Pharmacist complaint leads to dentist censure

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A community pharmacist shared concerns to regulators about the high number of oxycodone scripts from a dentist, leading them to uncover prescribing practices that “horrified” an expert witness

A dentist has been found guilty of professional misconduct by the NSW Civil and Administrative Tribunal and now faces suspension or cancellation over his prescribing practices, particularly in relation to oxycodone.

The practitioner first came to the attention of authorities after a local pharmacist made a complaint to the Pharmaceutical Regulatory Unit (PRU) of NSW Health by telephone in June 2016.

In his complaint, the pharmacist said the dentist had come to the pharmacy and presented a prescription for oxycodone 10mg for a patient (Patient H), waited for the script to be filled, and then collected and paid for it.

This is despite Patient H having presenting to the pharmacy separately for an antibiotics script.

The pharmacist then observed the dentist speaking to Patient H, however at that time he did not give Patient H the oxycodone that he had collected from the pharmacy.

In a telephone conversation, the patient told the pharmacist that some days later she had been given a box of oxycodone by the dentist together with a bottle of wine as a birthday present. The pharmacist explained to her that it was dangerous to take oxycodone and alcohol.

The pharmacist told the tribunal that on most occasions when the dentist prescribed oxycodone or similar medication, he personally attended the pharmacy and presented the scripts himself, picked up the medication himself and either paid for it personally or charged it back to his practice account.

A second pharmacist who worked in a different local pharmacy also gave evidence to the tribunal that he had become concerned about the level of scripts issued by the respondent for drugs of addiction, many of which were issued as private scripts. He had further concerns that the dentist would often personally attend the pharmacy to pick up the scripts when filled.

Sometime in 2014 this pharmacist informed the dentist it was inappropriate for him to personally pick up medication for patients, and he ceased doing so.

Evidence of extensive opioid prescribing

Investigations by the PRU, which led the Health Care Complaints Commission to prosecute the dentist before the tribunal, uncovered extensive evidence of inappropriate prescribing.

One patient (Patient A), had been issued prescriptions for 410 tablets of varying strength of oxycodone in their name on 20 occasions.

However, patient records documented the prescribing of oxycodone on only 7 occasions. Furthermore, in reviewing the patient records, an expert witness told the tribunal there was “an extremely strong case” this patient did not need to be prescribed oxycodone at all, let alone on 20 occasions.

Pharmacy dispensing and Medicare records indicated that the respondent prescribed 840 oxycodone tablets of varying doses on 40 occasions between the period 15 March 2013 and 8 August 2016 to a different patient (Patient C) who had undergone a range of dental treatment including extractions and ongoing restoration work.

The patient records do not document prescribing oxycodone to this patient on 35 of the 40 occasions that he issued scripts in the patient’s name.

In regards to treatment of Patient C, the expert witness told the tribunal he was “horrified” at the inappropriate and reprehensible conduct of the respondent. 

Altogether the tribunal found proven that the dentist had prescribed oxycodone to 11 different patients in excessive quantities, when there was no sufficient clinical indication.

The varying quantities or strengths of oxycodone ranging from 5 mg, 10 mg and/or 20 mg in 20, 30 and/or 40 tablet form were prescribing patterns that exceeded best practice for patients in moderate or severe pain and was significantly below the relevant standard, the expert witness said.

It was found the dentist had failed to exercise appropriate judgement in prescribing and obtaining S4, S4D and S8 medications in the name of his dental practices, including 694 tablets of ondansetron, 250 tablets of alprazolam and 200 tablets of lorazepam, among others. This was done in circumstances where the amount of medication for practice use was outside the acceptable standards for a dental setting.

He was also found to have prescribed and obtained S4, S4D and S8 drugs in his own name, in circumstances again outside the acceptable standards for use in a dental setting, including 150 tablets of ondansetron and 300 tablets of diazepam among others.

The dentist was found to have provided ondansetron to members of his family on two or more than two occasions for nausea not related to dental work. After first declining to accept the quantity of ondansetron alleged, which added to a total of 844 tablets, he conceded that this allegation had been made out when confronted with the underlying documentation.

Use of this drug in the dental setting is exceedingly rare, and the prescription of it by the dentist was severely criticised by the expert witness. He said this drug can affect the liver and kidneys and should be used with caution.

“In all the circumstances we find that the conduct of the respondent which we have found that he engaged in is so serious that in the aggregate it justifies a finding that he is guilty of professional misconduct,” the NSW Civil and Administrative Tribunal found.

“That is, the conduct is so serious that it would justify cancellation or suspension of the respondent’s registration as a dental practitioner on the basis that he is not a fit and proper person to practice as such.”

A second hearing will be held to determine protective orders, with both parties to file evidence and submissions.

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