Struck off for ‘gross failure’ over prescribing requirements

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A specialist GP who lost his licence to practice explained that he never received training about regulations concerning the prescribing of S8 and S4 drugs

The Health Care Complaints Commission (HCCC) has won a case against a GP from Taree, New South Wales, after alleging professional misconduct relating to 19 patients.

It was alleged that the medical practitioner, who gained his Fellowship from the RACGP in 2013, had prescribed drugs of addiction to 19 drug dependent patients in circumstances where he held no authority to do so.

The S8 and S4D drugs that formed part of the allegation included fentanyl, alprazolam, temazepam, diazepam, buprenorphine, codeine phosphate, codeine phosphate linctus, oxycodone, morphine, hydromorphone, pethidine and anabolic steroids.

Initially trained in Egypt, the doctor became registered in Australia in 2004 and spent a few years working in hospitals covering various areas including aged care, general medicine, emergency and psychiatry, before choosing to specialise and move into general practice.

In regards to the allegations, the GP claimed he had not been trained properly regarding the regulations surrounding S8 and S4D drugs – either in his initial training, nor during his time working in hospital or Fellowship training with the RACGP.

“During the time I practised in Egypt in general practice I did not prescribe the drugs listed in S8 or S4,” he told the NSW Civil and Administrative Tribunal.

“They were not prescribed in general practice in Egypt. Paracetamol, ibuprofen or aspirin can be obtained over the counter at pharmacies. A GP cannot prescribe any stronger analgesics as they are not available in Egypt.

“During the time I spent in the Australian hospital system – August 2004 to April 2008, I did not receive any training or education about the regulatory system concerning the prescribing of Schedule 8 drugs. Nor did I encounter the issue during my studies for College Fellowship.

“Consequently I had little experience or knowledge of S8 and S4 medications when I commenced practising [as a GP] in Taree.

“I have never really received any specific education in relation to S8 medications. I only needed one year of supervised general practice experience in Australia to be eligible to sit the Fellowship exams.”

The GP also pointed out that a former supervisor and mentor had also been before a tribunal for inappropriate prescribing of S8 medications.

“Whilst this is not an excuse for my conduct, it is the context in which it occurred,” he told the tribunal.

“I first became aware of the need to apply for authorities when I was interviewed in February 2015 by … the Pharmaceutical Services Unit. I stopped prescribing S8 drugs on 10 April 2015.

“My approach to S8 drugs was that if a patient was being prescribed drugs by another general practitioner or specialist I would continue to do so. I naïvely believed that the treating medical practitioners work together as a team and that I could rely on what previous treating practitioners had done.”

The tribunal found the practitioner’s explanation that he was unaware of the need to have authorisation to prescribe S8 drugs to be credible, despite his considerable experience in Australia.

“Irrespective of such finding, the circumstances demonstrate a gross failure on the part of the practitioner to inform himself of the requirements for prescribing S8 drugs and S4 medications,” the tribunal found.

“As a consequence, there has been a flagrant breach of the National Law. The Tribunal acknowledges that such conduct was not performed with illegal intent: the practitioner was simply oblivious to the statutory requirements.

“But the practitioner should have known them, and the ignorance of the practitioner reflects very adversely upon his competence to practise medicine.”

It pointed out that the GP had frequently accepted – without question – complaints of pain or discomfort from patients and was willing to prescribe painkilling medication, oftentimes in high doses and quantities.

“The practitioner’s naïveté in the role of prescription medication in substance use disorders was evident in the majority of the patients who were the subject of these proceedings and were under his care,” found the tribunal.

“The practitioner was unable to discern drug seeking behaviour in circumstances which should have triggered a high degree of suspicion.

He was also unaware that the drugs he prescribed could have been diverted into the illicit drug market, it found.

The tribunal was satisfied that the conduct of the practitioner constituted professional misconduct.

It ordered that his registration be cancelled.

He may not apply for a review of the order for 12 months, and was also ordered to pay the HCCC’s costs.

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  1. Apotheke

    Blaming the foreign trained GP for the failings of the Australian training and regulatory bodies is a bit rich. I am also amazed that not one Pharmacist asked to see a copy of the GP’s authority to prescribe S8s over extended periods of time. I put this down to everyone failing to do their duty from the RACGP to AHPRA to the NSW Poisons regulatory authorities and the Pharmacists in Taree. This is ONE enormous FAIL!!!!

    • Philip Smith

      Some pharmacist may find it hard to approach doctors on the matter due to the power imbalance and if you get a doctor offside in a smallish town it can have a massive financial impact on the business.
      I normally photocopy the legislation and fax/email the doctor after a phone call discussing the situation.

      I also approach the doctors from a litigation point of view, stating our insurance may not cover the situation for ongoing treatment and a pain management plan/pain specialist needs to be provided for us to continue dispensing. This normally prompts them to discuss it with their’s.

      Problem is patients normally move on to the next doctor and pharmacy.

  2. Andrew B

    I am not surprised at all. My wife is a doctor and the only reason she has read our states legislation is because I “made” her do so. 4 years of med school and 5 years of practice before she read them – and she is a very conscientious person. Every doctor that I have spoken to at work about this, none of them have read the legislation. It is also painfully obvious when you are asking them to write certain things on the prescriptions and they flat out refuse and say it isn’t necessary to do so. We have questions on the legislation in our intern exams, we also have exams on it at university. Why shouldn’t the doctors be required to read and at least have a basic grasp of the legislation under which they are practising?

    • PharmOwner

      As a former hospital pharmacist, I was constantly frustrated with the ignorance of medical interns in the public hospital system with regards to their obligations surrounding schedule 8 medications. We used to have to give lectures to them on how to write prescriptions correctly and then reinforce every time they wrote a script inadequately – which was often. Considering the integral part prescribing plays in doctors’ daily practice, it is a massive failing on the part of our tertiary institutions.

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