‘Exceptional efforts’ help doctor avoid suspension


A GP has been reprimanded and conditions imposed on his registration after he inappropriately prescribed performance-enhancing medicines

The Medical Board of Australia has issued a statement about Dr Craig McCombe, a Queensland GP whom it had referred to the Queensland Civil and Administrative Tribunal.

The Board alleged that he had inappropriately prescribed performance enhancing and mitigation medications relating to bodybuilding to seven male and two female patients, aged between 21 and 38.

Though the allegations dated from 2011 to 2018, they primarily concerned prescribing for four patients between 2016 and 2018. It was alleged Dr McCombe’s record keeping and documentation were also inappropriate.

The Tribunal heard that in 2011, the doctor provided a script for Arimidex, which while ordinarily prescribed as a breast cancer treatment is known to be taken by bodybuilders to reduce the side-effects of anabolic steroids.

He also issued two scripts, in 2012 and 2015, for Tamoxifen, which is also known to be used by bodybuilders to inhibit estrogen and increase testosterone.

The Board filed an amended referral in June 2020, with the parties largely agreeing on the facts of the matter and the nature of the conduct, but disagreeing on the number of conditions and appropriate period of suspension.

The Board sought a six-month suspension while counsel for Dr McCombe argued a shorter suspension period was more appropriate.

While the doctor’s records did indicate that the patients were bodybuilders, and indicated that they were at the time illegally using illegally-obtained muscle enhancing agent, the doctor said he was attempting to assist abstinence by alleviating symptoms.

However an expert called by Ahpra noted that the prescriber did not provide sufficient clinical record suggesting this rational, nor did his experience demonstrate sufficient expertise to provide a competent withdrawal regime.

The tribunal found Dr McCombe had behaved in a way that constituted professional misconduct, noting he inappropriately prescribed the medications in circumstances where he was aware the patients were seeking them for bodybuilding or performance-enhancing purposes.

It also found Dr McCombe did not maintain sufficient patient records. In doing so, Dr McCombe breached a number of sections of Good medical practice: a code of conduct for doctors in Australia.

The Tribunal ordered that Dr McCombe be reprimanded and have conditions imposed on his registration.

The conditions require Board approval for each place of practice and prohibit his access to certain medications related to those he prescribed inappropriately.

The affected medications include but are not limited to androgenic anabolic steroids, human growth hormone and anti-estrogenic medications. The Board says it will review the conditions after 12 months.

Though the Tribunal noted the seriousness of his conduct, it opted not to suspend Dr McCombe’s registration due to “exceptional efforts made by the respondent to demonstrate his remorse and insight”.

The Tribunal took into account Dr McCombe’s early admissions about his inappropriate prescribing and prior to the hearing had undertaken education and mentoring initiatives, altered his practise of medicine to mitigate the risk to patients and had undergone two audits of his medical practice at his own expense.

Each party was required to bear their own costs of the proceedings.

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