A New Zealand doctor has been charged with professional misconduct after self-prescribing the prescription-only opioid painkiller, tramadol.
The decision was released in August this year over the matter that was heard by way of a defended hearing in August 2021.
The hearing spanned four days, over which the Health Practitioners Disciplinary Tribunal considered the charge laid by a Professional Conduct Committee.
The doctor, who first registered in 2017, had been at a course in Dunedin in 2019 when he decided to visit a pharmacy and self-prescribe, among two other medicines, tramadol for pain.
The pharmacist didn't dispense the tramadol.
A few days later, the doctor saw a GP for a separate matter after which a prescription was made that didn't include tramadol but the doctor altered the script to include the drug and went to a pharmacy to collect it.
But the pharmacist was suspicious and contacted the GP to verify the script.
The Medical Council’s Statement on Providing Care to Yourself and Those Close to You explains doctors should not prescribe for themselves in the “vast majority” of clinical situations.
Tramadol is one of the medications that doctors “must not” prescribe for themselves.
The doctor admitted that he did write and present the prescription for the opioid and should not have done so but argued he didn't know that altering it would attribute the GP as having written the script for tramadol.
When the pharmacist asked the doctor who wrote the tramadol prescription, he told her that the GP he saw did but later changed his story, telling the tribunal he wrote the tramadol prescription himself.
The pharmacist noted red flags in the doctor's account and needed to verify the script. Before leaving the pharmacy, the doctor changed his mind and said to the pharmacist he didn't need the tramadol.
The pharmacist and prescribing GP conversed the next morning and it was verified the opioid hadn't been prescribed by the GP.
The tribunal accepted the pharmacist's evidence as it was "clear and consistent". By comparison, the doctor wrote two letters to the Medical Council that demonstrated different versions of his account of presenting the prescription at the pharmacy.
The doctor's "repeated" and "premeditated" conduct was found to be negligent and amounted to malpractice. "It is also conduct that brings the medical profession into disrepute," the finding said.
The tribunal censured the doctor, placed conditions on the doctor’s practice for 18 months, fined the doctor $2,500 and ordered the doctor to pay 35% of the costs of and incidental to the hearing.
Aggravating factors included the clear breach of professional standards, repeated conduct, misleading in respect of the doctor’s interaction with the pharmacist and a lack of insight from the doctor.
"He did not appear to appreciate from his previous prescribing behaviour and his comments that whilst tramadol is on the middle step of the analgesic ladder, it has characteristics that have made it a drug of potential addiction and misuse," the finding said.
But in the doctor's favour, mitigating factors included he had no previous disciplinary history, he accepted that his actions in self-prescribing tramadol were a breach of the professional standards and "partially admitted wrongdoing".
"Patient safety was not compromised and there were no victims to the breach of professional standards and he is a "young doctor with his career ahead of him demonstrating a willingness for rehabilitation."
The doctor has attended an ethics course and reflected on his conduct, the finding said. There was also no evidence of any drug-seeking behaviour, only wanting tramadol for pain relief.
"The deception was not sophisticated or studied."
The tribunal granted name suppression to both the doctor and the pharmacist.
"Based on the medical and psychological evidence before the tribunal, we are satisfied that there are sufficiently compelling private interest factors in this case to justify overriding the principles of open justice."
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