Reprimand over chaotic home clinic

tribunal hearing legal case

A doctor’s “hoarding impulse” led to a chaotic home surgery where S8s and S4s were inappropriately stored and medicines and prescription pads stockpiled

A GP has been reprimanded and conditions imposed on her registration after it was found that she engaged in professional misconduct regarding the way she managed her home-based clinic.

The doctor established a clinic at her home in mid-2015 and operated it until December 2016.

It was closed after the Board received a notification and took immediate action to suspend her registration, following the execution of a search warrant by Ahpra investigators and Victoria Police.

This search had revealed inappropriate sharps disposal facilities and procedures, inappropriate disposal of medical treatment by-products, dogs entering the consultation and treatment rooms, a non-sterile environment in the medical procedures room, and inadequate sterilisation facilities.

The immediate action decision noted that the doctor had been stockpiling “vast quantities of opened and unopened medications (some expired) and prescription pads”.

The Victorian Civil and Administrative Tribunal heard that the search had found vaccines present at the clinic – but no dedicated vaccine refrigerator with daily temperature recording in which to store them.

The doctor said the vaccines were not intended to be used.

There was a bottle of methadone takeaway dose and a box of Oxynorm Capsules 5mg in parts of the home clinic which were not secured, as well as S4s in a carport that was open on one side, outside and in a treatment room to which access was not restricted.

There were also S2 and S3 medicines in the carport and treatment room.

The doctor told VCAT that the medicines she had “stockpiled” included drug samples, medications from the clinics’ doctors’ bag, and unused drugs that patients had returned, as well as vaccines that she took home instead of disposing of via the other clinic’s usual processes.

When explaining the state of the clinic on the morning of the search, the doctor said that between the day the notifier had visited the clinic, and the time the investigating team arrived, she had made the decision to “wind up” the home clinic.

This meant she had started to sort out her records and supplies, she said.

“She described her usual procedures for safely handling and disposing of sharps, but she said that on the day of the search officers entered her house unexpectedly. She was about to dispose of some needles, but she panicked when she heard people entering the house. She threw the needles towards the disposal container as she ran to the front door,” the Tribunal noted.

The doctor “made a distinction between the consultation room’s ‘clutter’ or ‘overcrowded’ state and the hygiene in the room,” it noted.

She said the way the medicines were found were not the way they usually kept them, and said that she would never have knowingly left a methadone bottle in open view; however she admitted that she might have brought it home intending to dispose of it.

She “acknowledged that she had excessive quantities of medication and consumables at her home,” the Tribunal noted.

“She said that she did not need the many drugs that had expired. She acknowledged that they ought to have been discarded. They were from doctors’ bag supplies. She was also given samples.

“Over time the medications accumulated. She did not intend to overstock in this way. She failed to check to see if she already had stock before she brought medications home. She also bought supplies.

“The prescription pads accumulated in a similar way. Some were blank. Some were in her name. Some were in the names of doctors at the clinics where she worked. If she used one that had another doctor’s name and details, she would first cross that out.

“She said that she never wrote prescriptions in another name and that none of the pads were misused. She had inquired about how to dispose of the pads safely and had been planning to do that.”

She since admitted that she had a “hoarding impulse” and wished she had taken steps earlier to close the home clinic and deal with this impulse.

She maintained that she “was not impaired in the sense of being unable to do her job as a doctor for her patients, but she had lost the ability to recognise and act on the increasing chaos in her home”.

The Medical Board also alleged that the doctor had failed to take steps to maintain patient confidentiality at the home clinic by failing to sore them securely, instead leaving the records throughout her home. Patient records were found in an unsecured wardrobe which could be accessed by other people living there.

She said they were not routinely left throughout the house, but locked up, but admitted that they should have not been left out overnight but returned to the locked cupboard.

The doctor also prescribed medicines for family members, including her mother, father, son, daughter, and husband.

She understood that this was “contrary to good practice” but explained that, culturally, it was difficult for her parents to accept the idea of another doctor looking after them when she could.

The Tribunal heard that the doctor had undertaken “numerous” courses on topics including infection control, medication safety and records management since the investigation.

For about 16 years, she had been the main breadwinner for three generations of her family, and was diagnosed with a major physical illness in 2003 which recurred after a few years.

The hoarding behaviour had become habitual since her father died.

The Tribunal was satisfied her actions amounted to professional misconduct in line with section 5 of the Health Practitioner Regulation National Law. 

In its decision the Tribunal ordered the doctor be reprimanded and have conditions imposed on her registration requiring her to work in a multi-doctor practice and not to practise in a home-based clinic.

She was required to practise under supervision for 24 months, continue to attend counselling for six months after returning to practice, and put in place appropriate strategies to manage her work-life balance.

In considering its determination, the Tribunal took into account the period of more than three years that the doctor’s registration had already been suspended, noting that it would have otherwise imposed a further period of suspension given the serious nature of the matter.

The Tribunal noted that no disciplinary findings had been made against the doctor before or since the matter at hand, and it considered the severity of her conduct was balanced by the fact her conduct was confined to her home-based clinic.

It considered that her actions could be reasonably explained by hoarding behaviour and underlying psychological issues. 

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