A doctor has been reprimanded after it was found he was prescribing for the two people with the highest incidence of pseudoephedrine dispensing in their state
The Medical Board of Australia has issued a statement about Dr Meng How (Stephen) Leow, who was found at the South Australian Civil and Administrative Tribunal to have engaged in professional misconduct.
This misconduct related to prescribing pseudoephedrine for two patients, identified as BC and CK, as well as their clinical management and inadequate medical records during the period of April 2014 to November 2015.
It also related to his having failed to exercise proper medical judgement, keep adequate records and refer for specialist advice and/or treatment of a further 14 patients over the period from July 2011 to April 2017.
CK had first contacted the doctor in April 2014. She had terminal small cell lung cancer and was receiving regular prescriptions for methadone and Endone (which were not prescribed by Dr Leow).
She was the domestic partner of BC, who had first consulted with the doctor in June 2014, though he had been to the practice before that.
The Tribunal noted that “at some point” during his treatment of CK, he became aware that she and BC were domestic partners.
In August 2014, a doctor from RAH Pain Management had advised the doctor of his concerns that CK “and possibly her partner” were misusing Oxycontin, and that CK was not sticking to her pain management plan.
In May 2015, BC was admitted to hospital and detained there for a drug-induced psychosis, and the next day, the doctor consulted with CK, who told him that this had happened, and that her partner had attempted suicide.
He was discharged several days later and a report was prepared which stated that the couple were obtaining pseudoephedrine tablets and using them at home to make methamphetamines.
Together, the couple were using this methamphetamine daily, up to four times a day.
As BC’s GP, Dr Leow was asked to review his progress post-discharge.
In August that year, BC was again admitted to hospital with further psychotic behaviour and thinking, and the medical practice was sent information that he was still using methamphetamines, as was CK.
BC was unlikely to stop using because of this relationship, this report said.
In October 2015, BC was admitted again with drug-induced psychosis. While on day leave, he took methamphetamines, and on another occasion absconded from the hospital and took the drugs.
In November 2015, the Drugs of Dependence Unit of SA Health wrote to the doctor, though he said he did not recall seeing this correspondence.
SA Health wrote about the doctor’s long-term prescribing of pseudoephedrine for the couple.
It advised that BC had been identified as the person with the highest incidence of pseudoephedrine dispensing in Australia in the last three months.
It also advised that “the person living with” BC had been identified as the person with the second-highest incidence of pseudoephedrine dispensing.
It asked the doctor to explain why he was prescribing pseudoephedrine to CK and BC on a long-term basis, but the doctor did not reply, even when the Drugs of Dependence Unit sent a fax asking for a reply.
CK died on a date shortly before 6 February 2016.
The next month, the doctor admitted to Ahpra that he had failed to take into account these matters and that he had erred in not ceasing the pseudoephedrine prescribing.
He admitted that he had failed to take and document, and update as appropriate, a clear history from CK of any substance use of psychiatric comorbidity; did not refer CK for specialist advice in relation to her medications; was aware, by at least 5 May 2015, that BC was the domestic partner of CK; and did not make inquiries of DOU in relation to CK and BC in the period he was treating them.
He also failed to give due regard to the case notes for the pair regarding their methamphetamine use and the other indicators or concerns about why they would require or seek pseudoephedrine on an ongoing basis.
Dr Leow was reprimanded and his registration suspended for six months.
Conditions were imposed on his registration. These included the prohibition of his access to pseudoephedrine and zolpidem tartrate, and he was limited to supervised practice, with a Board-approved registered practitioner. He was to submit to audits of his practice and required to successfully complete Board-approved education.
A review period of 12 months was set for these conditions.
He was also told to pay the Board’s legal costs.