Australian physician Peter Spencer performed an independent cricothyroidotomy on his wife in 2015 and failed to call paramedics.
Physicians who treat family members can open themselves and those family members up to the risk of harm.
A physician is facing new scrutiny around the events of his wife's death. In January 2015, emergency responders were called to the Docklands neighborhood of Melbourne, Australia, for 29-year-old Mayumi Spencer. Spencer’s husband, physician Peter Spencer, had called paramedics because his wife wasn’t breathing. However, according to paramedics' observations, Mayumi Spencer had likely been dead for several hours when they arrived. Now, new reports shed light on what may have happened.
A recently released coroner’s report reveals that Mayumi Spencer first went into distress at about 4 a.m. but that her husband didn’t contact emergency services until 7:38 a.m. During those nearly four hours, Peter Spencer, a respiratory and sleep physician, attempted to perform independent life-saving medical care on his wife.
Details from the coroner’s report confirm that Mayumi Spencer’s initial medical distress was caused by a cocaine overdose. Earlier that evening, the Spencers had been out with friends. They returned home at around 1 a.m., and at around 4 a.m., Mayumi Spencer began vomiting and seizing. In a statement to the coroner, Peter Spencer said he believed his wife was choking. In response, he made an incision in his wife’s neck and attempted to perform a cricothyroidotomy. The procedure was unsuccessful.
The details of the report may lead to the filing of charges of negligent manslaughter against Peter Spencer. According to an excerpt interviewed by the coroner’s office, it would not have been criminal or even unreasonable for Peter Spencer to make an attempt to clear his wife’s airways prior to calling emergency services. However, even with Peter Spencer’s medical training, that should have been a quick, basic lifesaving procedure that would have delayed an emergency call by minutes, not hours.
Additionally, according to the report, there was a history of domestic violence in the Spencer’s marriage. This includes reports from friends, family, and local family violence service centers that Peter Spencer had mentally and physically abused his wife and had, on at least one previous occasion, injected her with cocaine against her will. Peter Spencer claims the couple often fought but had been happy the in the months leading up to Mayumi Spencer’s death. Currently, Peter Spencer is still a practicing physician, but there are numerous restrictions on his license. The coroner’s findings have been released in full to the Australian Health Practitioners Regulation Agency (AHPRA).
Physicians treating family
The Spencer case is a headline-grabbing example of things going very wrong for a family member treated by a physician, but even less extreme cases can open family members and physicians up to the risk of harm. The danger of performing emergency home surgery on a family member, no matter your intentions, is clear. It can sometimes be harder to see the direct harm in things like writing a prescription renewal or a referral for family members. After all, these things aren’t illegal, and in many cases, they can seem like a simple and helpful solution. Often, physicians report that family come to them and request medical care, something that can be hard to refuse. Plus, for parents, it can sometimes seem like there are benefits to providing at least some of your children’s care.
However, there are multiple reasons these cross ethical lines, too.
Erkeda DeRouen, MD, a Maryland-based Family, Diversity, and Lifestyle Medicine Specialist who has spoken in TED Talks, podcasts, and events around the country about some of the biggest issues in healthcare today, says that the risk of harm is always present if a physician tries to treat a family member
“Emotions can cloud judgment, making it difficult to follow the standard of care. They could choose to treat loved ones with medications or techniques that are not evidence-based, pulling at straws to make them feel better. On the other end, they may downplay a patient’s complaints, assuming that they are being whiny, leading to delayed diagnosis and treatment,” says Dr. DeRouen.
The American Medical Association (AMA) Code of Medical Ethics says that treating family is only appropriate if very limited circumstances, such as during an emergency when care is needed and other physicians are present. The AMA specifies that, in these circumstances, physicians should always recognize the way family dynamics can influence doctor-patient dynamics and should turn over patient care to another physician as soon as possible. Dr. DeRouen agrees.
“Treating family members can unintentionally lead to serious harm,” DeRouen says. “For example, a patient may be experiencing severe depression and suicidal ideation. While a family member may certainly try to provide thoughtful care. There may be difficulty getting the patient to open up, given family dynamics. Allowing that patient to freely talk to a neutral party without judgment could save their life.”