Health Care Complaints Commission v Ragavan [2018] NSWCATOD 67

Civil and Administrative Tribunal New South Wales Medium Neutral Citation: Health Care Complaints Commission v Ragavan [2018] NSWCATOD 67 Hearing dates: 23 - 24 April 2018 Date of orders: 10 May 2018 Decision date: 10 May 2018 Jurisdiction: Occupational Division Before: D A Cowdroy ADCJ, Principal Member Dr M Cohen, Senior Member Dr K McCarthy, Senior Member M Kelly, General Member Decision: 1 The Tribunal orders that the practitioner be reprimanded pursuant to s 149A(1)(a) of the National Law. 2 The Tribunal orders that conditions be imposed upon the registration of the practitioner as follows. (1) Education (a) The practitioner shall within 12 months: (i) Undertake a course held by the University of Sydney headed "Opioid Treatment Accreditation Course" and provide evidence in writing to the Council of his successful completion of the course. (ii) Complete the E-Learning module E-Learning: E&5558 AVANT WEBINAR: Proscribing Perils – Opioids, polypharmacy and Medication Errors. (iii) Complete a course offered by the Chapter of Addiction Medicine (RACP) through the elearningracp.edu.au website entitled "Opioid Risk Management in Chronic Pain" comprising of two modules, namely: 1. Minimising Risk when Prescribing Opioids; and 2. Structuring Opioid Therapy. (iv) Complete the E-learning modules 1-12: Better Pain Management Complete Program offered by the Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists. (v) Complete a course in the keeping of medical records. (b) If any course specified in this condition is unavailable, then the practitioner is to complete an equivalent course as approved by the Medical Council of NSW ("the Council"). (2) Prescribing restriction (a) The practitioner shall not possess, supply, administer or prescribe any "drug of addition" (Sch 8 drug) as defined by the PATG Act. (b) The practitioner shall provide written evidence to the Council that he has attended the offices of the Pharmaceutical Services Branch and consented to an order being made under the Poisons and Therapeutic Goods Regulation 2008 to prohibit him from possessing, supplying, administering or prescribing any Sch 8 drug within 14 days of these orders. (c) The practitioner shall not reapply to the Pharmaceutical Services Branch for a new authority to possess, supply, administer or prescribe any "drug of addition" (Sch 8 drug) as defined by the PATG Act ("a new authority") at least until he has successfully completed the education courses required by condition (1). (3) Audits (a) To submit to an audit of his medical practice by a random selection of his medical records by a person or persons nominated by the Council to be held during the 12-month period from the date of these orders or as required thereafter by the Council. The auditor is to assess his compliance with good medical record keeping standards and legislative requirements. (b) To submit to an audit of his medical practice by a random selection of his medical records by a person or persons nominated by the Council to be held within 6 months from the grant of a new authority and subsequently as required by the Council. The auditor is to assess his compliance with appropriate prescribing of Sch 8 drugs and legislative requirements. (c) To authorise the auditor to provide the Council with a report on his/her findings. (4) Review (a) The above conditions may be altered, varied or removed at the discretion of the Council and the Council is the appropriate body for the purposes of Division 8 of Part 8 of the National Law. (b) Sections 125 and 127 of the National law are to apply while the practitioner's principal place of practice is anywhere in Australia other than New South Wales, so that a review of these conditions can be conducted by the Medical Board of Australia. (5) Expenses (a) The practitioner is responsible for any costs arising out of compliance with these conditions. 3 The Tribunal orders that the costs of the HCCC of these proceedings be paid by the practitioner as agreed. Catchwords: PROFESSIONS AND TRADES – Medical Practitioner – practitioner prescribing opiates without obtaining details of patient's psychosocial history specifically of previous drug use – inadequate record keeping – failure of practitioner to make holistic assessment of medical needs of patients – prescribing Sch 8 drugs without comprehensive assessment. Legislation Cited: Health Practitioner Regulation National Law (NSW) Health Practitioner Regulation (New South Wales) Regulation 2010 Poisons and Therapeutic Goods Act 1966 (NSW) Category: Principal judgment Parties: Health Care Complaints Commission (Applicant) Dr Rajen Ragavan (Respondent) Representation: Counsel: S Maybury (Applicant) M Fordham SC (Respondent)