Doc fined $10K over patient death

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A GP has been reprimanded and fined for prescribing controlled and restricted drugs to a patient who died from an overdose

A general practitioner from North Lakes, Queensland has been found guilty of professional misconduct and reprimanded for his treatment of a patient between 2011 and 2016.

This patient had a history of drug use, and suffered from dependency or addiction, of which the GP was aware.

Four days prior to her death, the patient consulted with the GP, when she complained of “pain” and informed him that she had lost her scripts.

In response he prescribed olanzapine and her “usual medications”: Alepam (oxazepam); Mogadon (nitrazepam); Zyprexa (olanzapine); Panadeine Forte; Targin (oxycodone and naloxone); Valium (diazepam); and Zoloft.

She was found deceased on 13 September 2016 with various controlled and restricted drugs prescribed by the GP found in her home.

The coroner noted olanzapine and alcohol were present during autopsy at a lethal level, and numerous other drugs were also detected.

Her death was caused by the combined depressant effect of alcohol, olanzapine and other drugs in her system, said the examining pathologist.

The Queensland Civil and Administrative Tribunal found the GP had continued to prescribe controlled and restricted drugs, and drugs of dependency, in circumstances where the patient failed to comply with referrals and requests, reported occasional IV drug use and drug use, and complained of lost or stolen scripts.

He was found to have commenced, increased or maintained the patient on high doses of Targin and Zyprexa (olanzapine) when it was not clinically or therapeutically warranted.

Additionally he prescribed benzodiazepines in combinations, as well as Duromine (Phentermine), where it was not clinically or therapeutically warranted.

The GP inadequately monitored the patient’s use of the controlled drugs and restricted drugs of dependency, and failed to take into account her history and conduct.

He also conceded that he failed to maintain adequate clinical records, and that he was not aware of his obligation to comply with the Poisons regulations in treating the patient as a drug dependent person with controlled drugs or restricted drugs of dependency.

The Poisons regulations set out certain requirements for the prescribing of controlled drugs and restricted drugs of dependency to a patient who is drug dependent.

An expert witness highlighted to the Tribunal that there was no evidence that the GP had availed himself of the Federal government’s prescription shopping information service to check if the patient was a doctor shopper.

The GP admitted by reasons of his inappropriate treatment of the patient, that he put her at risk or at potential risk of harm.

He eventually conceded that his treatment of the patient was inappropriate and substantially below the standard expected of a health practitioner.

The Tribunal found the GP had been slow to accept the serious nature of his conduct in relation to the patient, but noted he had since taken education courses regarding ethical and professional responsibilities.

“In my opinion, the respondent still appears to lack real insight into the importance of record keeping and the prescribing of dangerous drugs,” found Judicial Member, the Hon John Robertson.

“However, I am satisfied that given the positive matters in his favour, and given the long period of time that has elapsed since [the patient’s] tragic death, these issues can be addressed by the conditions proposed by the [Health Ombudsman].”

The respondent was found to have engaged in professional misconduct and reprimanded.

The Tribunal ordered him to pay to the Health Ombudsman a fine of $10,000 within three months.

A condition is imposed on his registration requiring quarterly audits of his practice, ensuring that the prescribing of controlled and restricted drugs of dependency are in compliance with statutory requirements and are otherwise appropriate, and that clinical records meet the relevant requirements.

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