Case descriptions
Agreement entered into between Director and person under review
Dr N
General practitioner
Victoria
Medicare Australia referred Dr N because of concerns that his prescribing under the PBS, in particular drugs of dependence may have been inappropriate.
Dr N, an elderly general practitioner, had been before PSR for similar concerns in 2003. That matter was resolved by a negotiated agreement that was ratified by the Determining Authority in 2004.
Dr N was in the 83rd percentile for prescribing drugs of dependence. Most of his patients were drug dependent, had chronic pain and were involved with multiple substance abuses.
From Dr N’s records it was apparent that he did not monitor the quantities of prescriptions or try to reduce the dosages of benzodiazepines. There was no evidence of a physical examination taking place before prescribing of the drugs, nor were there any warnings about the addictive nature of the drugs being prescribed. In addition Dr N prescribed a large number of many different medications to his patients without regard to the dangers of polypharmacy. Dr N’s behaviour was clearly not acceptable and it became apparent that Dr N might have submitted to patient demand for drugs.
In the meeting with Dr N, he stated that many patients were referred to him with existing substance abuse problems and were referred with multiple prescriptions for drugs of dependence. He explained that he experienced pressure from patients to prescribe the drugs in question. The Director advised that he considered Dr N’s conduct unacceptable and inappropriate.
Given the level of inappropriate conduct, the associated costs of establishing a committee, and the public interest in resolving this matter quickly, the Director entered into a negotiated agreement with Dr N. This agreement effectively retired Dr N from practice.
Dr N agreed to be reprimanded by the Director, his Part V11 authority to be suspended for three years and to be fully disqualified from provision of all MBS services for three years. As this agreement was Dr N’s second adverse finding under the PSR Scheme this action mandated referral to the Chairperson of the Medicare Participation Review Committees.
Given that Dr N’s prescribing had caused or was likely to cause a significant threat to the life or health of his patients, the Director referred him to the Medical Board of Victoria. The Medical Board advised that Dr N had entered into an agreement with them not to engage in any form of medical practice including but not limited to remunerated or unremunerated consultations or procedures, writing prescriptions and referrals and signing documents requiring the excise of knowledge and skills of a medical practitioner.