A wish to ease his patients’ distress was a key factor in a doctor’s overprescribing, a Tribunal has heard
In November 2017, the Medical Board of Australia referred Dr Christopher Watts to the Victorian Civil and Administrative Tribunal for professional misconduct as well as unprofessional conduct.
The allegations against Dr Watts related to his prescribing of drugs, primarily opioids and benzodiazepines, to eight patients over an extended period.
The longest period of time involved was just short of 13 years, between October 2001 and October 2014.
In nearly all the cases, the patients were already or became, as a result of Dr Watt’s prescribing, drug dependent.
One patient was 13 years old when Dr Watts first prescribed diazepam and Tramal. Dr Watts had been previously cautioned for similar offences in 2005.
The Board did not take immediate action on the allegations, and Dr Watts continued to practise until he received notice of the proceeding, when he began to experience anxiety, suffering insomnia and an inability to get out of bed.
The Tribunal observed that there was no evidence of any repetition of any professional misconduct or unprofessional conduct while Dr Watts continued to practise after the allegations were made.
By way of mitigation, Dr Watts advised that most patients at the clinic where he practised were people on low incomes who generally presented with a range of complex medical, social and psychological issues.
However, Dr Watts agreed that his prescribing behaviours placed his patients at risk, in terms of addiction, adverse drug effects and the potential for a fatal overdose.
Dr Watts also advised he had sought treatment for the anxiety that followed the notification, though at the time of the hearing he had not yet returned to practice.
As a result of this treatment, Dr Watts gained insight into why he had fallen into a pattern of excessive prescribing.
He said that he struggled when patients’ stress was not relieved, particularly if other family members were affected – and said that he had a tendency to focus on easing his patients’ distress, to the detriment of other considerations such as compliance with permits or identifying drug dependency.
He said that given these tendencies, we would need – and intends to – refer such patients to colleagues, and accept that he could not take responsibility for each and every patient.
The Tribunal found that his behaviour had, at different times, constituted professional misconduct and unprofessional conduct.
He was found to have kept inadequate records regarding some patients, inappropriately managed some patients’ conditions; prescribed drugs of dependence in a manner that was clinically inappropriate and/or excessive to others; failed to devise a treatment plan for one patient and failed to implement an appropriate treatment plan for another.
The Tribunal reprimanded Dr Watts, suspended him for six months and imposed conditions on his registration including that he:
- undertake education in relation to prescribing of medication including in accordance with the Drugs and Poisons legislation, record keeping and training in relation to the Medical Board’s Code of conduct;
- be treated by a psychiatrist at a frequency determined by the treating practitioner with reports to the Board;
- work only in places approved by the Board;
- have supervision of his practice by a Board approved supervisor with reports to the Board;
- have audit of his practice (upon return to practice); and
- be prohibited from prescribing schedule 8 medication throughout the period of supervision.
The Tribunal noted that in August 2013, Dr Watts had also appeared in the Magistrates’ Court of Victoria regarding charges relating to nine offences under the Drugs, Poisons and Controlled Substances Act 1981 in respect of his prescribing, some of which overlapped with the allegations the subject of the hearing proceedings.
In this instance he was released, without conviction on an undertaking to be of good behaviour for 12 months and agreement to pay prosecution costs.