Patient A had long-standing schizoaffective disorder, cannabis dependence and severe chronic obstructive pulmonary disease (COPD).
Caldwell found the language used by the psychiatrist in his written communication was inappropriately derogatory, reflected his personal views about the patient and was very unlikely to promote a trusting relationship with him.
In one note he wrote: "His respiratory function is severely compromised and if he continues to smoke, he will die within the next one year. The question is not if but when.
"Since we cannot allow him to commit chronic latent suicide, no leave (which he will utilise to consume alcohol and/or illicit substances) or smoking breaks will be allowed [while he is an inpatient].
"Unfortunately, however, he remains in denial, contemptuous and dismissive of medication advice, becoming really unpleasant and obnoxious if the point is pressed further, alleging that the psychiatric medications are 'poisoning' him. … I have little more to offer, even as [Consumer A] continues down the path of self-destruction."
Dr E also wrote: "In my first meeting with him on taking over as his responsible clinician, he tried the same stunt [intimidation], but when firmly told to cut this crap out, he shut up."
Caldwell also found the psychiatrist in breach over antipsychotic medication prescribed to the patient, which was at higher doses than normal, while he was under a compulsory treatment order.
The patient complained the medication gave him serious side effects including weight gain, dry mouth, erectile dysfunction, tremors, tiredness and lack of interest.
He also had extremely poor dental hygiene with rotten and broken teeth.
After the man, aged in his 40s, died from an irregular heartbeat, his parents complained to the HDC and said Dr E enraged them with his comments towards their son, showing no empathy and no concern for his overall wellbeing.
"I feel constantly dumbfounded that [Dr E] was able to make his dislike for [A] so obvious and yet no health professional questioned it.
"I could find no positive comments about [A] in [Dr E's] correspondence or any acknowledgment of who [A] was as a person."
Caldwell also found that the psychiatrist used inappropriate, non-therapeutic and disrespectful language towards and about the second patient.
The psychiatrist also allowed his personal views to inappropriately affect his interactions with the patient.
In the third case, Caldwell found the psychiatrist failed to recognise his and his mother's distress, to listen to or be receptive to their concerns in an empathetic and respectful way.
He also used disparaging and inappropriate language in his written communication.
"I find it very troubling that these three cases present consistent themes of the psychiatrist not treating people with respect, allowing his personal views - which often were negative and disparaging - to affect the care he provided, and using inappropriate language that was, at worst, likely to distress, and certainly unlikely to foster a trusting and therapeutic doctor-patient relationship," Caldwell said.
"These themes persisted across five years.
"I do not accept that the language and words he used to describe his patients was just blunt, factual, or to the point. On the contrary, particularly in his written referrals to medical colleagues, his words were subjective, his own opinion, unprofessional and derogatory."
With regards to the DHB, the Deputy Commissioner said all health boards were responsible for the clinical services they provide.
She said they also had responsibility for the actions of their staff, including ensuring all consumers were receiving care and being treated with respect.
"In my opinion empathetic and respectful communication is vital to effective psychiatric care. I am concerned and disappointed that the DHB failed to support the psychiatrist to communicate appropriately.
"Despite the issue being raised with the DHB previously, the psychiatrist's inappropriate language and lack of empathy towards and about patients persisted.
"As a result three patients have had upsetting interactions, often when they were at their most vulnerable or distressed, and needed and deserved supportive and respectful care," Caldwell said.
She recommended the psychiatrist, who was trained overseas and had 30 years experience when he began working in New Zealand in 2005, attend further training.
This should be provided by people with lived experience of mental distress on therapeutic communication, establishing trust and rapport with mental health patients, treatment of bi-polar disorder, and how to manage risk of countertransference.
He, along with the DHB, should also provide formal separate written apologies to each of the three patients and their whānau.
