A woman died after taking a cocktail of drugs prescribed by her doctor boyfriend
Coroner Simon Cooper found that Pamela Diane McCall died in February 2013 from an overdose of alcohol and prescription drugs bought at a local Tasmanian pharmacy.
The drugs were prescribed for her by her partner, Dr Stephen Bennett.
Ms McCall met Dr Bennett when she was working as a receptionist at a community health centre where Dr Bennett worked as a medical practitioner. The two began a relationship in 1999, and lived in a de facto relationship from “approximately 2008”.
For many years, she had been prescribed propranolol to treat frequent focal migraines, and Panadeine Forte for back pain, by another doctor; during 2008 Dr Bennett also began writing prescriptions for her, without letting her other doctor know.
“Indeed, he did not initiate any contact with Dr Skeat, at all, in relation to his prescribing propranolol and Panadeine Forte for Ms McCall,” the coroner noted.
“It is apparent from screen shots of text messages that passed between Dr Bennett and Ms McCall that the prescribing was done somewhat informally.
“On occasions Ms McCall seems to have requested ‘scripts’ from Dr Bennett by text message, and Dr Bennett apparently complied with those requests.”
Dr Bennett kept records at his practice in relation to “at least some” of this prescribing between December 2008 and February 2013. During this time Dr Bennett wrote 60 prescriptions for Ms McCall, most of which were for propranolol and Panadeine Forte, as well as at least one for cephalexin.
“In addition to those prescriptions recorded in the records, Dr Bennett agreed he wrote handwritten prescriptions on occasions, which were not recorded and the number of which he was unsure about,” the coroner noted.
“In the same period he wrote a number of medical certificates for Ms McCall, provided her with a letter dealing with her medication (for the purpose of overseas travel), and referred her for pathology testing.
“All of this occurred without Dr Bennett making Dr Skeat aware that he was doing it; although he claimed that at all relevant times Dr Skeat was Ms McCall’s treating general practitioner.
“All this occurred without Dr Bennett ever conducting a formal consultation upon Ms McCall, without ever examining her physically and without ever seeing her in his professional rooms.”
While Ms McCall was described as “happy and fine” in the weeks before her death by colleagues, the coroner also noted that she had been “deeply unhappy” in her place of employment due to workplace bullying issues, and that she had had a significant amount of sick leave.
A couple of days before her death, which occurred while she was on annual leave, several text messages were sent between Dr Bennett’s phone and Ms McCall’s, but these were later deleted. The coroner said he did not accept Dr Bennett’s assertion that he did not delete them.
That day, Ms McCall went to a pharmacy, bringing a prescription, written for her by Dr Bennett, for propranolol. She asked the pharmacist to fill all three repeats left on the prescription, which had a little less than two months left before it expired.
She said this was because there had been difficulty filling prescriptions for the drug in the past, and the pharmacist, who according to the coroner “impressed as a careful and accurate witness,” said this accorded with her knowledge of the product.
The pharmacist supplied Ms McCall with the three bottles, each containing 100 40mg tablets. The coroner pointed out that no criticism should be made of the pharmacist, who “discharged her duty in respect of the prescriptions appropriately,” and that her evidence was supported by CCTV footage.
Ms McCall was found by Dr Bennett at their shared home later that day, having taken a quantity of propranolol and paracetamol, as well as “almost certainly” consuming alcohol. He then called an ambulance.
Ms McCall was hospitalised but later died after the decision was made to withdraw artificial support on 12 February.
The coroner criticised Ambulance Tasmania for failing to notify Tasmania Police of their attendance.
“The failure to advise Tasmania Police meant that what may have been a crime scene went unsecured and unexamined for several days,” he said.
“It is recognised that the primary role of attending ambulance officers at any incident is to provide care to a patient and that they are not investigators, but the failure to report apparent suicide attempts which have critical and ultimately fatal results makes any investigation, whether it be criminal or coronial, very difficult.”
Dr Bennett objected to an autopsy, but one was ultimately carried out and the cause of death determined as mixed drug and alcohol toxicity.
The forensic pathologist gave evidence “that the drug of most significance in her death was propranolol which impacted on her heart so as to cause major, irreversible organ failure. That drug was prescribed for her by Dr Bennett.”
The coroner did not make any recommendations, but did comment that steps needed to be taken by Ambulance Tasmania in consultation with the Tasmania Police Service, to ensure the development of reporting guidelines to ensure the timely involvement of Tasmania Police at the scene of any likely suspicious death or anticipated suspicious death.