The key issue
What is the appropriate disciplinary sanction for practitioners who prescribe to individuals with whom they share a close personal relationship?
The background
The case relates to a medical practitioner who provided medical care and prescriptions to five patients with whom he shared a close personal relationship.
The respondent prescribed Fentanyl and Morphine to one patient and provided that patient medical care for six months. It was accepted that the medications were for the patient’s severe abdominal pain and the patient refused to seek assistance from any other medical professional.
The respondent prescribed several Schedule 4 medications to four other patients, including temazepam to one of the patients without any documentation of a formal mental health assessment. The prescribing to these patients was not unavoidable as:
- the individuals already attended general practitioners;
- the prescriptions were not provided in an emergency situation;
- less than half the prescriptions were provided on weekends; and
- the individuals were sufficiently proximate to other medical practices and providers.
The respondent also provided referrals to other medical practitioners for three of the patients.
The respondent prescribed numerous Schedule 4 medications to himself between March 2015 and September 2019.
In mitigation:
- the medications prescribed to the patients were repeat prescriptions based upon the judgment of the relevant person’s treating medical practitioner and following assessment of the previously recommended treatment to determine whether the circumstances warranted a repeat prescription;
- the respondent’s treatment of the patients was undertaken in unique and extraordinary family and personal circumstances;
- the respondent made early acknowledgements of his conduct; accepted that it cumulatively amounted to unprofessional conduct, was seriously wrong and expressed remorse for the conduct; and
- the respondent has ceased prescribing for himself and to individuals with whom he has a close personal relationship.
The outcome
The tribunal approved orders that the respondent behaved in a way that constitutes unprofessional conduct, reprimanded him, imposed several conditions on his practice (including that he must not provide treatment to individuals with whom he shares a close personal relationship) and ordered him to pay costs of $7,000.
The implications
While the case confirms the dim view taken by tribunals relating to practitioners treating individuals with whom they share a close personal relationship, the finding of unprofessional conduct and the fact that the respondent escaped suspension and a fine suggests that there are areas of grey with respect to the practise, depending on the surrounding circumstances and mitigation.
The decision Medical Board of Australia v Barker [2020] VR 54 can be read here.
