Doctor illegally prescribed drugs
A doctor has been censured after illegally prescribing the Class B controlled drug morphine to a patient he knew was dependent.
In a decision released today, the Health Practitioners Disciplinary Tribunal said Dr S had not been authorised to prescribe controlled drugs for the treatment of people dependent on controlled drugs.
The patient - Mr N - had gone to Dr S in December 2008 with an addiction to opiates and had asked for help to stop his drug use, the decision said.
From early 2009 to mid-2011 Dr S issued Mr N with prescriptions for high amounts of morphine sulphate to help him with his dependence on opiates.
Dr S had said he mistakenly assumed the addiction would not be too difficult to cure, and undertook the task because he thought going through the proper process was disproportionate to the problem.
The tribunal said it must conclude there was a serious lapse of judgment in that Dr S proceeded with a form of treatment that was illegal. The problem was exacerbated by the fact it continued for more than two years.
It was a concern that the prescribing of morphine had escalated rapidly.
"The dose increased over time, possibly exacerbating the addiction when the dose should have been decreasing to address the addiction," the tribunal said.
Dr S was often led by Mr N when issuing prescriptions, and he took the easy way out by going along with prescribing requests.
In another case, that of Mr H, Dr S prescribed the Class B controlled synthetic opioid analgesic Pethidine in tablet and injectable forms to alleviate pain associated with a significant rheumatoid arthritis problem.
While Mr H had severe and chronic disease and was not an easy patient to look after, it was not appropriate for Mr H to have been started at all on Pethidine. Nor should that have been facilitated by instructing Mr H's wife how to administer injections of Pethidine at home.
It was evident from notes that Dr S was aware Mr H was on a "slippery slope".
The tribunal said it accepted Dr S was trying to help with a complex problem, but the continued use of such an addictive opiate was not appropriate.
Dr S also prescribed Pethidine tablets for Mr H's wife Mrs H, who suffered from biliary colic and complained of frequent and painful gall bladder attacks.
From January 2007 Mrs H required prescriptions for Pethidine tablets and injections more and more regularly which reached its worst point in late 2009 when Mrs H could use two to three injections a day.
The patient should only have been prescribed a drug of that kind for a short period.
Dr S also facilitated the self-injection of opioids by Mr and Mrs H, which deviated significantly from the normal practice.
In another case he prescribed consistently large amounts of Triazolam or Nitrazepam for a number of years to a patient who was in pain associated with his achilles tendon, to help him sleep at night.
There had been a pattern of inappropriate and excessive prescribing of addictive drugs with a risk of misappropriation, the tribunal said.
It censured Dr S and expressed strong disapproval for the serious prescribing issued that arose.
But the tribunal also said it was appropriate for a rehabilitative approach to be taken. There was also a public interest in not ending the career of a competent doctor as relevant.
Dr S had devoted considerable efforts himself to rehabilitation, and it was unnecessary for a fine to be imposed. Following counselling, he realised he needed to be firmer in standing up to patients.
An order was made for $24,000 costs.