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Physician banned for a decade for unnecessary prescribing

A specialist physician has been found guilty of professional misconduct after prescribing anabolic steroids and drugs when there was no therapeutic basis, and for failing to keep adequate records.

Three separate notifications against the specialist physician were made concerning the prescribing of medication and record keeping after a practitioner made a complaint to the Medical Board of Australia.

The case, which was referred to the applicable state’s administrative tribunal, serves as a reminder to physicians to ensure they only prescribe medication for a therapeutic purpose and the importance of keeping good records.

Physician accused of prescribing drugs for body building

The Medical Board alleged that the specialist physician had prescribed anabolic androgenic steroids, human growth hormone (HGH), clenbuterol, clomid and ephedrine to numerous patients looking to lose weight or for body building and conditioning. It was also claimed he prescribed treatments such as iron and frozen plasma infusions, as well as DEXA scans without having a therapeutic indication.

The Medical Board claimed these drugs and treatments were prescribed when there was no therapeutic basis and that the specialist physician unnecessarily exposed patients to potential adverse effects associated with the drugs. Also, that the specialist physician had failed to keep adequate records. These allegations regarded both the specialist physician’s general practice and the specific treatment of two patients.

Honesty is the best policy

The physician didn’t deny he had prescribed the drugs or treatments in question to his patients, but in letters to the Australian Health Practitioner Regulation Agency (AHPRA) and Board, he emphasised that he was providing treatment for a therapeutic purpose and explicitly stated in one letter that “I do not prescribe to body builders.” Reasons given for prescribing such drugs included obesity, anaemia and osteoporosis.

However, it was noted that objective evidence didn’t correspond with the evidence provided by the specialist physician. In particular, the tribunal drew attention to Patient A’s case, where the specialist physician claimed the patient was being treated for obesity.

The tribunal referred to photographic evidence, which clearly revealed that Patient A was not obese, but a body builder. The patient’s prescription history showed that the specialist physician had prescribed – steroids and drugs used for body building and conditioning for five years.

In the witness box, the physician admitted to being Patient A’s steroid supplier for the purpose of body building because he believed it was better for him to prescribe these drugs than for the patient to purchase them on the street.

The specialist physician then admitted to doing the same for more than 20 patients, confirming he didn’t prescribe the medication for a therapeutic reason and therefore proving his previous statements to AHPRA and the Medical Board to be false.

While, initially, the specialist physician denied the clinical records were inadequate, in closing submissions it was conceded that he failed to make adequate notes for patients who consulted him for obesity and weight loss, physical conditioning, body building and for patients who were prescribed various drugs, including anabolic androgenic steroids.

Decision and penalty

The tribunal found that the specialist physician’s actions constituted professional misconduct because he prescribed anabolic steroids, HGH and clenbuterol (among other drugs and treatments) for no therapeutic reason and that this “unnecessarily put patients at risk of the adverse effects of those drugs”.

Not keeping accurate records of patient consultations and treatments it was said, would be “regarded as improper by professional colleagues of good repute and competence” and that “Such conduct was substantially below [the] standard reasonably expected of a registered medical practitioner of an equivalent level of training or experience”.

In its finding, the tribunal stated that the specialist physician’s misconduct was so serious, involved a large number of patients and that the misconduct extended over a substantial period of time, that had his registration not already lapsed, it would have been cancelled. The specialist physician was disqualified from applying for re-registration for 10 years and ordered to pay the Medical Board’s costs.

Ultimately, despite the Medical Board seeking a reprimand against the specialist physician, the tribunal decided the disqualification was significant enough of a penalty.

The specialist physician was also fined $5,000 for sending an abusive letter to the notifying practitioner, as a deterrent to other practitioners from doing the same.

Treating athletes

If you treat athletes you should note that in September 2017, AHPRA and the Australian Sports Anti-Doping Authority (ASADA) reached a Memorandum of Understanding (MOU). The purpose of the MOU is to ensure that AHPRA and ASADA cooperate in the investigation of practitioners who prescribe performance enhancing drugs without a genuine therapeutic need.

Key learnings

  • While this is an extreme example, this decision highlights the importance of making sure when you are prescribing medications that they are therapeutically indicated and do not unnecessarily expose patients to adverse side effects.
  • Be thorough when recording your consultations and prescriptions – note down the therapeutic indication as well as the dosage, frequency and period of prescription.
  • It goes without saying, that it is inappropriate to be derogatory or offensive to notifying practitioners (or patients) who have made a complaint about you to the Medical Board.

This article was originally published by Avant Mutual. You can access the original here.

Is it ever OK to prescribe for friends and family?

 

If you’ve been practising for any length of time, you’ve undoubtedly faced the dilemma of a friend or family member asking you whether you could write a prescription for them. Often it’s a repeat script for a treatment they’re already on, when it’s inconvenient for them to go to their GP. You might think that’s fair game – but is it really wise and safe to go ahead and write that script?

It’s a complex issue. First up, there’s the question of whether there could be any legal ramifications in prescribing for people with whom you have a close, non-patient relationship. The trouble is that legislation on this varies from state to state. Broadly, it is legal to prescribe for family members everywhere except in South Australia, where S8 medications can only be prescribed in a “verifiable emergency”.

Prescribing for you own use is more contentious. All states and territories ban self-prescription of S8 drugs, although NSW, NT, Queensland and South Australia will allow it under certain emergency conditions. All states except Victoria allow self-prescription of S4 drugs, but with varying levels of restrictions.

But even if it’s legal to prescribe for friends and family, there are other questions to consider. Many professional indemnity insurance policies specifically exclude claims arising from elective medical treatment provided to a doctor’s immediate family, which could leave you significantly out of pocket should anything go wrong.

And if things do go wrong, there’s not just insurance coverage to think of. The practice is not recommended by the Medical Board of Australia and there have been cases where it has led to disciplinary action.

A recent case involved a NSW doctor who had been in private practice for 30 years, with no previous disciplinary record or conditions on his registration.

He was found to have provided wrongful and inappropriate prescriptions to his adult children and spouse, including S4D medications. Conduct issues were confined to his prescribing habits for his family and did not involve the day-to-day treatment of his patients.

In handing down its decision of professional misconduct, the tribunal referred to the Medical Council of NSW guidelines for self-treatment and treating family members, which supplements the recommendations of the Medical Board’s Good Medical Practice.

Here’s what the latter document has to say about prescribing for family, friends or oneself:

“Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient. In some cases, providing care to those close to you is unavoidable. Whenever this is the case, good medical practice requires recognition and careful management of these issues.”

The upshot of this and other advice from the regulatory bodies is that:

  • It is not advisable to treat family members, friends, or yourself;
  • In an emergency situation, provide only the immediate treatment needed before handing the person over to an independent doctor;
  • You can collaborate with a family member’s treating doctor, as long as you’re not the primary doctor;
  • If you do treat a family member, document the treatment and provide it to the primary doctor;
  • Make sure you have your own GP.

It’s not always easy to resist emotionally-based pressures, especially when they come from friends or loved ones. But it’s precisely these subjective emotions that don’t mix well with the appropriate and objective care of a patient. A good idea is to prepare a sympathetic explanation beforehand as to why you can’t prescribe for them. It might run along the lines of: “I’d love to help out, but I’m afraid that kind of thing is frowned upon by the Medical Board. Let me see if I can get hold of a colleague for you.”

And remember that each time you do prescribe for someone, you are entering into a doctor-patient relationship with that person, even if she or he is a family member.

Sources: Avant, MDA National