Allegations of unsigned and undated prescriptions

In this case the doctor was complained by the Gardaí when they had had occasion to search premises which the doctor had occupied. During the search the Gardaí discovered quantities of blank signed prescriptions bearing the doctor’s stamp and the doctor’s registration number. The Gardai also found a medical certificate in favour of a named patient. The premises at the time were vacant.

In addition, complaints were received separately from pharmacists to the effect that patients had presented with prescriptions which were either undated or unsigned and some of the prescriptions had no registration number.

The following allegations were set out in the Notice of Inquiry:-

  1. left one or more blank, signed prescriptions with a stamp bearing the practitioner’s name and IMC registration number affixed to it at a certain address;
  2. issued one or more prescriptions for named medications, which prescriptions were undated and/or unsigned and/or did not contain his Medical Council registration number;
  3. left blank headed note paper with the practitioner’s signature on it and a stamp bearing his name and IMC registration number affixed to it at the same address;
  4. left an unsigned dated medical certificate in favour of Mr. X.Y. at the same address;
  5. failed to comply with one or more notices in writing requiring the practitioner to supply the Preliminary Proceedings Committee with the practitioner’s observations and comments;
  6. failed to provide any written response to one or more letters sent to the practitioner by the Medical Council in relation to the complaint.

The inquiry was held in public and the doctor did not attend nor was represented at the inquiry.

Apart from the allegations concerning the prescriptions and the medical certificate, at the initial consideration of the complaint the doctor did not engage with the Preliminary Proceedings Committee (PPC) when they were investigating the complaint prior to making a prima facie decision to hold an inquiry. The doctor failed to respond to correspondence requesting his response to the matters set out in the letters of complaint.

At the inquiry the doctor was found guilty of professional misconduct and subsequently the Council decided to cancel the doctor’s registration.

During the inquiry the Fitness to Practise Committee considered the following sections of the Medical Practitioners Act:-

Section 43(8) provides:-

“A registered medical practitioner shall, as soon as may be after the person has received the certificates referred to at subsection (5), cause the registration number stated on that certificate to be included on all medical prescriptions and all other documentation and records, whether in paper or electronic format, relating to that practitioner’s practice as a registered medical practitioner.”

In relation to the failure to respond to requests from the Preliminary Proceedings Committee concerning the initial consideration of the complaint, the Fitness to Practise Committee also considered section 59(7) of the Act which provides:-

“The Preliminary Proceedings Committee may, by notice in writing given to a registered medical practitioner the subject of a compliant, require the practitioner to supply the Committee, within a reasonable period specified in the notice, with such information relating to the complaint as is specified in the notice.”

In addition to the Statutory requirements the Fitness to Practise Committee also considered the following paragraphs from the seventh edition of “A Guide Professional Conduct and Ethics for Registered Medical Practitioners".

Paragraph 58 provides:-

Certification

In issuing certificate, reports, prescriptions and other formal documents, you must be accurate and make sure the document is legible. You must also include your Medical Council registration number. Normally you should only sign a certificate or other such prescription, report or document for a patient following review of the patient’s condition.”

Paragraph 59.1 provides:-

Prescribing

The prescriptions you issue must be legible, dated and signed and must state your Medical Council registration number.”

Explanatory Notes:

The vignettes outlined in our eNewsletter are based on inquiries held under the provisions of Part 8 of the Medical Practitioners Act 2007 (“The Act”). The purpose of these vignettes is to assist with learning outcomes in relation to the inquiries and the subject matter of the inquiries, names, places and certain facts have accordingly been omitted and/or altered.

The vignettes are, however, based on inquiries that resulted in findings being made against the doctor.

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).

The task of the FTPC is to decide having heard and considered all the evidence 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.

Note: Poor professional performance was introduced by Ministerial Order on 3rd July, 2008