A surgeon has been found guilty of professional misconduct over her treatment of 13 patients, including a man who died after she operated on the wrong end of his colon, and a woman whose bowel cancer tumour she missed during a rushed colonoscopy.
Dr Liu-Ming Schmidt had her medical registration suspended for six months by the NSW Civil and Administrative Tribunal, which found that the surgeon had spent as little as five minutes performing colonoscopies on patients at Albury Wodonga Health on the NSW and Victorian border.
Schmidt was the subject of a 2023 investigation that found a series of incomplete colonoscopies performed or supervised by the surgeon between 2018 and 2022.
The investigation led to recall of roughly 2000 of Schmidt’s colonoscopy patients, and 1084 underwent repeat colonoscopies. Seven patients were diagnosed with colorectal cancer.
The tribunal’s decision, published on Friday, included details of what one doctor providing evidence called Schmidt’s “catastrophic error” during a surgery in November 2019, which contributed to the death of her 79-year-old patient.
Schmidt was on call when the man arrived at the hospital with a life-threatening bowel perforation. During an emergency surgery, Schmidt brought out the wrong end of the man’s bowel to attach to a colostomy bag, causing a complete mechanical bowel obstruction.
“But most egregious, in our opinion, is Dr Schmidt’s failure to then closely monitor the patient after the operation,” the tribunal’s decision read.
Schmidt admitted she did not see the patient for several days despite knowing he was acutely unwell, and she was working in the same hospital. When she was then alerted to her error, she failed to adequately disclose it to the patient and his family.
Another complaint in the case brought by the Health Care Complaints Commission (HCCC) concerned a woman known as Patient A, who first saw Schmidt in 2017 after a positive bowel screening result, suffering abdominal pain and a change in bowel habits.
Schmidt performed four colonoscopies on Patient A between November 2017 and January 2022. The woman was referred back in January 2022 with iron deficiency anaemia and abdominal bloating – potential symptoms of bowel cancer.
On February 14, Schmidt performed a gastroscopy and colonoscopy. About three months later, Patient A was admitted to hospital with severe iron deficiency anaemia, and a PET scan identified an abnormal mass in her caecum – the pouch-like beginning of the large intestine and the furthest point reached by a colonoscope.
Another surgeon performed a colonoscopy on Patient A and identified a 5.5-centimetre adenocarcinoma.
“This type of cancer could not have grown to this size in only three months,” the tribunal’s decision read.
The tribunal agreed with an expert witness that Schmidt failed to detect the tumour during her February colonoscopy, which was performed too quickly. Her records did not show that her colonoscopy had reached the caecum.
Schmidt admitted to all the matters in the complaint, which included failing to take an adequate amount of time to perform colonoscopies for eight patients and adequately capture images during the procedures.
The time it took Schmidt to perform seven of these colonoscopies ranged from 10 to just five minutes. She spent 16 minutes performing both a colonoscopy and gastroscopy on one patient.
Colonoscopy withdrawal alone should usually take about eight minutes. All but one of these patients came from a random sample selected by Albury Wodonga Health who underwent colonoscopies performed by Schmidt.
The HCCC’s medical expert told the tribunal that rapid withdrawal during colonoscopy would lead to lesions being missed. The expert also raised concerns that Schmidt’s poor or infrequent imaging of the caecum during several procedures suggested that her colonoscope had not reached this section of the bowel – a requirement for a complete colonoscopy.
“We find that Dr Schmidt’s conduct was of a very serious nature and demonstrated a significant departure from accepted standards,” the tribunal’s decision read. “It is sufficiently serious to justify suspension or cancellation of her registration.”
The HCCC had sought to have Schmidt’s registration suspended for one year, but the Tribunal opted for a six-month cancellation, noting she had diligently tried to address the areas of concern that led to the complaints.
“[H]er success in doing so is illustrated by the support of many colleagues, several of whom have observed her in the operating theatre,” the decision read.
Following the January 2023 investigation, Schmidt stopped practising for one year. She then returned to practice with conditions, including limiting her surgical procedures, eventually completing a colonoscopy recertification program and only undertaking colonoscopies under supervision.
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