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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