Dr Rajen Ragavan prescribed various addictive medication to several patients that consulted him for pain management. In relation to these prescriptions, the Health Care Complaints Commission (the Commission) brought disciplinary actions against him before the Civil and Administrative Tribunal of New South Wales (the Tribunal) alleging that he was guilty of unsatisfactory professional conduct and professional misconduct.
Dr Ragavan is a rehabilitation medicine consultant in Taree New South Wales. His specialty pain management, especially for acute and chronic back pain.
On various occasions between 2013 and 2015, Dr Ragavan prescribed various addictive medication including fentanyl, oxycodone, naloxone, tramal, hydromorphone, morphine, tapentadol and buprenorphine to ten patients (Patients A – J). The Commission alleged that these prescriptions were not appropriate when it is taken into account that Dr Ragavan:
- provided them without conducting the required assessments;
- provided some of them where there were recognisable signs of drug dependency on the part of the patients;
- reduced some dosages without further referral to an addiction medicine specialist or the patients' GPs;
- prescribed a combination of drugs that were not appropriate;
- prescribed some drugs without appropriate therapeutic purpose;
- did not keep the required standard of medical records;
- did not reduce one patient's dosage when their pain reduced;
- provided single script prescriptions where follow-up was necessary;
- did not refer patients to counselling.
The Commission alleged that each of these conducts amounted to unsatisfactory professional conduct and that together, they were of sufficient seriousness that they amounted to professional misconduct. In some instances, Dr Ragavan admitted that he should have recognised the signs of drug dependency and made further referrals. He however, maintained that a broader assessment of patients is outside of his scope of inquiry.
Findings and Orders
The Tribunal found that Dr Ragavan's most significant failing is his lack of insight for the need to consider and treat each of the patients in a holistic manner. His focus was narrowly focused on the complaint of each patient that he did not give adequate consideration to other matters which may directly impact on the patient's need for medical treatment, like their existing prescription, psychosocial issues, work practices and living conditions. His submission that these were outside of his scope of inquiry demonstrated shortcomings in his assessment.
It was further held that Dr Ragavan's approach to his patients was more biomechanical than biomedical. It was more protocol-driven and entailed choosing to treat patients that fitted his approach rather than adopting the appropriate approach to each patient. This demonstrated a misplaced confidence in his ability.
The Tribunal held that Dr Ragavan's knowledge needed to be upgraded and his approach to medicine corrected, since there is indication that he had very limited examination skills. The Tribunal also expressed concern that Dr Ragavan lacked knowledge in opioid pharmacology, the prescription of medication (especially opioids) and recognition of drug dependence.
As a result of Dr Ragavan's failure to adequately elicit a comprehensive medical history, perform a comprehensive physical examination, formulate a diagnosis and prepare a holistic plan of management, his medical records are below the standard of consulting practice and not compliant with the Health Practitioner Regulation National Law.
As a result of the above, the Tribunal held that Dr Ragavan was guilty of unsatisfactory professional conduct in respect of each of the complaints by the Commission. It ordered that the practitioner be reprimanded and conditions placed on his registration, including further education and prohibition from prescribing schedule 8 drugs (drugs of addiction). The Tribunal ordered that Dr Ragavan pay the costs of the Commission.