Self-prescribing and prescribing for friends and family is something that many practitioners grapple with. Having the medical knowledge and the ability make this easy, but there are many pitfalls and with unfortunate regularity it becomes a ‘slippery slope’. The Medical Board’s Code of Conduct has something to say about this practice.
In Medical Board of Australia v GMZ  VCAT 902, a Victorian practitioner was found to have self-administered schedule 4 drugs over a 6 year period that had not been prescribed to him by a treating practitioner. It was alleged that the practitioner made false representations to obtain the drugs and forged prescriptions on a relative’s prescription pad on numerous occasions between 2009 and 2015.
Concurrent to the Medical Board’s investigation, the practitioner pleaded guilty to numerous criminal charges under the Drugs Poisons and Controlled Substances Act. No conviction was recorded and the practitioner was placed on a two year good behaviour bond.
The matter came before the Victorian Civil and Administrative Tribunal in June 2017 to make findings as to the practitioner’s conduct and to determine the appropriate sanction. On the practitioner’s application, the Tribunal made an order to suppress the practitioner’s name on the basis that its publication would be detrimental to his rehabilitation.
The Tribunal noted that it was rare for a suppression order to be made in disciplinary matters because the educative and deterrent function of the proceedings requires publication of the decision to demonstrate to the public and profession that certain conduct will not be tolerated. However, in granting the suppression order, the Tribunal took into account the opinion of the practitioner’s treating psychiatrist and the fact that his conduct had not directly affected the care or treatment of a patient. The Tribunal accepted the practitioner had made remarkable inroads into recovery and rehabilitation from what had been a longstanding addiction and that it would be unfortunate to displace the practitioner from this trajectory at that point in time.
The Tribunal found that the practitioner had engaged in two counts of professional misconduct and one count of unprofessional conduct over the 6 year period in question. It found the practitioner’s conduct extremely serious and that it represented a very significant departure from acceptable standards. The practitioner did not dispute this.
In deciding the appropriate sanction, the Tribunal took into account that the practitioner:
- cooperated fully with the Board;
- complied with the conditions imposed on his registration;
- worked successfully as a GP registrar in accordance with the conditions on his registration;
- successfully participated in the clinical training required for him to become a general practitioner;
- remained drug free since 2015, having submitted to monthly drug tests;
- demonstrated insight which is an important factor in assessing whether an individual poses a continuing risk;
- expressed shame and remorse in relation to his conduct; and
- had positive support from professional colleagues and had taken significant measures to address his personal issues in addition to becoming drug free.
Taking into account the above factors and the need to balance protecting the public against the doctor’s endeavours to rehabilitate himself, the Tribunal elected to reprimand the practitioner and impose onerous and prescriptive conditions as opposed to enforcing a suspension or cancellation of his registration. The conditions required the practitioner to:
- continue supervision and drug-screening;
- work with a supervisor;
- only take substances prescribed, approved or administered by a nominated treating practitioner;
- attend for treatment with a general practitioner and addiction specialist as determined by the treating practitioner;
- not undertake night shifts or on-call work in excess of 40 hours per week until the Board approves; and
- not prescribe or administer schedule 4 or 8 drugs except within his clinical role.
In this matter, the Tribunal took into account the efforts made by the practitioner to address the underlying reason for misconduct as well as the mitigating effect of cooperating with the Board.
The legality of a health practitioner self-prescribing varies under State and Territory legislation across Australia. For example, in Victoria, it is an offence for a doctor to prescribe schedule 4 and 8 medicines for themselves or a third party. In South Australia, a doctor cannot self-prescribe Schedule 8 medication unless in a “verifiable emergency”. In other States, while it might not be illegal to self-prescribe, the Medical Board’s Code of Practice – ‘Good Medical Practice’ cautions against prescribing for self, family and friends or those ‘you work with.’ It recommends ‘seeking independent, objective advice when you need medical care, and being aware of the risks of self-diagnosis and self-treatment.’
This decision highlights a number of key items:
- the importance of having a general practitioner of your own and making your health a priority;
- in the event of a complaint, seek advice and have insight – we regularly receive queries concerning legal and ethical issues around prescribing for self, family and colleagues as well as mandatory reporting obligations in this context and we are very happy to provide advice on these matters;
- if you are feeling vulnerable seek advice and help – there are a number of Doctors’ Health Services operating around Australia which have been set up to assist you and, their contact details are available on our website
- Also available on our website are information about MIGA’s Doctor’s Health Assessment, providing Risk Management Points for undergoing a comprehensive health assessment, and our Doctors’ Health e-Book, exploring key issues around the why and how of managing your own health
If you are uncertain about your prescribing and reporting obligations, our expert Claims and Legal Services team can provide you with confidential advice and we encourage you to call us.