Geriatrician and dementia researcher Dr Jane Tolman sought a review of a decision by the Tasmanian board of the Medical Board of Australia to impose a reprimand with 23 conditions on her practising, but was unsuccessful in a ruling handed down this week.

The allegations centred on 12 patients and included a lack of discussions with patients and families, lack of diagnosis prior to treatment, rapid acceleration of treatment, insufficient note-taking, rapid assessments that patients lacked decision-making capacity and inflexible diagnosis.

The tribunal analysed more than 9000 pages of material from the medical board in reaching its decision, including letters and interviews from other RHH doctors questioning Dr Tolman's conduct and methods.

Associate Professor Alan Sandford, then-executive director of medical services at the RHH, made the original notification to the Australian Health Practitioner Regulation Agency in June, 2013.

He alleged Dr Tolman had "lied" in regards to referring a patient's death to the coroner, and made general comments about her approach to palliative care.

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"I have also become particularly concerned with the nature of Dr Tolman's practice in respect to the management of patients coming into her service being rapidly and 'pragmatically' assessed as palliative and then managed with an end result of death," Associate Professor Sandford wrote.

"I believe Dr Tolman is practicing [sic] in a manner that constitutes risk to her patients."

RHH geriatric registrar Dr Kylie Butcherine worked with Dr Tolman on the care of several of the elderly patients in question, including one whose family was not informed of a fractured hip.

"Dr Tolman did not tell the family this," Dr Butcherine said in an interview with AHPRA.

"She offered terminal care and return to the nursing home. When this omission was detected by OPU junior medical staff after the weekend, the family were offered and accepted operative management.

"They were unaware of the fracture and alternative, non-terminal sedation, pathway.

"With an unstabilised fracture it is a very big thing to deny the family a choice on the course of action."

The tribunal relied heavily on the evidence of Dr Michael Chapman, a geriatrician and palliative medicine specialist, who prepared a report on Dr Tolman's conduct upon request.

He wrote that Dr Tolman's approach often seemed to be "one which assumes a position that a 'comfort care', palliative approach is the only way forward".

"Dr Tolman's view of the palliative approach is one where symptom management is addressed aggressively with sedating medications which are not always the most appropriate in the circumstances," he wrote.

"As highlighted in the cases above on some occasions these decisions have been contentious, and others potentially dangerous.

"Dr Tolman's approach is also to cease other medications which are not 'comfort care' medications which yet again in some of the above cases may have caused more harm than good."

Dr Tolman addressed the care of the 12 patients in her submission to the tribunal, including a letter from the son of a patient praising the care of his mother, defending the rapid acceleration of treatment as a last resort measure and that nonsurgical management of a fracture ensured a better and longer quality of life.

In the tribunal's findings, chairperson Robert Webster upheld the medical board's decision.

He said a caution finding would "trivialise" Dr Tolman's conduct and agreed that a reprimand was appropriate.

The 23 conditions on Dr Tolman's practising included her involvement in various education programs, and that she must submit three comprehensive geriatric assessments for current or recent patients every three months for review.