Disciplinary Action against Dr. Malcolm Hooper

Stephen Barrett, M.D.


The Victorian Civil and Administrative Tribunal (VCAT) has upheld a 2012 ruling by the Chiropractic Board of Australia that chiropractor Malcolm Hooper was guilty of professional misconduct, unprofessional conduct and bringing the profession into "undeserved ill-repute." The VCAT decision reprimanded Hooper, canceled his registration, disqualified him from reapplying for registration for two years, and ordered him to pay the costs of the proceedings. The board's action was based on Hooper's treatment of a man with cerebral palsy with hyperbaric oxygen (HBO) and a Lokomat device. (The Lokomat robot-assisted walking device that can help some disabled people walk.)

The man had sought treatment in 2007 with the hope that it it would make him suitable for stem cell treatment by David Steenblock, D.O., an American physician who has been disciplined several times. The Amended Final Notice of Allegations (shown below) states that within nine months, Hooper administered about 230 hours of HBO treatment and about 70 hours of Lokomat treatment for which the patient was billed more than AU$50,000. The board concluded that Hooper had made many unsubstantiated claims on his clinic Web site and had misrepresented the likelihood of helping the patient.


AMENDED FINAL NOTICE OF ALLEGATIONS
27 February 2013

Failure to Make a Proper Assessment

1. On 27 August 2007, Dr Malcolm Hooper failed to undertake or direct that a proper clinical assessment be undertaken prior to recommending that his patient, QS, undertake costly treatment in the form of more than 150 hours of hyperbaric oxygenation (HBO) treatment (which by 13 May 2008 totalled approximately 230 hours) and approximately 40-60 hours of Lokomat treatment (which by 13 May 2008 totalled approximately 70 hours).

PARTICULARS

(a) On 27 August 2007, QS attended Dr Hooper's HyperMED Neurorecovery Australia Clinic at Level 13, 15 Collins Street, Melbourne and sought HBO treatment, including in preparation for possible future overseas stem cell treatment of cerebral palsy.

(b) On 27 August 2007, Dr Hooper conducted an initial consultation with QS.

(c) Dr Hooper's clinical notes from the initial consultation on 27 August 2007 do not record that he undertook a physical examination and proper assessment of  QS prior to him commencing HBO and/or Lokomat treatment.

(d) The cost per hour for undertaking HBO treatment at HyperMED was between $100-$150 per hour and the cost of undertaking Lokomat treatment at HyperMED was $220 per hour.

(e) On 27 August 2007, QS commenced HBO treatment and undertook two hours of HBO treatment at HyperMED following the initial consultation with Dr Hooper.

(f) On 27 August 2007, Dr Hooper recommended during the consultation with QS that he undergo an MRI scan, whose results were communicated to Dr Hooper on 7 September 2007.

(g) Between 29 August 2007 and 5 September 2007, prior to QS submitting to an MRI scan and Dr Hooper receiving the results of the MRI scan on 7 September 2007,  QS undertook the following treatment at HyperMED:

(i) 2 hours of HBO treatment and 1 hour of Lokomat treatment on 29 August 2007;

(ii) 4 hours of HBO treatment on 1 September 2007;

(iii) 2 hours of HBO treatment and 1 hour of Lokomat treatment on 3 September 2007;

(iv) 2 hours of HBO treatment and 1 hour of Lokomat treatment on 5 September 2007.

(h) Dr Hooper failed prior to the commencement of HBO and Lokomat treatment to consult or communicate with QS's treating health practitioners in relation to his condition (cerebral palsy), his symptomatology and his general health.

Failure to Obtain Informed Consent

2. Prior to commencing HBO and Lokomat treatment on 27 and 29 August 2007, respectively, Dr Hooper failed to obtain informed consent, or sufficiently informed consent, from  QS in relation to undertaking the costly HBO and Lokomat treatment which he recommended.

PARTICULARS

(a) Dr Hooper failed to advise  QS prior to the commencement of either the HBO or the Lokomat treatment what were its advantages, disadvantages or contra-indications.

(b) Dr Hooper failed to advise  QS prior to the commencement of either the HBO or the Lokomat treatment what were its limitations for his condition (cerebral palsy), symptomatology, or readiness for stem cell treatment for cerebral palsy.

(c) Dr Hooper failed to advise  QS prior to the commencement of either the HBO or the Lokomat treatment what were its likely outcomes (including what permanent or temporary improvements in his condition (cerebral palsy), symptomatology or state of his stem cells could reasonably be expected.

(d) Dr Hooper failed to advise  QS of any options other than the HBO and/or the Lokomat treatment which he might consider, rather than submission to and expenditure on HBO and Lokomat treatment.

(e) Dr Hooper failed to advise  QS of risks that could arise in the course of the provision of the HBO and/or the Lokomat treatment.

(f) Dr Hooper's clinical notes between 27 August 2007 and 13 May 2008 do not record that he discussed with or advised QS in respect of those issues set out in paragraphs (a) to (e) above.

Failure to Prepare and Modify Treatment Plan

3. On or around 27 August 2007 and 13 May 2008, Dr Hooper failed to prepare a treatment plan, or adequate treatment plan, for QS which set out the planned recommended HBO and Lokomat treatment, and/or how and when such treatment would be periodically reviewed and/or assessed in order to clinically evaluate any improvements or progress (or lack thereof) by reference to the contrast (if any) as assessed by Dr Hooper between  QS's initial presentation and any later presentation in his condition (cerebral palsy), symptomatology or the state of his stem cells.

PARTICULARS

(a) Prior to the provision of HBO and Lokomat treatment to QS, Dr Hooper did not discuss a treatment plan with QS, including, for example, an end point to treatment or degree of improvement (including what permanent or temporary improvements in his condition, symptomatology or state of his stem cells could reasonably be expected) that were sought to be attained through the recommended HBO and/or Lokomat treatment.

(b) Dr Hooper allowed QS to commence undertaking, costly HBO and/or Lokomat treatment in the absence of a treatment plan, or adequate treatment plan.

(c) Dr Hooper's clinical notes on or around 27 August 2007 do not provide a record of a treatment plan, or adequate treatment plan, in respect of those issues set out in paragraphs (a) and (b) above.

4. Between 27 August 2007 and 13 May 2008, Dr Hooper failed to modify and/or properly modify any treatment plan which did exist for QS to set out the planned recommended further HBO and/or Lokomat treatment and how and when such treatment would be periodically reviewed in order to clinically evaluate any improvements or progress (or lack thereof) by reference to the contrast (if any) as assessed by Dr Hooper between  QS's initial presentation and any later presentation in his condition (cerebral palsy), symptomatology or state of his stem cells.

PARTICULARS

(a) During the provision of HBO and/or Lokomat treatment to  QS Dr Hooper did not discuss a treatment plan with QS, including, for example, an end point to treatment or degree of improvement (including what permanent or temporary improvements in his condition, symptomatology or state of his stem cells could reasonably be expected) that were sought to be attained through the recommended HBO and/or Lokomat treatment.

(b) Dr Hooper allowed QS to continue undertaking costly HBO and Lokomat treatment in the absence of modifications or proper modifications to any treatment plan.

(c) Dr Hooper's clinical notes between 27 August 2007 and 13 May 2008 do not provide a record of modifications to a treatment plan in respect of those issues set out in paragraphs (a) and (b) above.

Failure to Monitor Outcomes

5. Between 27 August 2007 and 13 May 2008, Dr Hooper failed to clinically monitor or evaluate any measurable improvements (or otherwise) in QS's condition (cerebral palsy), symptomatology or state of his stem cells or readiness for stem cell therapy for cerebral palsy cells attributable to the HBO treatment and/or Lokomat treatment provided to him

PARTICULARS

(a) During the HBO and Lokomat treatment, Dr Hooper did not conduct ongoing clinical evaluation of any measurable improvements (or otherwise) in QS's condition, symptomatology or state of his stem cells or his readiness for stem cell treatment for cerebral palsy attributable to the HBO and/or Lokomat treatment provided.

(b) Dr Hooper continued to allow  QS to undertake costly HBO treatment and Lokomat treatment in the absence of any measurable improvements or progress (or lack thereof) in  QS's condition, symptomatology or state of his stem cells or readiness for stem cell treatment for cerebral palsy.

(c) Dr Hooper failed to keep adequate and detailed records of any clinical observations as to improvements or progress (or lack thereof) in QS's condition (ie cerebral palsy), symptomatology or state of his stem cells or readiness for stem cell treatment for cerebral palsy attributable to the HBO treatment and/or Lokomat treatment provided.

Misrepresentation of Likely Efficacy of Treatment

6. In recommending the provision of HBO and/or Lokomat treatment by his clinic HyperMED to QS, Dr Hooper misrepresented the likely effectiveness of HBO and/or Lokomat treatment in relation to cerebral palsy either generally or for the purpose of QS undertaking possible future overseas stem cell treatment of his cerebral palsy.

PARTICULARS

(a) In recommending such treatment to  QS, Dr Hooper did not provide a balanced view as to the effectiveness of such treatment in relation to cerebral palsy, including a statement that such treatment is not conventionally used in Australia and/or in Western countries with a comparable health service culture in treating cerebral palsy or readying persons for stem cell treatment for cerebral palsy.

(b) Dr Hooper did not disclose to QS that such treatment in relation to cerebral palsy or readiness for stem cell treatment for cerebral palsy is not advocated by a significant percentage of qualified registered medical practitioners or medical representative organisations in Australia.

(c) Dr Hooper's recommendation of such treatment to  QS did not set out the health risks associated with such treatment.

(d) Dr Hooper did not disclose to  QS that available medical and scientific evidence published in internationally respected peer reviewed journals does not support the effectiveness of treatment of cerebral palsy or its symptomatology either generally or for the purpose of preparation for stem cell treatment with the use of HBO and/or Lokomat treatment.

(e) Dr Hooper did not disclose to QS that HBO and/or Lokomat treatment for adults with cerebral palsy is novel and non-mainstream.

(f) Dr Hooper did not disclose to QS that HBO treatment was not appropriate for the treatment of adults with cerebral palsy or its symptomatology in that, in spite of its expense, it has not been proved to provide specific and/or lasting benefit to the patient.

(g) Dr Hooper did not disclose to QS the outcomes or improvements that could reasonably be expected from the provision of HBO and/or Lokomat treatment in preparing QS for future stem cell treatment.

Misleading and Deceptive Advertising

7. In promoting the provision of HBO and/or Lokomat treatment by his HyperMED clinic on its website (http://www.hypermed.com.au/) in relation to numerous listed medical conditions (namely (1) soft tissue musculoskeletal injuries; (2) fracture repair; (3) acute and chronic spinal instability; (4) facet dysfunction; (5) disc protrusion; (6) canal stenosis; (7) inflammatory arthritides; (8) spinal cord neuropathy due to crush and neurovascular degeneration; (9) paraplegia and quadriplegia due to incomplete neurovascular compression; (10) peripheral nerve injury and neuropathies; (11) cerebrovascular stroke; (12) multiple sclerosis; (13) multi-infarct dementia; (14) cerebral palsy; (15) Parkinson's disease; (16) Alzheimer's disease; (17) Autism; (18) epilepsy due to hypoxia; (19) coronary heart disease; (20) heart insufficiency (post-surgical); (21) heart contractile dysfunction; (22) acute and chronic arterial insufficiency, (23) gastric and duodenal ulcers; (24) hepatitis; (25) diabetes; (26) lung abscess; (27) pulmonary embolism (as an adjunct to surgery); (28) complications of pregnancy (including gestational diabetes, eclampsia, heart disease, placental hypoxia, foetal hypoxia and congenital disease of the neonate); (29) infertility; and (30) reducing risk of cancer cell mutation) between 27 August 2007 and 3 March 2010, Dr Hooper engaged in advertising that was misleading and deceptive in that he invited inaccurate inferences to be drawn by potential patients about the effectiveness of such treatment in relation to those listed conditions.

PARTICULARS

(a) Dr Hooper did not provide a balanced view of the effectiveness of HBO and/or Lokomat treatment in relation to the listed medical conditions, including a statement that such treatment is not conventionally used in Australia and/or Western countries with a comparable health service culture in treating such medical conditions.

(b) Dr Hooper did not disclose that HBO and/or Lokomat treatment in relation to the listed medical conditions is not advocated by qualified registered medical practitioners or medical representative organisations in Australia.

(c) Dr Hooper's HyperMED advertising and literature did not disclose that available medical and scientific evidence does not support the effectiveness of treatment for the listed medical conditions with the use of HBO and/or Lokomat treatment.

(d) Dr Hooper's HyperMED advertising and literature did not disclose that HBO treatment is not appropriate for the treatment of the listed medical conditions in that no medical or scientific evidence published in internationally respected peer reviewed journals exists to demonstrate it provides substantive benefits.

Inadequate Clinical File

8. Between 27 August 2007 and 13 May 2008, Dr Hooper failed in his professional responsibilities by generating seriously inadequate clinical documentation in relation to the provision of costly HBO and Lokomat treatment to QS, including making a record in QS's clinical notes of:

(a) QS's medical history;

(b) any physical examination and proper assessment of QS (if there was any) prior to him commencing HBO and Lokomat treatment;

(c) QS's current symptomatology and level of spasticity at the commencement of treatment;

(d) QS's suitability for treatment; advice provided by Dr Hooper to  QS (if there was any) as to risks, options, advantages, disadvantages, contra-indications, limitations, or side-effects of the proposed treatment for his condition, symptomatology or state of his stem cells or readiness for stem cell treatment for cerebral palsy;

(e) questions and issues raised by QS with Dr Hooper as to the HBO and/or Lokomat treatment;

(f) treatment planning (if there was any), including likely outcomes or improvements (including what permanent or temporary improvements in QS's condition, symptomatology or state of his stem cells or readiness for stem cell treatment for cerebral palsy could be expected) from the treatment to be provided and/or treatment goals;

(g) treatment actually provided;

(h) QS's response to the HBO and/or Lokomat treatment as clinically evaluated by Dr Hooper and/or HyperMed staff;

(i) any clinical progress in or improvement from treatment;

(j) reasons for the need for further treatment; and communications between him and his patient about significant matters arising during the course of provision of treatment (other than moneys owed).

This article was posted on August 12, 2013.

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