Dr B faces an HDC investigation after he prescribes for himself and his partner – what was the outcome and the learnings of the case? By Dr Andrew Stacey, Medicolegal Consultant
Ms A, aged 26 years, had a medical history including depression, anxiety and difficulty sleeping.
Dr B was in a romantic relationship with Ms A for two years and lived with her for a year. During the course of their relationship he prescribed a number of medications including paracetamol and other forms of analgesia, ranitidine, zopiclone, tramadol and the oral contraceptive Ava 20.
Following the breakdown of their relationship Ms A complained to the HDC that Dr B had prescribed various medications to her (both in her name and also in the names of others, but for her use) and for himself. She said she attempted suicide by overdosing on medications prescribed by Dr B, and was admitted to hospital.
Dr B acknowledged to the HDC that he had prescribed various medications for Ms A during the course of their relationship, but denied prescribing for her under other people’s names. Dr B said that he always encouraged Ms A to seek help from her own doctor and there were many times when he took time off work to drive her to appointments to ensure that she got the help that she needed. He had prescribed to her because she was a student at the time she was living with him and had financial burdens. He felt compelled by Ms A to write prescriptions for her for simple medications to help her alleviate her financial stress, including the cost of seeing her GP.
Dr B told the HDC that regrettably he did not keep any record of the frequency of dosages prescribed. He said that to the best of his recollection he had prescribed medications at the commonly accepted therapeutic dose and frequency. The ranitidine, zopiclone and tramadol had each been prescribed on two to three occasions at therapeutic doses for a two-week period.
Dr B told the HDC that Ms A placed pressure on their flatmates, who were also doctors, asking for “medical consultations” on a number of occasions. One flatmate provided a statement to the HDC: “[Ms A] would frequently ask me for my medical opinion on various health complaints and request I examine her. Another flatmate and I told her on several occasions that she should see her own GP for this and that we are not in a position to be her doctor given we were her flatmates.”
Ms A disputed the suggestion that she pressured her flatmates into prescribing for her or examining her medically.
Dr B acknowledged that prescribing for Ms A was an error of judgement. “While it may have been misguided, my only intention was to help her … My actions, although misguided, were never aimed at taking advantage, manipulating, or harming [Ms A].”Dr B stated: “I will never again prescribe medication to a person with whom I am in a relationship or close to…It is with regret, disappointment (in me) and shame that I have had to learn this lesson. To say that this matter has been a learning process for me is an understatement.”
The HDC view
The HDC was critical of both the prescribing and the lack of documentation. While the HDC was unable to conclude whether medications had been prescribed in others’ names for Ms A’s benefit, Dr B had acknowledged prescribing to her. The HDC was concerned that Dr B had acknowledged that Ms A had psychological issues but still prescribed her zopiclone (a psychoactive medication with some potential for dependence), as well as prescribing a weak opioid to her in the form of tramadol. Further concerns surrounded the prescribing on a number of occasions and for medications where it would be difficult to justify there was any urgency in access. Concerns were also raised about the lack of documentation of the prescribing, and failure to communicate this to Ms A’s GP.
Outcome of case
The HDC concluded by declaring Dr B to be in breach of the Code (Right 4(2)) and recommended that the Medical Council consider whether a review of Dr B’s competence was warranted.
The matter was considered by the Medical Council. A Professional Conduct Committee (PCC) was convened and was of the opinion that Dr B’s prescribing breached professional standards and obligations, and created a risk of harm to himself and the individuals he prescribed to.
The Council accepted the PCC’s recommendation and advice that Dr B now understood the gravity of his mistakes, was able to identify the causal factors that had led him to prescribing for himself and others, and had taken steps to prevent this occurring again. The Council resolved to guide Dr B by way of an educational letter cautioning him for his conduct and warning him about the dangers of self-prescribing and prescribing to those close to him.
In addition a number of conditions were imposed on Dr B’s practice; that for a period of two years, Dr B’s prescribing information would be regularly audited by the Council to monitor any prescribing to himself, family members or those close to him. Dr B was required to supply the names and dates of birth of his immediate family members and those who he had a personal or close relationship with, and to meet any expenses associated with the compliance and monitoring of this condition.
Doctors should ensure that they are familiar with the Council’s statement on providing care to yourself and those close to you.
The guidelines state that wherever possible, you should avoid treating people with whom you have a personal relationship rather than a professional relationship, as providing care to yourself or those close to you may be inappropriate due to discontinuity of care and the lack of clinical objectivity. The Council expects that you will not provide care to yourself or those close to you in the vast majority of clinical situations.
In relation to the prescribing of drugs of dependence and psychotropic medications such as zopiclone and tramadol, the guidelines are even clearer in stating that in these specific circumstances practitioners must not treat themselves, family or those close to them.