Self-prescribing leads to deregistration

legal medical tribunal doctor overprescribing

A NSW doctor with a codeine dependency has been struck off for prescribing scheduled medicines to himself over 600 times in just two years

A doctor who had practised in Australia since 1986 has had his registration cancelled by the NSW Civil and Administrative Tribunal, for failing to display the judgement expected of a practitioner of his experience.

The practitioner was a fellow of the Royal Australian College of Physicians since 1997, specialising in gastroenterology, and a fellow of the Australian College of Rural and Remote Medicine since 1998.

In October 2013, the Director of the Local Health District made a formal notification in relation to matters of concern involving the practitioner, which had taken place at a local hospital.

The first concern related to his state of presentation as a duty doctor, when he was reported to have been unsteady on his feet, with slurred speech, and to have typed up clinical notes that made no sense.

He was also discovered to have been obtaining Panadeine from the hospital dispensary under his wife’s name when she had not attended for assessment, and had also been requesting Panadeine Forte for himself.

The Pharmaceutical Services Unit (PSU) subsequently undertook an investigation, which found that over a two-year period, from 11 October 2011 to 11 October 2013, the practitioner had issued numerous prescriptions for medications in his and his wife’s name, and had regularly self-prescribed various scheduled drugs.

Dispensing data in the region recorded him as having prescribed medication to himself on approximately 648 occasions, to his wife on approximately 128 occasions, and to one or other of his two older children on approximately 32 occasions.

He was found to have been self-prescribing Panadeine, Panadeine Forte, Valium, zolpidem, pseudoephedrine and Tramal SR.

The practitioner admitted all allegations of self-prescribing and prescribing medications to family members.

A regular user of codeine, the doctor acknowledged that he had developed a dependence on the drug, having commenced its use twenty years earlier when he suffered a back injury.

He stated that in the period from 2011 to 2013 he had suffered from clinical depression, and also acknowledged he had difficulties with alcohol consumption.

In 2014, the practitioner was suspended and, once permitted to return to practice, was banned from prescribing for himself or his family members, and banned from self-administering any Schedule 4D or 8 drug, or any narcotic derivative, non-prescription compound analgesic or cold medication, unless prescribed by his treating practitioner.

However the PSU found in January 2015 that the practitioner had resumed self-prescribing medications including pseudoephedrine, zolpidem and codeine, and had done so frequently since that time.

The PSU also found evidence of other breaches of the conditions that had been placed on his registration following the lifting of the first suspension.

While the practitioner acknowledged the wrongness of his conduct, and referred to a number of personal and financial stresses in his life, the NSW tribunal found that the practitioner had engaged in unsatisfactory professional conduct over a considerable period of time – with some instances dating back to 2002.

“His self-administration was of a habitual character,” said the tribunal in its decision.

“In our opinion, his conduct shows that at an early stage he had lost any perspective as to the unethical nature of the conduct, its wrongness, the damage it did to the public standing of the profession, and the harm and difficulty it caused for the maintenance of co-operative and professional relations between medical practices and pharmacies.

“It is plain that the practitioner routinely failed to display the judgement expected of a practitioner of his experience.”

It found four of five complaints proven, and ruled the practitioner guilty of professional misconduct.

While the tribunal accepted that the practitioner had begun to take “positive” steps to address his opioid dependence, and his mental health and other personality difficulties, they proceeded with orders with an aim to deter other members of the profession from engaging in similar conduct.

“The central consideration is what is in the best interests of the protection of the safety and welfare of the community. Those interests include the maintenance of disciplinary standards,” said the tribunal, which ruled that the practitioner’s registration be cancelled effective 14 February 2018.

He will be able to apply for re-registration after one year.

The practitioner was also ordered to pay the costs of the proceedings to the Health Care Complaints Commission (HCCC).

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