The key issue
What is the appropriate disciplinary sanction for inappropriate prescribing of Schedule 8 medicines over an extended period of time?
The background
An investigation was triggered by the daughter of Patient A who contacted the HCCC and reported that she believed the respondent had been prescribing highly addictive medication (Oxycodone) to her mother.
The respondent had been Patient A’s doctor between 2004 and December 2015.
Patient A would generally visit the respondent 2-3 times per week, with nearly all visits resulting in at least one prescription and many resulting in multiple prescriptions. Overall, the respondent prescribed 2,444 tablets of Oxycodone over a period of 2,098 days.
The respondent inappropriately administered morphine by injection to Patient A on 116 occasions from 8 March 2004 to 17 August 2015; inappropriately prescribed schedule 4D drugs, Panadeine Forte, Diazepam and Temazepam to Patient A; and inappropriately prescribed Janumet, a drug for the treatment of diabetes, to Patient A when she intended for the drug to be taken by Patient B.
The respondent admitted that she ought to have known that some of the schedule 4d medications being prescribed for Patients B, C, D and E (close family members of Patient A who were also treated by the respondent) were being diverted to Patient A.
It was found that the respondent prescribed to Patient A without, among other things, performing any appropriate clinical assessment, making any appropriate referrals, obtaining proper authority and taking steps to monitor the patient’s stockpiling of drugs.
The respondent was also found to have maintained inadequate clinical notes.
The tribunal stated that the respondent’s gross overprescribing to Patient A and her family seemed to arise from the respondent’s will effectively-being overborne by Patient A in the sense that the respondent complied with Patient A’s requests for prescriptions against the respondent’s better judgment.
Patient F accused the respondent of prescribing her Duromine 40mg for her for 20 years and that she had been addicted to the drug as a result. The respondent was found to have inappropriately prescribed Duromine and Quetiapine to Patient F.
The outcome
The tribunal found the respondent guilty of professional misconduct and unsatisfactory professional conduct, cancelled her registration and disqualified her from applying for registration as a medical practitioner for 2 years.
Implications
The case confirms the importance of ensuring that prescribing of Schedule 8 and Schedule 4 medications is clinically indicated, supported by thorough clinical records and consistent with relevant legislation and other prescribing codes. Further, such prescribing ought only occur with timely specialist assistance, in safe combination with other drugs and in circumstances where clear steps are taken to monitor any drug-dependent behaviour.
The decision in Health Care Complaints Commission v Ruff [2020] NSWCATOD 122 can be read here.
