Red flags ignored

A GP has been struck off for dangerously prescribing to patients, despite calls from pharmacists and clear signals of drug-seeking behaviours

A Central Coast GP has seen her registration cancelled for at least two years for what a NSW tribunal described as the “gross, dangerous and reckless” overprescribing of opioid medications.

The GP, who has been suspended from practice since January 2019, was discovered to have inappropriately prescribed S8 and S4D drugs of addiction to nine patients who were exhibiting drug-seeking behaviour.

Patients received prescriptions when they presented on multiple occasions with family or personal problems, needing scripts and presenting with minor ailments – for example, one patient received prescriptions for weight loss, asthma, hand stiffness, balanitis and nightmares, among others.

The GP also prescribed S8 and S4D drugs to patients upon request or in their absence in a way that the NSW Civil and Administrative Tribunal labelled as “egregious”.

For example, one patient was prescribed oxycodone by email or fax following her request on 17 occasions, while another was prescribed S8 and/or S4D drugs on 39 occasions when he claimed his prescription or tablets had been lost, stolen or damaged.

One of the most serious aspects of the doctor’s prescribing was that it continued despite clear evidence of drug-seeking behaviour by the patients, said the NSW Civil and Administrative Tribunal.

For example, three of the nine patients were at times banned from the practice and two had been identified as drug seeking by other practitioners. One patient had been denied scripts by three different doctors.

In another case, the GP had even called the Prescription Shopper Information Service and been notified that the patient was a “doctor shopper”.

Two calls were received from local pharmacies about the validity of prescriptions given a patient’s behaviour, yet the GP continued to prescribe to them.

Another patient had sought opioids scripts, claiming that they were not received in the pharmacy. Despite the pharmacy confirming that these scripts had in fact been received, the GP proceeded with inappropriately prescribing the medications days after the previous script.

The GP provided various reasons for her inappropriate prescribing, including that she was “too trusting”, that she was manipulated, and that patients were difficult to manage.

However the Tribunal did not find she gave a legitimate reason to explain the gross overprescribing of opioid drugs.

The GP was also found to have inappropriately disclosed to a patient confidential information – namely that her husband, another patient, had engaged in an extramarital affair – without consent, in the absence of a proper therapeutic or clinical reason.

The Tribunal found the breach of confidence constituted a breach of the Code.

Aware of disclosures that patient had been self-harming and had made a threat to the woman involved in the affair with her husband, the GP then failed to refer her for appropriate psychiatric support and to construct an appropriate ongoing management plan for her.

The Tribunal ordered the GP’s registration to be cancelled and she is prohibited from applying for re-registration for two years.

She was ordered to pay the majority of costs to the HCCC.

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