical Officer and treated cancer patients at Bathurst and Orange (Greater Western Area Health Service).

The majority of the patients treated by Dr Grygiel, who were the subject of the complaints before the Tribunal, suffered from head or neck squamous cell carcinomas and received chemo-radiotherapy. Two chemotherapy drugs were at the centre of the majority of the complaints in the matter, being Cisplatin and Carboplatin. The treatment issues raised were decisions regarding chemotherapy does, the adequacy of consent from patients, and record keeping.

The proceedings concerning Dr Grygiel were adjourned in 2020 due to the COVID-19 pandemic and were finalised on 17 March 2021. In March 2021 the Tribunal concluded that Dr Grygiel’s conduct amounted to unsatisfactory professional conduct and professional misconduct in that he:

1. Failed to obtain adequate and informed consent from 52 patients;
2. Failed to make and keep adequate records of his care and treatment of 52 patients;
3. Provided care and treatment of 11 identified patients that was significantly below the expected standard; and
4. Adopted a standard practice of prescribing a flat dose of 100mg Carboplatin for 33 head and neck squamous cell carcinoma (‘HNSCC’) patients. In so doing, he demonstrated that he holds firmly-held views in relation to the treatment of HNSCC as a result of which:

a.  there is a risk that his HNSCC patients treated with Carboplatin did not receive chemotherapy they were otherwise eligible to receive, and the efficacy of which was supported by published trials or meta-analyses; and

b.  he did not give comprehensive advice to the 33 patients to enable them to give informed consent (this was referred to as the ‘standard practice’ complaint).

In relation to informed consent, the Tribunal commented (at [340]) that:

 “[w]hile it would be unrealistic to ignore the constraints of time and resources facing practitioners, these proceedings highlight the need, particularly where patients are treated in a multi-disciplinary setting, for proper consent and recording processes rather than the reliance on generic consent forms. The vast majority of patients should be afforded an explanation where treatment proposed is non-standard with unknown efficacy and/or not supported by published data, and there should be sufficient place in pro forma consent forms for annotation of relevant information provided to the patient including particularly any material risk.” The Tribunal further commented (at [341]) that the, “days of the practitioner determining what the patient should or should not know or consent to about their treatment are long gone…it is a patient’s fundamental right to make their own choice about undergoing treatment if that treatment involves a material risk.”

In relation to the standard practice complaint, the Tribunal commented that this complaint was integral to the disciplinary proceedings and, with reference to Dr Grygiel’s conduct relating to a particular patient, commented that rather than adopting individualised clinical judgment, “the practitioner followed a practice he had adopted in the 1980s without consideration of prescribing based on an evidence based regime” (at [375]).

The Tribunal made the following protective orders:

1. If Dr Grygiel was still registered, the Tribunal would have cancelled his registration;
2. Dr Grygiel is precluded from seeking a re-instatement order for a period of two years;
3. The Medical Board of Australia is requested to record in the register the fact that the Tribunal would have cancelled Dr Grygiel’s registration.

The full decision is available at NSW Caselaw.

Further Information

For further information, contact the Executive Officer of the Health Care Complaints Commission, on 9219 7444 or send an email to media@hccc.nsw.gov.au.

The information in this media release is correct at the time of publication. Orders may change; for example, conditions may no longer apply. For current information regarding the status of a registered health practitioner, including any conditions that currently apply, please check the National Register at www.ahpra.gov.au.