Background
Patient A was a patient of the practitioner for 7 years (from 2011 to 2018), during which time he provided her general medical services, prescriptions and antenatal care. In September 2015, the practitioner employed Patient A on a casual basis at his medical practice and continued to provide minor medical care to the patient. In 2015 and 2016, the practitioner and Patient A developed a close friendship and, in 2016 and 2017, the couple engaged in sexual relations on four occasions. In late 2017, a mutual decision was made to end the relationship.
Following the ending of the relationship, Patient A worked occasionally at the practice as a registered nurse and the practitioner continued to provide her treatment for minor medical issues.
In addition to the above, the practitioner arranged for Patient A and her children to appear on his private health insurance, which was funded by him. He also purchased an investment property and offered for Patient A to stay there and for him to pay the rent. She rented the property for about 16 months across 2018 and 2019 and paid rent.
In April 2018, the practitioner attended Patient A’s residence after Patient A contacted him requesting lorazepam due to stress she was experiencing with her children’s father. The practitioner provided a prescription for diazepam and also performed an assessment on her, during which he concluded that she was experiencing acute stress and anxiety. He provided instructions to take one diazepam only. Patient A subsequently overdosed on the diazepam, consuming all 50 tablets from the box. On returning to Patient A’s residence after feeling uneasy about Patient A’s presentation, he found Patient A unconscious on her bed, following which he phoned an ambulance, who conveyed the patient to hospital.
With respect to:
- the sexual relationship, the parties agreed that the conduct constituted professional misconduct; and
- the prescription, the parties agreed that the conduct constituted unsatisfactory professional performance. No issue was taken about the clinical appropriateness of the prescribing but that the practitioner prescribed in circumstances where:
- he had a history of a significant personal relationship with Patient A; and
- he did not make any adequate clinical record of the treatment provided, reasons for prescribing or that he considered the risk of prescribing diazepam to Patient A.
The Board took immediate action in March 2019 by suspending the practitioner’s registration after the matter was referred to it by the Office of the Health Ombudsman in September 2018.
The practitioner sought review of the Board’s decision but withdrew that application after the Board agreed for him to be subject to various conditions on 3 June 2019, including indirect supervision and prohibitions on prescribing.
In December 2019, the practitioner voluntarily surrendered his registration for medical reasons.
In May 2020, the practitioner was granted registration as a medical practitioner upon providing an undertaking to the Board requiring limited mentoring.
In the disciplinary proceedings, the Board sought a suspension of one to three months. The practitioner sought a reprimand on the basis that his conduct was not predatory, did not involve exploiting or grooming the patient, and did not cause Patient A to suffer any harm, injury or inconvenience from the sexual, employment or financial relationship with him.
The tribunal considered that a reprimand sufficiently met the protective purposes of sanction, given, among other factors, the consequences already suffered by the practitioner.
Implications
The case highlights that suspension of a practitioner’s registration (or even the imposition of conditions), even when a sexual relationship has been admitted as between a doctor and patient, is not necessarily a proportionate response to the alleged conduct, particularly in circumstances where the practitioner has already suffered as a result of his conduct, further education has been completed relevant to the misconduct, early admissions are made and where there has been delay in bringing the proceedings.
To read the full decision of Health Ombudsman v Heath [2022] QCAT 30 click here
