Dangerous dispensing went unreported

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A pharmacist dispensed S8 medicines to a doctor shopper without a script or authority – and the GP who wrote scripts for the medicines afterwards has been reprimanded

The State Administrative Tribunal of Western Australia has found the general practitioner engaged in professional misconduct in relation to inadequate patient management and inappropriate prescribing of highly addictive opiate medication. The Medical Board has advised of the decision on its website.

The tribunal reprimanded Dr Aminah Simone Altaf, a specialist GP, imposed auditing and mentoring conditions on her registration and required her to pay $10,000 towards the legal costs of the Medical Board of Australia.

The tribunal’s decision related to Dr Altaf’s care of a patient who had a history of chronic pain and opiate dependency.

Between 15 February 2016 and 4 April 2016, Dr Altaf prescribed Schedule 8 drugs when she was not authorised to do so, the Board advised.

She also prescribed “unacceptably high” doses of oxycodone and fentanyl despite receiving advice not to do this from a patient’s pain management specialist, as well as warnings from the Health Department about the patient’s drug-seeking behaviour.

The patient was not a registered drug addict, but had visited multiple different doctors at different practices and their treatment with opioids met high risk criteria. The Department of Health had requested the patient be referred to an addiction treatment centre, but this did not appear to have occurred.

A pain management consultant had advised her that the patient’s fentanyl dose was too high and should be gradually reduced.

Dr Altaf agreed that she had failed to maintain adequate medical records for the same patient.

She also had failed to report to the Department of Health and to notify AHPRA when a pharmacist dispensed S8 medications to the patient without a prescription or verbal authority.

Instead, Dr Altaf had issued prescriptions for the medication that had been dispensed without authorisation.

These medicines included OxyContin 30mg; and fentanyl 75mcg/hr; on one occasion the patient was dispensed 56 x OxyContin and 15 fentanyl, and on another, 40 x fentanyl.

The tribunal noted that there were “clear grounds for a reasonable belief” that the pharmacist was practising in a manner that placed the public at risk and significantly departed from accepted professional standards.

It found Dr Altaf:

  • prescribed oxycodone and fentanyl to the patient in doses that were unacceptably high, with no clinical indication for such large doses;
  • prescribed oxycodone in erratic quantities;
  • prescribed in circumstances where she had no authorisation to prescribe Schedule 8 drugs to the patient in the period 15 February 2016 to 4 April 2016;
  • prescribed in circumstances where she had been advised by the Department of Health on 22 July 2015, that the patient was exhibiting drug seeking behaviour;
  • increased the amount of fentanyl prescribed to the patient, in circumstances where she had been advised by a pain management specialist that she should gradually reduce the patient’s fentanyl dose;
  • failed to maintain adequate clinical records for the patient on at least 38 occasions;
  • on eight occasions, issued prescriptions for S8 medications which had already been dispensed to the patient by the pharmacist in circumstances where she was aware that the S8 medications had been dispensed without a valid prescription or verbal authority from a medical practitioner; and
  • failed to notify AHPRA of the pharmacist’s conduct.

The tribunal made no observations regarding any action against the pharmacist pertaining to these matters, and his registration is active with no conditions, though the AHPRA website notes a tribunal decision and reprimand against his name.

When making its decision, the tribunal took into consideration Dr Altaf’s cooperation with the Board’s investigation, the fact that she felt pressured by the situation in which she found herself and that since the investigation into her conduct, the practitioner had already implemented changes to the way she practices.

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