A patient would visit her doctor several times a week and ask for “the usual”— thought to be Panadeine Forte, Temaze and Valium by her child who was in the consulting room
A NSW GP’s registration has been cancelled after a Tribunal found she prescribed huge quantities of Panadeine Forte and other drugs for a patient over a number of years – sometimes in the names of family members.
After the woman attempted suicide using medication, one of her daughters confronted the doctor who had prescribed the medicine, she told a hearing at the Civil and Administrative Tribunal NSW.
“I said you have put a gun in my mum’s hand and have ruined four children’s lives for over 20 years,” said the daughter, giving evidence.
Patient A’s adult daughter then contacted the HCCC via email, saying that she believed her mother’s doctor was being “neglect full (sic) and breaking the law”.
The daughter alleged that “For over 20 years her children and husband have been aware of this but had no idea just how much she was taking until the 14 December 2015 when she attempted to kill herself”.
“The police ambulance and hospital stuff found all the medication was dated the same day no one could believe a doctor could give so many highly addictive pills in one day,” the daughter wrote in January 2016.
“When my mum woke up (10 days in a coma) we all talked to her about how much she was abusing pills that’s when we found out her so called doctor was giving her on a Monday 3 to 4 different highly addictive prescriptions and then again on the Friday so in one week she was given 2 months worth of pills and this happens weekly.”
The daughter also alleged that the GP was issuing scripts in the names of family members since at least one of the children was only 10 years old.
At the time the daughter was in her late 20s.
The HCCC investigated the doctor and found that between 2004 and December 2015, Patient A visited the doctor two or three times a week, and almost all of these visits resulted in at least one prescription – or multiple scripts, in many cases.
The investigation found that the GP also issued scripts in the names of Patients B, C, D and E, all close family members of Patient A who had been treated by the practitioner on various occasions between 2004 and 2005.
A schedule attached to a complaint against the GP set out, in 2959 entries over 173 pages, scripts given to Patient A by the doctor between 7 January 2004 and 14 December 2015, and filled at a pharmacy.
This schedule was prepared from the doctor’s notes, Medicare records and pharmacy records.
However at the beginning of the hearing, the doctor produced a handwritten list of scripts from this schedule which she said she had not written.
She said, “under cross-examination, that it was her belief that the prescriptions which did not appear in her notes, and the prescriptions which were the second of two scripts provided on the same day, were forgeries,” the Tribunal noted.
She “subsequently said that she had formed the view that those scripts issued by her in March 2004 and dispensed at a particular pharmacy were forged, so then she came to believe that all of the scripts apparently issued by her and filled at that particular pharmacy were forged.”
Regarding days where two scripts had apparently been produced by her, she said that she had never issued two scripts on one day for the same patient.
“At first, she said that the first script might print on blank paper, so that she would send it to the printer again to be printed out on the prescription paper so ‘it shows as two prescriptions on the one day, but I would’ve only ever issued one prescription’,” the Tribunal said.
“Later in cross-examination [the doctor] was taken to her medical records, where some of the prescriptions she was challenging were, in fact, recorded.”
She “at first said that she could not write a prescription unless it was recorded on her computer. However, she then conceded that she was able to handwrite prescriptions from prescription pads in her possession”.
Scripts given to Patient C were also queried, with the doctor denying issuing them on a series of dates in 2013, on the basis that there was no record of a consultation with Patient C on those days.
She said that she thought the script pad had been stolen and that, at a time she could not specify, there were “break ins at the surgery” and a pad could have been taken.
Regarding other scripts for Patient A, for Panadeine Forte and Diazepam – which were recorded by Medicare and the pharmacies as having been issued on the same date and filled at different pharmacies – the doctor said her car had been stolen several years earlier and that a script pad could have been inside.
She implied these scripts were written by a person who might have stolen her car years before and given to patient A, or that Patient A had gotten hold of this script pad.
The Tribunal found that in regard to whether the doctor issued all the scripts listed in the schedule, she was “not a credible witness” and that some of her explanations were “unrelated, sometimes incoherent, inherently implausible”.
It rejected the doctor’s contention that she did not write all the scripts.
The schedule of scripts also recorded that the doctor had prescribed oxycodone to Patient A from 17 March 2010 to 14 December 2015, during which time 2444 tablets of the drug were prescribed.
An expert report from a leading doctor indicated that Patient A was addicted to Panadeine Forte and Diazepam at this time.
Patient D gave evidence that she would attend GP appointments with her mother as a teenager, during which her mother would ask for “the usual”.
Patient E gave similar evidence, saying he thought the drugs in question were “Panadeine Forte, Temaze and Valium” and were referred to as “my usual” at the time.
While the doctor denied providing scripts in response to a request for “the usual,” the Tribunal said this was at odds with the statements of Patients D and E.
The expert doctor noted that almost every consult between patient A and the GP resulted in a Panadeine Forte script.
Also alleged was that the GP inappropriately administered morphine to Patient A on around a monthly basis.
The GP was also accused of inappropriately prescribing Panadeine Forte to Patient B, who said that he had never asked for or been prescribed painkillers by any doctor, and had never taken Panadeine Forte.
At the time Patient A was in the room, purporting to direct the treatment of Patient B.
The Tribunal found that this was diverted to Patient A.
Patient C was also prescribed the same drug when Patient A was in the room, purporting to direct the treatment of Patient C, and the Tribunal heard that these were for an inappropriate therapeutic purpose and prescribed in inappropriate quantities.
Similar happened with Patients D and E, with Patient D prescribed Panadeine Forte in one instance at the age of 15: 100 tablets in two weeks.
In her evidence Patient D said that after asking for “the usual” at the doctor, “Mum would then go straight to the chemist and take the drugs. Sometimes she would get an injection at the doctors”.
She said she only took the painkiller once or twice while experiencing a “tooth problem” in 2015.
“lt would not surprise me if my mum was getting medication in my name,” she told the Tribunal.
“I remember seeing a doctor’s letter which had other medication on it I was not taking.”
Patient E, a year older than his sister Patient D, said that when he was a teenager “I can remember the sound of her emptying bottles of pills she could take so many”.
The expert doctor noted that the GP should have been alerted to potential abuse problems given that her notes in some cases described a range of fates for the Panadeine Forte tablets and scripts.
These were recorded as variously, “last script torn up,” “car broken into and tabs stolen,” “bottle thrown out in argument,” “continuing theft from house,” “dog chewed up tablets and became angry chased dog and fell into hole,” and “dog bit through packet tabs,” among numerous others.
“While patients like [Patient A] often do live disorganised lives, and a few of these excuses may have actually occurred, this is classic behaviour from patients inappropriately seeking medication,” the expert noted.
Patient A’s children gave evidence that their mother overdosed regularly throughout their childhood.
“From the age of five, I was taught if mum was vomiting or foaming from the mouth you had to put… her on her side and phone for the ambulance,” said the daughter who had made the initial complaint to the HCCC.
She said that during the 2015 overdose which sparked the complaint, she went to her mother’s bedroom and found “hundreds of boxes of pills”.
Patient A recovered from the overdose and her children reported that she has also recovered from the reliance on opioids.
Another complaint centred around the evidence of Patient F, who made a complaint about the doctor via an email sent in October 2018.
This patient said that the GP had prescribed Duromine 40mg for her for 20 years.
Patient F said she was addicted to Duromine and had become sick when she stopped taking it, blaming this addiction for “numerous” adverse health and life impacts.
The doctor had been Patient F’s GP from April 2007 to 21 July 2016, and she admitted to the particulars of this complaint.
The Tribunal cancelled the doctor’s registration and said she may not apply for a review of this cancellation for a period of two years from the cancellation.