Inappropriate prescribing led to ‘tragic’ outcome

A GP who mistakenly prescribed Roaccutane to a girl on a pharmacist’s advice, and whose morphine script saw a baby overdose, has been suspended

A GP and medical centre owner from south-west Sydney has been found guilty of professional misconduct after inappropriately prescribing oral isotretinoin to a teenage girl.

The 17-year-old patient attended the doctor for treatment of facial acne in the company of her mother, for which he prescribed her isotretinoin on 28 March 2018.

Isotretinoin, also known as Roaccutane, can only be dispensed by a specialist dermatologist or physician.

The doctor contacted a pharmacy specifically about prescribing Roaccutane and was mistakenly advised by the pharmacist that GPs were now permitted to prescribe the drug.

He also consulted the PBS website, which confirmed streamlined authority requirements for severe cystic acne, unresponsive to other therapy.

“I … was under the mistaken belief that I could prescribe the medication,” he told the NSW Civil and Administrative Tribunal.

While the patient informed the doctor that she was abstinent, the Health Care Complaints Commission (HCCC) complained that the practitioner failed to take a proper history, order a pregnancy test or prescribe the patient contraception.

“In hindsight, I can see that the fact that she was with her mother and that her family was religious may have led her to not be open with me. I acknowledge that I should not have prescribed this medication in the first instance,” said the GP.

The doctor admitted that during a follow-up appointment, he failed to consider possible pregnancy or record any discussion of contraception and the teratogenic effects of oral isotretinoin with the patient.

He prescribed Roaccutane to the patient for a second time on 31 January 2019. She became pregnant in early 2019 and sought a referral to the Royal Hospital for Women.

The GP wrote her a referral but deliberately failed to disclose that he had prescribed her isotretinoin.

Major brain abnormalities and heart defect were noted in the foetus and the patient requested termination of pregnancy. The foetus was found to have several dysmorphic features consistent with early pregnancy exposure to isotretinoin.

The GP was also questioned about the circumstances surrounding his provision of a referral letter to the Bankstown Hospital on 28 October 2008 which accompanied a 17-day-old baby who had been administered morphine based on a prescription he had provided to the baby’s carer.

The dosage prescribed by the doctor, to address neonatal abstinence syndrome (NAS), was “grossly excessive” and caused the baby to re-present to the GP narcotised, a few days later.

According to court documents, the GP immediately arranged for the baby to be presented to Bankstown Hospital and provided a written referral to accompany the baby.

He also rang the hospital and spoke to a medical practitioner in the Emergency Department of the hospital and advised that the child had taken an overdose of morphine, and that he had prescribed the dose.

However he failed to reveal in the referral letter that the narcotised infant he was referring to was in that condition because he had prescribed a dose of morphine grossly in excess of that which should have been prescribed for a baby born to a mother addicted to narcotics.

For this particular event, the GP had reportedly had conditions imposed upon his registration.

The Tribunal found the GP was “contrite and evidenced shame as he answered questions from the HCCC”.

Despite the misinformation from the pharmacist, he unreservedly accepted full responsibility for the error regarding prescription of Roaccutane to the patient.

“This is in many respects a very sad case,” stated the Tribunal. “The Complaint details a tragic set of circumstances for a young female patient of the respondent.

“Unfortunately for another patient (a newborn infant) this is not the first time that the respondent has sought to hide from the consequences of his incompetent and/or negligent actions as a medical practitioner,” it said.

The Tribunal was satisfied that there is an identifiable risk to the public that the GP will, “in a crisis, probably act in his own interests ahead of the interests of the patient”.

He was found guilty of professional misconduct and suspended for three months.

The GP was ordered to undertake education as well as treatment with a psychologist.

Several further conditions placed upon his registration when he returns to practice include limits on how many hours he may practice and how many patients he may treat, and to practice under supervision with regular audits.

He is forbidden from undertaking circumcisions and intrauterine device insertions.

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