Referred to as: treating doctor · Treating doctor
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A confirmatory affidavit from the treating doctor regarding the reply affidavit content was signed or should have been signed, confirming that the medical responses were provided by the doctor and not the lay deponent.
“There has or should have been a signed confirmatory affidavit from the treating doctor in respect of the content of the replying affidavit ... confirmed by the doctor themselves.”
The lay deponent is relying on medical responses confirmed by the treating doctor and is not offering her own medical opinion influenced by the legal team or others.
“It is not just the deponent offering her own opinion or thoughts influenced by the legal team or anybody else ... the medical responses are medical responses from a non-medical person but confirmed by the medical person themselves.”
The discussion concerns the deleterious effect of compelled examination by a third-party medical practitioner on the treating doctor's role, emphasizing that less intrusive means that respect the treating doctor's role are acceptable.
“what he is addressing in those circumstances is what the deleterious effect of a compelled imposition of a third party medical practitioner would be for what he is doing, but not to say that that is a total outruling of less intrusive means, provided that whatever the less intrusive means are, plays a suitably respectful role of him as the treating doctor”
ADV PREMHID asserts that compelled examination by a third-party medical practitioner would have a deleterious effect, but less intrusive means respecting the role of the treating doctor are acceptable.
“the deleterious effect of a compelled imposition of a third party medical practitioner would be for what he is doing, but not to say that that is a total outruling of less intrusive means provided that whatever the less intrusive means are, plays a suitably respectful role of him as the treating doctor”
The treating doctor does not oppose the interposition of a third-party medical practitioner if voluntary consent is obtained and the interposition is less intrusive than compelled attendance.
“the doctor has himself spoken about less intrusive means in a multiple, in a multitude of manifestations and if the doctor interposing in respect of a third party to obtain voluntary consent, whether it is given or not given, is within the basket of those less intrusive means as I see it because it is not the compelled examination”
The treating doctor asserts that if another doctor is to be interposed despite opposition, this should be done only in consultation with the treating doctor and with their involvement.
“another doctor should be interposed that should be done in , I am paraphrasing here , I have forgotten the actual wording , that should be done in consultation with me . I should be involved .”
The treating doctor's position is that unilateral or compelled interposition of another doctor without the treating doctor's consultation or facilitation is opposed, but voluntary interposition with consultation and facilitation that is not clinically detrimental would be acceptable.
“the position of the doctor is that it is not to say that none should be interposed as a blanket position . It is to say none can be interposed unilaterally or in a compelled sense that the doctor resists and then the doctor's position in respect of what then , so in other words if it is voluntary does it come through me or whatever the case might be , is expressly dealt with in that same affidavit ... The doctor's position is to say that I must be consulted and if I can facilitate something which is not clinically detrimental to my client 's , my patient 's current position or future position then I would have to give medical advice in that regard .”
The treating doctor would not object in principle to another doctor's involvement if a properly constituted assessment occurs and if, after engaging with the Commission, the doctor remains satisfied.
“A properly constituted assessment stands in a different footing . If after engaging me the Commission remain unsatisfied I do not object in principle .”
The treating doctor specified that they would not object to the interposition of another doctor provided certain conditions outlined in their affidavit are met.
“as matters stand , the doctor does not have an objection to an interposition provided there is a condition , the condition in there met .”
The purpose of putting up the movements evidence is not to challenge the clinical findings of Mr Carrim's treating doctor but to bear on his demonstrated ability and day-to-day functioning.
“the point of putting up the evidence on the movements is not to disprove any diagnosis, not to use it to challenge the clinical findings of a treating doctor, but it is important because what it does is it bears directly on his, Mr Carrim's demonstrated ability, his day-to-day functioning capacity.”
Movement from the hospital facility is not at will; it is only authorized through the treating doctor or by the patient discharging himself.
“I deal next with the facility's leave regime because I understand that an impression may exist that the facility is a place a patient may enter and leave at will. That impression would be false. ... there is only one or two ways that a person could leave, on the pass of the treating doctor or ... if the person discharges himself”
The treating doctor's report is in breach of professional guidelines because it involves the treating doctor providing an independent assessment, which should not be done according to the guidelines referenced by the doctor's affidavit.
“the argument that the doctor's report is definitive is also extraordinary for another reason, because it itself is a breach of the professional guidelines that are referred to by our doctor in his affidavit”
The treating doctor should not provide an independent assessment of the individual's capacity to participate in proceedings because of subjectivity and advocacy for the patient; independent assessment should be done by a different doctor.
“those professional guidelines, which say that a treating doctor should not be the person to provide an independent assessment ... the treating doctor is inherently subjective and an advocate for the patient”
The witness must be insulated from examination by an independent specialist as the treating doctor's determination of capacity is unreliable due to conflict and breach of guidelines.
“they say that then the witness must be insulated from any examination by an independent specialist ... the treating doctor's determination is in fact reliable, because ... the paragraph 3 and 73 of their doctor's affidavits saying that there should not be an independent examination”
The treating doctor's assessment is unchallenged and must be accepted by the Commission, leading to circular reasoning that no independent assessment is allowed and no challenge is possible.
“accept what, his says ... no, you cannot have an independent assessment ... no one is able to assess the treating doctor's determination is unanswered ... it is unchallenged and so it must be accepted ... it is circular reasoning”
The treating doctor must be insulated from any examination by an independent specialist, and the treating doctor's determination of capacity is a conflicted and unreliable assessment.
“the witness must be insulated from any examination by an independent specialist ... a conflicted determination of capacity by the treating doctor is in fact reliable”
The expert asserts that requiring the treating doctor to provide an opinion risks threatening the therapeutic relationship between doctor and patient.
“he says not to do so, to require the treating doctor to provide the opinion threatens that therapeutic relationship between the doctor and his patient.”
There has been a reply to the Commission's expert's report at paragraph 16 of the replying affidavit on pages 334 to 335, addressing inaccuracies raised about the treating doctor's affidavits and reports.
“You will find that reply at paragraph 16 of the replying affidavit, at pages 334 to 335”
The Commission is not impugning the treating doctor but rather questioning both the doctor's bona fides and clinical expertise in their affidavit, as confirmed by the doctor himself.
“the Commission is not impugning the treating doctor, in effect that is exactly what they are doing, both his bona fides and his clinical expertise, and in the affidavit that is filed in those paragraphs and pages I referred you to, and that it is confirmed by the doctor himself”
The treating doctor is not performing an independent medical assessment for the inquiry but is giving clinical opinions; any engagement between the independent doctor and the treating doctor should occur before the interview to understand the treatment plan.
“Our doctor has never pretended once to be performing an independent medical assessment inquiry. He is the treating doctor, and he is giving his clinical opinions...the engagement between the independent doctor and the treating doctors should occur before the interview by the treating doctor”
Reply to the Commission's expert's report is found at paragraph 16 of the replying affidavit, pages 334 to 335, specifically paragraphs 17 and 18, addressing inaccuracies raised about the quality of affidavits and reports by the treating doctor.
“You will find that reply at paragraph 16 of the replying affidavit, at pages 334 to 335, which I am not going to read for obvious reasons, except to please point your specific attention to what is said at paragraph 335, at, on page 335 at paragraph 17 and paragraph 18, because with all due respect, several inaccuracies have been raised about the quality of the affidavits and the reports presented by the treating doctor”
The Commission is impugning both the bona fides and clinical expertise of the treating doctor, despite claims to the contrary.
“even though my learned friends says that they are not, the Commission is not impugning the treating doctor, in effect that is exactly what they are doing, both his bona fides and his clinical expertise”
The treating doctor confirms in the replying affidavit that any interposition in the process of independent and treating doctors must involve the treating doctor.
“and in the affidavit that is filed in those paragraphs and pages I referred you to, and that it is confirmed by the doctor himself, that is the full answer. In fact, what our doctors says in response to their doctor, if I can use that phraseology, is that it actually confirms our doctor's position, which is if there is going to be any such interposition, that our doctor has to be involved in that process.”
The doctor's report states the Independent doctor should be advised that the treating doctor wishes to be engaged by the independent doctor before any interview so the independent doctor understands the treatment plan.
“he actually says the following: “The Commission should even advise the independent doctor that the treating doctor is the treating doctor, wishes to be engaged by the independent doctor …” And he goes on to say: “It is my opinion that the engagement between the independent doctor and the treating doctor should occur before the interview by the treating doctor, the independent doctor, so that the independent doctor understands the treatment plan …””
The treating doctor has never pretended to perform an independent medical assessment in the inquiry, he is giving clinical opinions as the treating doctor, and the report does not dislodge that.
“Our doctor has never pretend once to be performing an independent medical assessment inquiry. He is the treating doctor, and he is giving his clinical opinions, and this report does not dislodge that.”
The medical incident observed by the treating doctor when he came on board suggests a long-term medical issue that may have impacted Mr Carrim prior to diagnosis and treatment.
“the doctor observed, diagnosed, and treated after he came on board as the treating doctor suggests that actually the condition could have arisen and materially impacted Mr Carrim even prior to when it was diagnosed and treated thereafter.”