On 23 May 2019, the Civil and Administrative Tribunal of NSW published its reasons for making orders for the reinstatement of a medical practitioner's registration, subject to a number of conditions. These conditions were designed to prevent any future episodes of the practitioner prescribing addictive medications and to allow for careful monitoring of her consultations.
The practitioner graduated from the Guangzhou Medical College, China, in 1984. She worked as an Obstetrics/Gynaecology Registrar in China before moving to Australia in 1988. After further studies, she registered as a medical practitioner in 2003 and became a Fellow of the Royal Australian College of General Practitioners in 2009. She worked in a number of suburban general practices.
On 5-9 September and 26 October 2016, the Health Care Complaints Commission pursued complaints against the practitioner in the Civil and Administrative Tribunal of NSW (Tribunal). It was alleged that she was guilty of unsatisfactory professional conduct and professional misconduct because she had inappropriately prescribed drugs of addiction and failed to maintain adequate medical records in accordance with the requirements of the Health Practitioner Regulation (NSW) Regulation 2010 (Regulation). The applicant admitted the allegations and on 28 November 2016, the Tribunal cancelled the applicant's registration, ordering that she would not be allowed to apply for a review of the cancellation for 18 months. The practitioner appealed this decision, but this was dismissed by the Court of Appeal.
The Tribunal had given extensive reasons for the cancellation for its decision. Primarily, there were a number of inadequacies and breaches of the legislation in respect of the Applicant's treatment of 15 patients. In respect of 14 of those patients, the practitioner prescribed an addictive medication without making an appropriate assessment of the patient. In respect of 12 of these patients, she did so without complying with the requirement to obtain an authority under the Poisons and Therapeutic Goods Act 1966 and the Poisons and Therapeutic Goods Regulation. In a number of instances, she also:
- prescribed an addictive drug when this was contraindicated because she knew, or ought to have known, that the patient was exhibiting drug seeking behaviour;
- prescribed an addictive drug inappropriately as to the purpose or quantity and contrary to recognised therapeutic standards;
- failed to make an appropriate referral of the patient to a pain clinic or addiction specialist, even where her prior medical notes indicated that this was appropriate;
- prescribed an inappropriate combination of different drugs; and
- prescribed addictive drugs when she knew, or ought to have known, that another doctor in the practice had given the patient a referral to attend an addiction centre.
In was also found that, in respect of each of the 15 patients, the practitioner has breached the Regulation by failing to maintain adequate medical records. The Tribunal held that, together, these complaints constituted professional misconduct and which justified cancellation of her registration for the protection of the public.
Following the Tribunal's decision, the practitioner engaged in extensive continuing medical education, especially focussed on the problems identified by the Tribunal. She also attended a number of forums and courses run by universities and medical societies which focussed on prescribing medication. She also attended the Sydney Pain Management Centre under the guidance of a pain specialist, to observe a multidisciplinary team's approach to managing chronic pain.
During the period between her cancellation and the hearing of the application, the practitioner undertook a clinical placement with the Department of Drug Health Services at the Concord Repatriation Hospital. She observed consultations with patients suffering from addiction from a range of substances who sought admission for detoxification. She also observed ward rounds. In addition, she undertook an extensive clinical placement, observing consultations with patients which often involved treatment for chronic and acute pain and enjoyed the mentorship of another practitioner.
The practitioner provided positive statements and character references from both former colleagues and those practitioners whose practices she had observed during the period of her cancellation. A consultant psychiatrist gave expert evidence that she had well-developed insight and accepted responsibility for what she had done. She 'embraced enquiry, education and remediation of her shortcomings'.
A general practitioner instructed by the respondent provided details on the kind of conditions that should be attached to an order for reinstatement. The parties reached an agreement as to the imposition of conditions on the Practitioner's registration.
The application for a reinstatement order was made, subject to a number of conditions which included:
- authorising the exchange of information between the Medical Council and Medicare Australia and Pharmaceutical Services for the purpose of monitoring compliance;
- practising in a group practice where patients and patient records are shared and there is always one other registered medical practitioner on site;
- not possessing, supplying, administering or prescribing any “drug of addiction” (Schedule 8 drugs) as defined by the Poisons and Therapeutic Goods Act 1966 (NSW) or Schedule 4 appendix D of the Poisons and Therapeutic Goods Regulation 2008 (NSW);
- submitting to an audit of her medical practice, by random selection of her medical records, by a person(s) nominated by the Medical Council;
- nominating an experienced specialist GP to act as her mentor; and
- treating no more than 30 patients per day.