Dr Dick Cheong Quan was a medical practitioner and director of a well-established general practice in Sydney. He had an unblemished record as a doctor for 30 years.
In early 2016, Dr Quan prescribed multiple drugs with the aim of building up stock for a nearby clinic. As a result of this, the Health Care Complaints Commission ('the Commission') brought disciplinary actions against him before the Civil and Administrative Tribunal of New South Wales ('the Tribunal').
In early 2016, in his capacity as a Director of a medical practice, Dr Quan met with a registered pharmacist who was seeking to open a hydration clinic nearby. The pharmacist told Dr Quan that the clinic would offer intravenous infusions and intramuscular injections of vitamins, mineral and antioxidants. In order for the clinic to have stock to use when it opened, the pharmacist requested that Dr Quan write multiple prescriptions for various drugs.
On 13 January 2016, Dr Quan wrote prescriptions for 84 vials of 'Myers' cocktail' (which is a combination of magnesium, calcium, various B vitamins and vitamin C), as well as Methylcobalamin (Vitamin B 12) and Glutathione to be administered by infusion or injection. A main issue with the prescription was that Dr Quan wrote the prescriptions in the name of his reception staff, without their knowledge or consent. Furthermore, Dr Quan did not keep clinical records of the prescriptions. The Tribunal also heard that Dr Quan prescribed a section 4 drug (a drug of limited addiction) without reference to the relevant regulations.
On 13 February 2016, the pharmacist administered the 'Myers' cocktail' and an intramuscular injection of Glutathione to a patient of the clinic. Shortly after receiving the treatment, the patient was hospitalised, presenting with a fever, myalgia, abdominal pain and hypotension. It was unclear why the patient had become ill, but it was suggested that the injection became contaminated with bacteria. It was also suggested that there was poor aseptic technique by the nurses at the time of the procedure.
Upon learning of the hospitalisation, the Pharmaceutical Regulatory Unity ('PRU') ceased all of the clinic's stocks – noting that some of the drugs were prescribed by Dr Quan. Dr Quan was subsequently contacted by the PRU, asking for a justification of his actions. Dr Quan fully admitted to filling out the prescriptions and expressed sincere embarrassment and shame for his 'uncharacteristic' actions. The Commission commenced proceedings against Dr Quan regardless.
The expert reports were unanimous in their finding that Dr Quan had indeed failed to obtain consent from his staff to prescribe the drugs, and also failed to keep proper medical records.
Dr Quan claimed that he did not know that the parenteral Glutathione was classified as a schedule 4 drug, and should not be reprimanded for prescribing it. However, the experts agreed that it was not surprising that the drugs were prescribed, since it was available over-the-counter for chronic fatigue. It was found however, that Dr Quan should have researched the drug that he was prescribing.
The reports indicated that it was clear from the pattern of prescription, that the drugs were for the accumulation of stock, rather than managing a patient's symptoms. Nevertheless, one expert noted that the practice of prescribing medication for the purpose of accumulating stock was not unheard-of.
It was found that Dr Quan's conduct fell significantly below the standard reasonably required of a practitioner with equivalent experience to Dr Quan.
Findings of the Tribunal
The Tribunal found that Dr Quan was very remorseful, and noted that, since learning of the incident, he had received further education to ensure that this failing would not occur again. However, the Tribunal decided that Dr Quan's conduct fell below the standard required of medical practitioners and constitutes unsatisfactory professional conduct.
The Tribunal was understanding of the fact that Dr Quan's conduct occurred in an unique and unusual two-day period, and transpired because he had naively relied of the representations made by the clinic's pharmacist. The Tribunal decided that it was highly unlikely that Dr Quan would make the same mistake again, given his good character.
In regard to the lack of consent and failure to keep proper records, the Tribunal found that Dr Quan's conduct was improper. However, the Tribunal was not convinced that Dr Quan's actions were so serious as to suspend or cancel his registration as a doctor. Accordingly, he was not found guilty of professional misconduct.
Dr Quan was reprimanded and ordered to pay 50 per cent of the Commission's costs.