Prescribing without proper authority

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A doctor has narrowly escaped deregistration after continuing to prescribe Endone to a patient for nearly three years, despite having his authority application rejected

A Sydney GP and former practice owner has been reprimanded after a tribunal found him guilty of professional misconduct over his prescribing practice in relation to seven patients.

The conduct occurred within a six-year period, between 2009 and 2015, with 12 drugs being “mal-prescribed” by the doctor including diazepam, Oxycontin, lorazepam, phentermine, Endone, methadone, buprenorphine, alprazolam, tramadol, morphine, fentanyl and temazepam.

According to tribunal documents, the GP prescribed drugs of addiction where he had ought to have formed the opinion that the patient was a drug dependent person.

In several cases he prescribed drugs of addiction for a purpose and in quantities that did not accord with the recognised therapeutic standard, and ignored software computer warnings on his prescribing in respect of some patients.

He concurrently prescribed S8 and S4D medications “without exercising responsible medical judgement” and failed to make referrals to a pain physician or drug and alcohol specialist, or to an opioid treatment program, in the case of four patients.

In five patients, he failed to make appropriate and timely referrals for specialist advice or assistance.

Six patients were prescribed drugs of addiction such as morphine, oxycodone, buprenorphine, without the GP obtaining a proper authority to prescribe from the NSW Ministry of Health.

In one case, the GP had sought approval from the Department of Health to prescribe 30mg of Endone for one patient in February 2010, in order to provide pain relief.

His application was rejected but despite this, he continued to prescribe Endone to the patient for nearly three years, until 12 November 2012.

“His persistence in prescribing such medication for [the patient] when the permission sought was denied should properly be regarded as both improper and unethical,” the NSW Civil and Administrative Tribunal found.

The GP also failed to provide and keep appropriate records for his patients.

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The GP told the tribunal that the period from 2009 and 2016 was “incredibly stressful” due to a variety of personal circumstances.

An expert witness described his standard care as “significantly below the level expected of a practitioner of an equivalent level of training and experience”.

He admitted to all the complaints, for which he was found guilty of both unsatisfactory professional conduct and professional misconduct by the tribunal this month.

The GP conceded that several of the patients had exhibited drug-seeking behaviour or were drug dependent, with one patient being a recovering heroin addict.

He told the tribunal that the period from 2009 and 2016 was “incredibly stressful” for himself and his family due to a variety of personal circumstances, including the acrimonious breakup of his marriage and medical and psychological difficulties among his children.

“Those circumstances, coupled with his deficient clinical knowledge, undoubtedly led to poor clinical decisions,” found the tribunal.

Evidence revealed that during this same period, the doctor did detect and refuse to treat a number of people who he discerned were shopping for prescriptions for addictive drugs.

However he said he was possibly oversympathetic to some patients who appeared to him to be “suffering genuine pain”.

The Health Care Complaints Commission (HCCC) called for a suspension or cancellation of his registration.

However after taking into account positive references from colleagues and patients, the tribunal decided the doctor should be reprimanded but allowed to continue practising subject to conditions.

These conditions include regular mentoring, restrictions from prescribing S8 and S4D drugs, restricted work hours and an audit of his medical practice.

The GP was ordered to pay costs to the HCCC.

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