Statement of Dr Guy Kinsella

Mr Henry Norman

1. Qualifications and experience

(a) My name is Dr Guy Kinsella. I am a general practitioner. I graduated

from the University of New South Wales in 1989 and begun working
as a GP in 1991. I have a special interest in skin cancer treatment [do
you have any additional qualifications or training in skin?]

(b) I became a Fellow at the Royal Australian College of General

Practitioners (‘FRACGP’) in X

(c) My work history includes:

(i)

(d) Annexed and marked “A” is my curriculum vitae.

2. General Comments

(a) In preparing this statement, I have had regard to the letter received
from Barry Nilsson formally advising me of a potential claim for
contribution against me relating to District Court proceedings
commenced by Mr Henry Norman against Dr Poonacha.

(b) This statement has been prepared for the purposes of my solicitors at
Avant Law.

(c) As background, I often get referrals for other general practitioners

seeking my opinion on skin lesions. I perform skin grafts three to five
times a week. At the clinic, we have four procedure rooms, a nurse
practitioner always assists, and I use local anaesthetic and take the
graft mostly from under the arm. I offer my patients the option to have
excisions performed by myself or offer a referral should they prefer
this.

3. Management of Mr Norman

Consultation on 21 December 2021

(a) On 21 December 2021, I attended to Mr Norman. I made the following

note:

“Probable SCC right lateral forehead has been present for about 18 months
punch biopsy to confirm diagnosis prior to any treatment discussed with the
patient. The possibility that treatment will involve a full thickness in draft”

(b) I do not have an independent recollection of this consultation. My

usual practice is to review the letter from the referring general

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 practitioner and perform a full skin check of the patient. Based off the
notes, it appears Mr Noman was referred for management of a
specific lesion which is what was reviewed on this date. I diagnosed a
probable squamous cell carcinoma which had been present for 18
months. I arranged for a punch biopsy and considered that treatment
would likely involve a full thickness skin graft.

(c) Although I do not have an independent recollection, given the date

being 4 days before Christmas, I could have either discussed the
option of performing the biopsy on this date or offered Mr Norman
come back after Christmas to get the biopsy taken given the lesion
was very visible on his face. Alternatively, we may not have had a
nurse assisting that day so would not have been able to perform the
biopsy.

(d) Given this lesion had been present for over 18 months prior I would
have been reassured. If the lesion had been growing quickly over a
short period of time I would not have waited to perform the biopsy.

Consultation on 19 January 2022

(e) On 19 January 2022, I attended to Mr Norman. I made the following

note:

“punch Biopsy

Right lateral forehead”

(f) I do not have an independent recollection of this consultation. My

usual practice when performing biopsies is for one of the nurses at the
Clinic to prepare the patient and explain what is involved when taking
a biopsy, I clarify any allergies of the patient, and answer any
remaining questions. I administer the local anaesthetic; the nurse then
applies pressure while I attend to another patient to allow the
anaesthetic to settle and ensure that the area is numb. As there were
‘two circular pieces’ noted in the Histopathology Report I consider I
would have taken a few punch biopsies of the lesion. [why did you
take a few?]

Consultation on 21 January 2022

(g) On 21 January 2022, I reviewed the histopathology report. Although

not noted my usual practice is to review the results in Best Practice
and contact the patient via telephone. I review the results 2-3 times a
week in the evening or on a needs basis. In these circumstances,
although I do not have an independent recollection, I consider I would
have called Mr Noman, confirmed that the lesion was not a wart but
rather a skin cancer. I would have advised that we will cut the SCC out
and that will require Mr Norman to come back into the clinic. I was
reassured that it was ‘well differentiated’ and had been present for a
significant amount of time.

(h) Following this consultation on 10 February 2022, I underwent a

cystoscopy, right ureteroscopy, laser stone and insertion of bilateral

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 ureteric stents at Lingard Private Hospital. On 22 February 2022, I
underwent a bilateral flexible ureteroscopy and laser lithotripsy at
Newcastle Private Hospital. On 1 March 2022, I underwent removal of
bilateral ureteric stents.

(i) I cannot see whether Mr Norman had been booked in earlier and then
this was cancelled due to my own health issues. Another practitioner
may have been able to perform the procedure, the clinic is very busy
so this date may have been the first available.

Consultation on 7 March 2022

(j) On 7 March 2022, I reviewed Mr Norman. I noted:

“Minor surgery

Removal of lesion from the right lateral forehead, full thickness skin graft,
commenced on Keflex 500 mg after care instructions given”

(k) I do not have an independent recollection of this consultation. My

usual practice when performing excisions is for one of our practice
nurses to speak with the patient about the procedure, I confirm any
allergies and current medications, as well as answer any remaining
questions. I administer the local anaesthetic and wait 3-5 minutes to
allow the anaesthetic to settle in and ensure the site is numb.
Although you cannot see the margins by the naked eye, I excise the
lesion [explain how you decide how much to take out?] wait until there
is no bleeding, measure the area and provide local anaesthetic to the
donor site. I choose under the right arm as there was no hair and the
graft was going on Mr Norman’s head. I then removed the skin from
the graft site. I cut off the fat off the graft and stitched up the donor site
then placed the graft on the lesion.

(l) Following the excision, the usual practice is for our patients to return
seven days after the graft to take the dressing off, which I note has
occurred in Mr Norman’s case.

(m) On 8 March 2022, the histology report was available, and it noted
‘moderately differentiated squamous cell carcinoma’ I cannot recall if I
accessed the report on this date. As Mr Norman was due to attend in
6 days’ time, I would have waited until this consultation so
management and next steps could be discussed with him in person.
[Is this correct?]

Consultation on 14 March 2022

(n) On 14 March 2022, I reviewed Mr Norman. I noted:

‘removal of sutures

Patient commenced on dicloxacillin 500 mg’

(o) I do not have an independent recollection of this consultation. On

review of the notes, I prescribed Mr Noman antibiotics and would have

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 likely taken off the dressing but not yet the sutures. [Why were the
results not discussed at this consultation?]

Consultation on 21 March 2022

(p) On 21 March 2022, I reviewed Mr Norman. I noted:

“Removal of sutures

Possibility incompletely excised the margin. I therefore refer the patient to the
head and neck clinic at the mater Hospital for an opinion”

(q) I do not have an independent recollection of this consultation. On

review of the records, I would have removed the sutures. The margins
were moderately differentiated rather than well differentiated. As the
lesion was on Mr Norman’s face and being mindful of achieving an
optimal cosmetic result, I referred Mr Norman to Dr Kumar at the Head
and Neck Clinic at the Mater Newcastle for their opinion and
management. The Clinic is a multidisciplinary team which includes
surgeons and oncologists who consider each patient on a case-by-
case basis when deciding the appropriate course of treatment. Dr
Mahesh Kumar (Radiation Oncologist) is my contact at the Hospital
when I refer patients for further management. I did not make the
decision of whether radiotherapy was to be undertaken, I simply
referred Mr Norman for opinion and management and that decision is
made at the Clinic.

(r) On 31 March 2022, Mr Norman was seen 10 days later at the

Hospital, at which time options were discussed including ‘observation,
post-operative radiotherapy and further surgery. After a discussion
today, Henry has elected for adjuvant radiotherapy to reduce his risk
of local recurrence to the primary site. He is aware of the logistics and
acute and late toxicities of treatment’.

Ongoing consultations

(s) I continue to attend to Mr Norman for skin check reviews.

4. Comments on the allegations in the statement of claim

(a) Delay and failure to perform a deep enough excision leaving a

moderately differentiated SCC to the deep margin

[I accept/deny this allegation – explain]

(b) Decision to refer the plaintiff to a radiologist for radiation therapy

rather than re-excising the lesion, or referring to a surgeon

[I accept/deny this allegation – explain]

Dated: date

_______________________________

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Dr Guy Kinsella

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