S8s case highlights ‘tragic and significant problem’

A GP and pharmacist has been suspended after his inappropriate prescribing of S8s painkillers and other drugs of concern

The Health Care Complaints Commission prosecuted a general practitioner and pharmacist before the NSW Civil and Administrative Tribunal, alleging that he was guilty of professional misconduct.

This complaint related to what the Commission called his inappropriate prescribing of opioids and other drugs to 13 patients from 2011 to 2016 at a medical centre in suburban Sydney.

The HCCC also said that the practitioner’s record-keeping for these patients contravened legislative requirements.

It said that the patients he prescribed to displayed drug-seeking behaviours, which he failed to manage.

The practitioner admitted the allegations against him, but he said that he could identify this drug-seeking behaviour only now through education and reflection.

The practitioner was the part and then sole owner of a pharmacy in Sydney’s west, and two years after becoming the sole owner in 2006 he commenced practising as a GP at a surgery next to the pharmacy.

From that time in 2008, he stopped working at the pharmacy other than in a management role.

In January 2016, his prescribing of various S8 drugs of addiction attracted the attention of the Pharmaceutical Regulatory Unit of NSW Health, which subsequently complained to the HCCC.

In May 2016, he voluntarily surrendered his S8 prescribing rights and in August 2016, the Medical Council of NSW conducted proceedings in which it determined that he not possess, supply or administer any S8 or S4D drug.

It also determined that he should authorise consent to exchange of information between the Council, Medicare Australia and the PRU. The conditions also included a condition that the practitioner authorise the Council to notify the practitioner’s then employer, or any future employer, of any breach of the conditions.  

In July 2019, the HCCC commenced disciplinary proceedings against him as a GP, while proceedings against him as a pharmacist have also been commenced, but not yet heard or determined.

At the time of the 2020 hearing, the practitioner had sold his interest in the pharmacy, which he said was at a loss because the practice owners refused to extend the lease.

He has been practising as a solo GP in his own practice, and said he had tried but failed to have other GPs work alongside him at the practice.

The Tribunal heard that this case highlighted a “tragic and significant problem for many persons in the Australian community”.

“These persons are the cohort of patients, many of whom suffer chronic pain, and who may, or often have, become addicted to opioids obtained by them legally on prescription from a medical practitioner.

“The adverse consequences of addiction to these drugs for the patients, their families and the community cannot be underestimated.”

In one case, the practitioner had prescribed oxycodone on 33 occasions, fentanyl on 80 occasions and buprenorphine between December 2011 and November 2015; he admitted that he did not prescribe for an appropriate therapeutic purpose, that he did not properly assess the patient or conduct an adequate examination before prescribing.

The practitioner also admitted he did not implement a pain management plan and that he prescribed to a drug dependent person without proper authority.

For another patient, he admitted prescribing alprazolam on 18 occasions on average every month between July 2014 and April 2016.

Another patient was prescribed fentanyl on 72 occasions: on average, twice a month in 2012 to 2013, and with increased frequency (three times per month) in late 2014 and 2015. The practitioner prescribed oxycodone on four occasions in 2012 and Tramadol on four occasions, three of which occurred in 2015.

Another patient, a war veteran, was prescribed fentanyl on 23 occasions between March 2014 and April 2015, and the practitioner noted in this patient’s records that he would not prescribe for him again and that he had directed him to find another GP.

However he continued to prescribe patches for this patients until the patient went overseas. Another doctor in the practice had already refused this patient oxycontin in 2013 and noted this in his file.

In its decision in March 2020, the Tribunal found the complaints proved, that it amounted to professional misconduct, and did not accept the practitioner’s explanations for his failure to manage their drug seeking behaviour.  

The Tribunal formally reprimanded him, suspended his registration for six months and imposed various practice restrictions to take effect when his suspension ends, including that he be subject to a performance assessment and be supervised.   

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