Civil and Administrative Tribunal New South Wales Medium Neutral Citation: Health Care Complaints Commission v Dr Jamieson [2014] NSWCATOD 56 Hearing dates: 1 and 2 April 2014 Decision date: 21 May 2014 Jurisdiction: Occupational Division Before: Wright J, President Dr Giuffrida, Professional Member Dr Ilbery, Professional Member A Gray, General Member Decision: 1The respondent, Dr Jamieson, be and hereby is reprimanded. 2The conditions set out below in the schedule headed "Health Care Complaints Commission v Dr Jamieson - Conditions" (the Conditions) be imposed on the respondent's registration, on terms that the respondent may not make an application for review of this order in respect of: (a)conditions 1, 2, 3 or 4 in the Conditions before the expiration of 5 years from the date of these orders; and (b)condition 8 in the Conditions before the expiration of 3 years from the date of these orders. 3The Conditions may be altered, varied or removed at the discretion of the Medical Council of New South Wales and the Medical Council is the appropriate review body for the purposes of Division 8 of the Health Practitioner Regulation National Law (NSW). 4Sections 125 to 127 of the Health Practitioner Regulation National Law are to apply whilst the respondent's principal place of practice is anywhere in Australia other than in New South Wales, so that a review of the Conditions can be conducted by the Medical Board of Australia. 5The respondent pay the complainant's costs. Catchwords: ADMINISTRATIVE LAW - Civil and Administrative Tribunal (NSW) - medical law - health practitioner - professional misconduct - unsatisfactory professional conduct Legislation Cited: Civil and Administrative Tribunal Act 2013 (NSW) Civil and Administrative Tribunal Rules 2014 Health Practitioner Regulation (New South Wales) Regulation 2010 Health Practitioner Regulation National Law (NSW) Medical Practice Regulation 2003 (NSW) Medical Practice Regulation 2008 (NSW) Cases Cited: Briginshaw v Briginshaw (1938) 60 CLR 336 Health Care Complaints Commission v Dr Della Bruna [2014] NSWCATOD 31 Director General, Department of Ageing, Disability and Home Care v Lambert (2009) 74 NSWLR 523 Health Care Complaints Commission v Gorondy-Novak [2011] NSWMT 3 Health Care Complaints Commission v Karalasingham [2007] NSWCA 267 Health Care Complaints Commission v King [2013] NSWMT 9 Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 Latoudis v Casey (1990) 170 CLR 534 Lee v Health Care Complaints Commission [2012] NSWCA 80 Ohn v Walton (1995) 36 NSWLR 77 Prakash v Health Care Complaints Commission [2006] NSWCA 153 Category: Principal judgment Parties: Health Care Complaints Commission (Complainant) Dr Colin Jamieson (Respondent) Representation: Counsel C P O'Donnell (Complainant) M Lynch (Respondent) Health Care Complaints Commission (Complainant) Avant Law Pty Ltd (Respondent) File Number(s): 1420055 Publication restriction: The Tribunal made the following orders under cl 7 of Schedule 5D of the National Law and for the purposes of Rule 42(3)(c) of the Civil and Administrative Tribunal Rules 2014: 1. The names and addresses of, and any other personal information relating to or tending to identify, any patients of Dr Jamieson not be disclosed or published but the 10 patients referred to in the Notice of Complaint dated 20 March 2013 as patients A to J may be referred to using those designations. 2. Any document on the Tribunal files containing any of the information referred to in the preceding order not be disclosed, published or made available for inspection by a person other than a party to the proceedings, a member of the Tribunal or a staff member of the Tribunal. reasons for decision 1The Tribunal has before it for inquiry 2 complaints made by the complainant, the Health Care Complaints Commission (the HCCC), against the respondent, Dr Colin Jamieson, a medical practitioner registered under the Health Practitioner Regulation National Law (NSW) (the National Law). These complaints are set out in the Notice of Complaint dated 20 March 2013. 2The allegations the subject of the 2 complaints can be summarised as follows: Complaint 1: Dr Jamieson was guilty of unsatisfactory professional conduct (under s 139B of the National Law) in the treatment of 10 patients, designated Patients A to J, in that he: (c)Engaged in conduct that demonstrated that the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of medicine was significantly below the standard reasonably required of a practitioner of an equivalent level of training or experience; (d)Contravened provisions of the Medical Practice Regulation 2003, the Medical Practice Regulation 2008 and the Health Practitioner Regulation (New South Wales) Regulation 2010; and/or (e)Engaged in improper or unethical conduct relating to the practice or purported practice of medicine. Complaint 2: Dr Jamieson was guilty of professional misconduct (under s 139E of the National Law) arising out of the nature and/or repeated occurrences of unsatisfactory professional conduct as alleged in Complaint 1. 3Dr Jamieson's position was that he admitted each of the complaints, subject to certain inaccuracies being clarified in relation to Patient B. The HCCC accepted that there had been an inaccuracy in relation to that patient and did not press the allegations in paragraph 15 of the particulars to Complaint 1. The Tribunal and the parties then proceeded on the basis as if the Notice of Complaint had been amended by deleting paragraph 15. 4The 2 complaints or grounds of complaint in the Notice of Complaint as amended fall within s 144(b) of the National Law since they consist of complaints that the practitioner has been guilty of unsatisfactory professional conduct and that the practitioner has been guilty of professional misconduct. 5Paragraph 15 of the Notice of Complaint having been abandoned, Dr Jamieson tendered without objection a document which was signed by him, dated 1 April 2014 and which stated: To the Presiding Judge Civil and Administrative Tribunal Pursuant to s 149 of the Health Practitioner Regulation National Law, I, Colin Jamieson, hereby admit the subject matter of the complaints against me by the Director of Proceedings dated 20 March 2013 as amended. 6In these circumstances, under s 149 of the National Law, the Tribunal may exercise any power conferred on it by ss 149 to 149D of the National Law. Accordingly, it was neither necessary nor appropriate to conduct the proceedings in 2 stages and the hearing on 1 and 2 April 2014 focused upon what protective orders should be made under those sections in the circumstances. For this purpose the Tribunal considered the documentary evidence in relation to the complaints, heard oral evidence from Dr Jamieson and from Dr Read, a psychiatrist who had been responsible for supervising Dr Jamieson and who had provided a report which was tendered without objection by Dr Jamieson, and received oral and written submissions from the parties. 7In carrying out its functions in this matter and to the extent relevant, the Tribunal has taken into account the seriousness of the allegations made by the HCCC and the gravity of the consequences of the protective orders the Tribunal might make. The matter has been approached having regard to the principles in Briginshaw v Briginshaw (1938) 60 CLR 336 at 361 and 362. Transitional Matters 8These proceedings were originally commenced in the Medical Tribunal of New South Wales but had not been heard by the Medical Tribunal as at 1 January 2014. 9On 1 January 2014, the Civil and Administrative Tribunal of New South Wales (NCAT) was established and on its establishment the Medical Tribunal was abolished: see Civil and Administrative Tribunal Act 2013 (the Act), s 7 and cl 3 of Schedule 1. 10By operation of cl 7(1) of Schedule 1 to the Act, these proceedings are taken to have been duly commenced in NCAT and may be heard and determined by NCAT. For this purpose and under cl 7(3), NCAT has and may exercise all the functions which the Medical Tribunal previously had and the applicable legislation is that which would have applied if the NCAT legislation had not been enacted. Consequently, the National Law as in force at 31 December 2013 and the legislation applicable to the conduct the subject of the complaints at the time the conduct occurred apply in respect of these proceedings. Non-publication Orders 11As the documentary material before the Tribunal contained the names and other personal information relating to patients of Dr Jamieson which were, and should be treated as, confidential, the Tribunal made the following orders under cl 7 of Schedule 5D of the National Law and for the purposes of Rule 42(3)(c) of the Civil and Administrative Tribunal Rules 2014: (1)The names and addresses of, and any other personal information relating to or tending to identify, any patients of Dr Jamieson not be disclosed or published but the 10 patients referred to in the Notice of Complaint dated 20 March 2013 as patients A to J may be referred to using those designations. (2)Any document on the Tribunal files containing any of the information referred to in the preceding order not be disclosed, published or made available for inspection by a person other than a party to the proceedings, a member of the Tribunal or a staff member of the Tribunal. Background 12Dr Jamieson graduated from the University of Sydney as a Bachelor of Medicine and a Bachelor of Surgery in 1978 and was first granted general registration as a medical practitioner in New South Wales on 6 October 1978 (according to the Section 244A Evidentiary Certificate from the Medical Council of New South Wales dated 19 March 2014) or 6 October 1979 (according to the Confirmation of Registration Status dated 26 March 2014 issued by the Australian Health Practitioner Regulation Authority). He remains registered until 30 September 2014. 13Between about 1978 and 1981, Dr Jamieson was an Intern and Resident Medical Officer at St George Hospital at Kogarah, NSW. He spent six months in 1982 in the United Kingdom working as a Senior House Officer at Essex County Hospital and obtained a Diploma of Obstetrics and Gynaecology before returning to Australia to take up a position as a Family Medicine Program Trainee at Mudgee in 1983. In July 1983, he joined the Russell Street Medical Practice in Bathurst and became a partner in that practice in 1984. He has remained a partner in the Russell Street Medical Practice since that time. In Bathurst, Dr Jamieson soon became a GP Visiting Medical Officer (VMO) at the local hospital where all patients, except those going into the Intensive Care Unit or the Cardiac Care Unit, were admitted under a GP VMO. When he arrived in Bathurst there was one resident psychiatrist who retired soon after Dr Jamieson arrived and one visiting psychiatrist who slowly reduced his service. As Dr Jamieson recalled it, for most of the 1990s there were several visiting psychiatrists who offered a limited service. Generally, these psychiatrists would do sessions with the mental health team and his only means of referral was through the mental health team. 14In 1983, Dr Jamieson was asked to conduct GP clinics in X Wing at Bathurst gaol. At that time, X Wing only housed female inmates. In some cases, when the women he treated were released, Dr Jamieson became their GP. Some of these patients had addiction and abuse issues including heroin addiction. As Methadone was beginning to be used in the treatment for these women, Dr Jamieson became an authorised Methadone prescriber in 1989. The number of patients for whom Dr Jamieson prescribed Methadone grew and may have numbered in the order of 100 at the maximum. When Methadone was introduced in the Prison Medical Service in around 1992, Dr Jamieson started prescribing Methadone there as well. At about this time, Dr Jamieson started attending the annual Methadone conferences that subsequently evolved into the Australian Professional Society for Alcohol and other Drugs (APSAD) conferences. 15During the period from about 1990 to 2003, Dr Jamieson apparently formed the view that the ideal was to adopt an integrated approach when dealing with a patient who had both mental health and addiction issues. Given what he described as the shortage of psychiatrists and addiction specialists around Bathurst, he relied on himself to deal with his patients' problems of this nature. 16Another significant development in Dr Jamieson's practice occurred around 2005 with his development of a program which he called "The Wonderment Programme". He described it as an amalgamation of concepts such as cognitive behaviour therapy (CBT), mindfulness and psychodynamic techniques and, according to his oral evidence, psychoanalytical techniques. He says that his aim was to bring together ideas regarding how to interact with thoughts and feelings and to use it as a tool in his counselling sessions with patients. Dr Jamieson acknowledged that this program was not peer-reviewed and its use was inappropriate. It was also the case that he was not relevantly qualified in psychiatry or psychology. 17During the time he was prescribing Methadone, Dr Jamieson saw the purpose and benefit of doing so as being to "chemically stabilise" a patient in order for the patient to function and, in Dr Jamieson's words, "hopefully engage in non-medicated ways of interacting with their thoughts and feelings". He formed the view that it was better from the patient's perspective to be dependent on a prescribed drug than an illegal drug. He believed that "a lot of the time, drug dependent people were 'self-medicating' with illicit drugs to achieve 'chemical stability' and that they were using drugs to function and not for intoxication". This belief led him to consider that there was an artificial separation of drugs into legal and illegal and prescribed and non-prescribed drugs. 18Dr Jamieson applied the concept of "chemical stability" in his approach to his prescribing with respect to each of patients A to J. His clinical rationale was aimed at creating inner stability so the individual could use counselling techniques to deal with their emotional reactions and develop skills to aid in coping. 19When prescribing a Schedule 4D or Schedule 8 drug, he would explain to the patient that his purpose in doing so was to help them achieve "chemical stability" not "intoxication" but he acknowledged that he had no direct control over how the patient would use the drugs he prescribed once they left the surgery. He did not control adequately the dosage and quantum of the drugs as he should have done. 20The conduct the subject of the 2 complaints against Dr Jamieson related to his prescribing the drugs, including Schedule 4D and Schedule 8 drugs, for patients A to J during the periods as set out below: Patient Period Schedule Drugs A July 2005 to December 2010 4, 4D, 8 B February 2008 to January 2009 4, 4D C September 2005 to December 2010 4, 4D, 8 (incl Methadone) D June 2010 to December 2010 4,4D, 8 E October 2004 to January 2011 4, 4D, 8 F March 2007 to December 2010 4D, 8 G December 2003 to January 2011 4D, 8 (incl Methadone) H January 2004 to December 2010 4, 4D, 8 (incl Methadone) I May 2002 to January 2011 4, 4D, 8 J January 2004 to December 2010 4, 4D, 8 (incl Methadone) 21In so far as the prescriptions appeared to have been written after 16 December 2010, it was admitted that these prescriptions had been written by Dr Jamieson prior to that date but had been post-dated. This conduct also formed part of the 2 complaints. Medical Council Processes 22Following receipt of two letters of complaint in 2009, a performance interview was conducted by the Medical Council of New South Wales in August 2009. A Performance Assessment in November 2009 found Dr Jamieson's professional performance to be unsatisfactory and the Medical Council referred the matter to a Performance Review Panel. In June 2010 the Panel found Dr Jamieson's performance to be unsatisfactory. Effective from the end of June 2010 conditions were imposed on his registration including that he undertake a nominated 3 day training course in CBT, pursue further training in psychopharmacology as approved by the Medical Council, have level 3 supervision with a GP experienced in addiction medicine and have level 3 supervision with a psychiatrist experienced in addiction medicine. These conditions were slightly amended or satisfied in the period up to 16 December 2010. 23On 11 and 12 November 2010, the Medical Council also received two notifications concerning Dr Jamieson's prescribing. Section 150 proceedings were convened on 16 December 2010. As a consequence, additional conditions were imposed on Dr Jamieson's registration effective from 16 December 2010 including, most significantly, a tightening of the GP supervision to level 2 and prohibitions on his possessing, prescribing, supplying, dispensing or administering any Schedule 8 drugs and on his prescribing Schedule 4D drugs or derivatives. 24By letter dated 20 December 2010, the Medical Council formally referred the matter to the HCCC for investigation. The HCCC's Notice of Complaint 25The 2 complaints before the Tribunal are set out in the Notice of Complaint, dated 20 March 2013 and filed by the HCCC, noting that the Notice of Complaint has been effectively amended to remove paragraph 15. The allegations the subject of these Complaints 1 and 2 have been summarised above. Complaints Established 26The HCCC put before the Tribunal a substantial number of documents which were relied upon as establishing the subject matter of the 2 complaints in the Notice of Complaint as amended. Apart from clarifying certain aspects of the allegations in paragraph 32 of the Notice of Complaint in relation to patient E, none of the facts and conclusions alleged in the Notice of Complaint or the material upon which they were based was challenged by Dr Jamieson in any way. The documents included most relevantly: (1)handwritten and computerised clinical records from the Russell Street Medical Practice, prescription and pharmacy records and Medicare patient history reports, for patients A to J for the relevant periods and statements relating to the compiling of this material; (2)the expert reports of Dr Seidler of 16 October 2011, 3 January 2013 and 14 January 2013; (3)correspondence from the HCCC to, and responses by, Dr Jamieson in the period from 14 April 2009 to 27 July 2012; and (4)guidelines, policies and articles relating to the use and prescription of benzodiazepines, opioids, methadone and other drugs of addiction and relevant extracts from the Monthly Index of Medical Specialties, MIMS, 2006, 2007, 2008, 2010 and 2011 27As already noted, under s 149 of the National Law, Dr Jamieson has formally admitted the subject matter of Complaints 1 and 2 made against him in the Notice of Complaint dated 20 March 2013 as amended. In addition Dr Jamieson put before the Tribunal a statement by him dated 12 December 2013 which he affirmed was true and correct. Dr Jamieson was also examined in chief and cross examined. The Tribunal accepts that Dr Jamieson was a truthful witness who was trying to give an accurate account of what had occurred and why it had occurred, as he perceived it. Although Dr Jamieson did provide some clarification of the circumstances relating to the allegations in paragraph 32 of the Notice of Complaint concerning patient E, in his oral evidence he did not resile from his admissions in any way. 28In his statement, Dr Jamieson stated: 14. Having now read in detail all the material served by the Commission, I admit that my management and treatment of the 10 patients referred to in the Complaint was significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience. 15. In particular, I accept Dr Seidler's criticisms regarding my management of the 10 patients [subject to correcting an inaccuracy which was the subject of paragraph 15 of the Notice of Complaint which was not pressed by the HCCC and clarifying the circumstances relating to paragraph 32]. ... I also accept that my approach to the prescribing, treatment and management of these patients was inconsistent with the [guidelines, policies and articles referred to above] and the additional material extracted from the Monthly Index of Medical Specialties (MIMS) re relation to my prescribing. 16. In making these admissions, I acknowledge that I am potentially exposing myself to suspension or deregistration from medical practice. Complaint One 17. With respect of Complaint One, sub-particulars (i), (ii) and (iii) of the Complaint, I admit that my conduct in the manner alleged amounts to unsatisfactory professional conduct in view of my obligations arising under the Poisons and Therapeutic Goods Act, 1962 and the Poisons and Therapeutic Goods Regulations, 2002 and 2008. 18. In all the circumstances, I admit that my failure to keep adequate records in the way alleged amounts to unsatisfactory professional conduct in view of my obligations arising under the former Medical Practice Regulations 2003, Schedule 2 and Medical Practice Regulations 2008, Schedule I and the Health Practitioner Regulation National Law Regulation (NSW) 2010, Schedule 2. Complaint Two 19. With respect to Complaint Two, sub-particulars (i) and (ii), I admit that my conduct in the manner alleged amounts to professional misconduct. 29Given the admissions made by Dr Jamieson, the Tribunal has not set out in detail in these reasons all the evidence relied upon. In particular, whilst the Tribunal has accepted and taken into account the opinions and conclusions of Dr Seidler in his 3 reports referred to above these have not been set out in full. The Tribunal notes that, except in relation to the circumstances covered by paragraph 15 of the Notice of Complaint where what is now accepted to have been mistaken information was provided to Dr Seidler and formed the basis of his opinion in that regard, these opinions and conclusions were accepted and not challenged by Dr Jamieson. The Tribunal accepts Dr Seidler's evidence except in relation to allegations in paragraph 15 of the Notice of Complaint. 30Having regard to the material before the Tribunal referred to above, the Tribunal finds that the admissions made by Dr Jamieson 1 and 2 were properly made. The Tribunal is satisfied to the requisite standard that the allegations made in the Notice of Complaint dated 20 March 2013 as amended have been made out and, in particular, makes findings in respect of the treatment of patients A to J as set out in the paragraphs which follow. These findings generally reflect the wording of the allegations in the Notice of Complaint since both Dr Jamieson's formal admission under s 149(b) and his admissions in paragraphs 17, 18 and 19 of his statement of 12 December 2013 admit those allegations. Patient A 31Dr Jamieson prescribed morphine sulphate ampoules to Patient A between 22 May 2007 and 15 December 2010 in 30mg doses and on 2 occasions in 15mg doses on 22 June and 16 July 2007: (1)Without exercising responsible medical judgement as to whether it was appropriate to issue such prescriptions; (2)In quantities in excess of recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the Poisons and Therapeutic Goods Regulation 2008 (PTG Regulation); (3)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; (4)When the practitioner knew or ought to have known that Patient A was at risk of becoming dependant on the drug; (5)When the practitioner knew or ought to have known that Patient A was likely to abuse the drug; (6)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulations; (7)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (8)Over the telephone without consulting Patient A in person after she relocated to Ballina between approximately February 2009 and May 2009 and relocated to Coffs Harbour between approximately November 2009 and December 2010; (9)Without referring Patient A to an appropriate specialist for assessment, management or advice; and/or (10)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the Poisons and Therapeutic Goods Act 1966 (PTG Act). 32Dr Jamieson prescribed morphine tablets (kapanol) to Patient A between 15 August 2005 and 31 December 2007 in 10mg doses with an additional undated occasion recorded in the patient notes: (1)Without exercising responsible medical judgement as to whether it was appropriate to issue such prescriptions; (2)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (3)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (4)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; (5)When the practitioner knew or ought to have known that Patient A was at risk of becoming dependant on the drug; (6)When such prescribing was contra-indicated given Patient A's Post Traumatic Stress Disorder (PTSD) and migraines; (7)In an inappropriate combination with other drugs; and/or (8)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act. 33Dr Jamieson prescribed codeine phosphate (codeine) to Patient A between 16 July 2005 and 31 December 2007 in 30mg doses: (1)Without exercising responsible medical judgement as to whether it was appropriate to issue such prescriptions; (2)In an inappropriate combination with other drugs; (3)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulations; (4)When such prescribing was contra-indicated given that the practitioner knew or ought to have known that Patient A was also taking other narcotics and benzodiazepines; (5)When the practitioner knew or ought to have known that Patient A was at risk of becoming dependant on the drug and/or likely to abuse the drug; (6)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act; (7)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (8)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (9)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 34Dr Jamieson prescribed xanax (alprazolam) to Patient A between15 August 2005 and 27 December 2007 in 1mg or 2 mg doses: (1)Without exercising responsible medical judgement as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulations; (3)When such prescribing was contra-indicated given that the practitioner knew or ought to have known that Patient A was also taking maxalon, morphine, promethazine, valium, tramal, codeine phosphate, pethidine ampoules and kapanol and/or suffered from PTSD; (4)In an inappropriate combination with other drugs; (5)When the practitioner knew or ought to have known that Patient A was at risk of becoming dependant on the drug and/or likely to abuse the drug; (6)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (7)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (8)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; and/or (9)Over the telephone without consulting Patient A in person after she relocated to Ballina between approximately March 2009 and December 2010. 35Dr Jamieson prescribed valium (diazepam) to Patient A between 16 December 2005 and 27 December 2007 in 5mg doses and separately on 7 June 2007 when Dr Jamieson supplied and administered 10mg at his surgery: (1)Without exercising responsible medical judgement as to whether it was appropriate to issue such prescriptions; (2)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (3)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (4)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; (5)When such prescribing was contra-indicated given that the practitioner knew or ought to have known that Patient A was also taking other benzodiazepines; (6)When the practitioner knew or ought to have known that Patient A was at risk of becoming dependant on the drug and/or likely to abuse the drug; and/or (7)In an inappropriate combination with other drugs. 36Dr Jamieson prescribed endone to Patient A between 11 November 2008 and 17 September 2010 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act; (3)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulation; (4)In an inappropriate combination with other drugs; (5)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (6)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (7)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; and/or (8)When the practitioner knew or ought to have known that Patient A was at risk of becoming dependent on the drug and/or was likely to abuse the drug. 37Dr Jamieson failed to keep proper medical records for Patient A in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); Medical Practice Regulation 2008 Schedule 1 (repealed) and the Health Practitioner Regulation National Law Regulation (NSW) 2010 Schedule 2 in that: (1)He failed to record sufficient particulars of any medication prescribed to Patient A; (2)The records did not contain an appropriate level of detail given Patient A's case and the medical practice concerned; and/or (3)The records did not include sufficient information concerning Patient A's case to allow another medical practitioner to continue management of Patient A's case. Patient B 38Dr Jamieson prescribed temazepam to Patient B between 18 February 2008 and 18 August 2008 in 10mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulation; (3)When such prescribing was contra-indicated given that Patient B was 16 years old; and/or the practitioner had not sought psychiatric opinion; (4)When the practitioner knew or ought to have known that Patient B was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (5)In an inappropriate combination with other drugs; (6)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (7)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (8)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 39Dr Jamieson prescribed alprazolam to Patient B twice on 19 September 2008 in 2mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)When such prescribing was contra-indicated given that Patient B was taking other psychotropic medication including chlorpromazine, olanzapine and paroxetine; (3)In an inappropriate combination with other drugs; (4)When the practitioner knew or ought to have known that Patient B was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (5)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (6)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (7)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 40Dr Jamieson prescribed nitrazepam to Patient B between 29 September 2008 and 12 January 2009 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulation; (3)When such prescribing was contra-indicated given that Patient B was 16 years old and/or was not being supervised by a child psychiatrist; (4)In an inappropriate combination with other drugs; (5)When the practitioner knew or ought to have known that Patient B was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (6)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (7)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (8)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 41Dr Jamieson prescribed diazepam to Patient B between 28 October 2008 and 12 January 2009 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulation; (3)When such prescribing was contra-indicated given that Patient B was 16 years old and was not being supervised by a child psychiatrist; (4)In an inappropriate combination with other drugs; (5)When the practitioner knew or ought to have known that Patient B was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (6)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (7)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (8)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 42 Dr Jamieson prescribed chlorpromazine to Patient B between 13 October 2008 and 20 December 2008 in 100mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulation; (3)When such prescribing was contra-indicated given that Patient B was 16 years old and was not being supervised by a child psychiatrist; (4)When the practitioner knew or ought to have known that Patient B was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (5)In an inappropriate combination with other drugs; (6)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (7)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (8)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 43Dr Jamieson prescribed olanzapine to Patient B between 21 February 2008 and 20 December 2008 in 10mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate contrary to clause 79 of the PTG Regulation; (3)When such prescribing was contra-indicated given that Patient B was 16 years old and was not being supervised by a child psychiatrist; (4)In an inappropriate combination with other drugs; (5)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (6)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (7)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 44Dr Jamieson prescribed paroxetine to Patient B between 10 April 2008 and 20 December 2008 in 20mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)When such prescribing was contra-indicated given that Patient B was 16 years old and was not being supervised by a child psychiatrist; (3)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (4)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (5)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 45Dr Jamieson failed to refer Patient B for an urgent psychiatric or psychological assessment despite two overdoses, mood swings, aggression, irritability sleep and mood disturbances. 46Dr Jamieson prescribed temazepam, alprazolam, nitrazepam, diazepam, chlorpromazine, olanzapine and paroxetine to Patient B between 18 February 2008 and 12 January 2009, in circumstances where the practitioner was aware that Patient A was providing Patient B with some of her medication on a regular basis. 47Dr Jamieson failed to keep proper medical records for Patient B in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); and Medical Practice Regulation 2008 Schedule 1 (repealed) in that: (1)He failed to record sufficient particulars of any clinical opinion reached; (2)The records did not contain an appropriate level of detail given Patient B's case and the medical practice concerned; and/or (3)The records did not include sufficient information concerning Patient B's case to allow another medical practitioner to continue management of Patient B's case. Patient C 48Dr Jamieson prescribed oxazepam (serapax) to Patient C between 12 September 2005 and 6 December 2010 in 30mg doses : (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)In an inappropriate combination with other drugs; (3)For a purpose that does not accord with recognised therapeutic standards; (4)When the practitioner knew or ought to have known that Patient C was or was at risk of becoming dependent on the drug and/or abusing the drug; (5)When such prescribing was contraindicated as it was known to the practitioner that Patient C was on the methadone program and/or was taking another benzodiazepine; (6)When Bloomfield Psychiatric Hospital recommended that no benzodiazepines be prescribed to Patient C following discharge on 18 September 2000 due to Patient C's addictive personality; (7)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (8)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (9)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 49The practitioner prescribed alprazolam (xanax) to Patient C 29 January 2007 and 27 September 2010 in 2mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)In an inappropriate combination with other drugs; (3)For a purpose that does not accord with recognised therapeutic standards; (4)When the practitioner knew or ought to have known that Patient C was or was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (5)When such prescribing was contraindicated as it was known to the practitioner that Patient C was on the methadone program and/or that Patient C was taking another benzodiazepine; (6)When Bloomfield Psychiatric Hospital recommended no benzodiazepines for Patient C following discharge on 18 September 2000 due to Patient C's addictive personality; (7)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (8)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (9)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 50 The practitioner failed to formulate a mental health care plan for Patient C. 51The practitioner failed to refer Patient C for detoxification from benzodiazepines. 52The practitioner failed to keep proper medical records for Patient C in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); Medical Practice Regulation 2008 Schedule 1 (repealed) and the Health Practitioner Regulation National Law Regulation (NSW) 2010 Schedule 2 in that: (1)He failed to record sufficient particulars of any clinical opinion reached; (2)He failed to record any plan of treatment; (3)The records did not contain an appropriate level of detail given Patient C's case and the medical practice concerned; and/or (4)The records did not include sufficient information concerning Patient C's case to allow another medical practitioner to continue management of Patient C's case. Patient D 53Dr Jamieson prescribed endone (oxycodone hydrochloride) to Patient D between 3 August 2008 and 6 December 2010 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate either: (a)Pre diagnosis of psoriatic arthritis; or (b)Post diagnosis of psoriatic arthritis; (3)In an inappropriate combination with other drugs; (4)When the practitioner knew or ought to have known that Patient D was or was at risk of becoming dependent on the drug and/or likely to abuse the drug; (5)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act; (6)When such prescribing was contra-indicated given that Patient D complained of chronic inflammatory knee pain and/or was diagnosed with psoriatic arthritis on 8 November 2010; (7)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (8)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (9)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 54The practitioner prescribed oxycontin (oxycodone hydrochloride) to Patient D between 8 November 2010 and 16 December 2010 in 20mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate either: (a)Pre diagnosis of psoriatic arthritis; or (b)Post diagnosis of psoriatic arthritis (3)In an inappropriate combination with other drugs; (4)When the practitioner knew or ought to have known that Patient D was or was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (5)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act; (6)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (7)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (8)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 55The practitioner prescribed temazepam to Patient D between 3 August 2010 and 16 December 2010 in 10mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)In an inappropriate combination with other drugs; (4)such prescribing was contra-indicated given that Patient D was taking opioid analgesics and codapane forte; (5)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (6)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (7)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 56The practitioner post-dated a prescription for temazepam for Patient D on 6 December 2010 for 16 December 2010 in contravention of clause 80 of the PTG Regulation 2008. 57The practitioner post-dated a prescription for oxycodone hydrochloride for Patient D on 6 December 2010 for 16 December 2010 in contravention of clause 80 of the PTG Regulation 2008. Patient E 58Dr Jamieson prescribed oxycodone hydrochloride to Patient E between 10 June 2009 and 12 January 2011 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)When the practitioner knew or ought to have known that Patient E was or was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (4)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (5)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (6)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; and/or (7)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act. 59Dr Jamieson post-dated a prescription for oxycodone hydrochloride for Patient E on 8 December 2010 for 12 January 2010 in breach of clause 80 of the PTG Regulation 2008. 60Dr Jamieson prescribed temazepam to Patient E between 28 February 2006 and 22 November 2011 in 10mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)When such prescribing was contraindicated as it was known to the practitioner that Patient E was epileptic; (3)When the practitioner knew or ought to have known that Patient E was or was at risk of becoming dependent on the drug; (4)When the practitioner knew or ought to have known that Patient E was or was at risk of abusing the drug; (5)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (6)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (7)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 61Dr Jamieson failed to adequately manage Patient E's hypothyroidism in that he: (1)Failed to review Patient E's pathology results of 25 August 2010; (2)Failed to order a follow up test within one month as requested by the pathologist. 62Dr Jamieson failed to keep proper medical records for Patient E in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); Medical Practice Regulation 2008 Schedule 1 (repealed) and the Health Practitioner Regulation National Law Regulation (NSW) 2010 Schedule 2 in that: (1)He failed to record sufficient particulars of any clinical opinion reached; (2)The records did not contain an appropriate level of detail given Patient E's case and the medical practice concerned; and/or (3)The records did not include sufficient information concerning Patient E's case to allow another medical practitioner to continue management of Patient E's case. Patient F 63Dr Jamieson prescribed oxycodone hydrochloride (endone) to Patient F on 17 December 2010 in 10mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act; (4)When the practitioner knew or ought to have known that Patient F was or was at risk of becoming dependent on the drug and/or likely to abuse the drug; (5)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (6)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (7)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; and/or (8)In an inappropriate combination with other drugs. 64Dr Jamieson post-dated a prescription for oxycodone hydrochloride for Patient F on 8 December 2010 for 17 December 2010 in breach of clause 80 of the PTG Regulation 2008; 65Dr Jamieson prescribed valium (diazepam) to Patient F between 7 March 2007 and 8 December 2010 in 5mg and 10mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (4)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (5)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; and/or (6)In an inappropriate combination with other drugs. 66Dr Jamieson post-dated a prescription for valium (diazepam) for Patient F on 8 December 2010 for 17 December 2010 in breach of clause 80 of the PTG Regulation 2008. 67Dr Jamieson failed to keep proper medical records for Patient F in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); Medical Practice Regulation 2008 Schedule 1 (repealed) and the Health Practitioner Regulation National Law Regulation (NSW) 2010 Schedule 2 in that: (1)He failed to record sufficient particulars of any clinical opinion reached; (2)The records did not contain an appropriate level of detail given Patient F's case and the medical practice concerned; and/or (3)The records did not include sufficient information concerning Patient F's case to allow another medical practitioner to continue management of Patient F's case. Patient G 68Dr Jamieson prescribed valium (diazepam) to Patient G between11 April 2005 and 10 January 2011 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)When the practitioner knew or ought to have known that Patient F was or was at risk of becoming dependent on the drug and/or likely to abuse the drug; (4)When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (5)When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient G was on the methadone program; (6)Without appropriate referral to a psychiatrist (7)In an inappropriate combination with other drugs; (8)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (9)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (10)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 69Dr Jamieson post-dated two prescription for valium (diazepam) for Patient G on 15 December 2010 for 17 December 2010 and 10 January 2011 in breach of clause 80 of the PTG Regulation 2008. 70The practitioner failed to keep proper medical records for Patient G in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); Medical Practice Regulation 2008 Schedule 1 (repealed) and the Health Practitioner Regulation National Law Regulation (NSW) 2010 Schedule 2 in that: (1)He failed to record sufficient particulars of any clinical opinion reached; (2)He failed to record any plan of treatment including either: (a)A mental health plan; and/or (b)A plan to overcome benzodiazepine dependence; (3)The records did not contain an appropriate level of detail given Patient G's case and the medical practice concerned; and/or (4)The records did not include sufficient information concerning Patient G's case to allow another medical practitioner to continue management of Patient G's case. Patient H 71Dr Jamieson prescribed oxycodone hydrochloride (endone) to Patient H between 23 February 2005 and 20 May 2005 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (3)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; (4)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (5)When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient H was on the methadone program and/or was epileptic and/or was alcohol dependent and/or was suffering from an ongoing brain injury; (6)When the practitioner knew or ought to have known that Patient H was or was at risk of becoming dependent on the drug; (7)When the practitioner knew or ought to have known that Patient H was or was at risk of abusing the drug and/or was likely to abuse the drug; (8)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (9)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act; and/or (10)In an inappropriate combination with other drugs. 72Dr Jamieson prescribed valium (diazepam) to Patient H between 5 January 2004 and 22 December 2010 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient H was on the methadone program and/or was alcohol dependent and/or was epileptic; (3)In an inappropriate combination with other drugs; (4)When the practitioner knew or ought to have known that Patient H was or was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (5)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (6)For a duration in excess of recognised therapeutic standards of what is medically appropriate; and/or (7)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate. 73Dr Jamieson failed to keep proper medical records for Patient H in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); Medical Practice Regulation 2008 Schedule 1 (repealed) and the Health Practitioner Regulation National Law Regulation (NSW) 2010 Schedule 2 in that: (1)He failed to record sufficient particulars of any clinical opinion reached; (2)He failed to record any plan of treatment; (3)The records did not contain an appropriate level of detail given Patient H's case and the medical practice concerned; and/or (4)The records did not include sufficient information concerning Patient H's case to allow another medical practitioner to continue management of Patient H's case. Patient I 74Dr Jamieson prescribed oxycodone to Patient I between 4 August 2003 and 10 December 2010 without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the PTG Act. 75Dr Jamieson prescribed nitrazepam (alodorm) to Patient I between 29 January 2003 and 10 December 2010 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient I had unstable diabetes and/or peripheral vascular disease and/or below the knee amputation; (4)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (5)Without obtaining an authority to prescribe the medication from the Director-General of the Department of Health contrary to section 28 of the Poisons and Therapeutic Goods Act 1966; and/or (6)When the practitioner knew or ought to have known that Patient I was or was at risk of becoming dependent on the drug and/or was likely to abuse the drug. 76Dr Jamieson post-dated a prescription for nitrazepam (alodorm) for Patient I on 10 December 2010 for 24 December 2010 in breach of clause 80 of the PTG Regulation 2008. 77Dr Jamieson failed to keep proper medical records of Patient I in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); Medical Practice Regulation 2008 Schedule 1 (repealed) and the Health Practitioner Regulation National Law Regulation (NSW) 2010 Schedule 2 in that: (1)The records did not contain an appropriate level of detail given Patient I's case and the medical practice concerned; and/or (2)The records did not include sufficient information concerning Patient I's case to allow another medical practitioner to continue management of Patient I's case. Patient J 78Dr Jamieson prescribed temazepam (normison) to Patient J between 1 March 2004 and 4 October 2006 in 10mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (4)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (5)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; (6)In an inappropriate combination with other drugs; (7)When the practitioner knew or ought to have known that Patient J was or was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (8)When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient J was on the methadone program and/or was dependent on alcohol and/or was dependent on cannabis and/or had a history of sexual abuse and/or was epileptic. 79Dr Jamieson prescribed nitrazepam (mogadon) (alodorm) to Patient J between 25 June 2007 and 24 December 2010 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (4)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (5)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; (6)In an inappropriate combination with other drugs; (7)When the practitioner knew or ought to have known that Patient J was or was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (8)When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient J was on the methadone program and/or was dependent on alcohol and/or was dependent on cannabis and/or had a history of sexual abuse and/or was epileptic. 80Dr Jamieson prescribed valium (diazepam) to Patient J between 1 March 2004 and 21 September 2010 in 5mg doses: (1)Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; (2)For a purpose that does not accord with recognised therapeutic standards of what is medically appropriate; (3)When the practitioner knew or ought to have known that Patient J was or was at risk of becoming dependent on the drug and/or was likely to abuse the drug; (4)In quantities in excess of recognised therapeutic standards of what is medically appropriate; (5)For a duration in excess of recognised therapeutic standards of what is medically appropriate; (6)With greater frequency than accords with recognised therapeutic standards of what is medically appropriate; (7)In an inappropriate combination with other drugs; and/or (8)When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient J was on the methadone program and/or was dependent on alcohol and/or was dependent on cannabis and/or had a history of sexual abuse and/or was epileptic. 81Dr Jamieson failed to keep proper medical records for Patient J in accordance with the requirements of the Medical Practice Regulation 2003 Schedule 2 (repealed); Medical Practice Regulation 2008 Schedule 1 (repealed) and the Health Practitioner Regulation National Law Regulation (NSW) 2010 Schedule 2 in that: (1)He failed to record sufficient particulars of any clinical opinion reached; (2)He failed to record any plan of treatment; (3)The records did not contain an appropriate level of detail given Patient J's case and the medical practice concerned; and/or (4)The records did not include sufficient information concerning Patient J's case to allow another medical practitioner to continue management of Patient J's case. Unsatisfactory Professional Conduct 82Complaint 1 was that, by engaging in the conduct about which we have made findings in the preceding paragraphs, Dr Jamieson was guilty of unsatisfactory professional conduct (under s 139B of the National Law) in the treatment of patients A to J, in that he: (1)Engaged in conduct that demonstrated that the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of medicine was significantly below the standard reasonably required of a practitioner of an equivalent level of training or experience; (2)Contravened provisions of the Medical Practice Regulation 2003, the Medical Practice Regulation 2008 and the Health Practitioner Regulation (New South Wales) Regulation 2010; and/or (3)Engaged in improper or unethical conduct relating to the practice or purported practice of medicine. 83"Unsatisfactory professional conduct" is relevantly defined in the National Law s 139B(1) as follows: (1)Unsatisfactory professional conduct of a registered health practitioner includes each of the following- (a)Conduct significantly below reasonable standard Conduct that demonstrates the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of the practitioner's profession is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience. (b)Contravention of this Law or regulations A contravention by the practitioner (whether by act or omission) of a provision of this Law, or the regulations under this Law or under the NSW regulations, whether or not the practitioner has been prosecuted for or convicted of an offence in respect of the contravention. ... (l)Other improper or unethical conduct Any other improper or unethical conduct relating to the practice or purported practice of the practitioner's profession. 84On the basis of: (1)the findings made by the Tribunal above in relation to Dr Jamieson's prescribing for patients A to J and his ; (2)Dr Seidler's opinion stated in his report of 16 October 2011 as follows: It is certainly clear that Dr Jamieson's prescribing of opioid medication and benzodiazepines to this vulnerable group of patients that I have reviewed was excessive and uncontrolled. Many of the patients I have reviewed had severe psychiatric diagnoses co morbidly existing with their drug dependence. Such patients are at extreme risk of misadventure when prescribed benzodiazepines and opioids. Overdose death, violence, and worsening of psychiatric symptoms are all associated with this level of prescribing an uncontrolled primary care setting. Of particular concern is the provision of post dated prescriptions to unstable patients without an actual review of the patient's mental state and level of functioning in contravention of therapeutic goods requirements. As a methadone prescriber, Dr Jamieson had some training and extensive experience of this type of patient. There is no doubt he should have been aware of the dangers of prescribing opioids and benzodiazepines to this particular patient population. (3)the evidence of Dr Seidler that Dr Jamieson's care was "significantly below what is reasonably expected of a practitioner with the same training or experience as [Dr Jamieson]" in the relevant instances identified in the table attached to Dr Seidler's report of 16 October 2011; (4)the further evidence of Dr Seidler in his report of 3 January 2013 including his conclusions that Dr Jamieson's care for the 10 patients was "below the standard reasonably expected of practitioner of an equivalent level of training or experience applicable at the time of the conduct" and the departure from the standard was such that the conduct was "significantly below that standard" as set out in numbered paragraphs 1 to 10 and 12 to 33 (on pages 19 to 23) having regard to the other opinions relating to those matters expressed in that letter; (5)the supplementary evidence of Dr Seidler in his report of 14 January 2013 that Dr Jamieson's prescribing, as identified in that report and the subject of the findings made above, fell "significantly below the expected standard in terms of quantity, frequency and duration"; and (6)Dr Jamieson's admissions generally and, in particular, his acknowledgement in paragraph 14 of the statement of 12 December 2013 that his "management and treatment of the 10 patients referred to in the Complaint was significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience", the Tribunal is satisfied to the requisite degree that Dr Jamieson, by engaging in conduct found by the Tribunal above, demonstrated that the knowledge, skill or judgment possessed, or care exercised, by him in the practice of medicine was significantly below the standard reasonably required of a practitioner of an equivalent level of training or experience and thereby engaged in unsatisfactory professional conduct within the meaning of s 139B(1)(a) of the National Law. 85In relation Dr Jamieson's medical record keeping, the obligations in relation to medical records were governed by the regulation applicable at the relevant time being the Medical Practice Regulation 2003 Schedule 2 (repealed), the Medical Practice Regulation 2008 Schedule 1 (repealed) or the Health Practitioner Regulation (New South Wales) Regulation 2010 Schedule 2. 86The relevant provisions of Schedule 2 of the Health Practitioner Regulation (New South Wales) Regulation 2010 applicable from 1 July 2010 provided: 1Information to be included in record (1)A record must contain sufficient information to identify the patient to whom it relates. (2)A record must include the following: (a)any information known to the medical practitioner who provides the medical treatment or other medical services to the patient that is relevant to the patient's diagnosis or treatment (for example, information concerning the patient's medical history, the results of any physical examination of the patient, information obtained concerning the patient's mental state, the results of any tests performed on the patient and information concerning allergies or other factors that may require special consideration when treating the patient), (b)particulars of any clinical opinion reached by the medical practitioner, (c)any plan of treatment for the patient, (d)particulars of any medication prescribed for the patient. (3)The record must include notes as to information or advice given to the patient in relation to any medical treatment proposed by the medical practitioner who is treating the patient. (4)A record must include the following particulars of any medical treatment (including any medical or surgical procedure) that is given to or performed on the patient by the medical practitioner who is treating the patient: (a)the date of the treatment, (b)the nature of the treatment, (c)the name of any person who gave or performed the treatment, (d)the type of anaesthetic, if any, given to the patient, (e)the tissues, if any, sent to pathology, (f)the results or findings made in relation to the treatment. (5)Any written consent given by a patient to medical treatment (including any medical or surgical procedure) proposed by the medical practitioner who treats the patient must be kept as part of the record relating to that patient. 2General requirements as to content (1)In general, the level of detail contained in a record must be appropriate to the patient's case and to the medical practice concerned. (2)A record must include sufficient information concerning the patient's case to allow another medical practitioner to continue management of the patient's case. (3)All entries in the record must be accurate statements of fact or statements of clinical judgment. 87For the period prior to 30 June 2010, cl 2 of Schedule 1 to the Medical Practice Regulation 2008 and cl 2 of Schedule 2 to the Medical Practice Regulation 2003 were in terms that were not materially different from cl 2 of Schedule 2 of the Health Practitioner Regulation (New South Wales) Regulation 2010 cited quoted above. Accordingly, at all times material to the present matter, Dr Jamieson was required, among other things, to keep records: (1)in which the level of detail was appropriate to the patient's case and to the medical practice concerned - cl 2(1) of each schedule; (2)which included sufficient information concerning the patient's case to allow another medical practitioner to continue management of the patient's case - cl 2(2) of each schedule. 88In the light of: (1)The medical records contained in the documents before the Tribunal; (2)the findings made by the Tribunal set out above; (3)Dr Jamieson's admissions; (4)Dr Seidler's evidence concerning Dr Jamieson's medical records in his two earlier reports; and (5)the supplementary evidence of Dr Seidler in his report of 14 January 2013 that: (a)the records for patient A did not contain the level of detail which was appropriate "to the complex nature of the patient's clinical history"; (b)the records for patient B did not contain the level of detail which was appropriate to "this complex patient's case and the medical practice concerned"; (c)the records for patients C, E, G, H, I and J did not contain the level of detail appropriate to the patient's case and the medical practice concerned; (d)the records for each of patients A, B, C, E, G, H, I and J did not include sufficient information concerning the patient's case to allow another medical practitioner to continue management of the patient's case; the Tribunal is satisfied to the requisite degree that Dr Jamieson contravened the applicable regulation in relation to the keeping of medical records and thereby engaged in unsatisfactory professional conduct within the meaning of s 139B(1)(b) of the National Law. 89Finally, given Dr Jamieson's express admission of the subject matters of the complaints against him in the Notice of Complaint as amended and the Tribunal's findings and conclusions set out above, the Tribunal is satisfied that Dr Jamieson engaged in improper conduct relating to the practice of medicine and thereby engaged in unsatisfactory professional conduct within the meaning of s 139B(1)(l) of the National Law. 90On these bases, the Tribunal finds that Complaint 1 has been made out. Professional Misconduct 91Complaint 2 was an allegation that Dr Jamieson was guilty of professional misconduct under s 139E of the National Law in that he had: (i)engaged in unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of his registration; and/or (ii)has engaged in unsatisfactory professional conduct on a number of occasions which, when considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of his registration. 92The particulars to Complaint 2 were as follows: The Particulars of Complaint Two are repeated and relied upon, both individually and cumulatively. The Tribunal understands that the reference to "Complaint Two" is a typographical error and should be a reference to "Complaint One". 93"Professional misconduct" is defined in the National Law s 139E in terms which include: (1)For the purposes of this Law, professional misconduct of a registered health practitioner means- (a)unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration; or (b)more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration. 94As noted above, Dr Jamieson has formally admitted the subject matter of this Complaint 2 and in his statement he acknowledged that in making the admissions set out in that statement he was potentially exposing himself to suspension or deregistration. He also said in paragraph 19 of his statement: 19.With respect to Complaint Two, sub-particulars (i) and (ii), I admit that my conduct in the manner alleged amounts to professional misconduct. 95On the material before the Tribunal, it is comfortably satisfied that the unsatisfactory professional conduct engaged in by Dr Jamieson was of a sufficiently serious nature to justify suspension or cancellation of his registration. The Tribunal is similarly satisfied that the instances of unsatisfactory professional conduct engaged in by him, when considered together amount to conduct of a sufficiently serious nature to justify suspension or cancellation of his registration. 96Accordingly, the Tribunal concludes that Dr Jamieson engaged in professional misconduct as alleged. On this basis the Tribunal finds that Complaint 2 has been made out. Protective Orders 97Having found that the subject matter of the 2 complaints against Dr Jamieson set out in the Notice of Complaint as amended has been proved and given Dr Jamieson's formal admissions, the Tribunal is empowered under s 149A of the National Law to do any one or more of the following in relation to the practitioner: (a)caution or reprimand the practitioner; (b)impose the conditions it considers appropriate on the practitioner's registration; (c)order the practitioner to seek and undergo medical or psychiatric treatment or counselling (including, but not limited to, psychological counselling); (d)order the practitioner to complete an educational course specified by the Tribunal; (e)order the practitioner to report on the practitioner's practice at the times, in the way and to the persons specified by the Tribunal; (f)order the practitioner to seek and take advice, in relation to the management of the practitioner's practice, from persons specified by the Tribunal. 98The Tribunal may also impose a fine under s 149B but only in the limited circumstances referred to in s 149B(2)(b). In addition, the Tribunal may suspend or cancel the practitioner's registration under s 149C(1) as it has found that Dr Jamieson is guilty of professional misconduct. Principles Concerning Appropriate Protective Orders 99In determining the appropriate protective orders that it should make in this matter, the Tribunal has applied the following principles taken from Health Care Complaints Commission v Dr Della Bruna [2014] NSWCATOD 31 at [88] to [91]: (1)In the exercise of its functions under Subdivision 6 of Division 3 of Part 8 of the National Law, the protection of the health and safety of the public must be the Tribunal's paramount consideration - s 3A of the National Law. (2)Disciplinary proceedings against members of a profession are intended to maintain proper ethical and professional standards, primarily for the protection of the public but also for the protection of the profession - Health Care Complaints Commission v Litchfield (1997) 41 NSWLR 630 at 637, (3)The public interests served by protective orders include, indirectly, the standing of the medical profession and the maintenance of public confidence in the high standards of medical practitioners - Prakash v Health Care Complaints Commission [2006] NSWCA 153 at [91]. (4)Protective orders also involve an element of deterrence or, to put it more positively, encouragement to other practitioners to recognise the importance of complying with professional standards and the risks of failing to do so - Prakash v Health Care Complaints Commission [2006] NSWCA 153 at [91]. (5)Although the specific purpose for which the Tribunal makes orders is protective of the public interest and not punitive with respect to the practitioner, that is not to deny that such orders may be punitive in effect and that punitive effect may be relevant in formulating a protective order - Lee v Health Care Complaints Commission [2012] NSWCA 80 at [20] citing Director General, Department of Ageing, Disability and Home Care v Lambert (2009) 74 NSWLR 523 at [83]. 100Although the Tribunal has concluded that Dr Jamieson's conduct was of a sufficiently serious nature to justify suspension or cancellation of his registration, it does not necessarily follow that suspension or cancellation is the appropriate protective order to make in the circumstances of the present case. Health Care Complaints Commission v Karalasingham [2007] NSWCA 267 was a decision under the Medical Practice Act 1992 (NSW) but the relevant provisions of that Act are substantially the same as the applicable provisions of the National Law and the Court of Appeal's reasoning is equally applicable to the present case. At [67] it was held: ... However, it is clear that the definition [of professional misconduct] is focused on the nature of the conduct, which must have the capacity to justify such an order [suspension or cancellation], whether or not such an order should be made in particular circumstances. That such an order need not be made is clear from the terms of ss 60-64 [which are substantially the same as ss 149 to 149C of the National Law], which provide that the full range of disciplinary powers is available on a finding of professional misconduct. The statutory constraints operate differently. Thus, a person may not be suspended or deregistered unless the Tribunal finds the person is not competent to practice medicine, is guilty of professional misconduct, is not of good character or has been convicted of an offence which renders the person unfit in the public interest to practice medicine: s 64(1) [s 149C(1) of the National Law is to a similar effect]. Further, the power to impose a fine depends upon a finding that the person is guilty of unsatisfactory professional conduct or professional misconduct: s 62(2) [see s 149B(2) of the National Law]. Otherwise, the discretion of the Tribunal is at large and will depend upon the circumstances of the individual case : see, in relation to legal practitioners, Walsh v Law Society of New South Wales [1999] HCA 33; (1999) 198 CLR 73 at [76] (McHugh, Kirby and Callinan JJ). 101In Health Care Complaints Commission v Gorondy-Novak [2011] NSWMT 3, the Medical Tribunal said at [200]: The authorities also clearly establish that before a medical practitioner is deregistered or exposed to the sanction of their livelihood being taken away, albeit, for a protective purpose, this Tribunal needs to find that the practitioner is probably permanently unfit to practice: see Ex Parte Lenehan [1948] HCA 45; (1948) 77 CLR 403 at 424 - 425 (Latham CJ, Dixon and Williams JJ (Rich and Starke JA dissenting)); The Prothonotary of the Supreme Court of New South Wales v Ritchard (Court of Appeal, 31 July 1987 unreported), (Kirby P, Mahoney and McHugh JJA). 102This quotation should not, however, be taken to support the proposition that the Tribunal may order deregistration only if it finds that the practitioner is permanently unfit to practise - see Health Care Complaints Commission v King [2013] NSWMT 9 at [25]). The expression used by the High Court in Ex parte Lenehan was "probable permanent unfitness" and referred to the finding which usually underlies an order striking off a solicitor. It serves to indicate that striking off a lawyer or deregistering a medical practitioner will generally only be appropriate if he or she is unfit to practise at the time of making the order and is likely to remain so for a significant or indefinite period. Dr Jamieson's Conduct 103The professional misconduct and unsatisfactory professional conduct of which Dr Jamieson has been guilty were most serious. Dr Jamieson's prescribing for patients A to J endangered their physical and mental well-being and potentially, in some cases, their lives. The prescribing conduct extended over the period from 2002 to 2010 in the case of one patient and over shorter periods for others of the 10 patients as recorded in the table set out above. In large measure, the prescribing conduct only came to an end following the intervention of the Medical Council in 2010. 104The Tribunal also regards Dr Jamieson's failure to formulate appropriate treatment plans for various patients, failure to refer certain patients to appropriate specialists and failure to keep appropriate medical records, all of which have been established in this case, as serious departures from proper and required practice for a medical practitioner, especially one of his experience and training. 105In the absence of the changes in Dr Jamieson's prescribing and referring practices and record keeping which were consequent upon the intervention by the Medical Council in 2010, deregistration may well have been the most appropriate course for the Tribunal to have taken in this matter. Having regard, however, to what had occurred since late 2010, the Tribunal is of the view that it is appropriate to consider other protective order as alternatives to deregistration before determining the matter. The Practitioner's Remorse, Insight and Rehabilitation 106The Tribunal accepts the evidence of Dr Jamieson that it took a considerable period of time for him to come to appreciate the seriousness of what he had done and the extent to which it fell short of the standard required of him. In our view, Dr Jamieson demonstrated his remorse in the admissions he made, in the way in which he gave evidence and in the evidence he gave, including in the following passages from his statement of 12 December 2013: 5.It has taken me a long time to come to terms with the criticisms that have been made against my prescribing practices. Since then it has been a slow process for me to fully understand and appreciate the magnitude of what I have done. At the time I thought that 'meeting the demand" to service a large number of patients was more important than 'quality'. I no longer see it that way. 6.I found reading the Health Care Complaints Commission's (the Commission) Complaint and the 10 volumes of documents served with it, extremely confronting. 7.As I read through the Commission's material, I recognised that there was a significant and recurring pattern of practice in relation to my management of the patients named in the Complaint. This is reflected in my ill-chosen prescribing practices, my failure to utilise non-medicated techniques for dealing with these patients, my failure to refer these patients to specialists or specialty units, lack of follow up on pathology test results and record keeping, all of which are the subject of the Complaint. ... 74.As a result of having my views challenged, I now share the view of most who work in addiction and mental health that it is not best practice to prescribe benzodiazepines in the context of addiction or to use them to treat anxiety or insomnia. I also see that it is important to prescribe S8 drugs with great care to treat patients especially if they have mental health and/or past/present addiction problems. 107Further, Dr Jamieson has reflected on his conduct and has sought to understand how he came to engage in what he now acknowledges was professional misconduct and unsatisfactory professional conduct. In his statement of 12 December 2013 he explained his understanding of the reasons that led to his misconduct and he acknowledged that his former approach was mistaken. Part of that evidence which gave the Tribunal an indication of Dr Jamieson's insight was as follows: 8.When I reflect back on my management of the patients named in the complaint, I can see that there were a number of factors that influenced the way I approached patients with mental health and/or addiction issues and my attitude to prescribing s4D and S8 drugs. These factors include my upbringing, my self-belief, my experiences working as a GP in a under-resourced rural area and my experiences prescribing Methadone. ... 10.I now see my self-belief was over-inflated. Instead, I realise that I practised in isolation and in a way that meant I failed to recognise the implications of the treatment I prescribed for these patients. ... 50.[In relation to the so called "Wonderment Programme" which Dr Jamieson developed on his own and used to treat patients] I acknowledge that I was using a tool that I had developed for the purposes of counselling which had not been peer-reviewed. In these circumstances it was inappropriate to do so. ... 53.As a result [of the benefits Dr Jamieson perceived from prescribing Methadone], I slowly formed the view that it was better from the patient's perspective to be dependent on a prescribed drug than an illegal drug. I mistakenly saw this as a logical extension of prescribing Methadone. ... 58.I now recognise that the real issues surrounding the prescribing of S4D and S8 drugs are the potential for abuse, addiction and patient safety which is why there are regulations and guidelines surrounding the use of these drugs. ... 61.I see my failure to engage in non-medicated techniques as being linked to the idea of trying to chemically stabilise the patient. 62.... I can see that when my patients now see addiction specialists for their pharmacotherapy the focus is on their addiction issues and not their medication. ... 65.Probably the greatest factor in my record keeping practices was the busy nature of my practice where note-writing seems to be a low priority for me in terms of time. In addition, I knew the patients well and therefore I was more focused in trying to deal with the patient. As a result, I did not think about the importance of good record-keeping. ... 68.Losing my S4D and S8 prescribing rights and having conditions placed on my practice was a wake-up call. The effect was to reduce my work load and work pressure. It allowed me to step back and have a more objective view of my prescribing practices. However, it has been a slow process. 108This material, the other evidence Dr Jamieson gave to a similar effect and the extensive admissions he made satisfy the Tribunal that he has some insight into what occurred and why it occurred. This, we believe, makes it less likely that Dr Jamieson will in the future engage in similar professional misconduct or unsatisfactory professional conduct, especially if he remains unable to prescribe Schedule 4D and Schedule 8 drugs. 109In addition to the rehabilitative effect of being confronted with the HCCC's Notice of Complaint in this matter and the material in support, Dr Jamieson has undergone the evaluation and training required of him as a result of the conditions imposed by the Medical Council upon his registration. He had attended a number of relevant training courses, as set out in attachment B to his statement of 12 December 2013. By December 2013 Dr Jamieson had obtained considerably in excess of the required number of QI & CPD points for the 2011 - 13 triennium, according to his QI&CPD Points Statement accessed online on 17 December 2013. The Tribunal is satisfied that as a consequence Dr Jamieson has now significantly improved his general medical knowledge and his ability to care for his patients compared to the position in 2010. 110The Tribunal concludes that the remorse and insight he has shown as well as the rehabilitative steps taken by Dr Jamieson outlined above tend to reduce to a significant extent the need for suspension or deregistration in order to achieve the appropriate protection of the public. Dr Jamieson's Supervision in the Period from June 2010 to the Present 111In addition to the matters referred to in the preceding section, Dr Jamieson has also undergone a regime of supervision by both a GP and a psychiatrist since late 2010. This supervision was required under the conditions imposed by the Medical Council on his registration. The supervisors were as follows: Supervisor Period GP or Specialist Dr MacQueen September - October 2010 GP Dr Read October 2010 - December 2013 Psychiatrist Dr Chew March 2011 - January 2013 GP Dr Rikard-Bell January 2013 - March 2014 GP 112The Tribunal has before it the supervision reports from each of these medical practitioners for the relevant periods. These reports record a process of Dr Jamieson gaining a level of insight into his conduct over the period from September 2010 to March 2014. 113The reports from the GP supervisor Dr MacQueen in September and October 2010 establish that although he worked in a group practice he was in effect isolated and tended to apply his personal philosophy rather than evidence based medicine. Dr MacQueen stated in his September 2010 report: He deals with complex issues & patients [with] complex problems but seems to be left alone to decide on management plans. He admits that there are areas of disagreement [with] management (eg chronic pain & opioid use) amongst colleagues; he accepts that his approach may not be the most evidence based, but is his style. I think that if Col [Dr Jamieson] is going to change management style ([with] maybe reduce what may be seen as risky & perhaps non-evidence based behaviours) that this will take time. ... 114The nature of Dr Jamieson's problem was also the subject of Dr MacQueen's report of October 2010 in the following terms: CJ [Dr Jamieson] seems to see many people [with] complex issues, usually involving [drug and alcohol] & some behavioural or mental health issues. He seems to maintain a confident, positive view but I am not sure that his is based upon any evidence [with] respect to their health problems (or past history) as opposed to this approach being a personal philosophy. He seems to believe the best of people, even when there are issues (such as misuse of medications) that may incline one to be more cautious. 115After his prescribing rights in relation to Schedule 4D and Schedule 8 drugs were removed in late 2010, the GP supervisor was Dr Chew who worked with Dr Jamieson in the Russell Street Medical Practice. In his March 2011 report, Dr Chew noted: I feel he is practicing at the level of a safe + competent GP. I use the same criteria that I use to judge our GP registrars. He seems very confident with psychological medicine (in the patients we reviewed he seemed to know the limits of his ability + when to refer). He seemed to lack confidence in some areas of general medicine (due to lack of exposure recently). His manner was courteous + humble, he was open to feed back. Needs to update knowledge in some areas of gen medicine (reflecting his change in direction away from drug + alcohol work) eg therapeutics with hypertension + diabetes. Needs to streamline history taking for some medical problems. eg headaches, gastro-oesophageal reflux). 116Over the period of Dr Chew's supervision, his reports indicate that Dr Jamieson "made significant progress in moving his practice back towards the 'mainstream'" and he was following evidence based medicine more closely (see the report for September 2011). In his mid-2012 report, Dr Chew stated that Dr Jamieson was "Practicing medicine to quiet a high standard. Much less psychological medicine and more general medical problems. ... Seems much more willing to refer clinical problems and not take on so much himself". In November -December 2012 Dr Chew reported that Dr Jamieson was "Practicing to a good standard Consulting style is becoming much more conservative and safe." 117Dr Chew also provided a report dated 20 February 2014 in which he described Dr Jamieson's improvement from early 2011 to early 2013 in the following terms: During my early sessions with Dr Jamieson I felt his history taking and examination technique somewhat haphazard. I informed him of my observations and that if he had sat his fellowship exams now I felt his clinical performance would not allow him to pass the FRACGP clinical exams. During the next 2 years I felt his standard of history taking, examination and patient management improved significantly. I took this to mean that Dr Jamieson had acknowledged these shortcomings and was trying hard to fix his problems, by following the standards set out by the FRACGP. I felt Dr Jamieson's general medical management of patients had improved. He seemed to be prescribing within accepted therapeutic guidelines. I felt that by the time I left the practice he was working at a level that would allow him to pass the FRACGP clinical exams. ... In conclusion I feel that Dr Colin Jamieson has been a competent, caring general practitioner over many years. I feel that an obsession with certain self-developed ideologies caused him to deviate from accepted practice standards. At the time I left the Russell Street Practice in January 2013, I felt Dr Jamieson was practising at a safe and competent level. ... 118Dr Rikard-Bell's reports as supervising GP from January 2013 to March 2014 record that the improvement noted by Dr Chew has been maintained. In relation to the standard of Dr Jamieson's clinical practice, Dr Rikard-Bell noted: "My observation: appropriate interaction with patients and clinical application of skills. Quite conservative I'd say." in January 2013; "knowledge base sound" in February 2013; "Cases discussed Topic presentation on mental health - normal appropriate" in August 2013; "A range of typical general practice patients. Coping well now." in March 2014. 119Dr Rikard-Bell had also prepared a report dated 22 January 2014 which was before the Tribunal. In that report he expressed the view that Dr Jamieson was capable of practising "without supervision and without drug addiction medicine". We take this to mean that the restriction on his prescribing rights should not, in Dr Rikard-Bell's view, be lifted. 120Dr Read, a registered medical practitioner and a Fellow of the Royal Australian and New Zealand College of Psychiatrists and a Fellow of the Australian Chapter of Addiction Medicine, has been Dr Jamieson's psychiatrist supervisor from October 2010. Dr Read was aware of the prescribing issues raised in December 2010. By March 2011, it was recorded that "Dr Jamieson identifying strength and weakness in past management. He offered opinion that was consistent with a changed view in terms of Benzodiazepines prescription" and "Overall feeling less stressed by having the responsibility of certain complex patients shifted from him" which the Tribunal infers was the result of his prescription rights in relation to Schedule 4A and Schedule 8 drugs being removed. In mid-2011, Dr Read recorded his opinion that Dr Jamieson's "use of multidisciplinary teams and engagement with multimodal treatment approaches appears sound." and noted that "some patients are upset that he now has prescription restriction. He is managing well." Dr Read's September 2011 report recorded: "Based on clinical discussion about case management, it would appear that the standard of his practice is satisfactory. Has been able to identify deficits in his past practice and can outline appropriate current practices." The reports for the following years are consistent with the changes recorded being consolidated and re-enforced. For the period November 2013 to January 2014, Dr Read recorded: "Dr Jamieson's clinical practice as evidenced by topics discussed in supervision would appear to be consistent with expected professional standards. He would appear to be providing long term management to patients with complex medical psychiatric presentations. This treatment/management model evidences sound treatment framework." 121Dr Read also provided a report dated 26 March 2014 in which he noted that in his supervision of Dr Jamieson he had addressed Dr Jamieson's "prescription practices in terms of dependence forming medications that reflected decision-making inconsistent with accepted treatment guidelines", "the difficulty Dr Jamieson had in providing for the complex specialised needs of patients" and the Wonderment Programme discussing "aspects of the approach he used in the context of more evidence-based treatments". Dr Read expressed the opinion that over the period of his supervision Dr Jamieson has gained insight in relation to his previous style of practice. With respect to psychological management approaches, Dr Jamieson now has an evidence-based framework in place. 122At the Tribunal's request, Dr Read was called to give oral evidence, by telephone. The Tribunal formed the view that Dr Read was a careful and reliable witness. In relation to his opinion that Dr Jamieson had gained insight, Dr Read gave answers which appeared to the Tribunal to be somewhat generic and did not firmly establish that Dr Jamieson had true or full insight into the seriousness of what he had done. Dr Read was asked whether in his opinion Dr Jamieson would benefit from ongoing supervision and he expressed the view that it would be useful and Dr Jamieson was likely to be the sort of medical practitioner who would continue to benefit from supervision. Dr Read also noted that it was not necessary for the supervision to be in the model that he provided but that it could be done with a colleague and said that he would recommend it for any medical practitioner with complex patients. Later, Dr Read gave his opinion that he thought it would be appropriate for the restrictions on Dr Jamieson's prescribing to be maintained in the first instance with the supervision model in place. He noted that the restriction on prescribing rights had been a healthy circuit breaker, it was appropriate to maintain it at this stage and those rights might not be wanted back. 123Dr Read also indicated that, in relation to Dr Jamieson's prescribing and treatment framework, he had discussed with Dr Jamieson a safe framework of treatment that included limiting prescribing drugs to prescribing in accordance with the relevant guidelines and not making exceptions based upon knowledge of the particular circumstances and complexities of the individual patients' cases. In addition, he discussed with Dr Jamieson not relying on himself alone and having a framework for treatment that utilised multi-disciplinary services where appropriate. 124The Tribunal accepts that this material from Dr Jamieson's supervisors is reliable and accurately sets out their opinions and the progress Dr Jamieson has made. On this basis, the Tribunal is of the view that Dr Jamieson is now, with the supervision and the restriction on his prescribing rights presently in place, practising medicine to an acceptable standard as a general practitioner and in a manner that is safe for his patients and the public. References in Support of Dr Jamieson 125A number of references were put forward by Dr Jamieson and the Tribunal has had regard to this material. We note that Dr Robyn Vines, a clinical psychologist, in her reference of 3 February 2014 states her perception that Dr Jamieson was trying to do his best by his patients, even if he like many others got it wrong some of the time, whilst aiming not to. Mr Cameron, an accountant, gives in his reference dated 12 February 2014 his opinion that Dr Jamieson is honest and reliable with a strong sense of integrity as a doctor as well as being a genuinely compassionate person. The Tribunal has also taken into account references from Jean Clulow, Dr Geoff Marshall and Helen Gotch who also gave opinions consistent with those referred to above. 126The references are not inconsistent with the Tribunal's conclusions expressed above. Appropriate Protective Orders 127In the light of the changes in Dr Jamieson's conduct, mode of practice and treatment frameworks since late 2010, the education and training programs he has undertaken, the supervision he has undergone, the assessment of his capabilities by his supervisors and the remorse and insight he has shown, the Tribunal believes it would be inappropriate to suspend or cancel his registration. Such a course is not necessary to protect the health and safety of the public or to maintain the reputation of the profession in this case. The Tribunal is not satisfied that the practitioner is not currently fit to practise. 128Nonetheless Dr Jamieson's conduct was serious and protective orders are required, especially in regard to his prescribing practices, his record keeping and his treatment of patients with psychiatric and similar conditions or addiction issues. Consequently, to mark out the extent to which his conduct fell short of the required standard and to encourage other practitioners to recognise the importance of complying with professional standards and the risks of failing to do so, the Tribunal is of the view that a reprimand together with appropriate conditions on his registration are the minimum necessary. 129As to the appropriate conditions, firstly the Tribunal is of the view based upon the evidence in the present matter that Dr Jamieson should continue to be subject to conditions that he should not be entitled to possess, supply, administer or prescribe any Schedule 8 drug nor should he be able to prescribe any Schedule 4D drug or derivative nor apply to the Pharmaceutical Services of New South Wales for his authority to prescribe such drugs. Neither the HCCC nor the practitioner opposed the imposition of such conditions or the related condition concerning the exchange of information. We shall address below whether any minimum time during which these conditions might operate should be included in the orders. 130Secondly, in the light of what occurred in the present case, the improvement and change achieved by Dr Jamieson as a result of the GP and psychiatric supervision between late 2010 and the present, and Dr Read's evidence of the need for, and benefit which Dr Jamieson was likely to derive from, continued supervision, the Tribunal considers that a form of supervision by a general practitioner should be required as a condition on Dr Jamieson's registration. In the Tribunal's view, level 2 supervision as specified in the Medical Counsel of New South Wales Policy on Supervision would be appropriate. The Tribunal has noted the comments of Dr Rikard-Bell that he believes Dr Jamieson should be able to continue to practice without supervision. Whilst it is accepted that there has been substantial improvement in Dr Jamieson's performance, the Tribunal believes that it is in the interests of the public and in Dr Jamieson's interests, having regard to what Dr Read has said, to continue with supervision. Nonetheless the Tribunal accepts that it is no longer necessary to have monthly meetings with the supervisor and meetings every two months should be sufficient. The condition to be imposed in this regard reflects that view. It is not necessary to continue with supervision by a psychiatrist in addition to a GP and consequently the Tribunal does not propose to include such a condition. 131Thirdly, Dr Jamieson failed to meet the standard required of him in respect of keeping appropriate medical records and, in particular, for some of the patients the records did not contain the level of detail appropriate to the patient's case and the medical practice concerned nor did they include sufficient information concerning the patient's case to allow another medical practitioner to continue management of the patient's case. Although it appears that this aspect of Dr Jamieson's practice has now been improved, the Tribunal is of the view that it would be appropriate to have Dr Jamieson's medical records audited from time to time and a suitable condition should be imposed on his registration to achieve this. 132Fourthly, the Tribunal has noted the views of Dr MacQueen in his first supervision report for September 2010 that "I also have serious concerns not for the first time about solo doctors having a practice mostly with D&A with complex behavioural issues .... Colin is in a group but effectively in his practice solo and feel this is a hard area and needs a lot of personal and professional support and guidance." Dr Read in his report dated 26 March 2014 noted that "active participation in peer review groups would be viewed as essential". This is likely to be assisted by requiring that Dr Jamieson only practise in a group practice or hospital. The HCCC proposed a condition requiring that Dr Jamieson practise only in a hospital or group practice subject to certain matters. Dr Jamieson did not oppose the condition in the terms proposed by the HCCC and the Tribunal is prepared to adopt the condition proposed. 133Fifthly, the Tribunal heard evidence concerning the development and use of the "Wonderment Programme" which Dr Jamieson acknowledged was not peer reviewed and was not appropriate for use in counselling. It was far from clear exactly what that program actually involved. According to Dr Jamieson it was an amalgamation of concepts such as cognitive behaviour therapy, mindfulness and psychodynamic techniques and included, according to his oral evidence, elements of psychoanalysis. This explanation suggested to the Tribunal that this so called program might be a pastiche of vague and possibly even contradictory psychological terms or concepts rather than an appropriate tool for use in psychotherapy. The Wonderment Programme was apparently used at the same time as Dr Jamieson was attempting to "chemically stabilise" patients by prescribing Schedule 8 drugs, sometimes in conjunction with Schedule 4D drugs, in combinations and quantities, for a duration and at a frequency well outside recognised therapeutic standards of what is medically appropriate. It is not clear to the Tribunal the extent to which this program played a part in Dr Jamieson's management of his patients and his approach to prescribing. In his oral evidence, Dr Jamieson appeared to seek to downplay any connection between the programme and his prescribing. Dr Read suggested that in struggling with complex patients and putting in time trying to assess both the physical and psychological aspects of his patients' cases Dr Jamieson engaged with his patients to such an extent that he made inappropriate prescribing decisions because he believed he knew them and their problems so well that the usual guidelines on prescribing could be disregarded in the cases he was dealing with. The Wonderment Programme played a part in Dr Jamieson's engagement with his patients. Consequently, the Tribunal believes it is likely that the Wonderment Programme did contribute to the approach to prescribing which Dr Jamieson adopted. Further, to the extent that use of this program encouraged Dr Jamieson not to refer his patients to a psychiatrist, psychologist or other appropriate health professional, it could also be seen as having had a negative impact upon his ability to treat his patients appropriately. 134In these circumstances and given Dr Jamieson's previous willingness to use the Wonderment Program in providing psychotherapy despite the inappropriateness of doing so, the Tribunal believes the protection of the health and safety of the public renders it appropriate to impose a condition on Dr Jamieson's registration restricting his ability to treat patients who require psychiatric or psychological care or treatment. 135Both the HCCC and Dr Jamieson have put forward a proposed condition to the effect that the practitioner not use the Wonderment Programme in treating patients. The Tribunal is concerned that if a condition were imposed using the description "the Wonderment Programme" the content of the condition would be so uncertain and vague that compliance with that condition could not be effectively monitored or assessed. For this reason, the Tribunal does not propose to include a condition which refers to the Wonderment Programme but it will impose a condition restricting Dr Jamieson's ability to treat patients presenting with any psychiatric or psychological symptoms or problems. The HCCC and Dr Jamieson have also put forward competing proposed conditions in this latter regard, although the primary submission made on Dr Jamieson's behalf was that the prohibition on the use of the Wonderment Program should be sufficient and no additional condition should be required. 136The HCCC has proposed the following condition: To not perform psychotherapy on any patient, that is, not to treat emotional, behavioural, personality and psychiatric disorders with verbal or non-verbal communication and interventions with the patient. Any patient requesting psychotherapy or whom the practitioner assesses is in need of psychotherapy, must be referred to a psychiatrist, psychologist, social worker, counsellor or any other appropriately trained health professional for such treatment. 137Dr Jamieson proposed the following: Any patient requiring ongoing psychotherapy to treat emotional, behavioural, personality and psychiatric disorders or whom the practitioner assesses is in need of ongoing psychotherapy for longer than one month, must be referred to a psychiatrist, psychologist, social worker, counsellor or any other appropriately trained health professional for further assessment and/or treatment. Any management plan prepared following referral to an appropriately trained health professional must be implemented by the practitioner. The Tribunal has considered both proposals and is nonetheless of the view that the lack of competence, perhaps even recklessness, that Dr Jamieson demonstrated in the treatment of patients with addiction issues as well as psychological or psychiatric problems requires conditions which restrict his ability to treat patients with either or both types of issues. In relation to treating patients with psychiatric or psychological symptoms or problems, the Tribunal proposes to impose a condition as follows: The practitioner is not to treat or manage patients with psychiatric or psychological symptoms or problems and any patient requesting psychotherapy treatment or whom the practitioner assesses is in need of psychiatric or psychological treatment must be referred to a psychiatrist, psychologist or other appropriate health professional. 138The HCCC has proposed a condition that Dr Jamieson not be able to treat or manage drug and/or alcohol addiction patients. Dr Jamieson has responded to this proposal with a somewhat amended condition for the consideration of the Tribunal which provides that he would be entitled to treat such patients if they have first been assessed by an appropriate addiction specialist and that he must follow any management plan established by an appropriately trained health professional. In the light of the difficulties experienced by Dr Jamieson in dealing with drug and alcohol addiction patients in the past, his present and continuing inability to prescribe Schedule 4D and Schedule 8 drugs and the change in his practice from concentrating on drug and alcohol addiction patients to a more general medical practice, the Tribunal accepts that it is appropriate to have a condition restricting Dr Jamieson's ability to deal with such patients and requiring him to refer them to an appropriate specialist. Having regard to those same matters, the seriousness of what occurred when Dr Jamieson was treating drug and alcohol addiction patients and the need to ensure the protection of the public, the Tribunal is of the view that the restrictions proposed by the HCCC are more appropriate than what has been proposed on Dr Jamieson's behalf. 139Sixthly, the Tribunal is concerned to ensure that the changes which Dr Jamieson has made in his approach to his practice of medicine in the period from late 2010 to the present are maintained and that he continues to practice in a safe and competent manner. To this end, the Tribunal believes it would be useful to include a condition that Dr Jamieson is to have his professional performance re-assessed within a year of the Tribunal's decision and thereafter as the Medical Council may determine. 140Seventhly, the Tribunal proposes to include an order that the conditions imposed may be varied or removed at the discretion of the Medical Council. As noted above, this provides appropriate flexibility so that the conditions can be reconsidered or reformulated in the light of any changes in circumstances that may occur. 141Lastly, the Tribunal has also considered whether it should specify a minimum time for which the conditions relating to prescribing rights or the use of psychotherapy should apply. An appropriate way in which that can be done is by making it a term of the order imposing the conditions that an application for review not be made within a certain period. This can be done under s 163A(3)(a) of the National Law. Section 163A relevantly provides: 163ARight of review [NSW] (1)A person may apply to the appropriate review body for a review of- (a)a prohibition order made in relation to the person; or (b)a relevant order made in relation to the person. (2)A person may also apply to the appropriate review body for a review of an order made under this Division. (3)An application for review of an order may not be made- (a)while the terms of the order provide that an application for review may not be made; or (b)while an appeal to the Tribunal or the Supreme Court in respect of the same matter is pending. (4)In this section- decision-making entity means the following- (a)a Committee; (b)a Performance Review Panel; (b1)a Council, but only in relation to orders made under this Division or under Subdivision 5 of Division 3; (c)an existing health practitioner tribunal (within the meaning of Part 2 of Schedule 1 to the Civil and Administrative Tribunal Act 2013) or the Chairperson or Deputy Chairperson of such a tribunal; (d)the Tribunal or the Tribunal List Manager; (e)the Supreme Court. relevant order, in relation to a person, means any of the following orders made by a decision-making entity- (a)an order that the person's registration as a registered health practitioner or student is suspended; or (b)an order that the person's registration be cancelled or that the person is disqualified from being registered in a particular health profession; or (c)an order that conditions be imposed on the person's registration in a health profession. 142An order by the Tribunal imposing conditions on Dr Jamieson's registration will be a relevant order for the purposes of s 163A(1)(b) because it falls within paragraph (c) of the definition of "relevant order" in s 163A(4). The appropriate review body is determined under s 163 and as a result of the order which the Tribunal proposes to make for the purposes of s 163(1)(a) will be the Medical Council of New South Wales. 143In the light of the seriousness of the departure from acceptable prescribing standards, the Tribunal believes that Dr Jamieson should not be entitled to apply in relation to the prescribing conditions or for his authority to prescribe Schedule 4D or Schedule 8 drugs for a period of 5 years from the date of the orders in these proceedings. If after that time Dr Jamieson did apply for any condition to be altered, varied or removed, the conduct the subject of these complaints, his conduct between 2010 and the present and his conduct and circumstances after the making of the orders in this matter might all be relevant. By including such a term in the order by which the conditions are to be imposed, the Tribunal is not indicating in any way that it anticipates that it would be appropriate for Dr Jamieson to be permitted to prescribe either Schedule 4D or Schedule 8 drugs after the expiration of 5 years. Indeed, his supervisors have noted that pressure was removed from Dr Jamieson when he did not have those prescribing rights and this may well be a continuing reason why he should not in the future ever seek to have or be given those rights again. 144Similarly, the Tribunal believes that considerations of protection of the public and the profession also render it appropriate to specify that Dr Jamieson not make any application in relation to varying the condition restricting the treatment of patients requiring psychiatric or psychological care within 3 years from the making of the orders in this matter. Costs 145The HCCC has sought an order that Dr Jamieson pay the HCCC's costs in these proceedings. Clause 13 of Schedule 5D to the National Law relevantly provides: (1)A Tribunal may order the complainant (if any), the registered health practitioner or student concerned, or any other person entitled to appear (whether as of right or because leave to appear has been granted) at an inquiry or appeal before the Tribunal to pay costs to another person as decided by the Tribunal. 146The principles to be applied by the Tribunal in exercise of its discretion to award costs under a provision such as cl 13(1) were considered by the Court of Appeal in Ohn v Walton (1995) 36 NSWLR 77. Regulation 27(1) of the Medical Practitioner Regulations which were the subject of that decision is substantially the same as cl 13(1). Gleeson CJ held at 79: Although a complaint before the Medical Tribunal is different in a number of respects from civil litigation, and from a summary prosecution for an offence, they are both examples of proceedings in which orders for costs may be made, and what has been said about costs in such proceedings offers guidance in the present context. 147Cole JA at 84 - 85 referred to comments by Mason CJ in Latoudis v Casey (1990) 170 CLR 534 at 542-3 and cited the passage from McHugh J at 568 that "even when the discretion [to award costs] is uncontrolled, civil courts act on the basis that a successful party has a reasonable expectation of obtaining an order for costs and that the discretion to refuse to award costs should not be exercised against a successful party except for reason connected with the case". Cole JA went on to state at 85: Whether the Medical Tribunal be a court or not, the principles enunciated by Mason CJ and McHugh J are of general application and should be applied by a tribunal such as the Medical Tribunal, absent contrary legislation or regulation [citations omitted]. 148The HCCC was successful on each of the two complaints contained in the Notice of Complaint. There was nothing in the conduct of the proceedings or the circumstances in which they were brought against the Dr Jamieson which would render it not just and reasonable to award costs in the HCCC's favour in this case. Consequently, there will be an order for costs in favour of the HCCC. Final Orders 149For the reasons set out above, the Tribunal makes the following orders: (1)The respondent, Dr Jamieson, be and hereby is reprimanded. (2)The conditions set out below in the schedule headed "Health Care Complaints Commission v Dr Jamieson - Conditions" (the Conditions) be imposed on the respondent's registration, on terms that the respondent may not make an application for review of this order in respect of: (a)conditions 1, 2, 3 or 4 in the Conditions before the expiration of 5 years from the date of these orders; and (b)condition 8 in the Conditions before the expiration of 3 years from the date of these orders. (3)The Conditions may be altered, varied or removed at the discretion of the Medical Council of New South Wales and the Medical Council is the appropriate review body for the purposes of Division 8 of the Health Practitioner Regulation National Law (NSW). (4)Sections 125 to 127 of the Health Practitioner Regulation National Law are to apply whilst the respondent's principal place of practice is anywhere in Australia other than in New South Wales, so that a review of the Conditions can be conducted by the Medical Board of Australia. (5)The respondent pay the complainant's costs. Schedule Health Care Complaints Commission v Dr Jamieson - Conditions 1The practitioner is not to possess, prescribe, supply, dispense or administer any drug of addiction (Schedule 8 drugs). 2The practitioner is not to prescribe any prescribed restricted substance (Schedule 4D drug or Schedule 4D derivative). 3The practitioner is not to apply to the Pharmaceutical Services of the New South Wales Department of Health for his authority to have possession of, prescribe, supply, dispense, administer or handle any drug of addiction (Schedule 8 drugs). 4The practitioner is not to apply to the Pharmaceutical Services of the New South Wales Department of Health for his authority to prescribe any prescribed restricted substance (Schedule 4D drug or Schedule 4D derivative). 5Within four weeks from the date of this decision, the practitioner is to nominate a supervisor to be approved by the Council, to monitor and review his clinical practice in accordance with Level 2 Supervision as contained in the Medical Council of New South Wales Policy on Supervision (Performance, Health, Conduct) (the Council's Supervision Policy). The supervisor is to be a General Practitioner experienced in the work currently undertaken by the practitioner. The supervisor is to be provided with a copy of the Council's Supervision Policy and a copy of these conditions, the Report of the Assessors, the Review Panellists and the written decision of the Tribunal. The practitioner is to be responsible for all costs associated with the supervision arrangement. The practitioner is to ensure that: (a)He and the supervisor meet every second month for at least two hours, the first meeting to occur within one month of being advised by the Council that his nominated supervisor has been approved. (b)At each meeting, they address the practitioner's practice of medicine including the concerns raised by the New South Wales Civil and Administrative Tribunal in its written decision. (c)At each meeting, the supervisor completes a record of matters discussed at the meeting in a format prescribed or approved by the Council. (d)The supervisor forwards to the Council, initially on a monthly basis for the first three months and then subsequently on a basis approved by the Council, a Supervision Report in a format prescribed or approved by the Council. (e)The supervisor is authorised to inform the Council immediately if there are any concerns in relation to the practitioner's compliance with the supervision requirements, clinical performance, health, or if the supervisor relationship ceases. (f)In the event that the approved supervisor is no longer willing or able to provide the supervision required, details of a replacement supervisor are forwarded for approval by the Council within 21 days of the cessation of the original supervisory relationship. (g)That the supervisory arrangement remains in place for 12 months with the supervision period being extended if upon consideration of the supervision reports received, the Council deems such extension necessary. 6The practitioner is to submit to an audit, at his premises, of a random selection of his medical records by a person or persons nominated by the Council, to assess his compliance with relevant provisions of the Health Practitioner Regulation (NSW) 2010 and compliance with these conditions. The audit is to occur within three months from the date of this decision and subsequently at intervals as required by the Council. The practitioner is to authorise the auditor(s) to provide the Council with a report on their findings. The practitioner is to meet all costs associated with the audit(s) and any subsequent reports. 7The practitioner is to practise only in a hospital or group practice where the most senior practitioner or clinical supervisor is aware of the conditions on his registration and is to provide the Council with a copy of these conditions signed by the senior practitioner or clinical supervisor within 7 days of the Tribunal decision. If the practitioner commences work in a new practice or hospital, he must provide the Council with a copy of these conditions signed by the most senior practitioner or clinical supervisor within 7 days of commencing work. 8The practitioner is not to treat or manage patients with psychiatric or psychological symptoms or problems and any patient requesting psychotherapy treatment or whom the practitioner assesses is in need of psychiatric or psychological treatment must be referred to a psychiatrist, psychologist or other appropriate health professional. 9The practitioner is not to treat or manage patients for drug and/or alcohol addiction and any patient requesting drug and/or alcohol addiction treatment or whom the practitioner assesses is in need of drug and/or alcohol addiction treatment must be referred to an appropriate addiction specialist. 10The practitioner is to have his professional performance re-assessed within 12 months following the date of the Tribunal decision and then at a frequency deemed appropriate by the Medical Council. 11The practitioner is to authorise and consent to the exchange of information between the Council, Medicare Australia and Pharmaceutical Services for the purpose of monitoring compliance with these conditions. I hereby certify that this is a true and accurate record of the reasons for decision of the Civil and Administrative Tribunal of New South Wales. Registrar DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated. Decision last updated: 21 May 2014