Australian physician Peter Alexakis who inherited over $20 million from a patient, has been accused of fraud, malpractice, and inappropriate conduct.
The unnamed patient changed their will to leave assets to Alexakis just three months before their death.
Inheriting or accepting large gifts from patients can be ethical and legal. It’s best to avoid it by not accepting either.
A physician in Sydney, Australia, Peter Alexakis, MD, has been found guilty of malpractice after a legal battle with the Salvation Army in the New South Wales, Australia Supreme Court. Dr. Alexakis inherited $24 million from a patient, including the title to that patient’s $3 million home. The unnamed patient’s two wills, amended to leave these assets to Dr. Alexakis just three months before their passing in 2017, were drawn up by Dr. Alexakis’ family lawyer. Before the changes, the Salvation Army, an acquaintance of the patient, and a former business associate were the named beneficiaries.
The original beneficiaries contested the will in the Supreme Court in 2023. They claimed that Dr. Alexakis had committed fraud and abused his doctor-patient relationship. The case before the NSW Supreme Court was unsuccessful but did not end the controversy surrounding the will or Dr. Alexakis’ relationship with the patient. The Health Care Complaints Commission later presented a case against Dr. Alexakis to the NSW Civil and Administrative Tribunal. They alleged that Dr. Alexakis established a close relationship with the patient to exploit him for financial gain.
According to the charges brought forth by the Commission, Dr. Alexakis visited the patient, who was 83, unmarried, and had no children or other family, almost daily. The Commission claims there were 92 visits in the months before the patient’s death. Records also show that Dr. Alexakis interfered with the patient's treatment when admitted to the hospital in May 2017 and then to palliative care in October 2017. Physicians at Royal Prince Alfred Hospital in May and June 2017 and the palliative care program at Concord Hospital were the ones to originally raise concerns about Dr. Alexakis’ involvement with the patient to the Commission.
Dr. Alexakis claimed he was not the only physician to visit the patient, pointing to social visits from another doctor as a defense for his own relationship with the patient. However, that physician didn’t inherit anything from the patient. Additionally, financial records show that this case isn’t the first time Dr. Alexakis inherited money from a patient. He received $80,000 as a beneficiary in 2015. 
After reviewing the evidence presented by the Commission, the NSW Civil and Administrative Tribunal found that Dr. Alexakis’ visits to the were inappropriate, excessive, and blurred the professional and personal lines of a doctor-patient relationship. Although the Tribunal agreed there was a reason for suspicion, they did not feel there was enough evidence to say there had been clear manipulation or exploitation. Dr. Alexakis has been charged with malpractice and unprofessional conduct. A later hearing will determine the consequence of these charges. Dr. Alexakis might lose his medical license or see restrictions placed on it. Currently, he is still practicing.
Doctor-patient relationships, gifts, and malpractice
Inheriting money from a patient isn’t illegal. A person can, in theory, name anyone they choose as the beneficiary on their will, life insurance, or other asset documents. However, as a treating physician, this can quickly become an ethical and legal problem. Even with sums much smaller than the $24 million left to Dr. Alexakis, or assets worth much less than a $3 million home, inheriting can blur doctor-patient relationship lines. It can influence patient care and decision-making.
The American Medical Association’s Code of Ethics doesn’t specifically address inheriting. Still, it does advise that physicians decline any disproportionately or inappropriately large gifts, as accepting them is “likely to damage the patient-physician relationship.” It's still not a good idea, even if inheriting from a patient or accepting any other large asset doesn’t affect your professional judgment or your ability to provide patient care. You might not be affected or influenced by financial gain, but it can appear to others as if you have been. Inheriting from a patient or accepting a large gift can leave you open to malpractice charges.
When a patient gives a gift, Arun Durgam, MD, a Texas internal medicine specialist, says it’s best to consider the intent and possible effect of the gift before you accept.
“Usually, a small gift that is a token of appreciation isn’t an ethical problem,” says Dr. Durgam. “A large gift might come with expectations of preferential treatment. It can undermine professionalism and interfere with objectivity in the care of the patient.”
What this means for you
As a rule, it’s always best to prioritize maintaining an appropriate doctor-patient relationship. Any time a situation sets up a conflict of interest compromises your judgment, or otherwise changes the standard doctor-patient dynamics, it’s better for you and the patient to avoid it. It’s why you should avoid providing care and treatment to family, and it’s why you shouldn’t inherit or accept large gifts from patients.