Dentist repeatedly breached conditions

dentist's hands with implements

Pharmacists made several mandatory notifications about a suspended dentist who attempted to fill scripts he had written in the names of other people

A tribunal has found that it would have cancelled a former dentist’s registration if it were still current, after findings of misconduct, impairment and lack of capacity to practise.

The Civil and Administrative Tribunal NSW heard about a series of incidents which took place due to the dentist’s self-prescription of S8 and S4 drugs including codeine, benzodiazepines and fentanyl.

From 2011, the dentist began to take prescription painkillers which had been prescribed to his wife, and in late 2012 he was diagnosed with severe lumbar scoliosis.

The Tribunal noted that it was “undisputed that this is a very painful condition” and the former dentist has since undergone three surgical procedures in an attempt to treat the symptoms.

After developing a tolerance to codeine, the dentist began to take benzodiazepines, and soon began to use other forms of opioids. In 2014 he was admitted to hospital suffering cellulitis in his leg as a result of self-injecting pethidine.

By early 2015 he was taking “very significant” amounts of opioids in a number of forms.

In early 2015 the Pharmaceuticals Services Unit raised a complaint about his prescribing practices and his S8 prescribing authority was withdrawn.

In resultant proceedings by the Dental Council, the dentist admitted prescribing drugs in his wife’s name and using them.

Conditions requiring drug testing three times a week were imposed and he was assessed as part of the impaired registrants program, but the doctor concerned found that the dentist’s use of opioids was only over a few months because of acute pain, and did not find that the dentist had a substance use disorder.

However a couple of months later another health assessment was conducted by another doctor, who this time found that the dentist’s tolerance to opioids and his illegal methods of obtaining them did warrant a diagnosis of substance use disorder – and that pain and restricted movement from the spinal condition also constituted an impairment.

The Tribunal noted that the dentist had understated the quantity of medicine he was taking and the time he had taken it for to both doctors – for example, claiming he began self-injecting pethidine in 2015, despite having been hospitalised as a result of this practice in 2014.

The dentist repeatedly failed to comply with the conditions on his registration, and further conditions were imposed; later in 2015 he voluntarily agreed not to prescribe S8, S4 and S4D medicines except local anaesthetics and antibiotics for dental treatment.

He also agreed to advise the Council if another prescriber prescribed these medicines, and to use the services of a pain specialist and a clinical psychologist.

However from October 2015 to January 2016 he breached these conditions “literally dozens” of times.

These breaches included failing to attend drug testing, failing to attend for medical treatment, failing to disclose that he had been prescribed the drugs in question, and failure to attend health assessments directed by the Council.

Eventually, after new proceedings were postponed three times on medical advice, the Dental Council was able to bring proceedings against the dentist and his registration was suspended.

While the proceedings were being postponed, the dentist continued to breach his conditions, including obtaining drugs by writing scripts in the names of other people, and having medicines including fentanyl – on which he overdosed twice in this period – from other prescribers.

After he was suspended, he continued to prescribe S4D medicines in the names of other people for his own use, mostly in the name of his wife.

“A number of mandatory notifications were made by pharmacists in January and May 2017 as a result of the practitioner attempting to fill those scripts,” the Tribunal noted.

In 2017 the dentist was again hospitalised for overdose and was treated for his “poor” mental health. He was convicted in January 2018 of one count of possession of prohibited drugs and three counts of the same in March 2018.

In March 2018, the dentist was also convicted of three criminal offences of obtaining a restricted substance by false representation in relation to the scripts he had written in the names of others and had taken to pharmacies to be dispensed.

He has since entered into the methadone program, and has on a number of occasions been found to be using diazepam and fentanyl.

In September 2019 the dentist attempted to relinquish his registration, and in November the Dental Council took the “unusual” step of lifting the suspension so the dentist could surrender his registration, which he did.

While the Tribunal noted that the former dentist did not want to return to his profession, it was important that a hearing and decision take place as “if no inquiry were held and no decision rendered, there would be no record on the public register concerning the practitioner’s registration, and he would effectively be free to reapply at any time in the future to be returned to the register”.

It found that all the complaints raised had been proven to the required standard.

It found that the dentist suffers an impairment due to his “longstanding and not fully resolved poly-substance use disorder” and that his “considerable” steps towards recovery had been marred by recent relapses into opioid and benzodiazepine use, and that this impairment would be very likely to impact his capacity to practice.

It also noted that his repeated breaches of conditions and professional standards, as well as the criminal convictions, were of “grave severity”.

It ordered that AHPRA is required to record on the national register that the Tribunal would have cancelled the former dentist’s registration, had he still been registered.

He will not be able to reapply for registration for five years, at which time he would need to demonstrate that he had tackled his psychological issues and abstained from substance use, and was ordered to pay the Health Care Complaints Commission’s costs.

Pharmacists who are distressed can contact the Pharmacists’ Support Service on 1300 244 910.

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