‘Reprehensible’: stoush over surgeon Paul Cozzi’s conduct

A trainee doctor operated unsupervised on four patients at a Sydney public hospital after the supervisor left to perform operations at a private hospital.

Paul Cozzi near Hurstville Private Hospital in Sydney on Wednesday. Picture: Britta Campion

A high-profile Sydney cancer surgeon left a trainee doctor to operate unsupervised on four patien­ts at a public­ hospital so he could treat his private patients at another facility­, one of whom was charged $10,000 for the surgery.

Paul Cozzi, a former consultant urolo­gist at the St George Hospital, has been ruled to have acted unethic­ally and improperly after an 11-month investigation found he left the public facility in the city’s southwest to treat patients at a leading private facility on Sydney­’s north shore.

The Healthcare Complaints Commission found Dr Cozzi jeopardised patient safety and exhibited­ “reprehensi­ble” conduct in November­ 2015 by running­ “two surgical lists in two different places­ at the same time”.

The professional standards committee found Dr Cozzi tried to cover up his “unethical conduct” by misleading investigators on multiple occasions, including by claiming he had poor memory because of “hypoxic brain damage” sustained while he was a student­.

According to the commission, Dr Cozzi, a senior urolog­ical and robotic surgeon, breached “basic standards of professional practice” by leaving a trainee to ­perform four operations unsuper­vised at St George Hospital on November 12, 2015.

He signed post-operative count sheets and safety checklists for patients at the public hospital in an “effort to document his presence” at the facility, before driving to the Mater Hospital in North Sydney, where he operated on two patients, one of whom was charged almost $10,000.

“He misled the local health district and the commission in attempts to obscure his inadequate professional conduct,” the commission­ found. “His conduct is reprehensible and it is only fortuitous that no patient suffered as a result of his actions.”

Dr Cozzi denies wrongdoing and rejects the alleg­a­tion that he compromised patient­ safety, claiming he was acting in the ­“patients’ best interests”.

“Patients on the day in ­question, including the cancer patients­ and one who had been cancelled three times previously on the public hospital list, were deemed to be urgent,” he said.

Dr Cozzi claimed he supervised the trainee “directly and indirectly­”, noting that the “experienced” doctor was capable of completing the operating list “without incident”.

“The decision (was made) after careful consideration, knowing that the nature and complexity of the cases was such that they could be completed safely,” he said.

The commission, however, found Dr Cozzi neglected to tell the trainee — who cannot be named for legal reasons — where he was going or how to contact him in the event of an emergency.

The committee criticised Dr Cozzi’s evidence and concluded that he lacked credibility and was an untrustworthy witness.

“Many of his answers were designed to obfuscate and deflect attention from the relevant issues,” the committee members said.

He was also accused of making “false and misleading statements” to investigators in an effort to conceal his whereabouts.

E-Toll records, which Dr Cozzi told the commission he was ­unable to access, revealed he had arrived at the Mater shortly after the trainee began unsupervised operations at St George.

At the time, Dr Cozzi said he was living in an “abusive domestic relationship” with his now ex-wife, who he claimed had blocked his access to his E-toll account.

Dr Cozzi told The Australian on Wednesday that he had been bullied and subjected to “inaccurate allegations” by members of the St George urology department, some of whom were former business associates.

He has previously accused colleagues­ of “a calculated campaign­ to try to discredit me” after being accused of operating at Hurstville Private Hospital ­despite a ban on elective surgery in the early months of the coronavirus pandemic this year.

Dr Cozzi said he would appeal against the decision, and was particularly concerned about the committee’s view that indirect or remote supervision was not accepta­ble. He said that was “at odds with common practice” and the urological society’s guidelines, which require 20 per cent of trainee hours to be spent on “un­supervised operative surgery”.

A South Eastern Sydney Local Health District spokeswoman said Dr Cozzi’s employment at St George Hospital was “terminated” in January 2017 following an investigation.

“SESLHD expects all medical officers to comply with the highest level of professional standards,” the spokeswoman said.

In a statement, a spokesman for the Mater said: “Dr Paul Cozzi ceased operating at the hospital in early May this year. He is no longer accredited at the Mater.”

The commission ordered that Dr Cozzi be subject to supervision, recommended he complete an ethics course and banned him from supervising trainees.