Allegation of prescribing drugs irresponsibly

The Medical Council publishes case studies based on fitness to practise inquiries held under the provisions of Part 8 of the Medical Practitioners Act 2007 for the purposes of providing learning outcomes. Names, places and certain facts have accordingly been omitted and/or altered.

The Council receives a number of complaints each year in relation to issues of irresponsible prescribing

Year                    No. of Complaints Received by the Medical Council relating to Irresponsible Prescribing
2011 10 (Represents 2.6% of total complaints received)
2010 8 (Represents 2.2% of total complaints received)
2009 7 (Represents 2.4% of total complaints received)
2009 18 (Represents 5.7% of total complaints received)

In one recent inquiry the doctor, a sole general practitioner was complained by another healthcare professional of irresponsibly prescribing certain drugs, and in particular benzodiazepines, to patients and particularly patients with addiction problems.

The Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners provides guidance on the responsibilities of doctors in relation to prescribing and referral including clear guidance to doctors on the prescribing of benzodiazepines:

“You must be aware of the dangers of drug dependency when prescribing benzodiazepines, opiates and other drugs with addictive potential”.

Following the inquiry which was held in public, the practitioner was found guilty of:-

Prescribing drugs in inappropriate quantities and strengths
Failed to prescribe the most appropriate medication to suite the patient’s conditions and/or best interest
Placed undue reliance on the prescribing of drugs
Failed to make any or adequate inquiries as to whether the patient was being treated by another general practitioner or specialist substance misuse practitioner
Failed to take or any adequate history
Failed to carry out any adequate examination and
Failed to maintain any or adequate medical records
The Medical Council at its subsequent meeting to decide on sanction decided to attach conditions to the practitioner’s registration:-

That the practitioner formulate a Professional Development Plan which would include attendance at a professional course approved by the Council that would include areas of deficiency and would include the following areas of deficiency:-
(a) Benzodiazepine prescribing

(b) Management of patients with addictions

(c) Approval of clinical records systems

(d) A familiarisation with care and referral patters of patients with addiction problems.

The Council’s decision was subsequently confirmed by the High Court.

Other Guidance from the Guide to Professional Conduct and Ethics for Registered Medical Practitioners relevant to this case includes:

Section B, Responsibility to Patients in particular paragraph 4 – Paramount responsibility to patients:-

4.1 Your paramount professional responsibility is to act in the best interests of your patients. This takes priority of responsibilities to your colleagues and employers.”

Paragraphs 59.2, 59.3, 59.4 and 59.5 provides:-

59.2 When prescribing medications, you must comply with the misuse of drugs legislation and other relevant regulations and/or guidelines

59.3 You should ensure you have appropriate training, facilities and support before treating patients with drug dependency or abuse problems. You should refer patients to other services and supports where this is in the patient’s best interests.

59.4 You must be aware of the dangers of drug dependency when prescribing benzodiazepines, opiates and other drugs with addictive potential.

59.5 You should refer patients with drug dependency to the appropriate drug treatment services and supports unless you have appropriate training, facilities and support yourself. You should not undertake treatment of opiate dependency unless you have been approved under the Methadone Treatment Protocol. You should make reasonable efforts to ensure that patients with drug dependency are not inappropriately obtaining drugs from multiple sources and you should liaise with drug treatment services, other doctors and pharmacists to safeguard the patient’s interest in this regard.”

Paragraph 60 concerns referral of patients and in particular 60.2.

Finally, paragraph 23 of the Ethical Guide was also considered relating to medical records and in particular 23.1 which imposes a duty on medical practitioners to maintain accurate and up to date patient records in either manual or electronic form.

Explanatory Notes:

The case studies outlined  are based on inquiries held under the provisions of Part 8 of the Medical Practitioners Act 2007 (“The Act”). The purpose of these case studies is to provide learning outcomes from inquires.

Names, places and certain facts have accordingly been omitted and/or altered.

Allegations against doctors at inquiries before the Fitness to Practise Committee (“FTPC”) are set out in a document known as a Notice of Inquiry.

Evidence given at an inquiry (whether oral or documentary) is required to be proved to the criminal standard i.e. beyond reasonable doubt. The evidence in presented to the FTPC by the CEO. The doctor is normally represented by his/her solicitor (although some doctors are unrepresented).

Having considered all of the evidence, the role of the FTPC is to decide whether the facts have been proved beyond reasonable doubt and, if so, whether the facts as proved amount to either professional misconduct, poor professional performance or other grounds as may have been set out in the notice of inquiry.

The grounds on which inquiries are decided include professional misconduct and poor professional performance.

Professional misconduct is defined in paragraph 2.1 of the Ethical Guide as:

a) Conduct which doctors of experience, competence and good repute consider disgraceful or dishonourable; and/ or

b) Conduct connected with his or her profession in which the doctor concerned has seriously fallen short by omission or commission of the standards of conduct expected among doctors.

Poor professional performance is defined by the Medical Practitioners Act 2007:

‘Poor professional performance, in relation to a medical practitioner, means a failure by the practitioner to meet the standards of competence (whether in knowledge and skill or the application of knowledge and skill or both) that can reasonably be expected of medical practitioners practising medicine of any kind practised by the practitioner.’

Any sanction to be imposed on a doctor’s registration is a matter for the Medical Council.