Civil and Administrative Tribunal New South Wales Medium Neutral Citation: Health Care Complaints Commission v Low [2015] NSWCATOD 18 Hearing dates: 17 and18 November 2014 Decision date: 23 March 2015 Jurisdiction: Occupational Division Before: Hon G Mullane, ADCJ Dr G Yeo, Professional Member Dr E Kok, Professional Member K Sundquist , General Member Click here to enter text. Decision: (1) The Respondent is reprimanded. (2) The Respondent's registration as a medical practitioner is to be subject to the conditions set out below. (3) The Respondent must pay the Complainant's costs of the proceedings as agreed or as assessed. CONDITIONS: (a) Schedule 4D and Schedule 8 prescribing rights 1. To not prescribe, possess, supply, administer, handle or dispense any drug of addiction (Schedule 8 drugs) or any prescribed restricted substance (Schedule 4D drug or Schedule 4D derivative). 2. Any future change in his Schedule 8 or Schedule 4D authority must be in accordance with the protocol of the Medical Council of NSW (the Council). This must include consultation with the Council prior to the submission of any variation application to the Pharmaceutical Services Unit (PSU). 3. To not make an application for variation in any of Schedule 8 or Schedule 4D authority to the PSU or to the Council, or to the Council for review of any other conditions, before the expiry of 12 months from the date of these reasons. (b) Practice environment 4. To work only in an accredited group practice. A group is defined as 2 or more medical practitioners, excluding Dr Low. An accredited practice is defined as one that is currently certified by an appropriate General practice accrediting certifier as complying with the current (4th Ed) RACGP Standards of Accreditation). 5. If practising in general practice other than in his own practice, Dr Low is to notify the owner/s and principal of the practice [and any other practitioner (including future practitioners) who may be working on site with him] of these conditions and to forward to the Council, within 7 days, a copy of these Conditions signed by each one of those practitioners. 6. To obtain Council approval prior to changing the nature or place of his practice. (c)Supervision 7. The existing conditions on the Respondent's registration regarding supervision are to continue until 22 October 2015. (d) Monitoring 8. To authorise and consent to any exchange of information between the Council and Medicare Australia and/or the PSU for the purpose of monitoring compliance with these conditions. (e) Mentoring 9. On or before 1 October 2015, the practitioner must provide the Council the name and professional address of a registered medical practitioner who has agreed to act as his mentor. The mentor is to be independent of the practice within which the practitioner is working and must be approved by the Council. 10. The mentoring is to continue for a period of two years from 22 October 2015. The nature and frequency of contact with the mentor is to be determined by the mentor in accordance with the Council's Guidelines for Mentors (Policy PCR 10.1). 11. Dr Low must: (a) provide the mentor with a copy of the Tribunal's Decision and these conditions prior to the mentoring arrangement commencing. (b) ensure that mentoring sessions include discussion of issues highlighted in this Decision, personal and/or medical practice issues as they arise and professional development as a medical practitioner (including relevant CME activities). (c) authorise the mentor to report, in an approved format, to the Council every three months about the fact of contact, and to inform the Council if there is any concern about his professional conduct. (d) authorise the mentor to notify the Council if there is any failure to attend, termination of the mentoring relationship against the advice of the mentor, or any other matter the mentor considers appropriate. (e) participate in the mentor arrangements for two years and thereafter for such period as the Medical Council of NSW may determine. (f) authorise the mentor to notify the Council when of the view that professional mentoring is no longer required. (g) in the event that the approved mentor is no longer willing or able to continue as mentor, nominate another mentor for approval by the Council within 21 days of the cessation of the original mentor relationship. (h) be responsible for any costs associated with the mentoring process. (f) Education 12. Comply with the requirements of the Medical Council for Continuing Medical Education. 13.On or before 31 March 2015 join the Royal Australian College of General Practitioners and continue to be a member whilst he practices in general practice. 14.Meet the Continuing Professional Development /Quality Improvement requirements of the Royal Australian College of General Practitioners. 15.Complete in 2015 at his own expense the distance education course: "Issues in General Practice Prescribing" conducted by the Department of General Practice, Monash University, Melbourne. 16.Within one month of completing that course he provide documentary evidence to the Medical Council that he has satisfactorily completed the course. (g) Review of conditions 17. These conditions may be altered, varied or removed by the Council and the Council is the appropriate review body for the purposes of Division 8 Part 8 of the Health Practitioner Regulation National Law (NSW). 18. Should Dr Low seek to change or remove any of the conditions imposed as a result of this Tribunal's orders when his principal place of practice is anywhere in Australia other than in New South Wales, sections 125 to 127 inclusive of the Health Practitioner Regulation National Law are to apply, so that a review of these conditions can be conducted by the Medical Board of Australia. Catchwords: Medical practitioner prescribing drugs for patients – professional misconduct – ignorance, naivety, professional isolation, neglect of continuing medical education. Legislation Cited: Health Practitioner Regulation National Law (NSW) No. 86a; Therapeutic Goods Act 2008; Cases Cited: Health Care Complaints Commission –v- Litchfield [1997] 41 NSWLR 630; Prakash –v- Health Care Complaints Commission [2006] NSWCA 153; Lee –v- Health Care Complaints Commission [2012] NSWCA 80; Ex parte Lenehan (1948) 77CLR403 Texts Cited: Health Care Complaints Commission (Complainant) Dr Kon Hwa Peter Low (Respondent) Category: Principal judgment Parties: Health Care Complaints Commission (Complainant) Dr Kon Hwa Peter Low (Respondent) Representation: Counsel: P Dwyer (Complainant) M Lynch, (Respondent) Solicitors K Mobbs, Health Care Complaints Commission, (Complainant) Dibbs Barker, (Respondent) File Number(s): 1420169 Publication restriction: Publication, broadcast or disclosure of the name or address of any past or any present patient of Dr Low referred to in the reasons or information identifying such patient, is prohibited. reasons for decision INTRODUCTION 1. This was a hearing of a Complaint by the Commission about professional conduct of the Respondent practising as a general medical practitioner in 2011 and 2012. 2. At the hearing the parties presented an Amended Complaint and the Respondent and the Complaint agreed to the facts alleged in that document, including the background and particulars in the document, subject to minor corrections that in Clause 12 the date of 14 February 2011 was amended to 18 October 2011, and, in Subclause 44(c) the date 8 March 2011 was amended to 8 March 2012. 3. Accordingly, the parties were agreed on the complaints and the particulars in the complaints. The complaints relate to prescribing of addictive drugs to patients (some of whom were drug addicted), failure to keep adequate patient records, and other associated conduct. 4. The admissions include that the Respondent by the conduct admitted is guilty of professional misconduct. 5. The Complainant seeks in the Amended Complaint that the Respondent's registration be cancelled. 6. The Respondent submits that the appropriate outcome is a reprimand and imposition of conditions on his registration. GROUNDS AND FACTS ALLEGED BY COMPLAINANT AND ADMITTED BY RESPONDENT 1. The following are the Grounds and facts alleged by the Complainant and admitted by the Respondent in the Amended Complaint: AMENDED COMPLAINT The Civil and Administrative Tribunal of New South Wales has received a complaint from the Health Care Complaints Commission following consultation with the Medical Council of New South Wales in accordance with sections 39(2) and 90B(3) of the Health Care Complaints Act 1993 and section 145A of the Health Practitioner Regulation National Law ("the National Law'; THAT Dr Kon Hwa Peter Low of 40 Third Avenue, Blacktown NSW, 2148 ("the practitioner"), being a medical practitioner registered under the National Law COMPLAINT ONE Is guilty of unsatisfactory professional conduct under section 139B of the National Law in that the practitioner has: (i) engaged in conduct that demonstrates that the knowledge, skill or judgement possessed, or care exercised, by the practitioner in the practice of medicine is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience, and/or (ii) contravened a provision of the Health Practitioner Regulation (NSW) Regulation 2010; and/or (iii) engaged in improper or unethical conduct relating to the practice or purported practice of medicine. BACKGROUND TO COMPLAINT ONE At all relevant times, the practitioner practised as a general practitioner at the Highview Family Medical Centre in Blacktown NSW. PARTICULARS OF COMPLAINT ONE Patient A 1. The practitioner prescribed oxycodone for Patient A between 7 July 2011 and 5 March 2012 as set out in Schedule A: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (c) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient A was on an opiate replacement program. 2. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2, in respect of his medical records for Patient A in that he failed to appropriately record: (a) The patient's medical history; (b) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (c) Details of any examination of the patient's mental state; (d) Any investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment for the patient; 3. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 (3) by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone, to Patient A, a drug dependent person. 4. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 (2) by prescribing a drug of addiction, namely oxycodone, for more than two months to Patient A without obtaining prior written authority of the NSW Department of Health. 5. The practitioner failed to comply with the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxycodone: (a) On 1 August 2011 (prescription dated 2 August 2011); (b) One 10 August 2011 (prescription dated 11 August 2011). Patient B 6. The practitioner prescribed oxycodone for Patient B between 12 July 2011 and 24 November 2011 as set out in Schedule B: (a) Without exercising appropriate medical judgment as to whether it was appropriate to issue such prescriptions; (b) Without exercising appropriate medical judgement in that he provided frequent prescriptions at the patient's request within short intervals and prior to the expiry of supply of medication from previous prescriptions; (c) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate, in that, he failed to manage the patient's chronic pain by initially considering other treatment options such as physiotherapy, exercise, psychological interventions such as cognitive behavioural therapy and referral to a psychiatrist; (d) At a frequency not in accordance with recognised therapeutic standards as to what is medically appropriate; (e) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; 7. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient B in that he failed to record: (a) The patient's medical history; (b) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (c) Details of any examination of the patient's mental state; (d) Any investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 8. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone, to Patient B, a drug dependent person. 9. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, to Patient B for more than two months without obtaining prior written authority of the NSW Department of Health. 10. The practitioner failed to comply with the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxycodone: (a) On 10 October 2011 (prescription dated 12 October 2011); (b) On 16 November 2011 (prescription dated 24 November 2011). Patient C 11. The practitioner prescribed oxycodone for Patient C between 16 February 18 October 2011 and November 2011 as set out in Schedule C: (a) Without exercising appropriate medical judgment as to whether it was appropriate to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate, in that, he failed to manage the patient's chronic pain by initially considering other treatment options such as physiotherapy, exercise, psychological interventions such as cognitive behavioural therapy and referral to a psychiatrist; (c) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; 12. The practitioner prescribed benzodiazepines for Patient C between 14 February 18 October 2011 and 21 7 November 2011 as set out in Schedule C: (a) Without exercising appropriate medical judgment as to whether it was appropriate to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (c) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; 13. The practitioner failed to comply with the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient C in that he failed to record: (a) The patient's medical history; (b) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (c) Details of any examination of the patient's mental state; (d) Any investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 14. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone, to Patient C, a drug dependent person. 15. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, to Patient C for more than two months without obtaining prior written authority of the NSW Department of Health. Patient D 16. The practitioner prescribed oxycodone for Patient D between 5 October 2011 and 3 March 2012 as set out in Schedule D: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate, in that, he failed to manage the patient's chronic pain by initially considering other treatment options such as physiotherapy, exercise, psychological interventions such as cognitive behavioural therapy and referral to a psychiatrist; (c) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient D was on an opiate replacement program. (f) Without referring the patient to a specialist rheumatologist for an opinion; (g) Without conducting proper investigations such as x-rays and blood tests. 17. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient D in that he failed to record: (a) The patient's medical history; (b) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (c) Details of any examination of the patient's mental state; (d) Any investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 18. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient D, a drug dependent person. 19. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, to Patient D, for more than two months without obtaining prior written authority of the NSW Department of Health. 20. The practitioner failed to comply with the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxycodone to the forward date: (a) On 25 October 2011 (prescription dated 26 October 2011); (b) On 3 November 2011 (prescription dated 4 November 2011); (c) On 6 December 2011 (prescription dated 10 December 2011); (d) On 17 January 2012 (prescription dated 19 January 2012); (e) On 25 January 2012 (prescription dated 27 January 2012). Patient E 21. The practitioner prescribed oxycodone for Patient E between 24 April 2011 and 28 February 2012 as set out in Schedule E: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate, in that, he failed to manage the patient's chronic pain by initially considering other treatment options such as physiotherapy, exercise, psychological interventions such as cognitive behavioural therapy and referral to a psychiatrist; (c) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient E was on an opiate replacement program; (f) Failing to establish a treatment plan to decrease the patient's use of oxycodone; (g) In an inappropriate combination with Fentanyl. 22. The practitioner prescribed fentanyl for Patient E between 20 September 2011 and 8 November 2011 as set out in Schedule E: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate, in that, he failed to manage the patient's chronic pain by initially considering other treatment options such as physiotherapy, exercise, psychological interventions such as cognitive behavioural therapy and referral to a psychiatrist; (c) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient E was on an opiate replacement program; (f) In an inappropriate combination with oxycodone. 23. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient E in that he failed to record: (a) The patient's medical history; (b) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (c) Details of any examination of the patient's mental state; (d) Any investigations undertaken by the practitioner including results of a CT Scan on 25 April 2011; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 24. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient E, a drug dependent person. 25. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, for more than two months to Patient E without obtaining prior written authority of the NSW Department of Health. 26. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely Fentanyl, to Patient E, a drug dependent person. Patient F 27. The practitioner prescribed oxycodone for Patient F between 13 October 2011 and 22 December 2011 as set out in Schedule F: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (c) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (d) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient F was on an opiate replacement program; (e) Failing to seek specialist advice from the patient's other treating practitioner. 28. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient F in that he failed to record: (a) The patient's medical history; (b) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (c) Details of any examination of the patient's mental state; (d) Any investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 29. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient F, a drug dependent person. Patient G 30. The practitioner prescribed oxycodone for Patient G between 6 August 2011 and 16 April 3 March 2012 as set out in Schedule G: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (c) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient G was on an opiate replacement program. 31. The practitioner prescribed benzodiazepines for Patient G between 3 November 2011 and 3 March 2012 as set out in Schedule G: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (c) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient G was on an opiate replacement program. 32. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient G in that he failed to record: (a) The patient's medical history; (b) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (c) The physical examination of the patient; (d) Any investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 33. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient G, a drug dependent person. 34. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, for more than two months to Patient G, without obtaining prior written authority of the NSW Department of Health. Patient H 35. The practitioner prescribed benzodiazepines Oxycodone for Patient H between 13 November 2011 and 3 March 28 February 2012 as set out in Schedule H: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (c) Failing to appropriately assess the patient for pain by undertaking specific diagnostic tests such as a Nerve Conduction Study and MRI; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient H was on an opiate replacement program; (f) Failing to establish an appropriate plan to decrease the patient's use of oxycodone. 36. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient H in that he failed to record: (a) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (b) Assessment of the patient; (c) Any investigations undertaken by the practitioner; (d) Imaging reports of tests undertaken on the patient, (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 37. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient H, a drug dependent person. 38. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, for more than two months to Patient H, without obtaining prior written authority of the NSW Department of Health. 39. The practitioner failed to comply with the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxycodone: (a) On 4 January 2011 (prescription dated 8 January 2011); (b) On 11January 2011 (prescription dated 12 January 2011). Patient I 40. The practitioner prescribed benzodiazepines Oxycodone for Patient I between 23 May 2011 and 14 March 2012 as set out in Schedule I: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate, in that, he failed to manage the patient's chronic pain by initially considering other treatment options such as physiotherapy, exercise, psychological interventions such as cognitive behavioural therapy and referral to a psychiatrist; (c) Failing to carry out appropriate assessment of the patient; (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) Failing to establish an appropriate treatment plan to decrease the patient's use of oxycodone. 41. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient I in that he failed to record: (a) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (b) Results of investigations undertaken by the practitioner; (c) Progress of the patient at each visit; (d) The diagnoses made by the practitioner; (e) Plans, nature and results of treatment of the patient; (f) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 42. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient I, a drug dependent person. 43. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, for more than two months to Patient I, without obtaining prior written authority of the NSW Department of Health. 44. The practitioner contravened the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxycodone to the forward date: (a) On 1 August 2011 (prescription dated 2 August 2011); (b) On 1 September 2011 (prescription dated 2 September 2011); (c) On 8 7 March 2012 (prescription dated 8 August 2011 March 2012). Patient J 45. The practitioner prescribed oxycodone for Patient J between 25 January 2012 and 8 March 2012 as set out in Schedule J: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (c) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (d) Failing to correctly assess the patient for pain by undertaking specific diagnostic tests such as a Nerve Conduction Study and MRI. (e) In quantities in excess of recognised therapeutic standards as to what is medically appropriate; (f) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (g) Failing to establish appropriate management plans; (h) Failing to refer the patient to a drug and alcohol unit for treatment of drug dependency. 46. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient J in that he failed to record: (a) The patient's medical history; (b) Physical examination and assessment of the patient; (c) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (d) Results of investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 47. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient J, a drug dependent person. 48. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, for more than two months to Patient J without obtaining prior written authority of the NSW Department of Health. 49. The practitioner failed to comply with the Poisons and Therapeutics Goods Regulation 2008 Clause 8O, by forward dating prescriptions for oxycodone to the forward date: (a) On 15 February 2012 (prescription dated 16 February 2012). Patient K 50. The practitioner prescribed oxycodone for Patient K between 5 August 2011 and 6 March 2012 as set out in Schedule K: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate, in that, he failed to manage the patient's chronic pain by initially considering other treatment options such as physiotherapy, exercise, psychological interventions such as cognitive behavioural therapy and referral to a psychiatrist; (c) Failing to correctly assess the patient for pain by undertaking specific diagnostic tests such as a Nerve Conduction Study and MRI. (d) In a dosage in excess of recognised therapeutic standards as to what is medically appropriate; (e) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (f) Failing to establish an appropriate treatment plan to decrease the patient's use of oxycodone. 51. The practitioner prescribed benzodiazepine for Patient between 5 August 2011 and 13 March 2012 as set out in Schedule K: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate, in that, he failed to manage the patient's chronic pain by initially considering other treatment options such as physiotherapy, exercise, psychological interventions such as cognitive behavioural therapy and referral to a psychiatrist; (c) Failing to correctly assess the patient for pain by undertaking specific diagnostic tests such as a Nerve Conduction Study and MRI; (d) For a duration and in quantities in excess of recognised therapeutic standards as to what is medically appropriate; (e) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (f) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient K was on an opiate replacement program; (g) Failing to establish a treatment plan to decrease the patient's use of benzodiazepine. 52. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient K in that he failed to record: (a) The patient's medical history; (b) Assessment and physical examination of the patient; (c) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (d) Results of investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 53. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient K, a drug dependent person. 54. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, for more than two months to Patient K without obtaining prior written authority of the NSW Department of Health. 55. The practitioner failed to comply the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxycodone to the forward date: (a) On 21 September 2011 (prescription dated 23 September 2011); (b) On 10 October 2011 (prescription dated 11 October 2011). Patient L 56. The practitioner prescribed oxycodone for Patient L between 16 February 2011 and 9 April 2 March 2012 as set out in Schedule L: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) Failing to refer the patient for appropriate specialist assessment and opinion; (c) Failing to correctly assess the patient for pain by undertaking specific diagnostic tests such as a Nerve Conduction Study and MRI. (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) Failing to notify authorities that Patient L had admitted to an oxycodone addiction; (f) Failing to establish a treatment plan to decrease the patient's use of oxycodone. 57. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient K in that he failed to record: (a) The patient's medical history; (b) the patient's notes neatly and in a manner which could be easily read; (c) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (d) Results of investigations undertaken by the practitioner; (e) Progress of the patient at each visit; (f) The diagnoses made by the practitioner; (g) Plans, nature and results of treatment of the patient; (h) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 58. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient L, a drug dependent person. 59. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone, for more than two months to Patient L without obtaining prior written authority of the NSW Department of Health. 60. The practitioner failed to comply with the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxycodone to the forward date: (a) On 16 April 2011 (prescription dated 17 April 2011). Patient M 61. The practitioner prescribed benzodiazepines for Patient M between 24 April 2008 nd 28 November 2011 as set out in Schedule M: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (c) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (d) In dosages in excess of recognised therapeutic standards as to what is medically appropriate; (e) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient M was on an opiate replacement program. (f) Failing to refer the patient for appropriate specialist assessments and opinion; (g) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 62. Between 1 February 2008 and 25 July 2012 the practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient M in that he failed to record: (a) The patient's medical history; (b) Assessment of the patient; (c) the patient's notes neatly and in a manner which could be easily read; (d) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (e) Results of investigations and assessments undertaken by the practitioner; (f) Progress of the patient at each visit; (g) The diagnoses made by the practitioner; (h) Failed to record reasons for prescribing prior to expiry of supply of medication from previous prescriptions; (i) Plans, nature and results of treatment of the patient; (j) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. 63. Between 1 February 2008 and 25 July 2012 the practitioner contravened the Medical Practice Regulation 2008 Clause 4 and Schedule 1 (repealed) in respect of his medical records for Patient M in that he failed to record: (a) The patient's medical history; (b) Assessment of the patient; (c) the patient's notes neatly and in a manner which could be easily read; (d) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (e) Results of investigations and assessments undertaken by the practitioner; (f) Progress of the patient at each visit; (g) The diagnoses made by the practitioner; (h) Reasons for prescribing early prescriptions to the patient; (i) Plans, nature and results of treatment of the patient; (j) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. Patient N 64. The practitioner prescribed oxycodone for Patient N between 5 July 2011 and 3 September 2011 as set out in Schedule N: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (c) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient N was on an opiate replacement program. (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) Failing to establish an appropriate treatment plan to decrease the patient's use of oxycodone. 65. The practitioner prescribed benzodiazepines for Patient N between 5 July 2011 and 3 September 2011 as set out in Schedule N: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (c) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient N was on an opiate replacement program. (d) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (e) In an inappropriate combination with oxycodone. 66. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient N in that he failed to record: (a) The patient's medical history; (b) Assessment of the patient; (c) the patient's notes neatly and in a manner which could be easily read; (d) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (e) Results of investigations undertaken by the practitioner; (f) Progress of the patient at each visit; (g) The diagnoses made by the practitioner; (h) Plans, nature and results of treatment of the patient; (i) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. j) Failed to record reasons for prescribing prior to expiry of supply of medication from previous prescriptions. 67. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely oxycodone to Patient N, a drug dependent person. 68. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely oxycodone for more than two months to Patient N without a written authority of the NSW Department of Health. 69. The practitioner contravened the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxycodone: (a) On 9 July 2011 (prescription dated 10 July 2011); (b) On 14 July 2011 (prescription dated 14 July 2011). Patient 0 70. The practitioner prescribed methadone for Patient 0 between 14 August 2010 and 24 December 2011 as set out in Schedule 0: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (c) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (d) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient N was on an opiate replacement program. (e) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (f) Failing to establish an appropriate treatment plan to decrease the patient's use of methadone; (g) In an inappropriate combination with morphine in high dosages for an extended period of time. 71. The practitioner prescribed morphine for Patient 0 between 3 September 2010 and 30 January 2012 as set out in Schedule 0: (a) Without exercising appropriate medical judgment as to whether to issue such prescriptions; (b) For a purpose not in accordance with recognised therapeutic standards as to what is medically appropriate; (c) For a duration in excess of recognised therapeutic standards as to what is medically appropriate; (d) When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient N was on an opiate replacement program; (e) When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; (f) Failing to establish a treatment plan to decrease the patient's use of morphine; (g) In an inappropriate combination with methadone in high dosages for an extended period of time. 72. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely methadone to Patient 0, a drug dependent person. 73. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely methadone for more than two months to Patient 0 without a written authority of the NSW Department of Health. 74. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by failing to obtain a written authority from the NSW Department of Health, prior to prescribing a drug of addiction, namely morphine to Patient 0, a drug dependent person. 75. The practitioner failed to comply with the Poisons and Therapeutics Goods Act, 1966 section 28 by prescribing a drug of addiction, namely morphine for more than two months to Patient a without a written authority of the NSW Department of Health. 76. The practitioner contravened the Health Practitioner Regulation (NSW) Regulation 2010 Clause 7 and Schedule 2 in respect of his medical records for Patient a in that he failed to record: (a) The patient's medical history; (b) Comprehensive assessment of the patient (c) The patient's notes neatly and in a manner which could be easily read; (d) Sufficient history of previous or ongoing drug use by the patient other than that prescribed by the practitioner; (e) Results of investigations undertaken by the practitioner; (f) Progress of the patient at each visit; (g) The diagnoses made by the practitioner; (h) Plans, nature and results of treatment of the patient; (i) Sufficient information concerning the patient's case to allow another registered medical practitioner to continue management of the patient's case. (j) Reasons for prescribing early prescriptions to the patient; 77. The practitioner contravened the Poisons and Therapeutics Goods Regulation 2008 Clause 80, by forward dating prescriptions for oxyoodone MsContin: (a) On 1 April 2011 (prescription dated 2 April 2011); (b) On 2 12 April 2011 (prescription dated 13 April 2011); (c) On 8 18 April 2011 (prescription dated 19 April 2011); (d) On 6 May 2011 (prescription dated 7 May 2011); (e) On 11 May 2011 (prescription dated 12 May 2011); (f) On 25 May 2011 (prescription dated 26 May 2011); (g) On 30 May 2011 (prescription dated 31 May 2011); (h) On 189 18 June 2011 (prescription dated 19 June 2011); (i) On 28 June 2011 (prescription dated 29 June 2011); (j) On 26 July 2011 (prescription dated 27 July 2011); (k) On 8 October 2011 (prescription dated 9 October 2011); (I) On 7 November 2011 (prescription dated 8 November 2011); (m) On 11 November 2011 (prescription dated 12 November 2011); (n) On 29 November 2011 (prescription dated 30 November 2011); (o) On 12 December 2011 (prescription dated 13 December 2011); (p) On 19 December 2011 (prescription dated 20 December 2011); (q) On 23 December 2011 prescription (dated 2 January 2012); COMPLAINT TWO Is guilty of professional misconduct within the meaning of section 139E of the National Law in that he has: (i) Engaged in unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration, or (ii) Engaged in 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 his registration. BACKGROUND TO COMPLAINT TWO As for Complaint One. PARTICULARS OF COMPLAINT TWO Complaint One and the particulars thereof are repeated and relied upon, both individually and cumulatively. Dated …………………………. 2014 Karen Mobbs Director of Proceedings, Health Care Complaints Commission Schedule A: Prescribing for Patient A by Dr Kon Hwa Peter Low Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity 1 7/07/2011 7/07/2011 Oxycodone 80mg 1 unit 8-12 hourly prn 28 2 14/07/2011 14/07/2011 Oxycodone 80mg 1 unit 8 hourly prn 28 3 23/07/2011 23/07/2011 Oxycodone 80mg 1 unit 8-12 hourly prn 28 4 25/07/2011 25/07/2011 Oxycodone 80mg 1 unit 12 hourly prn 28 5 1/08/2011 2/08/2011 Oxycodone 80mg 1 unit BD 28 6 10/08/2011 11/08/2011 Oxycodone 80mg 1 BD 28 7 23/08/2011 23/08/2011 Oxycodone 40mg 1 q8-12h prn 28 8 31/08/2011 31/08/2011 Oxycodone 40mg 1 q8h prn 28 9 6/09/2011 6/09/2011 Oxycodone 40mg 1 tds 28 10 16/09/2011 16/09/2011 Oxycodone 40mg 1 unit BD 28 11 29/09/2011 Oxycodone 40mg 1 unit BD 28 12 1/10/2011 Oxycodone 40mg 1 unit BD 28 13 13/10/2011 13/10/2011 Oxycodone 40mg 1 unit 12 hourly prn 28 14 26/10/2011 26/10/2011 Oxycodone 20mg 1 unit 8 hourly prn 28 15 8/11/2011 8/11/2011 Oxycodone 20mg 1 unit BD 28 16 21/11/2011 21/11/2011 Oxycodone 20mg 1 unit BD 28 17 5/12/2011 5/12/2011 Oxycodone 10mg 1 unit 8 hourly prn 28 18 9/12/2011 9/12/2011 Oxycodone 20mg 1 unit BD 28 19 21/12/2011 21/12/2011 Oxycodone 20mg 1 unit BD 28 20 3/01/2012 3/01/2012 Oxycodone 10mg 1 unit q8h prn 28 21 19/01/2012 19/01/2012 Oxycodone 40mg 1 mdiu 28 22 3/02/2012 3/02/2012 Oxycodone 40mg 1 unit 8-12 hourly prn 28 23 11/02/2012 11/02/2012 Oxycodone 40 mg 1 bd prn mdu 28 24 21/02/2012 21/02/2012 Oxycodone 30mg 1 unit 8 hourly prn 28 25 5/03/2012 5/03/2012 Oxycodone 20mg 1 unit 8 hourly prn 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule B: Prescribing for Patient B by Dr Dr Kon Hwa Peter Low 1 12/07/2011 Oxycodone 80mg 1 unit BD 28 2 25/07/2011 25/07/2011 Oxycodone 80mg 1 unit bd prn 28 3 28/07/2011 28/07/2011 Oxycodone 80mg 1 unit BD 28 4 9/08/2011 9/08/2011 Oxycodone 80mg 1 unit BD 28 5 14/08/2011 14/08/2011 Oxycodone 80mg 1 unit BD 28 6 16/08/2011 16/08/2011 Oxycodone 80mg 1 unit 12-18 hourly prn 28 7 24/08/2011 24/08/2011 Oxycodone 80mg 1 unit BD 28 8 3/09/2011 6/09/2011 Oxycodone 40mg 1 unit tds 28 9 4/09/2011 4/09/2011 Oxycodone 40mg 1 unit tds 28 10 21/09/2011 21/09/2011 Oxycodone 40mg 1 unit BD 28 11 5/10/2011 Oxycodone 40mg 1 unit BD 28 12 12/10/2011 16/10/2011 Oxycodone 40mg 1 unit BD 28 13 16/10/2011 16/10/2011 Oxycodone 40mg 1 unit BD 28 14 16/11/2011 16/11/2011 Oxycodone 20mg 1 unit 8 hourly prn 28 15 24/11/2011 24/11/2011 Oxycodone 20mg 1 unit 8 hourly 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule C: Prescribing for Patient C by Dr Dr Kon Hwa Peter Low 6/04/2011 Oxycodone 1 18/10/2011 18/10/2011 Oxycodone 40mg 1 unit 12 hourly prn 28 2 18/10/2011 18/10/2011 oxazepam 30mg 25 3 7/11/2011 9/11/2011 Oxycodone 40mg 1 unit 12 hourly prn 28 4 7/11/2011 7/11/2011 oxazepam 30mg 25 5 25/11/2011 25/11/2011 Oxycodone 40mg 1 unit BD 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule D: Prescribing for Patient D by Dr Dr Kon Hwa Peter Low 1 5/10/2011 5/10/2011 Oxycodone 80mg 1 unit BD 28 2 18/10/2011 18/10/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 3 26/10/2011 26/10/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 4 3/11/2011 4/11/2011 Oxycodone 40mg 1 unit BD 28 5 14/11/2011 14/11/2011 Oxycodone 40mg 1 unit BD 28 6 22/11/2011 24/11/2011 Oxycodone 20 mg 1 unit BD 28 7 2/12/2011 2/12/2011 Oxycodone 20mg 1 unit BD 28 8 6/12/2011 10/12/2011 Oxycodone 20mg 1 q8 prn 28 9 13/12/2011 13/12/2011 Oxycodone 20mg 1 unit 8 hourly prn 28 10 19/12/2011 19/12/2011 Oxycodone 20mg 1 unit 8 hourly prn 28 11 30/12/2011 30/12/2011 Oxycodone 20mg 1 unit BD 28 12 4/01/2012 5/01/2012 Oxycodone 10mg 1 q6 prn 28 13 13/01/2012 13/01/2012 Oxycodone 20mg 1 unit BD 28 14 17/01/2012 17/01/2012 Oxycodone 20mg 1 unit 8 hourly prn 28 15 25/01/2012 27/01/2012 Oxycodone 20mg 1 unit 8 hourly prn 28 16 2/02/2012 2/02/2012 Oxycodone 20mg 1 unit 8-12 hourly prn 28 17 7/02/2012 7/02/2012 Oxycodone 20mg 1 unit BD 28 18 17/02/2012 17/02/2012 Oxycodone 20mg 1 unit BD 28 19 23/02/2012 23/02/2012 Oxycodone 20mg 1 unit 12 hourly prn 28 20 3/03/2012 3/03/2012 Oxycodone 20mg 1 unit BD 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule E: Prescribing for Patient E by Dr Dr Kon Hwa Peter Low 1 25/04/2011 27/04/2011 Oxycodone 80mg 1 q5h 20 2 27/04/2011 27/04/2011 Oxycodone 40mg 1t 28 3 10/05/2011 10/5/201 Oxycodone 40mg 1t 28 4 3/06/2011 3/06/2011 Oxycodone 40mg 1bd mdu 28 5 6/08/2011 6/08/2011 Oxycodone 40mg 1 q6h to q8h prn 28 6 16/08/2011 16/08/2011 Oxycodone 40mg 1 bd 28 7 20/09/2011 20/09/2011 Fentanyl 50mg 1 patch every 3 days 5 8 12/10/2011 12/10/2011 Fentanyl 50mg 5 9 27/10/2011 27/10/2011 Fentanyl 50mg 5 10 8/11/2011 8/11/2011 Fentanyl 50mg 1 patch every 3 days 5 11 15/11/2011 15/11/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 12 22/11/2011 22/11/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 13 26/11/2011 26/11/2011 Oxycodone 40mg 1 unit tds 28 14 1/12/2011 1/12/2011 Oxycodone 40mg 28 15 6/12/2011 6/12/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 16 12/12/2011 12/12/2011 Oxycodone 40mg 1 unit tds 29 17 17/12/2011 19/12/2011 Oxycodone 40mg 1 bd 28 18 22/12/2011 22/12/2011 Oxycodone 40mg 1 unit tds 28 19 30/12/2011 30/12/2011 Oxycodone 40mg 28 20 30/12/2011 30/12/2011 Oxycodone 40mg 1 unit tds 28 21 11/01/2012 11/01/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 22 18/01/2012 18/01/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 23 25/01/2012 25/01/2012 Oxycodone 40mg 1 unit tds 28 24 30/01/2012 30/01/2012 Oxycodone 40mg 1 unit 6-8 hourly prn 28 25 9/02/2012 9/02/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 26 21/02/2012 21/02/2012 Oxycodone 40mg 1 unit 8-12 hourly prn 28 27 28/02/2012 28/02/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule F: Prescribing for Patient F by Dr Dr Kon Hwa Peter Low 1 25/04/2011 27/04/2011 Oxycodone 80mg 1 q5h 20 2 27/04/2011 27/04/2011 Oxycodone 40mg 1t 28 3 10/05/2011 10/5/201 Oxycodone 40mg 1t 28 4 3/06/2011 3/06/2011 Oxycodone 40mg 1bd mdu 28 5 6/08/2011 6/08/2011 Oxycodone 40mg 1 q6h to q8h prn 28 6 16/08/2011 16/08/2011 Oxycodone 40mg 1 bd 28 7 20/09/2011 20/09/2011 Fentanyl 50mg 1 patch every 3 days 5 8 12/10/2011 12/10/2011 Fentanyl 50mg 5 9 27/10/2011 27/10/2011 Fentanyl 50mg 5 10 8/11/2011 8/11/2011 Fentanyl 50mg 1 patch every 3 days 5 11 15/11/2011 15/11/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 12 22/11/2011 22/11/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 13 26/11/2011 26/11/2011 Oxycodone 40mg 1 unit tds 28 14 1/12/2011 1/12/2011 Oxycodone 40mg 28 15 6/12/2011 6/12/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 16 12/12/2011 12/12/2011 Oxycodone 40mg 1 unit tds 29 17 17/12/2011 19/12/2011 Oxycodone 40mg 1 bd 28 18 22/12/2011 22/12/2011 Oxycodone 40mg 1 unit tds 28 19 30/12/2011 30/12/2011 Oxycodone 40mg 28 20 30/12/2011 30/12/2011 Oxycodone 40mg 1 unit tds 28 21 11/01/2012 11/01/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 22 18/01/2012 18/01/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 23 25/01/2012 25/01/2012 Oxycodone 40mg 1 unit tds 28 24 30/01/2012 30/01/2012 Oxycodone 40mg 1 unit 6-8 hourly prn 28 25 9/02/2012 9/02/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 26 21/02/2012 21/02/2012 Oxycodone 40mg 1 unit 8-12 hourly prn 28 27 28/02/2012 28/02/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule G: Prescribing for Patient G by Dr Dr Kon Hwa Peter Low 1 25/04/2011 27/04/2011 Oxycodone 80mg 1 q5h 20 2 27/04/2011 27/04/2011 Oxycodone 40mg 1t 28 3 10/05/2011 10/5/201 Oxycodone 40mg 1t 28 4 3/06/2011 3/06/2011 Oxycodone 40mg 1bd mdu 28 5 6/08/2011 6/08/2011 Oxycodone 40mg 1 q6h to q8h prn 28 6 16/08/2011 16/08/2011 Oxycodone 40mg 1 bd 28 7 20/09/2011 20/09/2011 Fentanyl 50mg 1 patch every 3 days 5 8 12/10/2011 12/10/2011 Fentanyl 50mg 5 9 27/10/2011 27/10/2011 Fentanyl 50mg 5 10 8/11/2011 8/11/2011 Fentanyl 50mg 1 patch every 3 days 5 11 15/11/2011 15/11/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 12 22/11/2011 22/11/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 13 26/11/2011 26/11/2011 Oxycodone 40mg 1 unit tds 28 14 1/12/2011 1/12/2011 Oxycodone 40mg 28 15 6/12/2011 6/12/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 16 12/12/2011 12/12/2011 Oxycodone 40mg 1 unit tds 29 17 17/12/2011 19/12/2011 Oxycodone 40mg 1 bd 28 18 22/12/2011 22/12/2011 Oxycodone 40mg 1 unit tds 28 19 30/12/2011 30/12/2011 Oxycodone 40mg 28 20 30/12/2011 30/12/2011 Oxycodone 40mg 1 unit tds 28 21 11/01/2012 11/01/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 22 18/01/2012 18/01/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 23 25/01/2012 25/01/2012 Oxycodone 40mg 1 unit tds 28 24 30/01/2012 30/01/2012 Oxycodone 40mg 1 unit 6-8 hourly prn 28 25 9/02/2012 9/02/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 26 21/02/2012 21/02/2012 Oxycodone 40mg 1 unit 8-12 hourly prn 28 27 28/02/2012 28/02/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule H: Prescribing for Patient H by Dr Dr Kon Hwa Peter Low 1 23/03/2011 23/03/2011 Oxycodone 40mg 1 unit 12 hourly prn 20 2 25/03/2011 25/03/2011 Oxycodone 40mg 1 unit 6 hourly prn 20 3 31/03/2011 31/03/2011 Oxycodone 40mg 1 unit 8 hourly prn 20 4 6/04/2011 6/04/2011 Oxycodone 40mg 1 unit 8 - 12 hourly prn 20 5 15/04/2011 15/04/2011 Oxycodone 40mg 1 unit 12 hourly prn 20 6 30/04/2011 30/04/2011 Oxycodone 20mg 1 unit BD 28 7 9/11/2011 9/11/2011 Oxycodone 20mg 1 unit 8-12 hourly prn 28 8 9/12/2011 Oxycodone 20mg 28 9 3/01/2012 3/01/2012 Oxycodone 10mg 1 unit 12 hourly prn 28 10 8/01/2012 8/01/2012 Oxycodone 40mg 1unit 4-6 hourly prn 28 11 12/01/2012 12/01/2012 Oxycodone 40mg I unit 6 hourly prn 28 12 19/01/2012 19/01/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 13 27/01/2012 27/01/2012 Oxycodone 40mg 1 unit 12 hourly prn 28 14 28/02/2012 29/02/2012 Oxycodone 40mg 1 unit BD 28 15 13/03/21012 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule I: Prescribing for Patient I by Dr Dr Kon Hwa Peter Low 1 7/05/2011 7/05/2011 Fentanyl 75mcg 1 patch 3x daily 5 2 23/05/2011 23/05/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 3 1/06/2011 1/06/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 4 9/06/2011 9/06/2011 Oxycodone 40mg 1 every 8 to 12 hrs prn mdu 28 5 21/06/2011 21/06/2011 Oxycodone 40mg 1 bd prn mdu 28 6 29/06/2011 29/06/2011 Oxycodone 40mg I unit tds 28 7 15/07/2011 17/07/2011 Oxycodone 80mg I unit tds 28 8 26/07/2011 26/07/2011 Oxycodone 40mg I unit tds 28 9 2/08/2011 2/08/2011 Oxycodone 40mg 1 unit tds 28 10 15/08/2011 15/08/2011 Oxycodone 80mg 1/2 tablet BD 28 11 25/08/2011 25/08/2011 Oxycodone 40mg 1 unit BD 28 12 2/09/2011 2/09/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 13 10/09/2011 10/09/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 14 16/09/2011 16/09/2011 Oxycodone 40mg 1/2 tablet BD 28 15 27/09/2011 27/09/2011 Oxycodone 80mg 1 unit BD 28 16 8/10/2011 8/10/2011 Oxycodone 80mg 1 unit BD 28 17 12/10/2011 12/10/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 18 14/10/2011 15/10/2011 Oxycodone 80mg 1 unit 8 hourly prn 28 19 17/10/2011 17/10/2011 Oxycodone 80mg 1 unit 12 hourly prn 28 20 26/10/2011 26/10/2011 Oxycodone 80mg 1 unit 12 hourly prn 28 21 4/11/2011 4/11/2011 Oxycodone 80mg 1 unit BD 28 22 5/11/2011 5/11/2011 Oxycodone 40mg 1 unit 6 hourly prn 28 23 12/11/2011 12/11/2011 Oxycodone 80mg 1 unit BD 28 24 21/11/2011 21/11/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 25 24/11/2011 24/11/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 26 1/12/2011 1/12/2011 Oxycodone 40mg 1 unit tds 28 27 7/12/2011 7/12/2011 Oxycodone 40mg 1 unit tds 28 28 13/12/2011 13/12/2011 Oxycodone 40mg 1 unit tds 28 29 20/12/2011 20/12/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 30 30/12/2011 3/01/2012 Oxycodone 30mg 1 tablet 6-8 hourly prn 28 31 6/01/2012 6/01/2012 Oxycodone 80mg 1 unit nocte 28 32 14/01/2012 14/01/2012 Oxycodone 40mg 1 unit 12 hourly prn 28 33 23/01/2012 23/01/2012 Oxycodone 40mg 1 unit 8 hourly prn 28 34 27/01/2012 27/01/2012 Oxycodone 40mg 1 unit 6-8 hourly prn 28 35 1/02/2012 6/02/2012 Oxycodone 40mg 1 unit BD 28 36 1/02/2012 6/02/2012 Oxycodone 40mg 1 unit BD 28 37 1/02/2012 1/02/2012 Oxycodone 40mg 1 unit BD 28 38 10/02/2012 10/02/2012 Oxycodone 40mg 1 unit BD 28 39 16/02/2012 16/02/2012 Oxycodone 40mg 1 unit tds 28 40 21/02/2012 21/02/2012 Oxycodone 40mg 1 unit nocte prn 28 41 1/03/2012 1/03/2012 Oxycodone 40mg 1 unit BD 28 42 8/03/2012 8/03/2012 Oxycodone 30mg 1 unit 8 hourly prn 28 07/03/2012 43 14/03/2012 14/03/2012 Oxycodone 30mg 1 unit tds 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule J: Prescribing for Patient J by Dr Dr Kon Hwa Peter Low 1 25/01/2012 25/01/2012 Oxycodone 40mg 1 unit 6 hourly prn 28 2 30/01/2012 30/01/2012 Oxycodone 40mg 1 unit 6-8 hourly prn 28 3 3/02/2012 3/02/2012 Oxycodone 40mg 1 unit 6-8 hourly prn 28 4 11/02/2012 11/02/2012 Oxycodone 40mg 28 5 15/02/2012 15/02/2012 Oxycodone 40mg 28 6 23/02/2012 23/02/2012 Oxycodone 30mg 1 unit 8 hourly prn 28 7 1/03/2012 1/03/2012 Oxycodone 30mg 1 unit 8 hourly prn 28 8 8/03/2012 8/03/2012 Oxycodone 30mg 1 unit tds 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule K: Prescribing for Patient K by Dr Dr Kon Hwa Peter Low 1 5/08/2011 5/08/2011 Oxycodone 80mg 1 unit BD 28 2 5/08/2011 5/08/2011 Oxazepam 30mg 25 3 15/08/2011 17/08/2011 Oxazepam 30mg 25 4 18/08/2011 18/08/2011 Oxycodone 80mg 28 5 1/09/2011 1/09/2011 Oxazepam 30mg 25 6 1/09/2011 1/09/2011 Oxycodone 80mg 1 unit 12 hourly prn 28 7 16/09/2011 16/09/2011 Oxycodone 40mg 1 unit 8-12 hourly prn 28 8 16/09/2011 16/09/2011 Nitrazepam 5mg 25 9 23/09/2011 23/09/2011 Oxycodone 40mg 28 10 1/10/2011 1/10/2011 Oxycodone 40mg 1 unit 8-12 hourly prn 28 11 1/10/2011 1/10/2011 Oxazepam 30mg 25 12 11/10/2011 11/10/2011 Oxycodone 40mg 28 13 18/10/2011 18/10/2011 Oxycodone 40mg 1 unit tds 28 14 19/10/2011 19/10/2011 Oxazepam 30mg 25 15 26/10/2011 26/10/2011 Oxycodone 40mg 1 unit 8 hourly prn 28 16 6/11/2011 6/11/2011 Oxycodone 80mg 1 bd 28 17 17/11/2011 17/11/2011 Oxazepam 30mg 25 18 17/11/2011 17/11/2011 Oxycodone 40mg 1 unit BD 28 19 19/12/2011 19/12/2011 Oxycodone 40mg 28 20 19/12/2011 19/12/2011 Oxazepam 30mg 25 21 28/12/2011 29/12/2011 Oxycodone 40mg 28 22 4/01/2012 4/01/2012 Oxycodone 30mg 1 unit 8 hourly prn 28 23 4/01/2012 4/01/2012 Oxazepam 30mg 25 24 12/01/2012 12/01/2012 Oxycodone 30mg 1 unit 8 hourly prn 28 25 11/02/2012 12/02/2012 Oxazepam 30mg 25 26 11/02/2012 13/02/2012 Oxycodone 30mg 28 27 28/02/2012 25/03/2012 Oxazepam 30mg 25 28 28/02/2012 28/02/2012 Oxycodone 30mg 1 tds 28 29 6/03/2012 8/03/2012 Oxycodone 30mg 28 30 13/03/2012 2/04/2012 Oxazepam 30mg 25 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule L: Prescribing for Patient L by Dr Dr Kon Hwa Peter Low 1 16/02/2011 17/02/2011 Fentanyl 100mg 1 patch every 3dys 5 2 16/02/2011 18/02/2011 Oxycodone 80mg 20 3 23/02/2011 24/02/2011 Oxycodone 80mg 20 4 26/02/2011 26/02/2011 Oxycodone 80mg 1 unit 6 hourly prn 20 5 1/03/2011 2/03/2011 Oxycodone 80mg 1 unit 6 hourly prn 20 6 4/03/2011 4/03/2011 Oxycodone 80mg 1 unit 6-8 hourly prn 20 7 7/03/2011 9/03/2011 Oxycodone 80mg 1/2 to 1 unit 4 hourly prn 20 8 10/03/2011 13/03/2011 Oxycodone 80mg 1/2 tablet 2 hourly 20 9 15/03/2011 15/03/2011 Oxycodone 80mg 1 unit 4-6 hourly prn 20 10 18/03/2011 20/03/2011 Oxycodone 80mg 1 unit 4 hourly prn 20 11 22/03/2011 22/03/2011 Oxycodone 80mg 1 unit 4-6 hourly prn 20 12 28/03/2011 29/03/2011 Oxycodone 80mg 1 unit 8 hourly prn 20 13 1/04/2011 2/04/2011 Oxycodone 80mg 1 unit 6 hourly prn 20 14 6/04/2011 6/04/2011 Oxycodone 80mg 1 unit 6 hourly prn 20 15 12/04/2011 12/04/2011 Oxycodone 80mg 1 unit 6-8 hourly prn 20 16 16/04/2011 17/04/2011 Oxycodone 80mg 1 unit 6 hourly prn 20 16/04/11 17 20/04/2011 22/04/2011 Oxycodone 80mg 1 unit 6 hourly prn 20 18 23/04/2011 27/04/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 19 29/04/2011 29/04/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 20 4/05/2011 6/05/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 21 9/05/2011 9/05/2011 Oxycodone 80mg 1 unit 4 hourly prn 28 22 16/05/2011 16/05/2011 Oxycodone 80mg 1 unit 4-6 hourly prn 28 23 20/05/2011 20/05/2011 Oxycodone 80mg 1 unit 6-8 hourly prn 28 24 21/05/2011 21/05/2011 Oxycodone 80mg 1 unit 6-8 hourly prn 28 25 25/05/2011 25/05/2011 Oxycodone 80mg 1 unit 4 hourly prn 28 26 29/05/2011 9/06/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 27 30/05/2011 30/05/2011 Oxycodone 80mg 1 unit 4-6 hourly prn 28 28 4/06/2011 4/06/2011 Oxycodone 80mg 1 unit 4 hourly prn 28 29 8/06/2011 9/06/2011 Oxycodone 80mg 1 unit 4-6 hourly prn 28 30 10/06/2011 11/06/2011 Oxycodone 80mg 1 every 4 to 6 hrs prn 28 31 16/06/2011 25/06/2011 Oxycodone 80mg 1 unit 4-6 hourly prn 28 32 24/06/2011 2/07/2011 Oxycodone 80mg 1 unit 4-6 hourly prn 28 33 30/06/2011 6/07/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 34 2/07/2011 2/07/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 35 6/07/2011 6/07/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 36 10/07/2011 11/07/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 37 11/07/2011 12/07/2011 Oxycodone 80mg 1 unit 4-6 hourly prn 28 38 17/07/2011 20/07/2011 Oxycodone 80mg 1 unit 6 hourly prn 28 39 1/12/2011 1/12/2011 Oxycodone 40mg 1 unit 6 hourly prn 28 40 14/12/2011 14/12/2011 Fentanyl 75mcg 1 patch every 3 days 5 41 20/12/2011 21/12/2011 Fentanyl 75mcg 1 patch every 3 days 5 42 29/12/2011 29/12/2011 Fentanyl 75mcg 1 patch every 3 days 5 43 8/01/2012 9/01/2012 Fentanyl 75mcg 5 44 17/01/2012 17/01/2012 Fentanyl 5 48 26/01/2012 26/01/2012 Fentanyl 75mcg 1 patch every 3 days 5 45 9/02/2012 9/02/2012 Fentanyl 70mcg 1 patch every 3 days 5 46 16/02/2012 18/02/2012 Fentanyl 50mcg 1 patch every 3 days 5 47 23/02/2012 23/02/2012 Fentanyl 50mcg 1 patch every 3 days 5 49 1/03/2012 3/03/2012 Fentanyl 50mcg 1 patch every 3 days 5 50 2/03/2012 3/03/2012 Oxycodone 80mg 1 BD UTD 28 51 10/03/2012 10/03/2012 Oxycodone 28 52 18/03/2012 21/03/2012 Oxycodone 80mg 28 53 9/04/2012 9/04/2012 Oxycodone 80mg 28 54 9/04/2012 10/04/2012 Oxycodone 28 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule M: Prescribing for Patient M by Dr Dr Kon Hwa Peter Low 1 24/04/2008 Oxazepam 30mg 6 tab every 3 days 25 2 5/05/2008 Oxazepam 30mg 6 tab every 3 days 25 3 16/05/2008 Oxazepam 30mg 6 tab every 3 days 25 4 28/05/2008 Oxazepam 30mg 6 tab every 3 days 25 5 2/09/2008 Oxazepam 30mg 6 tab every 3 days 25 6 25/05/2010 Diazepam 5mg 50 7 22/09/2010 Diazepam 5mg 50 8 20/10/2010 Diazepam 5mg 50 9 13/11/2010 Diazepam 5mg 50 10 10/12/2010 Diazepam 5mg 50 11 24/01/2011 Diazepam 5mg 50 12 11/02/2011 Alprazolam 2mg 50 13 2/03/2011 2/03/2011 Alprazolam 2mg 1 unit BD 50 14 22/03/2011 22/03/2011 Alprazolam 2mg 1 unit BD 50 15 15/04/2011 15/04/2011 Alprazolam 2mg 1 unit BD 50 16 4/05/2011 4/05/2011 Alprazolam 2mg 1 unit BD 50 17 25/05/2011 25/05/2011 Alprazolam 2mg 1 unit BD 50 18 25/05/2011 10/06/2011 Alprazolam 2mg 1 unit BD 50 19 1/07/2011 3/07/2011 Alprazolam 2mg 1 unit BD 50 20 1/07/2011 18/07/2011 Alprazolam 2mg 1 unit BD 50 21 8/08/2011 8/08/2011 Alprazolam 2mg 1 unit BD 50 22 8/08/2011 25/08/2011 Alprazolam 2mg 1 unit BD 50 23 9/09/2011 9/09/2011 Alprazolam 2mg 1 unit BD 50 24 9/09/2011 23/09/2011 Alprazolam 2mg 1 unit BD 50 25 19/10/2011 19/10/2011 Alprazolam 2mg 1 unit BD 50 26 19/10/2011 7/11/2011 Alprazolam 2mg 1 unit BD 50 27 28/11/2011 30/11/2011 Alprazolam 2mg 1 unit BD 50 28 28/11/2011 22/12/2011 Alprazolam 2mg 1 unit BD 50 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule N: Prescribing for Patient N by Dr Dr Kon Hwa Peter Low 1 5/07/2011 5/07/2011 Oxycodone 40mg 1 unit tds 28 2 5/07/2011 5/07/2011 Diazepam 5mg 50 3 10/07/2011 10/07/2011 Oxycodone 80mg 1 unit BD 28 4 14/07/2011 14/07/2011 Oxycodone 40mg 1 unit 4-6h 28 5 20/07/2011 20/07/2011 Diazepam 5mg 50 6 20/07/2011 20/07/2011 Oxycodone 40mg 1 unit tds 28 7 1/08/2011 1/08/2011 Oxycodone 40mg 1 unit tds 28 8 3/09/2011 3/09/2011 Oxycodone 40mg 1 unit BD 28 9 3/09/2011 3/09/2011 Diazepam 5mg 50 Ref: Date Prescribed Date Dispensed Drug Drug Strength Dose Prescribed Quantity Schedule O: Prescribing for Patient O by Dr Dr Kon Hwa Peter Low 1 14/08/2010 14/08/2010 Methadone 10mg 1 unit BD 20 2 20/08/2010 24/09/2010 Oxycodone 20mg 1 unit BD 20 3 3/09/2010 3/09/2010 Morphine 30mg 1 unit BD 20 4 3/09/2010 3/09/2010 Methadone 10mg 1 unit BD 20 5 10/09/2010 Morphine 30mg 20 6 10/09/2010 Methadone 10mg 20 7 15/09/2010 15/09/2010 Morphine 30mg 1 unit BD 20 8 15/09/2010 15/09/2010 Methadone 10mg 1 unit BD 20 9 27/09/2010 Morphine 30mg 20 10 27/09/2010 Methadone 10mg 20 11 1/10/2010 1/10/2010 Morphine 30mg 20 12 1/10/2010 1/10/2010 Methadone 10mg 1 unit 8 hourly prn 20 13 8/10/2010 8/10/2010 Morphine 30mg 1 unit 8 hourly prn 20 14 8/10/2010 8/10/2010 Methadone 10mg 1 unit 8 hourly prn 20 15 18/10/2010 Morphine 30mg 20 16 18/10/2010 Methadone 10mg 20 17 23/10/2010 23/10/2010 Methadone 10mg 1 unit 8 hourly prn 20 18 23/10/2010 23/10/2010 Morphine 30mg 1 unit 8 hourly prn 20 19 28/10/2010 28/10/2010 Morphine 30mg 1 unit 8 hourly prn 20 20 28/10/2010 28/10/2010 Methadone 10mg 1 unit 8 hourly prn 20 21 2/11/2010 2/11/2010 Morphine 30mg 1 unit 8 hourly prn 20 22 2/11/2010 2/11/2010 Methadone 10mg 1 unit 8 hourly prn 20 23 8/11/2010 Morphine 30mg 20 24 8/11/2010 Methadone 10mg 20 25 12/11/2010 Morphine 30mg 20 26 12/11/2010 Methadone 10mg 20 27 17/11/2010 Morphine 30mg 20 28 17/11/2010 Methadone 10mg 20 29 22/11/2010 22/11/2010 Morphine 30mg 1 unit 8 hourly prn 20 30 22/11/2010 22/11/2010 Methadone 10mg 1 unit 8 hourly prn 20 31 26/11/2010 Morphine 30mg 20 32 26/11/2010 Methadone 10mg 20 33 2/12/2010 2/12/2010 Morphine 30mg 1 unit 8 hourly prn 20 34 2/12/2010 Methadone 10mg 20 35 7/12/2010 7/12/2010 Morphine 30mg 1 unit 8 hourly prn 20 36 7/12/2010 7/12/2010 Methadone 10mg 1 unit 8 hourly prn 20 37 12/12/2010 12/12/2010 Methadone 10mg 1 unit 8 hourly prn 20 38 12/12/2010 12/12/2010 Morphine 30mg 1 unit 8 hourly prn 20 39 17/12/2010 Morphine 30mg 1 unit 8 hourly prn 20 40 22/12/2010 Morphine 30mg 1 unit 8 hourly prn 20 41 22/12/2010 Methadone 10mg 1 unit 8 hourly prn 20 42 28/12/2010 Morphine 30mg 1 unit 8 hourly prn 20 43 28/12/2010 Methadone 10mg 1 unit 8 hourly prn 20 44 10/01/2011 10/01/2011 Morphine 30mg 1 unit 8 hourly prn 20 45 15/01/2011 Morphine 30mg 1 unit 8 hourly prn 20 46 15/01/2011 Methadone 10mg 20 47 20/01/2011 20/01/2011 Morphine 30mg 1 unit 8 hourly prn 20 48 31/01/2011 31/01/2011 Morphine 30mg 1 unit 8 hourly prn 20 49 31/01/2011 31/01/2011 Methadone 10mg 20 50 5/02/2011 7/02/2011 Morphine 30mg 1 unit 8 hourly prn 20 51 10/02/2011 10/02/2011 Methadone 10mg 1 unit 8 hourly prn 20 52 10/02/2011 10/02/2011 Morphine 30mg 1 unit 8 hourly prn 20 53 15/02/2011 15/02/2011 Morphine 30mg 1 unit 8 hourly prn 20 54 21/02/2011 21/02/2011 Morphine 30mg 1 unit 8 hourly prn 20 55 21/02/2011 21/02/2011 Methadone 10mg 20 56 26/02/2011 Morphine 30mg 1 unit 8 hourly prn 20 57 3/03/2011 3/03/2011 Methadone 10mg 1 unit 8 hourly prn 20 58 3/03/2011 3/03/2011 Morphine 30mg 1 unit 8 hourly prn 20 59 8/03/2011 8/03/2011 Methadone 10mg 20 60 8/03/2011 8/03/2011 Morphine 30mg 1 unit 8 hourly prn 20 61 14/03/2011 14/03/2011 Methadone 10mg 20 62 14/03/2011 14/03/2011 Morphine 30mg 1 unit 8 hourly prn 20 63 18/03/2011 18/03/2011 Methadone 10mg 20 64 18/03/2011 18/03/2011 Morphine 30mg 1 unit 8 hourly prn 20 65 23/03/2011 23/03/2011 Methadone 10mg 20 66 23/03/2011 23/03/2011 Morphine 30mg 1 unit 8 hourly prn 20 67 28/03/2011 28/03/2011 Methadone 10mg 1 unit 6 hourly prn 20 68 28/03/2011 28/03/2011 Morphine 30mg 1 unit 6 hourly prn 20 69 2/04/2011 2/04/2011 Methadone 10mg 1 unit 6-8 hourly prn 20 70 2/04/2011 2/04/2011 Morphine 30mg 1 unit 6-8 hourly prn 20 71 7/04/2011 7/04/2011 Methadone 10mg 1 unit 8 hourly prn 20 72 7/04/2011 7/04/2011 Morphine 30mg 1 unit 8 hourly prn 20 73 13/04/2011 13/04/2011 Methadone 10mg 1 unit 6-8 hourly prn 20 74 13/04/2011 13/04/2011 Morphine 30mg 20 75 19/04/2011 19/04/2011 Morphine 30mg 1 unit 8 hourly prn 20 76 19/04/2011 19/04/2011 Methadone 10mg 1 unit 8 hourly prn 20 77 25/04/2011 25/04/2011 Methadone 10mg 20 78 2/05/2011 Morphine 30mg 20 79 2/05/2011 Methadone 10mg 20 80 7/05/2011 6/05/2011 Morphine 30mg 1 unit 8 hourly prn 20 81 7/05/2011 6/05/2011 Methadone 10mg 1 unit 8 hourly prn 20 82 11/05/2011 12/05/2011 Morphine 30mg 1 unit 6-8 hourly prn 20 83 11/05/2011 12/05/2011 Methadone 10mg 1 unit 6-8 hourly prn 20 84 21/05/2011 21/05/2011 Morphine 30mg 1 unit 6-8 hourly prn 20 85 21/05/2011 21/05/2011 Methadone 10mg 20 86 26/05/2011 26/05/2011 Methadone 10mg 1 unit 6-8 hourly prn 20 87 26/05/2011 26/05/2011 Morphine 30mg 1 unit 6-8 hourly prn 20 88 31/05/2011 31/05/2011 Methadone 10mg 1 unit 4-6 hourly pm 20 89 31/05/2011 31/05/2011 Morphine 30mg 20 90 3/06/2011 3/06/2011 Morphine 30mg 20 91 5/06/2011 5/06/2011 Methadone 10mg 1 unit 4-6 hourly prn 20 92 9/06/2011 9/06/2011 Methadone 10mg 1 unit 4-6 hourly prn 20 93 9/06/2011 9/06/2011 Morphine 30mg 1 unit 4-6 hourly prn 20 94 14/06/2011 14/06/2011 Methadone 10mg 20 95 14/06/2011 14/06/2011 Morphine 30mg 1 unit 6 hourly prn 20 96 19/06/2011 19/06/2014 Methadone 10mg 1 unit 4-6 hourly prn 20 97 19/06/2011 19/06/2011 Morphine 30mg 1 unit 4-6 hourly prn 20 98 23/06/2011 23/06/2011 Methadone 10mg 1 unit 4-6 hourly prn 20 99 23/06/2011 23/06/2011 Morphine 30mg 1 unit 4-6 hourly prn 20 100 29/06/2011 29/06/2014 Methadone 10mg 1 unit 6 hourly prn 20 101 29/06/2011 29/06/2011 Morphine 30mg 1 unit 6 hourly prn 20 102 5/07/2011 5/07/2011 Methadone 10mg 1 unit 8 hourly prn 20 103 5/07/2011 5/07/2011 Morphine 30mg 1 unit 8 hourly prn 28 104 12/07/2011 12/07/2011 Methadone 10mg 1 q8h prn 20 105 12/07/2011 12/07/2011 Morphine 30mg 1 unit 6-8 hourly pm 28 106 20/07/2011 20/07/2011 Methadone 10mg 20 107 20/07/2011 20/07/2011 Morphine 30mg 1 unit 6-8 hourly prn 28 108 27/07/2011 27/07/2014 Methadone 10mg 20 109 27/07/2011 27/07/2014 Morphine 30mg 1 unit 8-12 hourly prn 28 110 2/08/2011 2/08/2011 Methadone 10mg 1 unit 8-12 hourly prn 20 111 2/08/2011 2/08/2011 Morphine 30mg 1 unit tds 28 112 9/08/2011 9/08/2011 Methadone 10mg 1t q8h prn 20 113 9/08/2011 9/08/2011 Morphine 30mg 1 unit 8 hourly prn 28 114 17/08/2011 17/08/2011 Methadone 10mg 20 115 17/08/2011 17/08/2011 Morphine 30mg 1 unit 8 hourly prn 28 116 24/08/2011 24/08/2011 Methadone 10mg 1 unit 8 hourly prn 20 117 24/08/2011 24/08/2011 Morphine 30mg 1 unit 6-8 hourly prn 28 118 31/08/2011 31/08/2011 Methadone 10mg 1 unit 6-8 hourly prn 20 119 31/08/2011 31/08/2011 Morphine 30mg 1 unit 8 hourly prn 28 120 8/09/2011 8/09/2011 Methadone 10mg 20 121 8/09/2011 8/09/2011 Morphine 30mg 28 122 16/09/2011 16/09/2011 Methadone 10mg 1 unit 6-8 hourly prn 20 123 16/09/2011 16/09/2011 Morphine 30mg 1 unit 8 hourly prn 28 124 23/09/2011 23/09/2011 Methadone 10mg 20 125 23/09/2011 23/09/2011 Morphine 30mg 1 unit 8 hourly prn 28 126 1/10/2011 1/10/2011 Methadone 10mg 1 unit BD 20 127 1/10/2011 1/10/2011 Morphine 30mg 1 unit 8 hourly prn 28 128 9/10/2014 9/10/2011 Methadone 10mg 1 unit 8 hourly prn 20 129 9/10/2011 9/10/2014 Morphine 30mg 1 unit 8 hourly prn 28 130 13/10/2011 13/10/2011 Methadone 10mg 1 unit 8 hourly prn 20 131 13/10/2011 13/10/2011 Morphine 30mg 1 unit 8 hourly prn 28 132 19/10/2011 19/10/2011 Methadone 10mg 20 133 19/10/2011 19/10/2011 Morphine 30mg 1 unit 8 hourly prn 28 134 25/10/2011 25/10/2011 Methadone 10mg 20 135 25/10/2011 25/10/2011 Morphine 30mg 1 unit 8 hourly prn 28 136 1/11/2011 1/11/2011 Methadone 10mg 1t q8h prn 20 137 1/11/2011 1/11/2011 Morphine 30mg 1 unit 8 hourly prn 28 138 8/11/2011 8/11/2014 Methadone 10mg 1 unit 8 hourly prn 20 139 8/11/2011 8/11/2011 Morphine 30mg 1 unit 8 hourly prn 28 140 12/11/2011 12/11/2011 Methadone 10mg 1 unit 8 hourly prn 20 141 12/11/2011 12/11/2014 Morphine 30mg 1 unit 8 hourly prn 28 142 12/11/2011 12/11/2011 Nitrazepam 5mg 1 to 2 tabs per night 25 143 17/11/2011 17/11/2014 Methadone 10mg 20 144 17/11/2011 17/11/2011 Morphine 30mg 1 unit 8 hourly prn 28 145 23/11/2011 23/11/2011 Methadone 10mg 20 146 23/11/2011 23/11/2011 Morphine 30mg 1 unit 6 hourly prn 28 147 29/11/2011 29/11/2011 Methadone 10mg 20 148 29/11/2011 29/11/2011 Morphine 30mg 1 unit 8 hourly prn 28 149 6/12/2011 6/12/2001 Methadone 10mg 1 unit tds 20 150 6/12/2011 6/12/2011 Morphine 30mg 1 unit tds 28 151 13/12/2011 13/12/2014 Methadone 10mg 20 152 13/12/2011 13/12/2011 Morphine 30mg 1 unit 6 hourly prn 28 153 20/12/2011 20/12/2014 Methadone 10mg 20 154 20/12/2011 20/12/2011 Morphine 30mg 1 unit 8 hourly prn 28 155 24/12/2011 24/12/2014 Methadone 10mg 20 156 24/12/2011 24/12/2011 Morphine 30mg 1 unit tds 28 157 29/12/2011 29/12/2011 Morphine 30mg 1 unit 8 hourly prn 28 158 3/01/2012 3/01/2012 Morphine 30mg 1 unit 6 hourly prn 28 159 9/01/2012 9/01/2012 Morphine 30mg 1 unit tds 28 160 16/01/2012 16/01/2012 Morphine 30mg 1 unit 8 hourly prn 28 161 23/01/2012 23/01/2012 Morphine 30mg 1 unit 8 hourly prn 28 162 30/01/2012 30/01/2012 Morphine 30mg 1 unit tds 28 THE EVIDENCE 1. The Evidence before the Tribunal comprised: Documentary Evidence for the Complainant: 1 Complaint A Registration Certificate from AHPRA COMPLAINT 2 Letter to Commission from MCNSW, dated 23 October 2012 3 Letter from PSB to MCNSW, dated 23 March 2012 4 Outcome of s150 Proceedings 5 Written decision of s150 Proceedings 6 Transcript of s150 Proceedings PHARMACEUTICAL SERVICES INVESTIGATION 7 Letter of 31 August 2012 from PSU to MCNSW 8 PSU Investigation report of 31 August 2012, attaching: A Initial report for Dr Low B Fax requesting Dr Low produce medical records. 9 Fax, dated 5 March 2012, sent to Dr Low after a conversation a Senior Pharmaceutical Officer had with him regarding the requirement to obtain proper authority from NSW Health prior to prescribing a drug of addiction to drug dependent persons. EXPERT 10 Commission letter to expert, Dr Hani Bittar, dated 25 March 2013 11 Expert report from Dr Bittar, received 26 June 2013 12 Dr Bittar's CV 13 Email correspondence between Commission and Dr Bittar seeking clarification on aspects of the report. RESPONDENT 14 S40 letter from the Commission to Dr Low, dated 2 July 2013. 15 Letter to the Commission from Dr Low, dated 30 July 2013. 16 Dr Low's CV GUIDELINES I POLICIES 17 Guideline, NSW Health Drug and Alcohol Withdrawal Clinical Practice Guidelines Publication date: 4 July 2008 18 NSW Health Pharmaceutical Services Branch Requirements for an Authority To Prescribe Drugs of Addiction Under Section 28 of the Poisons and Therapeutic Goods Act. Publication: December 2006 19 NSW Health Pharmaceuticals Services Branch Guide to Poisons and Therapeutic Goods Legislation for Medical Practitioners and Dentists Publication: 2009 20 RACGP's Guidelines on Benzodiazepines 21 NSW Medical Board Code of Professional Conduct July 2008 22 MCNSW Code of Conduct for members, December 2012 PRESCRIBING AUTHORITY REQUIREMENTS 23 Section 27 Poisons and Therapeutic Goods Act 1966 24 Section 28 Poisons and Therapeutic Goods Act 1966 25 Division 3 Poisons and Therapeutic Goods Regulation 2008 MIMS 26 Oxycontin 27 Valium 28 Xanax 29 Durogesic. CLINICAL RECORDS 30 Statement of Leanne Evans of 18 September 2013 Patient A 31 Schedule of Dr Low's prescribing to Patient A 32 Medical records 33 Medicare Australia Prescriber Patient Report 34 Copies of prescriptions 35 Pharmacy printout from Superchem Blacktown 36 Pharmacy printout from Cincotta Chemist Blacktown 37 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB. Patient B 38 Schedule of Dr Low's prescribing to Patient B 39 Medical records 40 Copies of prescriptions 41 Pharmacy printout from Superchem Blacktown 42 Pharmacy printout from Supersave Chemist 43 Pharmacy printout from Cincotta Discount Chemist Patient C 44 Schedule of Dr Low's prescribing to Patient C 45 Medical records by Dr Low 46 Medicare Australia Prescriber Patient Report 47 Copies of prescriptions 48 Pharmacy printout from Superchem Blacktown Patient D 49 Schedule of Dr Low's prescribing to Patient D 50 Medical records 51 Medicare Australia Prescriber Patient Report 52 Copies of prescriptions 53 Pharmacy printout from Healthmore Pharmacy 54 Pharmacy printout from Superchem Blacktown 55 Pharmacy printout from Oze-Pharmacy Blacktown 56 Pharmacy printout from Mazzei's Pharmacy 57 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient E 58 Schedule of Dr Low's prescribing to Patient E- 59 Medical records 60 Medicare Australia Prescriber Patient Report 61 Copies of prescriptions 62 Pharmacy printout from Granville Pharmacy 63 Pharmacy printout from Superchem Blacktown 64 Pharmacy printout from Medicines Plus 65 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient F 66 Schedule of Dr Low's prescribing to Patient F 67 Medical records 68 Copies of prescriptions 69 Pharmacy printout from Superchem Blacktown 70 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient G 71 Schedule of Dr Low's prescribing to Patient G 72 Medical records 73 Medicare Australia Prescriber Patient Report 74 Copies of prescriptions 75 Pharmacy printout from The Valley Pharmacy 76 Pharmacy printout from Superchem Blacktown 77 Pharmacy printout from Cincotta Discount Chemist Blacktown 78 Pharmacy printout from Medicines Plus 79 Pharmacy printout from Rochester's Pharmacy 80 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient H 81 Schedule of Dr Low's prescribing to Patient H 82 Medical records 83 Copies of prescriptions 84 Pharmacy printout from Blooms the Chemist 85 Pharmacy printout from Superchem Blacktown 86 Pharmacy printout from CWH Blacktown 87 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient I 88 Schedule of Dr Low's prescribing to Patient I 89 Medical records 90 Medicare Australia Prescriber Patient Report 91 Copies of prescriptions 92 Pharmacy printout from Cincotta Discount Chemist Blacktown 93 Pharmacy printout from Oze Pharmacy Blacktown 94 Pharmacy printout from John Bell Pharmacy 95 Pharmacy printout from Superchem Blacktown Patient J 96 Schedule of Dr Low's prescribing to Patient J 97 Medical records 98 Medicare Australia Prescriber Patient Report 99 Copies of prescriptions 100 Pharmacy printout from Superchem Blacktown 101 Pharmacy printout from Bob's Chemist Newtown 102 Pharmacy printout from CWH Five Dock 103 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient K 104 Schedule of Dr Low's prescribing to Patient K 105 Medical records 106 Medicare Australia Prescriber Patient Report 107 Copies of prescriptions 108 Pharmacy printout from Chester & Jake's Supasave Chemist 109 Pharmacy printout from The Lakes Pharmacy 110 Pharmacy printout from Eastwood Healthfirst Pharmacy 111 Pharmacy printout from Cincotta Discount Chemist Blacktown 112 Pharmacy printout from The Valley Pharmacy 113 Pharmacy printout from Rochester's Pharmacy 114 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient L 115 Schedule of Dr Low's prescribing to Patient L 116 Medical records 117 Medicare Australia Prescriber Patient Report 118 Copies of prescriptions 119 Pharmacy printout from The Valley Pharmacy 120 Pharmacy printout from Medicines Plus 121 Pharmacy printout from Amal's Discount Chemist 122 Pharmacy printout from Chemist Warehouse Liverpool 123 Pharmacy printout from Superchem Blacktown 124 Pharmacy printout from Fresh Therapeutics 125 Pharmacy printout from Granville Family Pharmacy 126 Pharmacy printout from Chester & Jake's Pharmacy 127 Pharmacy printout from Tolar Pharmacy 128 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient M 129 Schedule of Dr Low's prescribing to Patient M 130 Medical records 131 Medicare Australia Prescriber Patient Report 132 Pharmacy printout from Superchem Blacktown 133 Pharmacy printout from Blooms The Chemist Blacktown 134 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient N 135 Schedule of Dr Low's prescribing to Patient N 136 Medical records 137 Medicare Australia Prescriber Patient Report 138 Copies of prescriptions 139 Pharmacy printout from Superchem Blacktown 140 Pharmacy printout from Gardiner's Day & Night Pharmacy 141 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB Patient O 142 Schedule of Dr Low's prescribing to Patient 0 143 Medical records 144 Medicare Australia Prescriber Patient Report 145 Copies of prescriptions 146 Pharmacy printout from Pharmacy 4 Less Riverstone 147 Pharmacy printout from Chester & Jake's Pharmacy Westpoint 148 Pharmacy printout from Oze Pharmacy Blacktown 149 Pharmacy printout from Blooms the Chemist Blacktown 150 Pharmacy printout from Barone Pharmacy Woodcroft 151 Pharmacy printout from Cincotta Discount Chemist Blacktown 152 Pharmacy printout from Walter's Road Pharmacy 153 Pharmaceutical Drugs of Addiction Methadone Patient details from PSB 154 Medical Council Guidelines for Mentors 155 Precedent Orders - conditions for appointment of Mentor and for attendance at educative course 156 Precedent Orders for: a) random audit of medical records, b) for completion of a course in medical ethics, c) for ongoing supervision of the practitioner. 157 Documents from Monash University regarding on-line ethics training course and post-graduate course "Issues in General Practice Prescribing". Documentary Evidence For The Respondent: 1 Statement of Dr Hwa Peter Low dated 22 September 2014 Professional supervisor reports 2 Report of A/Prof Michael Fasher dated 10 August 2014 2A Letter from A/Prof Fasher dated 10 August 2014 2B Curriculum vitae of A/Prof Fasher 3. Supervision reports of A/Prof Fasher to NSW Medical Council for period 16 December 2012 to May 2014 Continuing medical education 4. Letter from Scius Solutions dated 22 February 2013 relating to March 2013 attendance at Pain Management Master Class 5. Brochure from Mundipharma relating to June 2014 attendance at course entitled "The 4 keys: Efficient chronic pain managemenf' 6. NSW Health Opioid Treatment Accreditation Course information 6A. Letter from University of Sydney dated 10 November 2014, relating to OpioidTreatment Accreditation course enrolment 6B. Letter from Monash University dated 10 November 2014, relating to enrolment in General Issues in Prescribing course Character References 7. Letter from Dr Vincent Chin dated 15 July 2014 8. Letter from Dr Roshni Gereis dated 6August 2014 9. Letter from Hugo Rodriguez dated 29 August 2014 10. Letter from Father Joseph Nguyen dated 1September 2014 11. Letter from Camil Gereis dated 6August 2014 12. Letter from Dr Andrew Co'burn dated 17 October 2014 Professional counsellling 13. File note of telephone conference with Dr Keith Chee, psychiatrist, on 10 November 2014, signed by Dr Chee 13A. Letter from Dr Chee dated 22 October 2014, received 6November 2014 13B. Letter to Dr Chee dated 10 October 2014 14 Document titled "Potential Orders/ Conditions" (pp 125 to127) 1. There was also the following additional evidence: Exhibit R1 – Continuing Medical Education Points earned by the Respondent in triennium 2011-2013 and 2014. Exhibit R2 – Supervision Guidelines and Mentor Guidelines from Medical Council. Oral evidence and cross-examination of Associate Professor Michael Fasher. Oral evidence and cross-examination of the Respondent. INVESTIGATION AND SECTION 150 HEARING 1. As a result of matters reported to it in February 2012 regarding the Respondent's prescribing of drugs, the Pharmaceutical Services contacted the Respondent and arranged to interview him and investigate his practises in relation to prescription of drugs. 2. A report was prepared and issued on 1 August 2012 expressing serious concerns about the Respondent's practices in relation to the issue of prescriptions for drugs. The report from the Service recommended the investigation be continued and that the right of the Respondent to prescribe Schedule 8 and Schedule 4 Appendix D drugs be withdrawn. A copy of the report was provided to the Medical Council. 3. Subsequently, on 11 October 2012 there was a hearing under s.150 of the Health Practitioner Regulation National Law (NSW) ("the National Law") of the Respondent before a Panel appointed by the Medical Council. 4. Legal representatives of the Respondent, the Pharmaceutical Services Unit and the Medical Council of NSW were also present. 5. The result of the s.150 hearing was that with effect from 22 October 2012 the Medical Council imposed the following practice conditions on the Respondent's registration: "Practice Conditions: 1. To not prescribe, possess, supply, administer, handle or dispense any drug of addiction (Schedule 8 drugs) or any prescribed restricted substance (Schedule 40 drug or Schedule 40 derivative): a. Unless this has already occurred, to attend the offices of the Pharmaceutical Services Unit of the NSW Department of Health by close of business on Monday 29 October 2012 and surrender his authority under the provisions of the Poisons and Therapeutic Goods Regulation 2008 to have possession of, prescribe, supply, dispense or administer any drug of addiction (Schedule 8 drugs) or any prescribed restricted substance (Schedule 4D drug or Schedule 40 derivative). b. Any future change in his Schedule 8 or Schedule 4D authority must be in accordance with the Medical Council of NSW's protocol. This must include consultation with the Medical Council of N5W prior to the submission of any variation application to the Pharmaceutical Services Unit. 2. To nominate a supervisor within the next 21 days to be approved by the Medical Council of NSW, to monitor and review his clinical practice and compliance with Conditions in accordance with Level 3 Supervision as contained in the Medical Council of NSW's Guidelines for Supervision (Policy PCH 7.5). The supervisor must be a Fellow of the Royal Australian College of General Practitioners and must not practise at the same location as Dr Low. The supervisor-is to be provided with a copy of the Medical Council of NSW's Policy PCH 7.5, a copy of the Decision outlining why this condition has been imposed and any other reports the Medical Council of NSW deems appropriate. To be responsible for all costs associated with the supervision arrangement. To ensure that: a. He and the supervisor meet on a fortnightly basis for at least one hour, the first meeting to occur within one fortnight of being advised by the Medical Council of NSW that his nominated supervisor has been approved. b. At each meeting they address all of these matters highlighted as concerns during the Hearing: case reviews, workload, clinical outcomes, patient follow up, assertiveness skills, overall patient care and management, substance abuse, appropriate prescribing practices, treatment plans and management of acute and chronic pain. Each meeting is also to include an inspection of his medical records with a view to monitoring them and reviewing them in order to assist him in complying with the requirements of the Health Practitioner Regulation (NSW) Regulation 2010. For the purpose of this inspection, at each supervision meeting he is to provide the supervisor with a list of all patients seen in the preceding fortnight, from which the supervisor is to randomly select 5 patient names. Dr Low must then bring the complete records of these 5 patients to the next supervision meeting for review. c. At each meeting, the supervisor completes a record of matters discussed at the meeting in a format prescribed or approved by the Medical Council of NSW. d. The supervisor forwards to the Medical Council of NSW, initially on a monthly basis, a Supervision Report in a format prescribed or approved by the Medical Council of NSW. e. The supervisor informs the Medical Council of NSW immediately if there is any concern in relation. to his compliance with the supervision requirements, compliance with other conditions of registration, clinical performance, or if the supervisor relationship ceases. To authorise the supervisor to provide such information to the Medical Council of NSW. 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 Medical Council of NSW within 21 days of the cessation of the original supervisory relationship. 3. To authorise and consent to any exchange of information between the Council and Medicare Australia and the Pharmaceutical Services Unit of NSW Health for the purpose of monitoring compliance with these conditions." 1. In its letter to the Respondent of 23 October 2012 the Medical Council stated: "Pending provision of the written decision, the issues identified by the delegates can be summarised as follows: • Dr Low's departure from the law (failure to obtain authorities, forward dating of prescriptions) and accepted medical practice in the manner in which he has been treating drug-dependent patients • Dr Low's prescription of multiple benzodiazepines to individual patients • Dr Low's professional isolation, noting that he makes few referrals of his drug-dependent patients, including to psychologists located within his practice •The lack of Continuing Professional development activities undertaken by Dr Low in recent years. • Dr Low's lack of awareness of current practice in pain management • The inadequacy of Dr Low's medical records." 1. The Health Care Complaints Commission obtained a report from Dr Hani Bittar, a practising General Practitioner, Adjunct Senior Lecturer in General Practice at the University of Sydney and Con-joint Senior Lecturer in the School of Medicine of the University of Western Sydney. 2. Dr Bittar critiqued the professional conduct of the Respondent in relation to his prescribing of drugs. Dr Bittar found that six different aspects of the Respondent's practices were each a significant departure from the standard of General Practitioners and attracted his strong criticism. He also found that the issue of pre-dated prescriptions by the Respondent contravened the regulations and "this is a departure from the standard and it does attract my criticism". EVIDENCE OF PROFESSOR FASHER (SUPERVISOR) 1. Professor Fasher is a practising General Practitioner. He is an Adjunct Associate Professor at the Sydney University Medical School and con-joint Associate Professor at the University of Western Sydney. 2. His Curriculum Vitae is attached to his report of 10 August 2014 (document 2 in the Applicant's case). There is no issue about his expertise in the area of general practice of medicine. 3. Since October 2012 Professor Fasher has supervised the Respondent by meeting with him fortnightly for an hour. At each of his meetings with the Respondent, they have had general discussions about practice issues and Professor Fasher has generally reviewed the case notes of five consultations randomly chosen by him and then discussed with the Respondent any clinical issues arising from the consultations and the quality of the records kept. He has submitted a monthly report to the Medical Council briefly outlining the discussions together with a summary in accordance with a template provided by the Council. 4. Professor's Fasher's report of 10 August 2014 is very positive about the Respondent. He says that throughout the Respondent has been: "… open to feedback and quick to incorporate that feedback into his consulting skills and record-keeping. It has been a satisfying relationship for me as Dr Low has at all times welcomed opportunities to learn and at no time has he responded to critical feedback by attempting to justify himself. Dr Low is an experienced clinician and our discussions have often resulted in opportunities for mutual learning." 1. In response to a question about what insight the Respondent has into his shortcomings in his practice which gave rise to the complaint, Professor Fasher says that they have discussed these issues and Dr Low has expressed remorse for the actions which gave rise to the complaint. "He believed at the time he was acting in his patients' best interests. "He reports that he accepts, in retrospect, that this was naïve. He reports that he accepts the ignorance of the rules regarding the prescribing of S8 drugs is no defence. Dr Low has demonstrated insight and accepted responsibility for the shortcomings that lead to the HCCC complaint. Dr Low has actively participated in the processes of supervision … His record keeping has significantly improved. The records I review are consistently of satisfactory quality or better." 1. Professor Fasher in that report expressed an opinion that the Respondent "will not re-offend with regards to inappropriate prescription of S8 drugs". 2. In response to a question about the Respondent's development of understanding into proper approaches towards management of chronic pain patients and clinical record keeping, the Professor added: "Dr Low has attended two workshops for continuing professional development that were devoted to the management of chronic pain in general practice. Very few of the randomly selected consultations have dealt with chronic pain. There was one such consultation recently. The patient was new to Dr Low and it was pleasing to discover that he had insisted on taking time to get a comprehensive view of the patient's situation and social context prior to considering medication as part of the plan of management. Dr Low made it clear to the patient that he would not be prescribing opioid medication." 1. In response to a further question, the Professor said: "As reported above, Dr Low's clinical record keeping has improved significantly in response to feed-back. [I formed the view early in this period of supervision that Dr Low was a much better clinician than the quality of his clinical records at that time suggested.] As described above, patients with chronic pain have not been common in the cases randomly chosen for review. Dr Low has actively pursued professional development and education with regards to the management of chronic pain in general practice during the period of supervision." 1. As to the likely future fitness of the Respondent as a General Practitioner, Professor Fasher supported the Respondent retaining his license to practise. He said: "His work as reviewed by me is of a good standard and in my judgment is likely to remain so in the future should he remain licensed to practise. Dr Low is a good clinician, valued by his patients and likely to make a constructive contribution to his patients' well-being into the future. I regard myself as a tough judge of General Practitioners." 1. Professor Fasher also expressed the view in his report of 10 August 2014 that there was no need for the supervision in its present form to continue. 2. Professor Fasher gave oral evidence on 18 November 2014. The individual reports from his meetings with the Respondent were in evidence. When asked, Professor Fasher said that he did agree that if the Tribunal was minded to have the Respondent continue practising without supervision, mentoring would be of value to him. Professor Fasher said that he is convinced that the reputation of the profession and the safety of the community did not require restrictions on the Respondent's license. He agreed that it would be of very much assistance to the Respondent to attend the course he plans in "issues in general prescribing". He said the Respondent was "absolutely contrite" about the conduct complained of and Professor Fasher also said he was "confident nothing like it will happen again". 3. Professor Fasher said that the Respondent accepted, understood and implemented suggestions that the Professor had made to him. "Where I made corrective suggestion he has not once been defensive of his practice." He said he had not discussed with the Respondent, though, the issue of naïvity. He said he had not investigated the reasons behind his misconduct and had not formed a judgment about it. He said he was convinced the proceedings and the events leading up to it would ensure that there would be no repetition of such conduct. He expressed the view that there is "no excuse for ignorance, but none of us in the profession is fully across all the legal requirements. In the real world many excellent and highly reputable practitioners would not be able to recite that." 4. In his report of 1 April 2013 Professor Fasher said that on that date when he met with the Respondent, the Respondent told him he was seeing 30 to 50 patients a day. The Professor reported that that would be beyond his capacity. In his oral evidence the Professor said that once the number of patients exceeds 30 per day: "it becomes difficult to manage". 5. He recommended that the Respondent should act to avoid "issues that arise from practising in isolation". He recommended such actions as participating in activities with other doctors (even social activities), having discussions of their work with other colleagues, and joining a professional organisation. He said he had recommended these things to the Respondent but he was not sure whether he had joined any professional organisation. 6. In answer to a question he said he was not aware that the Respondent had consulted a psychiatrist, but that "does not alter my judgment". He said: "I didn't ever suspect there could be a background of mood disorder." 7. In answer to questions from the panel Professor Fasher said that the Respondent's strengths were that he is an instinctive clinician, has an impressive grasp of differential diagnosis, has a conservative approach to management, has improved record keeping, and has truly benefited from the last two years. 8. When asked the doctor's weaknesses, he said that record keeping and practising solely were both weaknesses which had both ceased. 9. Professor Fasher could not remember when he recommended to the Respondent that he join a professional organisation, but he hasn't implemented that recommendation. 10. Professor Fasher said that as far as he is aware the Respondent does not seek restoration of his prescribing rights at this time. He said he was aware of several patients where the Respondent had declined to prescribe the medication the patient was seeking. 11. Professor Fasher said that in relation to the proposal of the Respondent to attend courses that address the issue of "saying no" to a patient, "I am comforted that he's sought that advice." THE RESPONDENT'S EXPLANATION FOR THE CONDUCT THE SUBJECT OF THE COMPLAINT 1. The Respondent was born in July 1954 and is 60 years of age. He graduated with Bachelor degrees in Medicine and Surgery in Western Australia in 1980. He completed his internship there and then worked in Ireland as a medical practitioner for 18 months. Then he worked as a medical practitioner in a hospital in England for 5 years. He returned to Australia in 1988 and then worked for 3 years in several group practices in the western suburbs of Sydney. He established his own general practice in the western suburbs for many years until 2012. In early 2013 he began working in another group practice. 2. He swore in his Affidavit of 22 September 2014 he was working 5 to 6 days per week and averaging 50 patients a day. He said he took about four weeks of leave each year, including public holidays. 3. In early 2005 he established a centre in Blacktown to combine medical and other health services with a gymnasium and patient rehabilitation facilities. The venture failed and by 2010 he had severe financial difficulties. His practice company went into liquidation. He was forced to sell the family home and one of two medical practices which he owned. 4. He says: "I now recognise that this was a very difficult period for me, during which my clinical care of some of my patients was compromised. I was working long hours, was very focused on my financial difficulties and did not undertake necessary continuing medical education." 1. Part of the evidence in his Affidavit is: "Past Management of Chronic Pain Patients 49. The Medical Council hearing and the Tribunal complaint exposed serious flaws in my past management of patients with chronic pain symptoms. 50. All of the patients which are part of this complaint were already on narcotic drugs, or other potent medications, for various ailments started by other medical practitioners. 51. In my misguided belief of not wanting to inflict more sufferings to those patients I continued prescribing the medications that they were already taking. I did make attempts to reduce their dosage of narcotics over a period of time, but those attempts were not usually successful. 52. I believed I was doing the patients and the community a good service by trying to minimise harm to themselves, with the aim of them being able to cope with their problems by taking the minimum amount of narcotics and hopefully even weaning them off the drugs. 53. When I was visited by Pharmaceutical Services Branch representatives in March 2012, I appreciated that some of my practices were inappropriate. 54. Through the Medical Council hearing, subsequent meetings with A/Prof Fasher and further training, I have come to realise even more bow my practices were inappropriate, unacceptable and significantly below expected standards. I can now see how these deficiencies arose out of my naivety, not recognising my limitations in managing such patients and the insufficient time that I had to devote to undergoing training in managing such patients. 55. It was inappropriate for me to prescribe Schedule 8 medications, including Oxycodone, to patients who were either drug dependant and / or on the opioid treatment program. I had an unacceptable lack of knowledge about the requirements for prescribing medication in those circumstances, particularly in obtaining authorities from NSW Health. I did not appreciate that I could not prescribe such medications to patients on the opiate treatment program. I now see the dangers in doing so. I am now also aware of the Medicare "Doctor Shoppers'" list, which I use if I have any suspicion of drug abuse behaviours in any of my patients. 56. Before March 2012, I had no knowledge of Section 28 of Poisons and Therapeutic Goods Act. This is no excuse. I was not aware that any patients who are on dependent on Methadone or equivalent programmes are usually precluded from getting further prescriptions of narcotic, i.e. it is illegal for practitioners elsewhere to prescribe further Schedule 8 drugs to them. I can appreciate the usefulness and the necessity of these requirements. They are a very important tool to prevent the usage of Schedule 8 drugs getting out of control, and minimising the damage to the patients and the community for drug dependent patients. With the central body overseeing the whole process of necessity to further prescribe Schedule 8 drugs to any patients after two months it is possible to minimise over-prescriptions and unnecessary prescriptions. 57. I had no knowledge whether my patients were enrolled on such programmes i.e. for Methadone. After my Pharmaceutical Services Branch interview, I did ring the phone number provided to me as required to obtain information about patients' enrolment in such programmes. I did stop prescribing Oxycodone and other medications once I became aware of their involvement in these treatment programs. In regards to methadone / opiate replacement program my prior knowledge of it was giving the patients the necessary dosage to allow them to function effectively in their daily lives with the aim of eventually withdrawing them from drugs completely. I did not realise the other safeguards and arrangements that were available. 58. In around 2011, I began to see a significant number of patients in my practice with chronic pain symptoms, many of which were of Middle Eastern background and had experienced significant issues of trauma in their life. I now realise I should have seen that the increasing numbers of such patients suggested that there was belief I was a "soft touch" for prescribing addictive medications to patients suffering from serious drug addiction issues. 59. With hindsight, I can see why the patients in question started to visit me. I was naive and too trusting of my patients' honesty and too willing to help them with their desire for drugs. I can now appreciate the fact that instead of helping them, I may have been jeopardising their health by providing them more Schedule 8 drugs than they should be allowed. 60. I was guided by the naive aim of reducing their dependence on addictive medication such as Oxycodone and benzodiazepines. Although I had intended to reduce the level of pain medication intake in each of those patients, I acknowledge that for many of them I did not effectively do so. I appreciate that, at a minimum, I should have put in place more detailed regimes for reduction of pain medications over time. I have since realised how at least some of these patients would have benefited from involvement of pain management specialists, even though such services are difficult to access in the Blacktown area, where there are long waiting lists, up to six months. 61. I now see how I had a limited ability to identify patients who were "drug dependent" and who were likely to be abusing their medications. Before I only suspected drug abuse in the context of patients who had been using certain medications unnecessarily for a long time. I now know that there are a variety of other signs which may suggest drug abuse, which were apparent for some of the patients in question, including complaints of loss of prescriptions, travelling significant distances to see me, presenting regularly for repeat medications and not undergoing imaging investigations I ordered. I now appreciate that many of those patients were dependant on the medications I prescribed, and that I was contributing to their dependence. 62. Although I took time with each of these patients to explore their history, particularly family background and social circumstances, and the nature of their pain complaints, I have since seen how this process was insufficient. In particular, more detailed clinical records should have been made by me, further investigations arranged and, as appropriate, referrals made to various specialists, particularly in pain management. I was too willing to accept patient histories, particularly about various imaging findings, at face value. Where patients had another general practitioner, I should have also liaised with those other general practitioners to discuss their presentation and need for, if any, further treatment. 63. I did not conduct further investigations or contact the GP involved for clarifications because I believed the history given to me by the patients and their desire to decrease the intake of Schedule 8 drugs. Forward Dating of Prescriptions 64. I acknowledge that I forward dated prescriptions for a number of patients the subject of the Tribunal complaint. 65.I was not aware that forward dating a prescription is illegal. My mistaken belief in doing so was for the following reasons: (a) if the patient came earlier than the schedule for a repeat script; (b) if the patient had to travel and expected they would not be able to find a GP to prescribe their medications; or (c) if the patient did not want to visit me again the next day or few days later for the scripts, which could be deemed to be over-servicing. 66. I now realise that forward dating prescriptions is unacceptable. For patients suffering drug addiction, such prescriptions increase the risk of medication abuse and lack of monitoring of their medication intake. Clinical record-keeping 67. I acknowledge that my clinical record-keeping for the patients the subject of the Tribunal complaint was inadequate, below expected standards and insufficient for another general practitioner to take over that patient's care. 68. Although I undertook examinations of each patient on the first occasion I saw them, I acknowledge that on a number of occasions the results of such examinations were not recorded. This was inappropriate. I now make detailed notes of all examinations which I perform. 69. I acknowledge a lack of results and correspondence, particularly from other practitioners such as specialists, in many of the patient records. I tended to accept at face value patient assertions about findings of certain investigations and who they had seen. I acknowledge that this was inappropriate. I should have sought access to the results of those investigations and communications from other practitioners, or absent that, arranged further investigations or specialist referral myself or interacted with their other general practitioners. 70. I now see that in many of the clinical records there is insufficient detail about the basis for prescriptions. I now detail the basis for such prescriptions, by reference to presenting complaints, examination and investigation findings, diagnosis, treatment plan and advice given to patients. 71. I also acknowledge that there was inadequate detail in many of the patient records during the course of follow-up consultations. I now appreciate that such consultations required detailed record-keeping of progress since last consultation, medication usage, examination findings, diagnosis and advice given to the patient. 72.I have now been using the Medtech Programme in my current practice and I have found it to be a very useful tool to help me to input my notes more concisely and logically. This also helps to collate the medical information in a timely and easily assimilated fashion. I have only been using this program for the last 18 months. Prior to that I had never used a computer. I am still learning and am becoming gradually more proficient with the system." FURTHER ASPECTS OF THE RESPONDENT'S CASE 1. The evidence in the Respondent's case includes glowing references from three General Practitioners who have worked with him or in the same area of Western Sydney. They have praised his dedication, diagnostic skills and rapport skills. They have spoken of his positive relationships with other general practitioners in the area and his excellent medical skills. There is also a long and positive reference from a clinical psychologist who has had a professional association with the Respondent for 16 years. 2. The Respondent and his family have since before 2008 been attending the Our Lady of the Rosary parish church at Kellyville. The priest has known them since arriving in 2008. He says that the complaints are completely out of character with "the devout, generous and family-oriented person that I have known over the years". 3. There is also a reference from a patient who is the International Business Development Manager with the NSW Chamber of Commerce. She has known the Respondent for 20 years and has been a patient and friend of his. She described him as: "an honest, trustworthy, fair-minded friend who worked exceptionally hard for his family, friends and colleagues at the time we did work together on developing some international projects and initiatives." She said that he is "always polite, courteous, caring and empathetic". She referred also to his involvement in the local community, as did his Priest. 4. There was no report before the Tribunal from Dr Chee the psychiatrist that the Respondent has consulted, but Dr Chee confirmed a typed tanscript of what he told the solicitor for the Respondent in a telephone conversation on 10 November 2014. In November he had seen Dr Chee on four occasions and was planning to see him for a final consultation by the end of 2014. The consultations involved discussions on how he dealt with difficult patients and strategies to respond to those. It included: "How difficult patients present, communicating with them, 'subterfuges' such patients may employ, how to refuse patient's requests in an appropriate manner, engaging with other medical practitioners already involved in patient care, and involving such practitioners where appropriate." 1. Dr Chee also explored with the Respondent the issues leading to his "…inappropriate prescribing practices including his lack of knowledge of appropriate clinical approaches and regulatory regimes for chronic pain, his past professional isolation and his misplaced desire to try and help reduce each patient's reliance on addictive medications." 1. They also explored the regulatory regime for prescribing practices. Dr Chee considers that the Respondent has genuinely engaged in those consultations and has accepted Dr Chee's insights and suggestions. He considers that the Respondent has been receptive to criticism and is genuinely contrite about what has occurred. He gave his opinion that the Respondent is fit to continue practising as a medical practitioner. Dr Chee recommended that the Respondent attend the NSW Health Opiate Treatment Addiction Course. 1. The Respondent gave oral evidence and was cross-examined. He said that he now has his building for sale and thinks he has a buyer. He said: "I think this will relieve a lot of pressure." 2. In re-examination the Respondent said, in relation to questions about whether his subject conduct was motivated by financial gain, that all his patients are bulk-billed, except patients who do not have a Medicare card. He said he had offered one patient a discount on the next appointment if he reduced the dosage of his medication. 3. When he was asked how he became ignorant of the requirements of the Therapeutic Goods Act he answered: "I wasn't aware of it". He said he was misguided in thinking he was helping patients who came to him suffering from pain from injury or trauma who had turned to narcotics, by prescribing narcotics for them. He said that when there was the s.150 enquiry by the Medical Board, he accepted the criticisms of him in the report. He acknowledged that one recommendation was that he attend a prescribing course at Monash University and he has enrolled to attend that course this year (2015). 4. He said he is sorry for his conduct and realises the important duty of a doctor to minimise the damage to the patient. "I realise I compounded the problems by not guiding them to the right help". 5. He attended a pain management master class in March 2013 and in June 2014 attended a course in efficient chronic pain management. He intends to refer to a pain management clinic for advice. He has not done that previously. He also recognises referral to a psychologist for therapeutic counselling as one of the options for patients with drug addictions. 6. With regard to his evidence that many of the patients involved in the complaints were suffering from chronic pain, the clinical notes for his patients that are in evidence do not generally refer to chronic pain and some do not refer to pain at all. 7. He said that until he saw the report of Dr Hani Bittar regarding the complaints against him: "I didn't realise I made such big mistakes. I realise I wasn't as good as I thought." 8. He also said that he will now join the Royal Australian College of General Practitioners. It is surprising, though, that, despite Professor Fasher's advice to do that, he has not done so already. 9. Since the intervention of the Medical Council in 2012 placing conditions on his registration, he has not been able to dispense Schedule 8 drugs or Schedule 4D drugs. His evidence is that the other members of his practice are aware that he is not able to prescribe Schedule 8 or Schedule 4D drugs. He said that there are less than 10 patients he has had to refer to another doctor because of the need to prescribe such drugs. He added: "Word gets around very fast". 10. He conceded that if a doctor is: "over prescribing such drugs to some patients the word gets around to other people who are drug addicted." He acknowledged that some of them followed him to his new practice and some of them he has been able to manage without prescribing those drugs. 11. In answer to questions from the members of the panel he said he did not know about phone services available to him to check whether a patient was already being prescribed addictive drugs. He said he never sought to verify patients' statements concerning drug use through a family member, hospital records, or another doctor. 12. He said that when a patient told him that the last script had been lost in the washing machine or otherwise, he did not seek any verification: "I didn't think of it". Instead he issued a replacement scrip. He said now he has heard of a "no replacement" policy where if a patient alleged that a script had been lost, the doctor would not issue a replacement. He said that he no longer issues replacement scripts in such situations and "I was very naïve then". He conceded that he was "very naïve" for "a very long time". 13. He said he is aware now of "patient contracts" where the patient enters into the contract before narcotics are prescribed. The contract can provide, for example, that it is agreed that the use of the narcotic is only for a trial and if there is no improvement in the pain the prescriptions will cease. 14. His evidence is that since the investigation of his practice, he now realises that you can check whether a patient is obtaining scrips from another doctor or a hospital, and can check whether his previous scrip has been dispensed. He also said he now realises that he can check on some of the information provided by the patient by contacting a family member or other person. 15. His strategies now if he has a patient with alleged chronic pain from an injury commence with exploring how the patient's functioning life is affected. Then he would do a check of possible "shopping" for prescriptions by the patient, followed by an assessment of pain. If medication is prescribed he would then assess the extent of any improvement from the use of the medication. He would prescribe a low dose only and only for a limited period before a review. If there is no significant improvement he would suggest another medication rather than an increased dose. Alternatively, he would refer the patient to a pain specialist. 16. When a panel member asked him when, if he could prescribe Schedule 8 and Schedule 4D drugs, he would refer to allied health professionals, such as pain specialists. He said he would do that from "day one". He said he would not prescribe narcotics. "At first I'd try to get the local hospital in" (to provide pain management services). He said he has done that already for one patient. When asked how the patient responded, he said: "He stormed out of the room". 17. He said not being able to prescribe Schedule 8 or Schedule 4D drugs was "not a problem" for the future because of the large volume of patients in the area. He said that if his right to prescribe such drugs is restored he will respond to patients differently. "The aim is to stop the addiction; not feed it." 18. He conceded in his oral evidence in chief that since the imposition of the condition to his registration that he not prescribe Schedule 8 or Schedule 4D drugs he has, in breach of the condition, prescribed a Schedule 4 D Drug for a 76 year old patient. He said it happened because he was unaware that the drug was in Schedule 4D. 19. In his oral evidence the Respondent told the Tribunal that since the enquiry into his practice he has adopted a computerised medical records system and all patient records are computerised. 20. He said that before his move to his present practice he was practising alone and not discussing patient issues with other doctors. He said that he now recognises that it is important for him to discuss patient problems with colleagues. There are 16 full time doctors in the practice and he can do that. He also acknowledged that: "I magnified the risk for patients. I was not paying attention to continuing education. I now know what I have to do when I have a problem." 21. His oral evidence is that his present practice has now commenced meetings of the doctors so that they can present cases to each other and discuss the issues. He described this as a "valuable re-education resource". 22. He likened his relationship with Professor Fasher to "an older brother to a younger brother", and said that he has: "guided me through some of the darkest periods". He said that if the supervision of his practice was to continue, "I'd gladly take it". 23. He said he consulted Dr Chee, the psychiatrist, because he thought that maybe he could "bounce" problems off him. He said that Dr Chee had taught him "tricks", such as how to say "No", and "how to deal with people who just want to use me". He said he has been "too soft" with patient demands and requests. He said Dr Chee had taught him "strategies to resist" and this had been very helpful. He said he proposes to continue his consultations with Dr Chee. 24. He said that now he does not see 50 patients per day and now spends more time with his patients: "I'm lucky if I get 40 now." When asked why he reduced the number, he said that he has been collecting patients that other doctors send to him with more difficult problems. 25. He acknowledged that he told the members of the s.150 enquiry that he had no general practitioner. He now does have, and his general practitioner is not a member of his own practice. He is not taking any medications, regularly uses a gymnasium, goes for occasional check-ups with his G.P. and rarely has health problems. ONE IMPORTANT ISSUE 1. An important issue is whether the Tribunal accepts on the balance of probabilities the explanations of the Respondent that when the subject conduct occurred: * he was ignorant of laws restricting prescribing of Schedule 8 and Schedule 4D drugs and relevant provisions of the Therapeutic Goods Act 2008; * he was ignorant of the requirement to obtain authority from NSW Health before prescribing addictive drugs to patients who were either drug addicted or on a methadone programme or other opioid treatment programme; * he was ignorant of facilities to check whether a patient seeking such prescription had already obtained such a prescription elsewhere; * he was ignorant of facilities for him to check whether a patient was already on a methadone programme or another opioid treatment programme; * he was ignorant that forward dating of prescriptions was illegal; * he was ignorant of what is required for adequate clinical records; * he was naive in not recognising that addicts are notorious for lying to doctors and others in order to obtain such drugs; * he failed to recognise the need to verify from other medical or hospital records or family or other sources any information given by patients seeking such prescriptions; * he was naive in issuing replacement prescriptions to patients who alleged a scrip had been lost or accidentally destroyed, without checking whether the original scrip had in fact been filled; * he was naive in not recognising that he was by his prescriptions of addictive drugs possibly or probably establishing a reputation that attracted drug addicts; and * he was ignorant of pain specialists and other alternative treatments to prescribing addictive drugs for pain or chronic pain. 1. The Respondent had about 30 years of experience as a medical practitioner when the subject conduct occurred. He was also in serious financial difficulties. His alleged ignorance and naivety are somewhat inconsistent with his excellent professional skills in other areas in his role as a general practitioner, as described by Professor Fasher and other doctors. 2. One alternative explanation is that he was not ignorant or naïve and was giving priority to maximising his income to address his financial problems. If that were our finding, then the subject conduct would be regarded as more serious. 3. There is no direct corroboration of his evidence of such ignorance and naivety. But there is no evidence that directly contradicts it. In addition, in his evidence and cross examination, the Respondent impressed as genuinely humbled, regretful, and contrite. He also impressed as dedicated to serving the best interests of his patients. He impressed too as a truthful witness. 4. For those reasons the Panel has accepted that evidence of ignorance and naivety. THE RELEVANT LAW 1. This is a hearing under Subdivision 6 of Division 3 of Part 8 of the National Law. Section 3A provides that in exercising its functions the Tribunal must treat "the protection of the health and safety of the public" as the paramount consideration. 2. Disciplinary proceedings against members of a profession are intended to maintain proper and 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 interest served by protective orders include the indirect effects such as the standing of the profession and maintenance of public confidence in the profession (Prakash –v- Health Care Complaints Commission [2006] NSWCA 153 at [91]). 4. Protective orders can also involve an element of deterrence in the sense of encouragement to other practitioners to recognise the importance of compliance with professional standards and the risks of failure to do so (Prakash –v- Health Care Complaints Commission [2006] NSWCA 153 at [91]). 5. The specific purpose for which the Tribunal makes orders is protective of the public interest rather than punitive with respect to the practitioner. But protective orders can also be punitive in their effects on the practitioner (Lee –v- Health Care Complaints Commission [2012] NSWCA 80 at [20]). An example would be where a condition is imposed requiring supervision and the practitioner has to pay the cost of the supervision. 6. Subdivision 6 of Division 1 of Part 8 of the National Law describes the powers that may be exercised by the Tribunal where a practitioner has been found to have engaged in professional misconduct. They include under s.149A: (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. 1. Under ss.149B there is also a power to impose a fine on a registered health practitioner of not more than 250 penalty units where the Tribunal has found the registered health practitioner is guilty of unsatisfactory professional conduct or professional misconduct and the Tribunal is satisfied there is no other order or combination of orders that is appropriate in the public interest. 2. Section 149C give the Tribunal power to suspend or cancel the registration of the practitioner where: (a) the practitioner is not competent to practise the practitioner's profession; or (b) the practitioner is guilty of professional misconduct; or (c) the practitioner has been convicted of or made the subject of a criminal finding for an offence, either in or outside this jurisdiction, and the circumstances of the offence render the practitioner unfit in the public interest to practise the practitioner's profession; or (d) the practitioner is not a suitable person for registration in the practitioner's profession. 1. Before a medical practitioner is deregistered, the Tribunal needs to find that the practitioner is probably permanently unfit to practice (Ex parte Lenehan (1948) 77CLR403 at 424-425 (per Latham CJ, Dixon and Williams JJ – Rich and Stark JA dissenting). 2. In relation to costs, under Subclause 13(1) the Tribunal may order the complainant or the registered health practitioner to pay costs to another person as decided by the Tribunal. Subclause 13(2) provides that: "When an order for costs has taken effect, the Tribunal is, on application by the person to whom the costs have been awarded, to issue a Certificate setting out the terms of the order and stating that the order has taken effect." 1. The Applicant has sought an order for the Respondent to pay the Applicant's costs. Given that these proceedings arise because of unsatisfactory professional conduct and professional misconduct of the Respondent, the power of the Tribunal under Clause 13 of Schedule 5D of the National Law to make a costs order should be exercised by making an order for the Respondent to pay the Applicant's Costs. In the orders proposed by the Respondent it is conceded that there should be such an order. CONCLUSIONS 1. The evidence does not establish that the respondent is unfit to practice or probably permanently unfit to practice, so deregistration is not an option. 2. The relevant conduct of the Respondent was serious professional misconduct. It is conduct that would damage the reputation of the profession and erode public confidence in the profession. It requires a reprimand to record serious disapproval of such conduct. The Respondent concedes that there should be a reprimand. 3. The Respondent has already had supervision for 2 Years and 4 months. Notwithstanding the opinion of Professor Fasher, that further supervision is not required, the Tribunal takes into account that even after the Respondent was prohibited from prescribing Schedule 8 or Schedule 4D drugs, he on one occasion breached that prohibition, and he says that was because he didn't know the drug was in one of the prohibited groups. This matter supports the continuance of supervision and of the prohibition regarding Schedule 8 and Schedule 4D drugs. That prohibition should continue until he has demonstrated conduct inspiring confidence that he will not repeat unsatisfactory professional conduct or professional misconduct in relation to such drugs. 4. The Tribunal is also concerned that although the Respondent has been shown to provide excellence to his patients in other areas, his skills in making medical records have been less than good for some of the time during the supervision and improved slowly. It appears from the evidence of Professor Fasher, that unlike the Respondent's excellent other clinical skills, his medical records are "satisfactory" and sometimes better. The quality of his medical record for a patient will directly impact on the treatment and welfare of the patient. Some further months of supervision will protect his patients by ensuring that he adopts and entrenches best practice in relation to medical records. 5. The Tribunal has determined that in the interest of protection the public and the profession, the supervision should continue until 22 October 2015. 6. The Respondent did not propose continuance of supervision, but did propose Mentoring for an initial period of 18 months and then for such additional period as the Medical Council decides. Exhibit R2 is the Medical Council Guidelines for Mentoring. Mentoring is not as formal as Supervision and appears likely to involve less of the mentor's time. The Mentor is nominated by the practitioner as a support person and is usually a respected senior professional. The mentoring is often effected by telephone conversations, but includes occasional face to face meetings. The guidelines suggest that the guidance and support can usefully be incorporated into the mentoring relationship by methods that include: * Discussion of the personal and professional effect that the issues which brought the practitioner to the attention of the Council had had on the practitioner; * Discussions of work-related problems; * Providing an opportunity to discuss issues with an objective colleague who is removed from the practitioner's practice; * Discussion concerning participation by the practitioner in continuing medical education, professional activities and professional discussions. 1. The mentor is not required to report to the Council except where the mentor is unable to continue in the role or has concerns about the circumstances that have led to the member being unable to continue. 2. The Tribunal is satisfied on the balance of probabilities that the protection of the public requires that the Respondent's registration be subject to a condition that from 22 October 2015 to 22 October 2017 the Respondent have a mentor and comply with the Guidelines for Mentors as published by the Medical Council of NSW. 3. Despite Professor Fashar's advice that he join the Royal Australian College of General Practitioners ("RACGP"), at the time of the hearing, the Respondent had not done so. He had at the time of the subject conduct a problem of practising "in isolation" and neglected his needs for continuing medical education. The protection of the public and the reputation of the profession require that there be conditions imposed on his registration that: * he practice only with other general practitioners to avoid professional isolation (in the form of the conditions proposed by his counsel on his behalf); * he comply with the requirements of the Medical Council for Continuing Medical Education; * on or before 31 March 2015 he join the RACGP and continue to be a member whilst he practises in general practice; * he meet the Continuing Professional Development/Quality Improvement requirements of the RACGP; * he complete in 2015 at his own expense the distance education course "Issues in General Practice Prescribing " conducted by the Department of General Practice , Monash University, Melbourne; and * within 1 month of completing that course he provide documentary evidence to the Medical Council that he has satisfactorily completed the course. 1. The Tribunal has considered whether to impose a fine on the Respondent. The Tribunal finds that the other orders proposed will satisfactorily address the public interest and protection of the public and the profession do not require a fine in addition to the other orders proposed. ORDERS 1. Accordingly, the Orders of the Tribunal therefore are: 1. The Respondent is reprimanded. 2. The Respondent's registration as a medical practitioner is to be subject to the conditions set out below. 3. The Respondent must pay the Complainant's costs of the proceedings as agreed or as assessed. CONDITIONS: (a) Schedule 4D and Schedule 8 prescribing rights 1. To not prescribe, possess, supply, administer, handle or dispense any drug of addiction (Schedule 8 drugs) or any prescribed restricted substance (Schedule 4D drug or Schedule 4D derivative). 2. Any future change in his Schedule 8 or Schedule 4D authority must be in accordance with the protocol of the Medical Council of NSW (the Council). This must include consultation with the Council prior to the submission of any variation application to the Pharmaceutical Services Unit (PSU). 3. To not make an application for variation in any of Schedule 8 or Schedule 4D authority to the PSU or to the Council, or to the Council for review of any other conditions, before the expiry of 12 months from the date of these reasons. (b) Practice environment 4. To work only in an accredited group practice. A group is defined as 2 or more medical practitioners, excluding Dr Low. An accredited practice is defined as one that is currently certified by an appropriate General practice accrediting certifier as complying with the current (4th Ed) RACGP Standards of Accreditation). 5.If practising in general practice other than in his own practice, Dr Low is to notify the owner/s and principal of the practice [and any other practitioner (including future practitioners) who may be working on site with him] of these conditions and to forward to the Council, within 7 days, a copy of these Conditions signed by each one of those practitioners. 6. To obtain Council approval prior to changing the nature or place of his practice. (c) Supervision 7. The existing conditions on the Respondent's registration regarding supervision are to continue until 22 October 2015. (d) Monitoring 8. To authorise and consent to any exchange of information between the Council and Medicare Australia and/or the PSU for the purpose of monitoring compliance with these conditions. (e) Mentoring 9. On or before 1 October 2015, the practitioner must provide the Council the name and professional address of a registered medical practitioner who has agreed to act as his mentor. The mentor is to be independent of the practice within which the practitioner is working and must be approved by the Council. 10. The mentoring is to continue for a period of two years from 22 October 2015. The nature and frequency of contact with the mentor is to be determined by the mentor in accordance with the Council's Guidelines for Mentors (Policy PCR 10.1). 11. Dr Low must: (a) provide the mentor with a copy of the Tribunal's Decision and these conditions prior to the mentoring arrangement commencing. (b) ensure that mentoring sessions include discussion of issues highlighted in this Decision, personal and/or medical practice issues as they arise and professional development as a medical practitioner (including relevant CME activities). (c) authorise the mentor to report, in an approved format, to the Council every three months about the fact of contact, and to inform the Council if there is any concern about his professional conduct. (d) authorise the mentor to notify the Council if there is any failure to attend, termination of the mentoring relationship against the advice of the mentor, or any other matter the mentor considers appropriate. (e) participate in the mentor arrangements for two years and thereafter for such period as the Medical Council of NSW may determine. (f) authorise the mentor to notify the Council when of the view that professional mentoring is no longer required. (g) in the event that the approved mentor is no longer willing or able to continue as mentor, nominate another mentor for approval by the Council within 21 days of the cessation of the original mentor relationship. (h) be responsible for any costs associated with the mentoring process. (f) Education 12. Comply with the requirements of the Medical Council for Continuing Medical Education. 13. On or before 31 March 2015 join the Royal Australian College of General Practitioners and continue to be a member whilst he practices in general practice. 14.Meet the Continuing Professional Development /Quality Improvement requirements of the Royal Australian College of General Practitioners. 15.Complete in 2015 at his own expense the distance education course: "Issues in General Practice Prescribing" conducted by the Department of General Practice, Monash University, Melbourne. 16.Within one month of completing that course he provide documentary evidence to the Medical Council that he has satisfactorily completed the course. (g) Review of conditions 17. These conditions may be altered, varied or removed by the Council and the Council is the appropriate review body for the purposes of Division 8 Part 8 of the Health Practitioner Regulation National Law (NSW). 18. Should Dr Low seek to change or remove any of the conditions imposed as a result of this Tribunal's orders when his principal place of practice is anywhere in Australia other than in New South Wales, sections 125 to 127 inclusive of the Health Practitioner Regulation National Law are to apply, so that a review of these conditions can be conducted by the Medical Board of Australia. I hereby certify that this is a true and accurate record of the reasons for decision of the New South Wales Civil and Administrative Tribunal. Registrar 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: 24 March 2015