A doctor who self-injected fentanyl in a hospital bathroom has been reprimanded and fined $5,000
The doctor was facing three allegations: that he misappropriated fentanyl from his employer by diverting fentanyl intended to be discarded in the intensive care unit (ICU) for self-administration; that he took possession of the drug for the purpose of self-administration without a lawful script or any other permission or authority; and that he self-administered it intravenously in the hospital’s bathroom.
The doctor, who had studied and worked overseas, had moved to Queensland in the early 2000s and completed an intensive care fellowship at two hospitals there, and after working in a metropolitan hospital in anaesthetics, was appointed director of the ICU.
He has currently stepped aside as the director to have more time to conduct research.
After moving overseas to study, and being separated from his family, he had been diagnosed with anxiety in his early 20s.
“This has at times developed into significant episodes of depression,” noted Judge Suzanne Sheridan.
The respondent had been on Prozac and Lexotan sporadically to manage his anxiety, and his condition did not interfere with his daily life or work.
In 2011, several triggers caused the doctor’s mental health to deteriorate, and in 2012 he again began to take Prozac, as well as occasional Lexotan.
By May 2013 he was feeling “increasingly overwhelmed,” the judge said.
“The respondent began to self-administer fentanyl by way of injection in the bathroom of the hospital in an effort to manage his considerable situational stress,” she noted.
“He found that the fentanyl took ‘the edge off’ his anxiety.
“Initially, the respondent administered around 20mg between one or two times a week. The dose steadily increased to 50mg and then to 70mg. The respondent’s use increased to such an extent that eventually he was taking fentanyl twice daily up to five or six times a week.
“The respondent would obtain the fentanyl from discarded fentanyl leftover from patients. Within the ICU at that time, no record was kept of discarded fentanyl. This system enabled the respondent to systematically misappropriate small amounts without detection.
“It is not alleged that the respondent diverted any fentanyl which had been intended for the direct use of patients.”
She said that there was no evidence the doctor had been intoxicated or affected by drugs at any time while at work, nor was it alleged that any patient had been harmed as a result of the self-administration of Fentanyl.
The doctor’s colleagues became suspicious of his conduct, and in August 2013 the director of medical services confronted him about it. At that time, the doctor denied the accusations.
But in November 2013, when asked again about them, he admitted personal usage, though he only admitted sporadic use.
In this meeting, the doctor said he would notify the Medical Board of Australia, and he voluntarily sought immediate treatment from a psychiatrist, and submitted to the care of his GP and a psychologist.
The Board’s Immediate Action Committee took action and imposed conditions upon his practice; and the doctor also took a number of months off work. The doctor had practised free from any conditions since September 2015. Meanwhile, the hospital also reprimanded the doctor.
The acting director of the ICU and nurse unit manager submitted evidence that the doctor was an “invaluable” member of the team, and that his suspension would have a negative impact on the ICU.
“The Tribunal finds that the steps taken by the respondent to rehabilitate show a very high level of insight and remorse,” Judge Sheridan noted.
“The Tribunal accepts, as was observed by his treating psychiatrist, the process of rehabilitation has resulted in structural changes in the respondent’s thinking, with the resultant effect of more open communication within his work place and changes in his domestic environment.
“The Tribunal considers the likelihood of future similar misconduct to be extremely low. The removal of any ongoing monitoring conditions by the Board supports such a conclusion.”
The Tribunal decided that the doctor had behaved in a way that constituted professional misconduct and reprimanded him.
He was fined $5,000.
The dose quoted in the QCAT decision report and hence in this report has the incorrect unit of measurement. It must be micrograms not milligram (mcg not mg). The mg dose would be impossible to administer and also would have killed him immediately.