His overprescribing patterns affected 13 patients, many of whom were drug dependent or recovering from dependency
According to a decision released this week, Dr Angelo Arreza was found to have prescribed opioids and other drugs of addiction to several patients between 2013 and 2015.
Dr Arreza, who worked as a general practitioner in Nabiac, NSW, at the time of the conduct in question, had a history of working and prescribing in hospital settings before moving into general practice, the NSW Civil and Administrative Tribunal heard.
Complaints brought against him by the Health Care Complaints Commission (HCCC) included prescribing several drugs of addiction to 13 different patients without conducting an appropriate medical assessment and without obtaining the proper prescribing authority.
These drugs included fentanyl, venlafaxine, diazepam, oxycodone, temazepam, morphine, alprazolam, panadeine plus codeine, pregabalin, buprenorphine, oxycodone plus naloxone, amitriptyline, hydromorphone, endone, phenytoin sodium and salbutamol.
Some of Dr Arreza’s patients were drug dependent and some had been severely injured in the past, leading to chronic pain issues.
This includes one patient who had fractured her thoracic spine, and another who had been in a car accident. Others had chronic back or knee pain.
One of the patients had participated in the Opioid Treatment Program, and finished just a year before she presented to Dr Arreza, who provided her with prescriptions for fentanyl, venlafaxine and diazepam.
It was also alleged that he had failed to identify drug-seeking behaviour in several patients, and failed to maintain adequate medical records.
There were some situations where the practitioner repeated prescriptions previously issued by doctors in the Nabiac practice, the tribunal heard.
At the March hearing, expert witness Dr Linda Mann admitted that while Dr Azzera was inexperienced and lacking mentorship, he was still responsible for his own conduct.
She conceded that it would be appropriate to refuse to supply an addictive medication where the doctor had become aware the patient was obtaining prescriptions from more than one practitioner.
However Dr Mann also said there was evidence that in some patients, Dr Azzera had reduced the dosage of an addictive drug over time.
Dr Arreza, who completed his Doctor of Medicine overseas in 1989 and obtained registration with AHPRA in 2008, said he was “deeply ashamed and embarrassed” about the complaint brought against him.
“I recognise and accept that my prescribing of drugs of addiction and maintaining adequate medical records was not appropriate. I am sorry that my conduct was not in my patient’s best interests,” Dr Arreza said in his statement to the tribunal.
“I do not want to be in this position again and I have learnt from the whole experience. I am relatively young and I hope to make a positive contribution in medicine over a long period of time.”
The tribunal concluded that Dr Arreza had a lack of prior experience in prescribing in general practice, and did not have much experience of ‘doctor shoppers’.
He also lacked supervision, training and mentoring from the Nabiac practice.
Due to his Dr Arreza’s unblemished professional record and commitment to his career as a medical practitioner, the tribunal decided not to suspend or cancel his registration.
However it found him guilty of professional misconduct. Dr Arreza was reprimanded, ordered to complete a course of difficult patient interactions, to work under supervision and pay costs.
He is also banned from possessing, administering or prescribing any Schedule 8 or Schedule 4D drugs, other than for palliative care patients (i.e. those already under the management of a palliative care specialist) or if working as an employee of a hospital.