The legality of a doctor self-prescribing varies from State and Territory across Australia. For example, in Victoria, it is an offence for a doctor to self-prescribe schedule 4 and 8 medications ¹.
Some other states and territories also preclude self-prescribing Schedule 8 and certain other restricted medications.², The Medical Board’s Code of Conduct – ‘Good Medical Practice,’ previously recommended that a doctor seek independent, objective advice when in need of medical care and to be aware of the risks associated with self-diagnosis and self-treatment. The Code has recently been amended with effect from 1 October 2020. The revised Code makes a clear recommendation that doctors should not self-prescribe ³.
There are numerous Tribunal decisions which highlight the range of sanctions which can be imposed on doctors who self-prescribe. While the severity of the sanctions imposed varies considerably and depends on the specific facts of the case, a clear takeaway message from these cases is that the Medical Board and disciplinary tribunals consider self-prescribing to be unacceptable, and in some instances, warranting suspension or even de-registration. The new wording in the Code makes this position unequivocal.
In a decision of the Victorian Civil and Administrative Tribunal3, a doctor forged prescriptions on a relative’s prescription pad on numerous occasions between 2009 and 2015. In determining the appropriate sanction, the Tribunal took into account a number of factors, notably the degree of insight and attempts to rehabilitate on behalf of the doctor. The Tribunal reprimanded the doctor and imposed onerous and prescriptive conditions in relation to drug-screening, supervision and medical treatment.
In a decision of the NSW Civil & Administrative Tribunal4, the Tribunal deregistered a doctor for a period of one year following a history of long-term prescribing to self and family. The doctor suffered from a health impairment and had been subject to prior suspensions and breached conditions previously imposed by the Medical Council of NSW.
In a decision of the Western Australian State Administrative Tribunal5, a doctor prescribed schedule 4 medications for himself and his partner and also prescribed in his partner’s name for personal use. While there was no suggestion the medication prescribed was inappropriate or in excessive quantities, the Tribunal found that the doctor acted contrary to the Code. The doctor was reprimanded, fined and made subject to conditions prohibiting prescribing for self and family with an audit to monitor compliance.
As these cases demonstrate, suspension and/or de-registration of a doctor are sanctions which are generally considered where the self-prescribing is serious and where there might be health impairment issues or clinical safety concerns. However, even comparatively less serious incidences of self-prescribing can mean that a doctor is caught up in a disciplinary process for a substantial period of time, with potentially onerous conditions and negative publicity. The impact that this can have on a doctor’s overall well-being and practice can be significant and is something that MIGA’s Legal Services team witness first-hand.
In the latest amendments, the Medical Board’s Code stipulates that good medical practice involves:
- Having a general practitioner
- Seeking independent, objective advice when you need medical care, and being aware of the risks of self-diagnosis and self-treatment
- Seeking help if you are suffering stress, burnout, anxiety or depression
- Making sure that you are immunised against relevant communicable diseases
- Not self-prescribing
- Recognising the impact of fatigue on your health and your ability to care for patients, and endeavouring to work safe hours wherever possible
- Being aware of the doctors’ health program in your State or Territory which provides confidential advice and support through the doctors’ health advisory and referral services
- If you know or suspect that you have a health condition or impairment that could adversely affect your judgement, performance or your patient’s health:
— not relying on your own assessment of the risk you pose to patients
— consulting your doctor about whether, and in what ways, you may need to modify your practice, and following the doctor’s advice.
MIGA’s Legal Services team receives numerous queries concerning legal and ethical issues around prescribing for self, family and colleagues as well as mandatory reporting obligations in this context6. If you are uncertain about your prescribing and reporting obligations, please contact our expert legal team.
Regulation 17, Drugs, Poisons and Controlled Substances Regulations 2017 (Vic)
Various preclusions on self-prescribing exist in South Australia, Queensland, Western Australia and Tasmania, and in the ACT this extends to both Schedule 8 and a range of restricted medication, including anabolic steroids, benzodiazepines, and Schedule 4D medications
Clause 11.2.5 Good Medical Practice: A Code of Conduct for Doctors in Australia (October 2020).
Medical Board of Australia v GMZ  VCAT 902
Health Care Complaints Commission v Geary  NSWCATOD 15
Medical Board of Australia and Lee  VR 123
See MIGA’s article “Treating practitioner mandatory reporting reforms beginning soon’ for new treating practitioner mandatory reporting obligations now in place (www.migabulletin.com.au/article/treating-practitioner-mandatory-reporting-reforms-beginning-soon) and Ahpra / National Boards guidelines and resources on these new obligations – www.ahpra.gov.au/Notifications/mandatorynotifications.aspx