Family divided as doctor cleared of misconduct

The Sydney Morning Herald/March 10, 2013

A doctor who managed his sick mother through palliative care and then buried her on private land without informing authorities has been found not guilty of professional misconduct at a medical tribunal.

Chris Maendel was the resident doctor of a restrictive Christian movement called the Bruderhof when, in March 2010, his mother, Irene, collapsed on the sect's property, in northern NSW, while she was visiting from the US.

After Dr Maendel diagnosed a possible stroke, his professional obligation was to transport her to hospital and arrange the appropriate CT scans. Instead, he placed faith over medicine and supervised her decline on the Bruderhof compound where, "surrounded by the love of Jesus," she died six days later.

Dr Maendel buried his mother on site and filled out her death certificate. Neither the police nor coroner were notified.

The Health Care Complaints Commission (HCCC) brought Dr Maendel before a tribunal in Sydney's District Court. On Friday - the third anniversary of Mrs Maendel's death - Judge Michael Elkaim ruled that, while two lesser penalties of unsatisfactory professional conduct had been established, Dr Maendel should not be found guilty of the professional misconduct complaint that could have led to him being deregistered.

The controversial case is the first before the tribunal that relates specifically to medical board policy on treatment of family members.

In his judgment, Justice Elkaim revealed the not-guilty decision was far from unanimous. "Two members took a very different view," he said.

Bernadette Tobin, director of the Plunkett centre for ethics at St Vincent's Hospital, said the case should serve as a warning, adding: "A doctor who treats a seriously ill parent runs the risk of confusing his role of doctor with his responsibilities as a member of the sick person's family … collaborative decision-making is impossible if one and the same person is acting in both roles."

While Dr Maendel refused to comment after the five-day hearing, a war of words has erupted between family members who are divided by his actions. Mrs Maendel's son James, who lives in Michigan, said his mother's "voice, life and inherent value as a person'' had been ''blatantly disregarded."

He said: "Had a responsible medical approach been taken and my mother afforded the dignity of a proper diagnosis, there is an excellent chance she would still be with us."

Another son Len, who claims to speak on behalf of seven other siblings, insisted his brother acted appropriately.

"Like many seniors who value their independence, it was our dear mother's wish to die with dignity at home. A woman of faith and intelligence, she understood both the benefits and limits of medical science."

Dr Maendel was found to have had insufficient information to determine if the stroke was too severe to treat. A revealing, handwritten letter from a young Bruderhof sister called Dorrie Rhodes raised further questions about his mother's actual condition.

In her account of Mrs Maendel's final days, Ms Rhodes wrote: "I was so touched how several times when I entered the room or came over to her, she waved at me and smiled … it was also very hard to witness her puzzlement over why she was in bed and what had happened. She asked several times, 'What happened to me?' or 'Am I sick?'"

"She wanted to get up to take a shower. We were at a loss at what to tell Irene about her situation. It was just so new for all of us."

Dr Maendel admitted he was guilty of unsatisfactory conduct when he failed to take "any steps" to seek appropriate care.

The court was advised by a medical expert that Mrs Maendel could have expected at least a 30 per cent chance of full recovery had she seen a neurosurgeon.

But according to Dr Maendel's brother Len, that misses the point: "Faced with a life-threatening condition, she did not wish for aggressive medical interventions with a poor prospect of success."

He said "the basic human right to decide such matters for oneself" had been respected.

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