Civil and Administrative Tribunal New South Wales Medium Neutral Citation: HCCC v Sadek [2017] NSWCATOD 181 Hearing dates: 30, 31 October, 1 November 2017 Date of orders: 20 December 2017 Decision date: 20 December 2017 Jurisdiction: Occupational Division Before: J Millbank, Senior Member K Carter, Senior Member M Cross, Senior Member J Griffin, General Member Decision: (1) A finding that Complaints 1-7 of unsatisfactory professional conduct are made out to the required standard; (2) A finding that Complaint 3 alone, and the other complaints cumulatively, amount to professional misconduct per Complaint 8; (3) A non publication order under s 64 of the Civil and Administrative Tribunal Act 2013 (NSW) prohibiting disclosure or publication of the names of the patients and medical practitioners in the schedule to the complaint, and any other patients named in evidence; (4) An order that the matter proceed to Stage 2 determination, with directions to the parties to communicate with the registry to set a hearing date. Catchwords: Pharmacy – multiple improprieties in recording and dispensing of Schedule 8 medications – failure to report unaccounted for Schedule 8 medication – failure to report suspect and tampered Schedule 8 scripts – dispensing very large quantities of high strength OxyContin with no directions for use – dispensing very large quantities of high strength OxyContin to person who was not the script holder and not authorised by patients to collect on their behalf Legislation Cited: Health Practitioner Regulation National Law NSW 2009 (NSW) ('The National Law') ss 139B; 139E Civil and Administrative Tribunal Act 2013 (NSW) s 64 Poisons and Therapeutic Goods Act 1966 (NSW) s 8; Poisons and Therapeutic Goods Regulation 2008 (NSW) cl 39; 85; 112; 113; 118; 124; 128P; 117 Cases Cited: Briginshaw v Briginshaw (1938) 60 CLR 336; HCCC v BXD (No 1) [2015] NSWCATOD 134; HCCC v Fisher [2016] NSWCATOD 62; HCCC v Flekser [2016] NSWCATOD 1; HCCC v Fraser [2014] NSWCATOD 29; HCCC v Phung (No 1) [2012] 1 NSWDT 3; Litchfield v HCCC (1997) 41 NSWLR 630; HCCC v Perroux [2011] NSWDC 99; HCCC v Simonson [2017] NSWCATOD 87 Pillai v Messiter (No 2) (1989) 16 NSWLR 197; Slezak, Dr Peter [2011] NSWMPSC 10; Texts Cited: Pharmacy Guild of NSW, Guide to Medicines and Poisons Schedule (2015); NSW Health, Guide to Poisons and Therapeutic Goods Legislation for Pharmacists TG79 (2009, 2013, 2014) Category: Principal judgment Parties: Health Care Complaints Commission (Applicant) Anthony Sadek (Respondent) Representation: Counsel Mr Maybury, instructed by Ms Bayley (Applicant) Mr Downing (Respondent) Lawyers Meridian Lawyers (Respondent) File Number(s): 2017/119854 Publication restriction: A non publication order under s 64 of the Civil and Administrative Tribunal Act 2013 (NSW) prohibiting disclosure or publication of the names of the patients and medical practitioners in the schedule to the complaint, and any other patients named in evidence. Reasons for decision Background 1. Mr Sadek was first registered as a pharmacist in 1989. Mr Sadek owns and operates a pharmacy located in Guildford. 2. In September 2013 the Pharmaceutical Services Unit (PSU) reviewed wholesale records of OxyContin and noted that Mr Sadek's pharmacy had purchased an unusually high quantity of OxyContin 80mg tablets in the period reviewed. The investigator requested information from Mr Sadek via email in September 2013 and upon noting a number of discrepancies pursued an investigation. 3. On 10 March 2014 and 20 March 2014 a PSU investigator inspected Mr Sadek's Schedule 8 drug register, retained scripts and dispensing records and then on 21 March 2014 served an order on him prohibiting him from obtaining, possessing or supplying Schedule 8 substances apart from methadone and buprenorphine for the purposes of treating patients on an Opioid Treatment Program. 4. On 9 April 2014 the Pharmacy Council held s 150 proceedings and imposed conditions that the practitioner not possess, supply or manufacture drugs of addiction and any preparation, admixture or extract of a drug of addiction other than methadone and buprenorphine for the purposes of treating patients on an Opioid Treatment Program. 5. The Tribunal has before it seven complaints of unsatisfactory professional conduct against the practitioner concerning his dispensing practices of Schedule 8 medication, principally OxyContin 80mg, between 2012 and 2014. Complaint 8 is of professional misconduct. The Complaint is attached as an appendix to this decision. 6. The practitioner did not contest many factual aspects underlying the complaint but did not concede that any of the conduct was unsatisfactory professional conduct, or professional misconduct. Relevant Law 1. The Tribunal is required to make findings for each particular if they are not conceded in writing: s 165H National Law. The Tribunal must be independently satisfied that the complaints are made out to the civil standard in Briginshaw before then proceeding to determine the appropriate protective orders. 2. The professional members of the Tribunal are entitled to apply their own specialist expertise to the evidence in forming opinions about whether there has been a departure from the relevant standard of conduct, with appropriate attention to the expert evidence if there is a genuine difference of view: HCCC v Fraser [2014] NSWCATOD 29 at [238]. 3. 'Unsatisfactory professional conduct' is defined in s 139B of the National Law as including: (a) Conduct that demonstrates the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of the practitioner's profession is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience. (b) A contravention by the practitioner (whether by act or omission) of a provision of this Law, or the regulations under this Law or under the NSW regulations, whether or not the practitioner has been prosecuted for or convicted of an offence in respect of the contravention. … (l) Any other improper or unethical conduct relating to the practice or purported practice of the practitioner's profession. 1. In making a finding of unsatisfactory professional conduct per (a), the Tribunal must compare the conduct of the practitioner with a standard 'reasonably expected'. In HCCC v Simonson [2017] NSWCATOD 87 the Tribunal noted at [9]: Obviously, there will be many cases where there is no one bright line which typifies the relevant knowledge, skill or judgement or care of such a practitioner. In most cases, the expected standard of relevant knowledge, skill or judgement or care of a practitioner will fall within a band, sometimes narrow and sometimes broader. 1. 'Improper' and 'unethical' are not defined in the National Law. The assessment of what constitutes improper or unethical conduct is based upon their ordinary meaning. In the professional disciplinary context there is necessarily some overlap between the two words. 2. 'Improper' conduct does not need to be intentional and includes conduct not in conformity with standards of professional conduct: HCCC v Phung (No 1) [2012] 1 NSWDT 3 at [68]; HCCC v Fisher [2016] NSWCATOD 62 at [57]; HCCC v Flekser [2016] NSWCATOD 1 at [119]. Improper and unethical conduct may be dishonest, disreputable to the profession, in breach of explicit professional standards such as codes of conduct, guidelines and competencies, and may also be determined by reference to the views of reasonable members of the profession: Slezak, Dr Peter [2011] NSWMPSC 10 at [83] and [87]. 3. The gravity of the conduct must be measured against the extent to which it departs from proper standards, not by reference to the worst cases: Litchfield v HCCC (1997) 41 NSWLR 630 (at 638). 4. 'Professional misconduct' is defined in section 139E of the National Law as: (a) unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration; or (b) more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration. 1. In making a finding of professional misconduct the Tribunal must determine whether 'when the respondent's contraventions are considered as a whole, they are of a sufficiently serious nature to justify suspension or deregistration': HCCC v Perroux [2011] NSWDC 99 at [18]. This level of seriousness requires more than 'mere incompetence', and can include a deliberate departure from accepted standards, indifference to them, or serious negligence: HCCC v BXD (No 1) [2015] NSWCATOD 134 at [37], quoting Kirby J in Pillai v Messiter (No 2) (1989) 16 NSWLR 197 at 200. 2. The Therapeutic Goods Act 1966 (NSW) and Poisons and Therapeutic Goods Regulation 2008 (NSW) closely regulate Schedule 8 medications addressing matters such as the supply, safekeeping, recording of details and requirements of dispensing. 3. Relevantly for this matter, the Poisons and Therapeutic Goods Regulation 2008 (NSW) (the Poisons Regulation) provides at Reg 86 'Certain Prescriptions not to be Filled': (1) A pharmacist must not supply a drug of addiction on prescription: … (c) if the interval of time that has elapsed since the drug was last supplied on the prescription is less than that indicated by the prescription as the minimum interval that must elapse between successive supplies of the drug, or (d) if the prescription is illegible or defaced, or … (f) if the prescription appears to have been forged or fraudulently obtained, or (g) if the prescription appears to have been altered otherwise than by the authorised practitioner by whom it was issued, or … (2) Immediately on being requested to supply a drug of addiction in any of the circumstances referred to in subclause (1) (f), (g) or (h), a pharmacist must retain the prescription and cause notice of the request to be given to a police officer. 1. The Poisons Regulation provides at Reg 87 'Prescriptions require verification': (1) A pharmacist must not supply a drug of addiction on prescription unless he or she: (a) is familiar with the handwriting of the person who issued the prescription, or (b) knows the person for whom the drug is prescribed, or (c) has verified that the person who is purported to have issued the prescription has actually issued the prescription. 1. The Poisons Regulation provides at Reg 112 'Entries in Drug Registers': (1) On the day on which a person manufactures, receives, supplies, administers or uses a drug of addiction at any place, the person must enter in the drug register for that place such of the following details as are relevant to the transaction: (a) the quantity of the drug manufactured, received, supplied, administered or used, (b) the name and address of the person to, from, or by, whom the drug was manufactured, received, supplied, administered or used, … (d) in the case of a drug that is supplied or administered on prescription: (i) the prescription reference number, and (ii) the name of the authorised practitioner by whom the prescription was issued, … (i) the quantity of drugs of addiction of that kind held at that place after the transaction takes place, (j) any other details approved by the Director-General. (2) Each entry in a drug register must be dated and signed by the person by whom it is made. 1. And at Reg 113 'Supply on prescription to be recorded': (1) A pharmacist who supplies a drug of addiction on prescription must record the following details in a manner approved by the Director-General: (a) the details required by clause 80 (1) to be included in the prescription, (b) a unique reference number for the prescription, (c) the date on which the substance was supplied, (d) the name of the person by whom the substance was supplied. … 1. Reg 124 'Loss or theft of drugs of addiction' provides that: A person who is authorised to be in possession of drugs of addiction must immediately notify the Director-General if the person loses a drug of addiction or if a drug of addiction is stolen from the person. 1. The Regulation also provides at Reg 177 'False or misleading entries in records and registers': (1) A person who is required by this Regulation to keep any record or register must not make any entry in the record or register that the person knows to be false or misleading in a material particular. (2) A person must not make any alterations, obliterations or cancellations in a record or register required by this Regulation, but may correct any mistake in any entry by making a marginal note or footnote and by initialling and dating it. The Hearing and Evidence 1. The Tribunal heard oral evidence from Mr Gavrilovic the PSU investigator, Ms Croker the peer expert engaged by the HCCC, Dr BW a doctor in whose name hundreds of scripts which were the subject of Complaint 3 were issued, Ms Younan a former pharmacist who worked part time at the relevant pharmacy, and the practitioner himself. 2. Much of the hearing centred upon contested accounts of events that were the subject of Complaint 3. Findings and Reasons 1. The Guide to Medicines and Poisons Schedule is guidance issued by the Pharmacy Guild of NSW periodically. Likewise the NSW Health PSU periodically issues a Guide to Poisons and Therapeutic Goods Legislation for Pharmacists. These documents provide detailed plain language guidance to assist pharmacists to understand their duties under the relevant legislation. 2. Mr Sadek's evidence was that he was aware of, and followed, this guidance. Despite this, Mr Sadek said that he was unaware of requirements in the regulations which mandate that prescriptions for S8 medications include: adequate directions for use, the patient's address, and the prescriber's phone number. Mr Sadek claimed to be unaware that the regulations and policy documents provide that scripts must not be issued if altered or defaced. Mr Sadek was also unaware that the regulations provide that the S8 drug register cannot be altered by crossing out or deleting entries. Complaint 1 1. Complaint 1 concerns the practitioner's failure, upon receiving an alert from the Pharmacy Guild concerning certain forged prescriptions, to alert the PSU to the fact that he had previously dispensed scripts of OxyContin 80mg to three different patients on scripts with the same prescriber details. 2. The practitioner's position was his conduct was reasonable in the circumstances as he had dispensed the scripts seven months prior to receiving the alert. 3. Mr Sadek's evidence was that his general practice was that when a new patient came in with a Schedule 8 script, or the script was from a doctor he was not familiar with, that he would carefully read the information on the script and check that the script was legitimate by telephoning the prescriber's number on the script and checking that the script was issued by him or her. 4. Mr Sadek's evidence was that when the first patient, Patient A had presented on 8 April 2013, he had telephoned the number on the script and said to the person who answered the phone, "I just wanted to make sure the script is ok" and that the person said, "The script is OK. I wrote it." He did not make calls concerning the following two patients who presented that day and two days later with scripts by the same doctor, as he was now satisfied that the scripts were legitimate. 5. Mr Sadek was asked at the hearing whether as a matter or usual practice he asked prescribing doctors whether a patient was opioid naïve, how long the doctor had been treating the patient, or what they were treating them for. Mr Sadek's response was, "When I say 'is it ok?' it means all of those things." 6. When Patient A returned eight days after filling a script for 28 tablets of OxyContin 80mg with a script for another 28 tablets, Mr Sadek said that he "had some concerns" but filled the script. At the hearing Mr Sadek justified this decision by claiming that this usage fell within "the therapeutic range" for such medication which he stated was 1-2 tablets twice a day based on his reading of the Australian Medicines Handbook. In fact the script filled on 8 April 2013 states that the medication is "1 b.d" (as does the script on 16 April, ie one tablet twice daily) so the usage was clearly in excess of the prescribed amount. 7. Mr Sadek's evidence was that over two weeks later he tried to search the practice address and locate the medical practice of the prescribing doctor and was unable to do so, as the address did not exist and local medical practices he phoned did not have the named doctor working there. Mr Sadek says, "I didn't have any proof that the scripts were not legitimate, but I was suspicious", and at that point he made an undated note in his computer system not to dispense any further scripts. Mr Sadek did not believe that he ought to have reported these concerns to the PSU or police at that time. 8. We find that the practitioner knew or ought to have known that the script presented to him on 18 April 2013 was suspicious and that when those suspicions were confirmed he failed to take appropriate action by contacting the PSU or police. 9. Mr Sadek's position was that he did not believe that he ought to have contacted the Pharmacy Guild when the November 2013 alert came out concerning scripts that had been reported over the previous six weeks with the same details. The alert states in bold, If you have already dispensed relevant prescriptions for OxyContin 80mg tablets consistent with the details of the prescriptions being forged, as detailed above, please contact the Duty Pharmaceutical Officer at Pharmaceutical Services…as soon as possible in order to assist in addressing this serious public health and safety issues and criminal activity. Pharmaceutical Services are liaising with NSW Police on this matter. (Emphasis added) 1. Ms Croker the peer expert found that this conduct was significantly below the standard expected, but she was not strongly critical because Mr Sadek's account was that he understood the alert to be referring to the last six weeks and he believed that because the scripts he had dispensed fell outside of the description given in the alert he was not required to respond. 2. The Tribunal rejects Mr Sadek's account that he understood "consistent with" in the alert to only mean scripts issued within the last six weeks. As will be discussed below, by November 2013 Mr Sadek was dispensing great quantities of OxyContin 80mg and we find that his failure to alert the PSU was a direct result of his anxiety not to draw attention to this practice. 3. Complaint 1 is made out to the required standard. Complaint 2 1. Complaint 2 contains several particulars concerning multiple failures to accurately record S8 drugs in the pharmacy drug register (including dispensings not recorded, recording the wrong drugs or wrong strength of drugs being dispensed, recording incorrect quantities on hand); alterations of the drug registers by crossing out entries, failure to make accurate inventories twice yearly as required by law, and failure to notify the Department of Health about missing drugs when discrepancies were identified. 2. While the practitioner was able to later account for some small discrepancies, there was no serious contest about the particulars of this complaint, which were amply demonstrated through the documentary evidence. Mr Sadek's position was that he was very busy and there may have been oversights. 3. One notable example is where the practitioner balanced the register in March 2014 and simply noted a shortfall of 60 OxyContin 80mg tablets and continued to record dispensings. The Tribunal does not accept the practitioner's account that he was prevented from remedying this failure by the seizure of his drug register and drugs later that month. The practitioner was provided with a copy of the register and could have, but did not, examine his records. 4. Ms Croker was strongly critical of these failings, in particular because there were such frequent and significant errors, and because there did not appear to be any attempt on the part of the practitioner to investigate and remedy even the glaring discrepancies that he had noted. 5. All particulars are proved and Complaint 2 is made out. Complaint 3 1. This complaint includes a number of particulars concerning the practitioner's conduct in filling hundreds of scripts for OxyContin 80mg between December 2012 and March 2014 which were purported to be issued by Dr BW to 46 patients in circumstances where: * The scripts were for large quantities and high strengths of OxyContin (generally 112 tablets of 80mg), presented at short intervals over prolonged periods which would lead to a dosage exceeding one tablet twice a day not in accordance with recognised therapeutic standards; * The scripts were private prescriptions for high cost medications; * The medications were collected by one person; * The medications were paid for in cash on each occasion; * The scripts did not contain directions for use; * There was pattern of similar patient names and addresses; * There was a high potential for misuse and misappropriation of the drug. 1. This complaint alleges failings of the practitioner to: confirm the authenticity of the scripts (particular 1); cease dispensing when he ought to have held serious doubt or concerns in relation to the authenticity of the prescriptions and/or prescribing practices of the prescriber (particular 2); report to the PSU or police serious doubts or concerns he ought to have had about the above (3); obtain written consent from the named patients for the collection of these medications by another person, and report concerns to the PSU or Medical Council about the collection practice (4). 2. Ms Younan's evidence was of limited assistance. Mr Gavrilovic's report records a conversation between himself and Ms Younan in March 2014 in which Ms Younan is reported to have stated that she had previously refused to dispense hand written scripts by Dr BW as she thought they were forgeries, but she did not discuss this with Mr Sadek. Ms Younan's evidence at the hearing was that she had never seen any scripts from Dr BW and did not say this to Mr Gavrilovic. The pharmacy dispensing records indicate multiple dispensing from Ms Younan on scripts issued by Dr BW, contradictory to either account. No weight is placed on Ms Younan's evidence. 3. Records compiled by the PSU investigation demonstrate that, based on Mr Sadek's dispensing records, Mr Sadek's pharmacy dispensed 120 tablets of OxyContin 80mg in 2008 and 840 such tablets in 2009 on scripts authored by Dr BW. 4. In 2010 on Mr Sadek's account he first began filling scripts issued by Dr BW, which were collected by one person, Patient D. During 2010 Mr Sadek's pharmacy dispensed 14,000 OxyContin 80mg tablets on scripts issued in the name of Dr BW, ie over 100 times as many as had been dispensed two years prior. During 2011 the amount dispensed doubled to 31,000 OxyContin 80mg tablets, and then stayed at that volume for 2012, before increasing to almost 52,000 in 2013. In the first 11 weeks of 2014, prior to the PSU seizure, 13,400 OxyContin 80mg tablets were dispensed by Mr Sadek's pharmacy on scripts issued in the name of Dr BW. 5. In total this amounted to 143,884 OxyContin 80mg tablets prescribed by one doctor, the bulk of which were dispensed by Mr Sadek personally over a four year period to a single person, who was presenting multiple scripts, multiple times per week, and paying cash amounts of up to $2000 at a time. 6. Looking at the massive quantities of opioid involved, and the fact that the prescribed strength was an unvarying maximum strength on every occasion, it is apparent that, whatever view Mr Sadek had of Dr BW's bona fides as a doctor, the possibility of misuse of these drugs was very significant, and increased exponentially over time. In addition in the relevant period every script was handwritten, for large numbers of pills (often 112), always for 80mg, and every script was issued as a private script: these were clear red flags indicating potential misuse that any responsible pharmacist should have attended to. 7. Mr Sadek's account was that he saw nothing unusual in all of the scripts being private scripts because the quantities were higher than that supported by the Pharmaceutical Benefits Scheme (PBS) which only funds scripts of 28 pills. 8. Mr Gavrilovic stated that utilising private scripts for opioids is a well-known method of avoiding detection – as the dispensings are therefore not monitored by the PBS. Mr Gavrilovic gave evidence that a prescribing doctor can request an authority from the PBS for larger quantities than 28 pills if clinically indicated, and that it is not uncommon for larger quantities to be prescribed under the PBS system using this approach. Mr Sadek said that he never asked any patient, nor Dr BW, why they did not request an authority from the PBS for a larger quantity in order to access the medication at the subsidized rate. 9. Taken together with the fact that there were never directions for use on the relevant scripts, and the practitioner never met with any of the purported patients to advise or question them about their usage, leads us to conclude that Mr Sadek had actual or constructive knowledge of the likely misuse of these drugs over a long period. 10. Mr Sadek's explanations of his conduct and his understanding of his professional obligations in dispensing Schedule 8 medication were implausible and unconvincing. In essence Mr Sadek stuck fixedly to the view that if an actual doctor had actually issued a script then there could be no professional failing on his own part if he filled it. His account was that in certain circumstances he telephoned the prescriber to ask, "Is this script okay?" and if the doctor said it was "okay" then his duties were discharged. Mr Sadek did not see it as part of his professional role to check directly with the patient that the patient knew how to take the medication, or with the doctor that the patient was on a safe or appropriate dose for their condition. 11. On key issues Mr Sadek embellished and altered his account, and we find as detailed below that aspects of his evidence were plainly false. However, we do accept some aspects of Mr Sadek's account of verifying scripts with Dr BW for the reasons set out below. 12. Dr BW's evidence was that he had not issued any of the handwritten scripts for OxyContin 80mg, and had no patients in his records that accorded with the names on the scripts. He very rarely issued scripts for OxyContin, only one or two per year, and these were usually only for a few tablets at a time. He issued all of his scripts by computer and only rarely wrote a handwritten script if it was for a compounding medication. 13. Dr BW said that he did not know Patient D and had not instructed any person to collect scripts from Mr Sadek. Dr BW did not recall being contacted by Mr Sadek by phone to verify the authenticity of any of the scripts, and he emphatically denied visiting him at the pharmacy to look over the scripts in person. On his account he had gone to Mr Sadek's pharmacy on two or three occasions to fill scripts for his own family. Dr BW did not think he had given his business card or mobile phone number to Mr Sadek. 14. Although trained as an orthopaedic surgeon Dr BW does not have visiting rights or perform surgery at any hospital in Sydney, nor does he have surgical rooms; he practices from a bulk billing general practice. 15. The handwritten scripts were all stamped with a Baulkham Hills medical centre practice address for Dr BW which he had left in October 2010. The stamped addresses do not include a phone or fax number. 16. Dr BW said that he had left behind his stamp and some script pads when he left the Baulkham Hills practice. Some years ago Dr BW also had a break in, or possibly two break ins at his current practice in Merrylands, and some time later realised that blank script pads had been taken. He had reported this to the practice manager, but not to the PSU or police. 17. A computer generated script dated 5 May 2010 in Dr BW's name for 40 OxyContin 80mg tablets was in evidence, and when presented with it, Dr BW confirmed that it "looked like his". The PSU investigation discovered other OxyContin scripts in Dr BW's name dispensed at other pharmacies that were computer generated, including one for a patient for whom Dr BW had no patient record. Dr BW had no explanation to offer for these anomalies. 18. Mr Sadek's account was that the first script presented to him from Dr BW was dated 5 May 2010 and at that time he did not recognise the name of the prescriber. As per his usual practice he phoned the number on the script to verify the prescriber, and entered Dr BW's details including phone number into his dispensing database. Mr Sadek then issued a number of subsequent handwritten scripts that were in the name of Dr BW. 19. At some later point when Patient D was collecting a script, Mr Sadek again phoned Dr BW to confirm that he had written the script and, "He told me that he authorised [Patient D] to collect the medication." On some later occasion when Mr Sadek phoned Dr BW about a script, Dr BW said he would come to visit the pharmacy. Mr Sadek says he showed Dr BW some of the handwritten scripts and asked whether they were issued by him and Dr BW confirmed that they were. Dr BW presented his business card and also provided his mobile telephone number, which Mr Sadek entered into his dispensing software. Mr Sadek says that Dr BW told him that he would be continuing to send Patient D to present scripts for "a number" of his patients. 20. Mr Sadek's evidence was that he did not know, and never asked, Patient D's surname, did not know his occupation and never asked for, or sighted, any form of identification for him until March 2014. Mr Sadek repeatedly referred to Patient D as a "carer" who was "authorised" by Dr BW but, apart from the collection and couriering of medication could not identify what caring role he performed. While Mr Sadek claimed that Patient D did not "always" pay cash, he did not provide any record of payment by credit or debit card. 21. Mr Sadek says that following the face to face meeting with Dr BW, Patient D came into the pharmacy approximately twice a week with handwritten scripts and that Mr Sadek continued to check the details including the phone number of the prescriber. In later 2012 or early 2013 Dr BW again came into the pharmacy and asked if Mr Sadek was agreeable to him increasing the number of scripts being presented by Patient D and Mr Sadek said he had no difficulty with that. 22. Mr Sadek states that the increasing volume over time and his familiarity with the prescriber meant that his attention to detail lessened. Mr Sadek states that he did not notice a "gradual" change in the scripts in that "some" of the Dr BW scripts were missing phone numbers and script ID numbers and "at times" parts of the scripts were covered by a black marker. "That was not something that registered with me at the time and I was not then aware that each script pad had an identifying number." However Mr Sadek also says that when he did identify discrepancies in scripts he checked those scripts against published stolen pads on alerts from the Pharmacy Guild. 23. We note that of the dozens of altered scripts in evidence containing blacked out areas, the script pad identification number was always blacked out. Mr Sadek's evidence was that he never asked Dr BW why these scripts had been altered in this way, but always assumed that the alteration was done by him to indicate that it was a private script. We note that on the handwritten scripts in evidence that are altered, the PBS box is clearly marked as a box on the left hand side of the script about one third of the way down the page, whereas the script number is on the upper part of the script on the right hand side. 24. Mr Gavrilovic examined the serial numbers of the scripts and found that the serial numbers on some of the altered scripts could be discerned using a strong light. When examined, the serial numbers indicated the scripts were not issued sequentially. His report concludes that at least six different prescription pads were used to produce 600 scripts issued in Dr BW's name. Mr Gavrilovic also notes that around 400 of the 600 scripts examined came from a batch numbered 4001_05/11, produced in May 2011 by the Commonwealth Department of Health and Aging. Prescription pads with the same batch number, 4001_05/11, were found in Dr BW's current practice. 25. When Mr Gavrilovic visited the pharmacy on 20 March 2014 Mr Sadek showed him CCTV footage of a purported interaction between Mr Sadek, Dr BW and Patient D at the pharmacy on 16 October 2012. Mr Sadek subsequently provided this footage to the HCCC and it was in evidence. The footage is 2 minutes and 20 seconds long, and is silent. 26. Mr Sadek's account is that the footage shows Patient D presenting a script at the counter when Dr BW enters the pharmacy, shakes Patient D's hand and then shakes Mr Sadek's hand. Dr BW presents two computer generated scripts and Patient D moves aside and sits down to wait while Dr BW is served by Mr Sadek. 27. Dr BW was shown the CCTV footage from 16 October 2012 in the witness box and confirmed that it was himself and Mr Sadek in the footage. He could not identify the other man, whom he thought was probably a patient because he has a lot of patients in that area and shakes their hands as a sign of respect and honour. 28. The Tribunal noted that it appeared in the CCTV footage that Dr BW indicated to the other man to back away while he was served, that the medication from behind the counter was not labelled by Mr Sadek, the sale was not rung up on the register, and that when Dr BW presented what appeared to be $100 in cash from his wallet he received no change and no receipt for his purchase. The Tribunal asked both Dr BW and Mr Sadek to comment upon this. 29. Dr BW accepted that the footage appeared to indicate a degree of familiarity between himself and Mr Sadek. Dr BW professed a very specific recollection of being in a hurry because he was in limited time parking space on that occasion and did not want to get a parking ticket so he did not wait for his change. He may have asked the other man to wait for him to be served first for this reason also. 30. Mr Sadek claimed at first that he added the sale up in his head and it came to exactly $100, then amended this to say, "once I had applied the discount." He stated that he only provides a receipt if the customer asks for one. Mr Sadek acknowledged that he did not label the prescription medication as is required and is his usual practice. He said he put the scripts through the register at a later point after he had served Patient D. 31. Mr Sadek gave evidence that his CCTV recording system was on a seven day setting and records over itself after that time. He stated that he has this recording from 2012 because he burnt it onto a CD immediately after the relevant incident, and then kept it. 32. Despite the fact that this recording appears to demonstrate rather poor professional practice on his part, Mr Sadek's account was that he made a copy, and kept it, as a professional development exercise to demonstrate "inter-professional collaboration" for his continuing professional development program. When pressed by the Tribunal to explain what collaboration this recording demonstrated, Mr Sadek repeatedly stated that it showed that he and Dr BW knew each other, and that Dr BW knew the other man. 33. The clear inference from the footage is that Mr Sadek and Dr BW were very familiar with each other by October 2012. There is only Mr Sadek's evidence that the other man was Patient D, and we make no finding as to his identity. 34. Based on the inconsistencies in Dr BW's evidence, and the apparent familiarity between Dr BW and Mr Sadek, we reject Dr BW's account and accept that Mr Sadek did communicate with Dr BW including on at least one occasion phoning Dr BW to ask if he had issued the relevant scripts. On this basis we cannot find that particular 1 is established on the balance of probabilities. 35. However, the Tribunal does not accept that a mere belief in the authenticity of the prescriber is a valid explanation for the balance of unsatisfactory professional conduct asserted in the bulk of Complaint 3. We also reject much of Mr Sadek's account as untrue. 36. We conclude that Mr Sadek took the unusual step of making a copy of the CCTV footage in October 2012 in order to prove that he and Dr BW were known to each other. The inescapable conclusion is that Mr Sadek had a consciousness of wrongdoing, and specifically that Dr BW's scripts or prescribing practices were not legitimate. Yet Mr Sadek continued to dispense very large quantities of high strength OxyContin for the next 17 months in the dubious circumstances described above, until prevented from doing so by the PSU and then the Pharmacy Council. 37. Mr Sadek's evidence was that the practice of having a single person collect what was an increasing number of high volume private scripts for high strength OxyContin "did not strike me as particularly unusual". In his written statements and oral evidence Mr Sadek's rationale was that: he understood orthopaedic conditions to be very painful and to require long term pain relief post-surgery; he believed for some reason that Dr BW was treating a number of overseas patients (who thus had no Medicare numbers and required private scripts), that these patients were residing near Dr BW's practices (explaining the concentration of patient addresses in a small number of streets with multiple patients with the same or similar names residing at the same address or street, or same street name in different suburbs), that these patients were incapacitated following surgery (who thus all required Patient D to collect their medication) and that they suffered chronic pain (requiring high volume and high strength, and necessitating private scripts). 38. In oral evidence Mr Sadek also provided for the first time an explanation for not finding that such a large number of handwritten scripts was unusual: a belief that they were all written while the doctor, BW, was making house calls on his incapacitated patients. 39. Mr Sadek never actually asked whether the patients had undergone surgery or what their underlying condition was. Nor did he ask how long each patient had been taking OxyContin. Mr Sadek's evidence was that he asked Patient D, "Do they all know how to take the medication?" and Patient D said, "Yes they've been on it for a while." Mr Sadek never attempted to contact any of the purported patients directly to seek their consent to an agent collecting their medication or to ensure that they were taking the medication appropriately. 40. Mr Sadek says, I did not believe it was appropriate or necessary for me to question [Dr BW's] judg[e]ment in writing the scripts for OxyContin. I accepted that as an orthopaedic surgeon, he was better qualified than me to make the decision as to whether OxyContin was clinically indicated for his patients. 1. The Tribunal rejects Mr Sadek's explanation of his role as both inherently implausible and at odds with the professional duties of a pharmacist. We find that by October 2012 Mr Sadek was well aware that the OxyContin he was dispensing in large quantities and high strengths in the name of Dr BW was not for legitimate use by patients. Apart from his evidence that Dr BW was personally known to him, we reject Mr Sadek's account as false. 2. It is notable that Mr Sadek stated to Mr Gavrilovic that he did not keep scripts for more than the two years required by law, yet in May 2014 presented him with a bundle of old scripts in Dr BW's name including some from 2010 and 2011. At the hearing Mr Sadek said that before he disposed of boxes of old scripts he looked through them and retained some scripts "for reference" because they were "important". He was unable to say what made a script important or what the reference was for. We find that Mr Sadek retained older scripts by Dr BW for the same reason that he retained the CCTV footage of Dr BW, because he was aware of impropriety and was retaining evidence that he thought would exculpate himself. 3. The particulars concerning dispensing, failure to report and providing medications to a third party are all proved. Complaint 4 1. This complaint concerns the practitioner dispensing Schedule 8 drugs on non-compliant prescriptions. The complaint concerns 18 patients on 19 occasions over a 14 month period. Mr Sadek did not contest these occurrences, and by the conclusion of the hearing did not seriously dispute that it amounted to unsatisfactory professional conduct. 2. Ms Croker was strongly critical of this conduct, in particular because of the multiple occurrences. 3. The Tribunal was independently satisfied that complaint 4 is established. Complaint 5 1. Complaint 5 concerned the dispensing of 2664 OxyContin 80mg tablets to one patient, BS, in a 14 month period, in circumstances where some of the scripts were non-compliant or suspicious and most were private scripts. The scripts were presented at short intervals and are said to exceed a "normal dose" of one tablet twice daily and be beyond the therapeutic range. 2. Ms Croker's report drew particular attention to August 2013, in which 5 scripts amounting to 360 tablets of OxyContin 80mg were dispensed to Patient BS, ie an average of 11.6 tablets per day in that period. 3. Mr Gavrilovic's report records a conversation with Mr Sadek in March 2014 in which Mr Sadek stated that the usual dose of OxyContin 80mg is "one to two tablets three to four times a day." At the hearing Mr Sadek claimed the this was a slip of the tongue and that he had immediately retracted it. However in his statement of 14 May 2014 to the s 150 proceedings Mr Sadek stated his recollection of the 10 March 2014 meeting as, "He then asked me what I understood the dose of OxyContin 80mg to be. I said 2 tablets up to 4 times per day." 4. At the hearing Mr Sadek's position was the OxyContin should be taken twice per day but that "1 to 2 tablets" of any strength (ie whether 10mg or 80) is a "normal dose" and would fall within the therapeutic range. 5. Mr Sadek's evidence was that he checked the prescriptions and the dosage with the prescriber, and that there was nothing to alert him to the prescriptions of Patient BS being anything other than genuine and the medication used for legitimate purposes. He made no inquiry into the patient's underlying condition. 6. OxyContin is a slow release medication. The expertise of the professional members of the Tribunal was that it should not be taken more frequently than 12 hourly. Indeed the TGA consumer advice leaflet, available in every box of every strength OxyContin, explicitly states this. 7. The Tribunal reviewed a number of the scripts that were in evidence, which stated the dose as "1 b.d", ie one tablet twice per day. The amount dispensed was clearly well in excess of the prescribed dose and also outside of what Mr Sadek contended was the therapeutic range. 8. The Tribunal concludes that Mr Sadek is well aware that OxyContin should not be taken more than twice a day, and that his account to the PSU investigator and the s 150 hearing was an ill-considered attempt to justify what was plainly his dispensing of excessive quantities. This complaint is established to the required standard. Complaint 6 1. This complaint contains two particulars, concerning two occasions on which the practitioner dispensed OxyContin 80mg to Patient BT, the first on 14 November 2012 on a script issued by a practitioner from outside NSW with a script that had unusual wording on it, and the second on a script dated two days after the script was presented. 2. Mr Sadek's statement was that when Patient BT presented the 14 November 2012 script he had telephoned the prescriber, and recalled that the service desk paged the prescribing doctor and that "he" confirmed the script. The script in evidence indicates that the doctor in question was a woman in a general practice. Moreover the retained scripts for this patient indicate that the patient had multiple addresses and Medicare numbers, including different addresses and Medicare numbers on the repeats as compared to the original scripts. 3. The Tribunal concludes that Mr Sadek did not confirm the authenticity of the script in particular 1, and should not have dispensed on the post-dated script in particular 2. This complaint is established. Complaint 7 1. This complaint concerns the practitioner dispensing large quantities of OxyContin 80mg to Patient BU on private scripts between November 2012 and July 2013, without confirming the authenticity of the scripts with the prescriber, some of which did not contain the patient's address and some of which indicated that the patient held a concession card. 2. Mr Sadek's account was that he had contacted the prescriber early in the initial stages of BU presenting to the pharmacy and discussed the patient's chronic pain condition requiring extreme pain management. The high dose for this chronic condition required private prescriptions. 3. Notably this account contradicts Mr Sadek's evidence concerning other complaints in which he insisted that as a matter of usual practice he did not inquire of the prescriber what the patient's condition was. 4. An examination of the retained scripts for this patient over this period indicates that the scripts were authored by eight different doctors (one of whom had the same practice address outside of NSW as that in the script for Patient BT in Complaint 6 particular 1). There are scripts dated 19 March 2013 and 21 March 2013 purportedly by the same doctor, for 28 OxyContin 80mg and 56 OxyContin 80mg, respectively. There is also a script from another doctor dated 22 March 2013 for 28 OxyContin 80mgs. The patient's Medicare number and address is different on all three scripts. The scripts were dispensed on 20 March, 27 March and 4 April 2013 by Mr Sadek. 5. The script dated 22 March 2013 includes a pharmaceutical benefits entitlement number (ie a concessional entitlement). Notably both the scripts for 28 tablets are marked as "PBS" but were issued as private scripts and charged at $125. A PBS script for this medication costs around $36 and a concessional entitlement is around $6. 6. Mr Sadek was unable to provide an explanation for these anomalies in his oral evidence. 7. The Tribunal rejects Mr Sadek's evidence that he confirmed the authenticity of the scripts and that he believed them to be within the therapeutic range. We find that the practitioner was aware that the amounts dispensed were excessive and that he knew or ought to have known that these were likely for illegitimate purposes. This complaint is proved. Professional Misconduct 1. The matters proved in Complaint 3 taken alone are of such seriousness, and such repetition, as rise to the level of professional misconduct. Mr Sadek is responsible for the dispensing of very large quantities of high strength OxyContin over a prolonged period in circumstances in which he had actual or constructive knowledge that the drugs were very likely being misused. 2. Mr Sadek was prepared to tailor and falsify his evidence under oath. Mr Sadek's claim of extreme deference to one medical practitioner in Complaint 3, and mild inattention to detail in the other complaints, is thoroughly displaced by the evidence, which demonstrates at best a wilful disregard of his professional obligations. The Tribunal concludes that more than mere incompetence was involved and that Mr Sadek's conduct was improper and unethical. Costs 1. The question of costs is reserved until the second stage of the matter is determined. Orders 1. Pursuant to findings under ss 139B and 139E of the National Law, an order that the matter proceed to Stage 2 determination, with directions to the parties to communicate with the registry to set a hearing date. 2. A non publication order under s 64 of the Civil and Administrative Tribunal Act 2013 (NSW) prohibiting disclosure or publication of the names of the patients and medical practitioners in the schedule to the complaint, and any other patients named in evidence. ********** Appendix: Further Amended Complaint COMPLAINTS ONE - SEVEN is guilty of unsatisfactory professional conduct under section 1398 (1)(a) and (I) 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 pharmacy is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience; and/or ii. engaged in improper or unethical conduct relating to the practice or purported practice of pharmacy. Each particular in itself justifies a finding of unsatisfactory professional conduct. In the alternative, when two or more of the particulars are taken together, a finding of unsatisfactory professional conduct is justified. PARTICULARS OF COMPLAINT ONE 1. The practitioner, on receipt of a facsimile ("fax") from the Pharmacy Guild of Australia ("the Pharmacy Guild") dated 19 November 2013 alerting pharmacists that a large number of forged prescriptions were being presented for OxyContin 80mg, a drug within the meaning of Schedule 8 of the NSW Poisons List, proclaimed under Section 8 of the Poisons and Therapeutic Goods Act 1966 and clause 128P of the Poisons and Therapeutic Goods Regulation 2008 ("a Schedule 8 drug"), purporting to have been issued in the name of Medical Practitioner BV, failed to report to the Pharmacy Guild or the Pharmaceutical Services Unit of the New South Wales Department of Health ("the PSU") that he had dispensed such prescriptions to Patients A, B and C between 8 April 2013 and 16 April 2013, on the occasions set out in Schedule A, in circumstances where the practitioner knew, or ought to have known, that such prescriptions had been dispensed. PARTICULARS OF COMPLAINT TWO 1. The practitioner failed to account for the Schedule 8 drugs Jurnista 8mg (14 tablets) and Norspan 1Omcg (4 patches), in the Pharmacy drug register for the period 30 November 2012 to 1 October 2013, or immediately notify the Director-General of the New South Wales Department of Health of the loss of the drugs, contrary to clause 124 of the Poisons and Therapeutic Goods Regulation 2008 ("the Poisons Regulation"). 2. The practitioner, between 11 December 2012 and 21 August 2013, failed to accurately record in the Pharmacy drug registers the quantity of the Schedule 8 drug Oxycodone supplied, contrary to clause 112(1)(a) and 113(1)(a) of the Poisons Regulation, namely: a. 4 tablets of Oxycontin 80mg which were dispensed were not recorded on 11 December 2012; b. 28 tablets of Oxycontin 80mg which were dispensed were not recorded on 4 February 2013; c. 60 tablets of Oxycontin 80mg which were dispensed were not recorded on 28 March 2013; d. 40 capsules of Oxynorm 20mg which were dispensed were not recorded on 21 August 2013; e. 112 tablets of Oxycontin 80mg which were dispensed were not recorded on 21 August 2013; f. 112 tablets of Oxycontin 80mg which were not dispensed but were recorded as being so on 21 August 2013. 3. The practitioner, on 5 April 2013 and 17 September 2013, failed to accurately record in the Pharmacy drug register the strength of the Schedule 8 drug Oxycodone supplied, contrary to clause 113(1)(a) of the Poisons Regulation in respect of: a. 28 tablets of Oxycontin 1Omg which were dispensed and incorrectly recorded as Oxycontin 80mg on 5 April 2013; b. 28 tablets of Oxycontin 30mg tablets which were dispensed and incorrectly recorded as Oxycontin 80mg on 17 September 2013. 4. The practitioner, on 24 May 2013 supplied approximately 112 tablets of the Schedule 8 drug Oxycodone to Patient A and failed to accurately record in the Pharmacy drug register the name of the patient to whom they were supplied, contrary to clause 112(1)(a) and 113(1)(a) of the Poisons Regulation. 5. The practitioner, on 24 May 2013, failed to accurately record in the Pharmacy drug register the name of the Schedule 8 drug supplied, contrary to clause 112(1)(a) and 113(1)(a) of the Poisons Regulation, in that 56 tablets of MS Contin 60mg which were dispensed were incorrectly recorded as Oxycontin 80mg. 6. The practitioner, between 7 February 2013 and 24 February 2014, failed to accurately record in the Pharmacy drug registers the quantity of the Schedule 8 drug Oxycodone held at the Pharmacy after dispensing Oxycodone, contrary to clause 112(1)(i) of the Poisons Regulation, including by: a. on 7 February 2013, understating the quantity held by 6 tablets; b. on 16 July 2013 , understating the quantity held by 60 tablets; c. on 14 January 2014, overstating the quantity held by 100 tablets ; d. on 24 February 2014, overstating the quantity held by 100 tablets. 7. The practitioner, on 30 July 2013 and 7 January 2014, altered the relevant Pharmacy drug registers, by crossing out entries, contrary to clause 177(2) of the Poisons Regulation. 8. The practitioner, in March 2013 , September 2013,and March 2014, failed to make an accurate inventory in the Pharmacy drug registers of the quantity of Oxycontin 80mg held at the Pharmacy, contrary to clause 118 of the Poisons Regulation, in that the quantity of Oxycontin 80mg recorded understated or overstated the actual quantity of drugs held. 9. The practitioner, on 3 March 2014, failed to account for 60 tablets of Oxycontin 80mg in the Pharmacy drug register for the period 1 October 2013 to 7 March 2014, or immediately notify the Director-General of the New South Wales Department of Health of the loss of the drugs, contrary to clause 124 of the Poisons Regulation, in circumstances where the practitioner became aware of the discrepancy on this date. PARTICULAR OF COMPLAINT THREE 1. The practitioner, between 3 December 2012 and 7 March 2014, failed to confirm the authenticity of prescriptions with the prescriber before dispensing the Schedule 8 drug Oxycontin 80mg to a person known as Patient D under prescriptions purported to be written by Medical Practitioner BW in the names of Patients E-W as described in Schedule B on the occasions listed in Schedule B1, in circumstances where: a. the prescriptions were for large quantities and high strengths of Oxycontin, namely for 112 tablets of 80mg strength, presented at short intervals over prolonged periods which would lead to a dosage exceeding the normal dose of the drug of one tablet twice daily, and which does not accord with recognised therapeutic standards; b. the prescriptions were private prescriptions for high cost medications; c. the medications were collected by one person. known as Patient D, who was himself prescribed large quantities of the drug, including up to 4704 tablets of Oxycontin 80mg in the period between 6 December 2012 and 23 February 2014; d. the medications were paid for in cash on each occasion; e. the prescriptions did not include directions for use, contrary to clause 85(1) of the Poisons Regulation; f. there was a pattern of similar patient names and addresses for patients for whom the prescriptions were issued, which the practitioner ought to have noticed given the consecutive entries in the drug registers, including a number of addresses at "Cardigan St, Merrylands". g. there was a high potential for misuse and misappropriation of the drug. 2. The practitioner, between 3 December 2012 and 7 March 2014, dispensed the Schedule 8 drug Oxycontin 80mg to a person known as Patient D under prescriptions purported to be written by Medical Practitioner BW in the names of up to 46 patients, being Patients E-W as described in Schedule B on the occasions listed in Schedule B1, where he ought to have held serious doubt or concern, in relation to the authenticity of the prescriptions and/or the prescribing practices of the purported prescriber.in the circumstances described in paragraphs a - g of Particular 1 above. 3. The practitioner, between 3 December 2012 and 7 March 2014, failed to report to an appropriate authority, including the Pharmaceutical Services Unit of the New South Wales Department of Health, the Medical Council of New South Wales , the Medical Board of Australia, or the New South Wales Police Force, serious doubt or concern which he ought to have had about the authenticity of the prescriptions and/or the prescribing practises of the purported prescriber, in the circumstances described in paragraphs a -g of Particular 1 above. 4. The practitioner, between 3 December 2012 and 7 March 2014, dispensed large quantities of Oxycontin 80mg under prescriptions purported to have been written by Medical Practitioner BW in the names of Patients E-W as described in Schedule B on the occasions listed in Schedule B1, to the person known as Patient D, and failed to: a. obtain written or verbal consent from the patients to whom the prescriptions were addressed for the medication to be collected by the person known as Patient D; b. discuss the appropriateness of the person known as Patient D collecting the prescriptions with Medical Practitioner BW; c. report to an appropriate authority, including the Pharmaceutical Services Unit of the New South Wales Department of Health, the Medical Council of New South Wales, or the Medical Board of Australia, serious doubt or concern which he ought to have had, in relation to the person known as Patient D collecting the prescriptions on behalf of Medical Practitioner BW in the circumstances described in paragraphs a - g of Particular 1 above. PARTICULARS OF COMPLAINT FOUR 1. The practitioner, contravened regulations made under the National Law in that between 21 December 2012 and 24 February 2014, he dispensed Schedule 8 drugs to Patients AY-BP as set out in Schedule C, without a valid prescription in circumstances where the prescription did not contain one or more of the following details: a. the name of the drug written in the prescriber's own handwriting contrary to clause 85(1) of the Poisons Regulation; b. the strength of the drug written in the prescriber's own handwriting contrary to clause 85(1) of the Poisons Regulation; c. the quantity of the drug written in words and figures in the prescriber's own handwriting, contrary to clause 85(1) of the Poisons Regulation; d. an interval of repeat, in circumstances where the drug had previously been supplied on the prescription, contrary to clause 85(3) of the Poisons Regulation. 2. The practitioner between 15 May 2013 and 14 March 2014 dispensed Schedule 4 Appendix D drugs to Patients BQ and BR, as set out in Schedule D without a valid prescription in circumstances where the prescription did not contain one or more of the following details: a. the name of the drug written in the prescriber's own handwriting contrary to clause 39(1) of the Poisons Regulation; b. the strength of the drug written in the prescriber's own handwriting contrary to clause 39(1) of the Poisons Regulation; c. the quantity of the drug written in words and figures in the prescriber's own handwriting, contrary to clause 39(1rot the Poisons Regulation; d. an interval of repeat, in circumstances where the drug had previously been supplied on the prescription, contrary to clause 39(3) of the Poisons Regulation. PARTICULARS OF COMPLAINT FIVE 1. The practitioner, between 14 November 2012 and 5 February 2014, dispensed approximately 2664 tablets of the Schedule 8 drug Oxycontin 80mg tablets to Patient BS, as set out in Schedule E in circumstances where: a. the prescriptions were for large quantities and most were presented at short intervals over prolonged periods which would lead to a dosage exceeding the normal dose of the drug of one tablet twice daily, and which does not accord with recognised therapeutic standards; b. most prescriptions were private prescriptions for high cost medications; c. some prescription did not specify the interval between repeats; d. [deleted]; e. some prescriptions referred to "Regulation 24" in circumstances where clause 24 of the National Health (Pharmaceutical Benefits) Regulations 1960 (Cth) was not applicable; f. there was a high potential for misuse and misappropriation of the drug. PARTICULARS OF COMPLAINT SIX 1. The practitioner, on 14 November 2012, dispensed the Schedule 8 drug Oxycontin 80mg to Patient BT, without confirming the authenticity of the prescription with the prescriber, in circumstances where the prescription presented: a. was from a medical practitioner with a practice address outside the State of New South Wales; b. included an unusual direction, namely the words "cash out after ten days"; c. there was a high potential for misuse and misappropriation of the drug. 2. The practitioner, on 2 March 2013, dispensed Oxycontin 80mg to Patient F, under a prescription which post-dated the date it was dispensed, namely dated 4 March 2013. PARTICULARS OF COMPLAINT SEVEN 1. The practitioner, between 21 November 2012 and 16 July 2013,dispensed the Schedule 8 drug Oxycontin 80mg to Patient BU, as set out in Schedule F, without confirming the authenticity of the prescription with the prescriber, in circumstances where: a. the prescriptions were for large quantities of Oxycontin presented at short periods; b. the prescriptions were private prescriptions for high cost medications; c. the prescriptions dated 11 October 2012 and 22 March 2013 indicated Patient BU held a concession card; d. there was a high potential for misuse and misappropriation of the drug. 2. The practitioner , on 25 January 2013 and 15 February 2013, dispensed the Schedule 8 drug Oxycontin 80mg to Patient BU, without confirming the authenticity of the prescription with the prescriber, in circumstances where: a. the prescriptions were for large quantities of Oxycontin presented at short periods; b. [deleted] c. the prescriptions did not contain Patient BU's address, contrary to clause 85(1) of Poisons Regulation [deleted]; e. there was a high potential for misuse and misappropriation of the drug. COMPLAINT EIGHT is guilty of professional misconduct under section 139E of the National Law in that the practitioner has: i. engaged in unsatisfactory professional conduct of sufficiently serious nature to justify suspension or cancellation of the practitioner's registrat ion; 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 the practitioner's registration. PARTICULARS OF COMPLAINT EIGHT 1. The following particulars are repeated and relied upon individually : a. particulars 1, 2, 3, and 4 of Complaint Three; b. particular 1 and 2 of Complaint Four; c. particular 1 of Complaint Five; d. particular 1 of Complaint Six ; e. particular 1 of Complaint Seven. 2. Any combination of two or more of the particulars relied upon individually in particular 1 above are relied upon in combination. Complaints One, Two, Three, Four, Five, Six, and Seven and the particulars thereof are repeated and relied upon cumulatively. ******** 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: 20 December 2017