Impairment leads to issues with prescribing, vaccination advice

A health practitioner has been given less than a month to show why she shouldn’t be struck off the register, after a tribunal found she had engaged in unethical conduct of a serious nature

The NSW Civil and Administrative Tribunal found the GP is unfit to practise as a medical practitioner, although an order to strike her off the register has been temporarily suspended.

She now has 28 days from the decision to make her case why she should be able to continue to practise as a doctor.

In the complaint brought by the Health Care Complaints Commission, tribunal members heard that the practitioner had inappropriately prescribed a young patient Amoxil sugar free forte 250mg/5ml syrup, an antibiotic containing penicillin for otitis media, in circumstances where the patient was allergic to penicillin.

The patient’s mother had informed the GP that the patient was allergic to penicillin and had recorded this on the registration form. The patient’s father also reminded the practitioner during a consultation that the patient had a penicillin allergy.

In response the practitioner said words to the effect of “No, it will be fine”, the Tribunal heard.

It found her clinical care and approach to this patient, as well as her communication skills, was significantly below the standard expected of her.

The GP was found to have refused to administer the whooping cough vaccine to a second patient who was pregnant, providing advice against guidelines including that “at 33 weeks it may not be effective at protecting your baby”, and stating, “well it is your choice, but don’t blame me if your baby dies”.

In providing this advice, the doctor displayed a “lack of up-to-date knowledge” of the readily accessible recommendations to Boostrix vaccine in pregnancy, and demonstrated communication skills significantly below the expected standard – amounting to unprofessional conduct, said the tribunal.

She was also found to have inappropriately prescribed a vulnerable close family member with a number of medications, including inappropriate quantities of esomeprazole (approximately 5100 tablets between January 2013 and December 2017), doxycycline (approximately 1260 tablets in November 2016) and antipsychotic medications risperidone and olanzapine in circumstances where he was under the care of a psychiatrist and she did not inform the psychiatrist that she prescribed the medication to the patient.

The practitioner also prescribed the patient Schedule 4 restricted substances Lomotil and Ponstan, in a quantity and for a purpose that was not in accordance with recognised therapeutic standards.

Her overall prescribing to a close family member, and in particular the prescribing of antipsychotic medications in the absence of an objective and arm’s length assessment and diagnosis of any mental health issue, was “fraught with danger and is in breach of the guidelines”, the Tribunal found.

She was additionally found to have provided deliberately false and misleading information to the Medical Council of NSW, telling delegates that she did not post the anonymous reviews of two doctors on the “Rate MDs” website, one of whom was a Council-appointed psychiatrist who had interviewed her.

The tribunal concluded the practitioner had behaved in a “dishonest, vindictive and retaliatory manner” to colleagues who had made professional complaints about her or provided expert evidence in matters considered by the HCCC, the Medical Council or the Tribunal. She has also initiated legal actions against certain of these colleagues.

Due to some of the complaints, the tribunal found that the doctor had engaged in unethical conduct of a serious nature.

In psychiatric assessments, the GP was found to have expressed fixed persecutory and grandiose beliefs including conspiratorial beliefs that her insight was impaired or lacking.

Based on conclusions from four expert psychiatrists, she was found to have an impairment of a sufficient nature and degree to impair her mental capacity to practise the profession.

It ordered her registration cancelled, with a non-review period of 18 months.

However as the GP filed no submissions or evidence in reply to the tribunal prior to the hearing, other than her submissions for an adjournment, a 28-day stay has been placed on the orders to allow any application to be made by the doctor to show cause why the orders should not be made.

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