Case descriptions
Agreement entered into between Director and person under review
Dr M
General practitioner
Queensland
Medicare Australia was concerned that Dr M may have been inappropriately prescribing drugs of dependence. Dr M’s statistics indicated that his prescribing of benzodiazepine derivatives had increased when patient numbers had decreased.
The records examined in relation to Dr M’s prescribing under the PBS indicated his reliance on drugs to treat symptoms. Dr M provided multiple prescriptions with no evidence that patients had been advised of the drugs’ habituating properties and without apparent regard to the dangers of polypharmacy.
It appeared Dr M made little or no effort to reduce dosages of benzodiazepines or narcotics prescribed to his patients. His records revealed a lack of management planning, with little evidence of counselling for patients receiving long-term benzodiazepines and/or narcotics. The impression gained from the records was that Dr M might have allowed patients to dictate treatment.
In conjunction with the Director’s review of the medical records a meeting was arranged with Dr M to discuss the Director’s concerns. Dr M’s clinic is in a low socioeconomic area.
After the meeting Dr M made a written submission to the Director in which he advised that he had taken the Director’s comments very seriously and outlined the steps he had taken to reduce the number of patients he sees who are on Schedule 8 drugs. He had ceased prescribing Schedule 4 drugs to some patients and had weaned a number of patients off these drugs. Dr M acknowledged that he would benefit from further education with respect to prescribing drugs of potential dependence and outlined the educational sessions in his area he intended to undertake.
In view of Dr M’s submission a further meeting was arranged. At this meeting Dr M acknowledged the need to change his practice management and to make changes to his current work style. At this meeting the Director agreed to delay making his final decision to enable Dr M time to re-educate himself with respect to prescribing drugs of potential dependence and to address practice management issues.
The Director obtained Dr M’s current practice statistics from Medicare Australia.
These statistics showed a considerable decrease in the prescription of drugs of dependence. Dr M provided proof of the further education he had undertaken and advised that these courses had been beneficial to him and had improved his understanding of the rationale for prescribing narcotics.
Dr M stated that he had had time to reflect on his previous conduct and had made improvements to his practice management. He no longer runs a patient-driven practice and practises in a more responsible manner.
The Director was satisfied that Dr M had fulfilled the commitments detailed in his submission and considered the most appropriate action in resolving this matter was to enter into a negotiated agreement. Dr M agreed that he had practiced inappropriately during the review period in his prescribing under the PBS and was reprimanded by the Director.