Health Ombudsman v Adhar

QUEENSLAND CIVIL AND
ADMINISTRATIVE TRIBUNAL

CITATION:

Health Ombudsman v Adhar [2025] QCAT 251

PARTIES:

HEALTH OMBUDSMAN

(applicant)

v

PREM ADHAR

(respondent)

APPLICATION NO/S:

OCR146-21

MATTER TYPE:

Occupational regulation matters

DELIVERED ON:

4 June 2025 (decision)

19 September 2025 (reasons)

HEARING DATE:

4 June 2025

HEARD AT:

Brisbane

DECISION OF:

Judicial Member Dick SC
Assisted by:
Dr B Bell
Dr E Chew

Mr P Zimon

ORDERS:

THE TRIBUNAL ORDERS THAT:

1. Until further order, pursuant to s 66(1) of the Queensland Civil and Administrative Tribunal Act 2009 (Qld), publication of:

(a)     the contents of a document or other thing filed in or produced to the Tribunal;

(b)     evidence given before the Tribunal;

(c)     any order made or reasons given by the Tribunal;

is prohibited to the extent that it could identify or lead to the identification of the patients identified in the material before the Tribunal save as provided for by the terms of this order and save as is necessary for the parties to engage in and progress these proceedings, or any appeal or review arising from these proceedings, and for the applicant to provide information to the Australian Health Practitioner Regulation Agency or National Board in the exercise of the Health Ombudsman’s statutory functions under the Health Ombudsman Act 2013 (Qld).

2.     Any material affected by the non-publication order shall not be copied or inspected without an order of the Tribunal, except by:

(a)     a judicial member;

(b)     a tribunal member;

(c)     an associate to a judicial officer or tribunal member appointed under relevant legislation;

(d)     any assessor appointed to assist the Tribunal;

(e)     the staff of the Tribunal registry;

(f)      any judicial officer, court staff or associate dealing with any appeal or review arising from these proceedings; or

(g)     the parties to these proceedings or any appeal or review arising from these proceedings.

IT IS THE DECISION OF THE TRIBUNAL THAT:

1. Pursuant to s 107(2)(b)(iii) of the Health Ombudsman Act 2013 (Qld) (‘HO Act’), the respondent has behaved in a way that constitutes professional misconduct.

2. Pursuant to s 107(3)(a) of the HO Act, the respondent is reprimanded.

3. Pursuant to s 107(3)(e) of the HO Act, the respondent’s registration is cancelled.

4. Pursuant to s 107(4)(a) of the HO Act, the respondent is disqualified from applying for registration as a registered health practitioner for a period of two (2) years from the date of this order.

5.    No order as to costs.

CATCHWORDS:

PROFESSIONS AND TRADES – HEALTH CARE PROFESSIONALS – MEDICAL PRACTITIONERS – DISCIPLINARY PROCEEDINGS – PROFESSIONAL MISCONDUCT AND UNPROFESSIONAL CONDUCT – GENERALLY – where the respondent is a medical practitioner – where the respondent provided wholly inadequate medical management to three patients – where the respondent knowingly prescribed Endone to a patient for another patient’s use and took steps to avoid detection of that conduct – where the respondent engaged in a non-sexual boundary violation with a patient – where the parties have reached an agreement as to characterisation and sanction – whether that agreement is within the permissible range

Health (Drugs & Poisons) Regulation 1996 (Qld)

Health Ombudsman Act 2013 (Qld)

Queensland Civil and Administrative Tribunal Act 2009 (Qld)

Health Ombudsman v Alinia [2021] QCAT 43

Health Ombudsman v Kimpton [2018] QCAT 405
Health Ombudsman v Kirkman [2023] QCAT 541
Health Ombudsman v Upadhyay [2020] QCAT 163
Health Ombudsman v Wood [2019] QCAT 35
Medical Board of Australia v Jansz [2011] VCAT 1026
Medical Board of Australia v Torres [2024] QCAT 459

Nursing and Midwifery Board of Australia v Clydesdale [2013] QCAT 191

APPEARANCES & REPRESENTATION:

Applicant:

C Templeton instructed by the Office of the Health Ombudsman

Respondent:

M Hickey OAM KC instructed by HWL Ebsworth Lawyers

REASONS FOR DECISION

Background to the referral

On 9 July 2024, the parties filed a document titled ‘Statement of Agreed and Disputed Facts’ which appeared to only contain agreed facts. On 8 April 2025, the Tribunal wrote to the parties and requested them to confirm whether there are any disputed facts contained in this document. On 8 April 2025, the solicitor for the respondent replied to the Tribunal’s email confirming that the document contained no disputed facts.
By way of antecedents, that document states that:[1]
(a)the respondent was born on 12 May 1963;
(b)he was awarded a Bachelor of Medicine and a Bachelor of Surgery in India in 1988;
(c)he has been registered as a medical practitioner in Australia since 2000;
(d)he was awarded a Fellowship of the Royal Australian College of General Practitioners in 2002; and
(e)he was first granted specialist registration in general practice in 2002.
[1]Statement of Agreed and Disputed Facts, filed in the Tribunal on 9 July 2024, 1 [1]-[5] (‘Statement of Agreed Facts’).
In 2013, the Medical Board of Australia (‘Board’) accepted an undertaking from the respondent to complete a record keeping course and undergo an audit both before and after that course. He fulfilled that undertaking in 2013.
At the time of the alleged conduct, he was practising as a specialist general practitioner at his own clinic in Brisbane. The respondent held an endorsement to deal with controlled drugs as a doctor pursuant to s 58 of the Health (Drugs & Poisons) Regulation 1996 (Qld) (‘Regulations’). On 12 April 2019, the respondent voluntarily surrendered that endorsement.
On 24 April 2019, the Health Ombudsman took immediate registration action pursuant to s 58 of the Health Ombudsman Act 2013 (Qld) (‘HO Act’) and imposed conditions on his registration that:
(a)prohibited him from prescribing Schedule 4 drugs (meaning those listed in Appendix 8 of the Regulations); and
(b)required him to practise at a place approved by the Office of the Health Ombudsman.
On 23 November 2020, the Board decided to impose conditions upon his registration requiring him to complete a course in relation to documentation and record keeping.

The conduct that is the subject of the referral

The conduct that is the subject of the referral involves four patients, who will be referred to as Patient AB, Patient CD, Patient EF and Patient GH.
As set out in the applicant’s submissions, the respondent’s conduct may be broadly described as follows:[2]
(a)Wholly inadequate medical management of Patients AB, CD and GH, characterised by failures to properly investigate, diagnose and manage their presenting concerns, excessive and inappropriate prescribing of opioids and benzodiazepines, and a failure to make adequate clinical records.
(b)Knowingly prescribing Endone (an opioid) to Patient EF for the purpose of it being used by Patient CD (who is Patient EF’s wife) and taking steps to avoid detection of that conduct by directing Patient CD to specific pharmacies for collection.
(c)Engaging in a non-sexual boundary violation concerning Patient CD, characterised by the respondent extracting benefits from the patient (i.e., real estate advice and gifts) by his exploitation of Patient CD’s addiction to the medication he prescribed.[3]
[2]Applicant’s Brief Written Opening, filed in the Tribunal on 14 February 2025, 2 [7] (‘Applicant’s Written Opening’).
[3]Affidavit of Patient CD, sworn on 2 October 2024 and filed in the Tribunal on 2 October 2024, 3-4 [10]-[18].
The respondent elected to not file any sworn evidence and it is understood he no longer contests any allegations in the amended referral filed in the Tribunal on 3 May 2024. The Tribunal accepts the uncontested evidence put before it. The factual conduct as alleged in the amended referral is as follows.

Patient AB

The respondent treated Patient AB from 2011 until early 2017, during which he prescribed to her Schedule 4 and Schedule 8 drugs including:[4]
(a)Panadeine Forte;
(b)Endone;
(c)Valium;
(d)Serepax;
(e)Antenex; and
(f)Seroquel.
[4]Statement of Agreed Facts (n 1) 3, [12]-[14].
Patient AB first attended the respondent in early 2011 for treatment of asthma. The respondent prescribed Patient AB Panadeine Forte. She did not complain of pain. He did not elicit a complete clinical history from her.
Later in June 2011, Patient AB attended presenting with a physical injury. The respondent prescribed Endone, which was inappropriate and excessive to her pain management requirements. This was while she was still being prescribed Panadeine Forte. He did not:
(a)consider or investigate alternative means of pain management;
(b)refer Patient AB to a specialist;
(c)elicit a comprehensive clinical history; or
(d)investigate, identify and analyse the nature and source of pain.
Approximately only two weeks later in June 2011, Patient AB attended the respondent for management of anxiety disorder where he:
(a)failed to take any adequate history of the signs or symptoms;
(b)failed to administer any of the accepted assessment tools; and
(c)prescribed drugs which were not clinically recommended.
He should have been aware that Patient AB was exhibiting drug-seeking behaviours including frequent claims that she had lost her prescriptions or that her prescriptions had been stolen and requesting additional medication for travel.
The respondent was advised by a clinician at Redlands Hospital that they declined to give Patient AB a script for pain relief due to her suspicious behaviour. She had a history of illicit drug use, which should have made the respondent alert to the fact that there was a problem.
To compound this, the respondent’s records are significantly lacking. There is no record of her history of illicit drug use, details of the clinical signs and symptoms set out above or any physical examinations of Patient AB conducted by the respondent.

Patient CD

Patient CD was treated by the respondent from 2012 to 2018. She was prescribed Schedule 4 and Schedule 8 drugs including:
(a)Panadeine Forte;
(b)Endone;
(c)Tramal;
(d)Valium;
(e)Temazepam;
(f)Targin;
(g)Serepax; and
(h)Antenex.
In April 2012, Patient CD attended the respondent for treatment of sinusitis. The respondent prescribed her Panadeine Forte which was an excessive medication in the clinical circumstances.
Patient CD subsequently attended in July 2013 for a urinary tract infection where she did not complain of pain. The respondent prescribed Tramal which was an inappropriate drug to manage her condition and not clinically indicated in the circumstances. Once again, the respondent had failed to:
(a)elicit a proper clinical history;
(b)investigate, identify and analyse the source of the pain;
(c)consider or investigate alternative means of pain management; or
(d)seek advice from a specialist pain management consultant.
The respondent continued to prescribe Patient CD Schedule 4 and Schedule 8 drugs, none of which were necessitated by the clinical conditions nor required in the quantities prescribed by the respondent. The respondent failed to recognise that Patient CD had become dependent upon narcotics and benzodiazepines and respond accordingly to those clinical circumstances.
Further, he abruptly ceased prescribing those drugs upon which Patient CD was or may have been dependent upon without providing an adequate titration plan or advice to an alternative appropriate practitioner to supervise with the withdrawal.
From 2014 to 2018, the respondent prescribed Patient EF, being Patient CD’s husband, Endone with the intention that the Endone dispensed would be used, wholly or in part, by Patient CD. Patient EF’s clinical conditions did not require management with Endone. The applicant alleges that, alternatively, if Patient EF did require management with Endone, he did not require the quantities prescribed by the respondent and that it was prescribed excessively.
In this regard, it is further alleged that the respondent engaged in conduct intended to avoid detection of the quantity of opioid medication he was prescribing to Patient CD by:
(a)advising her which pharmacies to attend to have the medication dispensed and which pharmacies to avoid; and
(b)prescribing numerous ‘private’ prescriptions (that is, a prescription that is not subsidised under the Pharmaceutical Benefits Scheme) of various opioid medications to Patient CD.
Once again, the treatment was not consistent with accepted clinical practice and the record keeping of the treatment was deficient.
It is further alleged that the respondent failed to maintain appropriate professional boundaries with Patient CD in that he:
(a)obtained advice about the business in which Patient CD was involved;
(b)made inappropriate personal disclosures during consultations;
(c)accepted gifts from Patient CD; and
(d)allowed Patient CD to book and pay for his accommodation for a family function without repaying her in a timely manner.

Patient GH

The respondent treated Patient GH from October 2015 to April 2019. During this period, the respondent prescribed her:
(a)Targin;
(b)Endone;
(c)Endep;
(d)Norspan; and
(e)Valpam.
The respondent increased, by double, Patient GH’s Targin prescription in October 2015, when the respondent knew, or ought to have known, that the Pain Management Service of the Princess Alexandra Hospital had recommended a management plan with a different course. The respondent did not elicit a complete clinical history from Patient GH but increased her Targin prescription anyway.
In March 2016, the respondent prescribed her Endone and Endep, which were inappropriate drugs to manage her condition and were excessive to her pain management requirements, again without:
(a)eliciting a comprehensive clinical history;
(b)following the advice of the specialists at the Pain Management Service and Neurology Department at the Princess Alexandra Hospital;
(c)considering or investigating alternative treatments; and
(d)keeping any clinical notes regarding her presentation.
In August 2017, the respondent prescribed Patient GH Valpam upon her attending for management of depression and anxiety, upon which he failed to:
(a)obtain any or any adequate history of her mental health and symptoms of her depression and anxiety;
(b)administer any of the accepted assessment tools for investigating and determining the level of depression, anxiety disorder or other mental health issues; and
(c)obtain information from and liaise with her treating psychologist.
Again, he prescribed Valpam to Patient GH without:
(a)eliciting a comprehensive mental health history;
(b)investigating, identifying and analysing the nature and source of mental health issues from which she suffered;
(c)considering or investigating alternative means of treatment;
(d)identifying and managing the serious nature of her depressive illness;
(e)performing a suicide risk analysis; and
(f)any or any adequate communications with her treating psychologist.
The applicant alleges that:
(a)the conditions which Patient GH suffered did not require management by Schedule 4 and Schedule 8 drugs; or
(b)even if the clinical conditions did warrant management by such drugs, those conditions did not require the quantities prescribed by the respondent; and
(c)the quantities prescribed greatly exceeded that which would be reasonably clinically indicated.
It is alleged that the respondent’s frequent and concurrent prescribing practices of narcotics and benzodiazepines, which were not clinically recommended, placed Patient GH at risk.
Additionally, in circumstances where the respondent knew or ought to have known that Patient GH was or may have been dependent upon Schedule 4 and Schedule 8 medications, he abruptly ceased prescribing those medications without providing an adequate titration plan or advice to an alternative appropriate practitioner to supervise with the withdrawal.
Lastly, in 2018, the respondent began prescribing Patient GH Prednisolone, which was not in accordance with accepted clinical practice because there was no clinical indication that she suffered from a condition requiring such medication. He again failed to record, or record consistently:
(a)her clinical history;
(b)symptoms upon presentation;
(c)details and results of physical examinations undertaken by him;
(d)details of information given to Patient GH; and
(e)sufficient information to facilitate continuity of patient care.

Expert opinion

The Tribunal has been assisted by three experts, Dr Kamerman, Dr Murray and Dr Stevens, who have provided helpful reports in relation to each of the allegations.
In broad terms, the reports of each of the doctors support the allegations that the respondent’s practice, including his prescribing and clinical documentation, falls below the standard of a registered health practitioner.
Characterisation of the conduct
The parties have agreed that, taken together, the respondent’s conduct clearly amounts to professional misconduct,[5] however the applicant acknowledges that it is useful to consider each broad category as set out above at [11].
[5]Respondent’s Submissions, filed in the Tribunal on 5 March 2025, 1 [1(a)] (‘Respondent’s Submissions’); Applicant’s Written Opening (n 2) [8].
With respect to Patients AB, CD and GH, the repeated and prolonged prescription of medications, especially opioids and benzodiazepines, when not clinically indicated or otherwise contrary to the Regulations, amounts to professional misconduct.[6] The applicant suggests, and the Tribunal accepts, that the nature of the respondent’s approach is best summarised by Dr Murray’s opinion regarding the respondent’s treatment of Patient CD:
[Patient CD’s] condition was mismanaged to such a degree that she was rendered addicted to a dangerously high dose of opioids and benzodiazepines. The blame for this can be ascribed solely to the practitioner. There is nothing to indicate that [Patient CD] was drug seeking when she first started seeing him.
[6]In this regard, the applicant relies on Health Ombudsman v Kirkman [2023] QCAT 541; Medical Board of Australia v Torres [2024] QCAT 459; Health Ombudsman v Alinia [2021] QCAT 43.
The Tribunal accepts that there are numerous examples of non-sexual boundary violations being characterised as professional misconduct.[7]
[7]In this regard, the applicant relies on Nursing and Midwifery Board of Australia v Clydesdale [2013] QCAT 191; Health Ombudsman v Wood [2019] QCAT 35; Health Ombudsman v Kimpton [2018] QCAT 405; Health Ombudsman v Upadhyay [2020] QCAT 163.
Knowingly prescribing addictive medication to a person for a different person’s use is obviously substantially below the standard of conduct expected from a medical practitioner.
In light of the facts and concessions made by the respondent, the Tribunal is comfortably satisfied that his behaviour is to be characterised as professional misconduct.

Discussion and sanction

The parties have agreed as to the appropriate sanction.[8]
[8]Respondent’s Submissions (n 5) 1 [1(b)]; Applicant’s Written Opening (n 2) 3 [14].
The main principle for the sanction is that the health and safety of the public are paramount.[9] It is not a punishment, however general and personal deterrence are important factors.
[9]Medical Board of Australia v Jansz [2011] VCAT 1026.

Insight and remorse

The only submission from the respondent is that the Tribunal may accept, and the respondent submits the Tribunal should accept, that:
(a)there is evidence of his insight and remorse because the effects of his admissions and concessions are that it saves patients from being cross-examined;[10] and
(b)he should not be impugned for having made that decision.[11]
[10]Respondent’s Submissions (n 5) 2 [3(a)-(b)].
[11]Ibid [6].
That latter submission, however, must be seen in light of the fact that much of the evidence is documentary and would be damning in any circumstance. Having said that, the Tribunal will allow that there has been some insight and remorse.

Sanction

The parties agree that the following sanction is appropriate:
(a)a reprimand;
(b)that respondent’s registration be cancelled; and
(c)that the respondent be disqualified from applying for registration for a period of two years from the date of the Tribunal’s order.
The Tribunal notes it is often said that a reprimand is not a trivial penalty.
Where the parties agree on sanction, it would be unusual for the Tribunal to intervene and order a different sanction unless the sanction agreed between the parties was outside the permissible range. The sanction proposed serves the objective of deterring the respondent himself and other members of the profession from engaging in like conduct. The prescription of opioids and benzodiazepines is notorious and both types of medication carry the risk of addiction and other negative outcomes.
The parties also refer to the respondent having completed education in relation to prescribing practices and professional boundaries. Further, that it has been a lengthy period since the conduct occurred, all prior to 2020, and he has been registered and able to practise during those years.

Orders

The Tribunal is satisfied that the following orders should be made:
Pursuant to s 107(2)(b)(iii) of the HO Act, the respondent has behaved in a way that constitutes professional misconduct.
Pursuant to s 107(3)(a) of the HO Act, the respondent is remanded.
Pursuant to s 107(3)(e) of the HO Act, the respondent’s registration is cancelled.
Pursuant to s 107(4)(a) of the HO Act, the respondent is disqualified from applying for registration as a registered health practitioner for a period of two (2) years from the date of the Tribunal’s order.
There is no order as to costs.

Non-publication order

The Queensland Civil and Administrative Tribunal Act 2009 (Qld) (‘QCAT Act’) provides that hearings are to be in public, unless an order is made by the Tribunal adapting that. Sections 66(2)(b) and (2)(d) of the QCAT Act provide that a non-publication order can be made to avoid:
(a)endangering the health or safety of a person; or
(b)the publication of confidential information.
In respect of this matter, each of those provisions apply to the patients who are named throughout the documents and evidence before the Tribunal. Section 66(3) provides that the Tribunal can, on its own initiative, order non-publication in those circumstances. I order that publication of:
(a)the contents of a document or other thing produced to the Tribunal;
(b)evidence given before the Tribunal;
(c)any order made or reasons given by the Tribunal;
is prohibited to the extent that it could identify or lead to the identification of the patients identified in the material before the Tribunal, save as provided for by the terms of this order, which are set out in the draft order that I have signed.

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Citations

Health Ombudsman v Adhar [2025] QCAT 251

Cases Citing This Decision

0

Cases Cited

7

Statutory Material Cited

3

Health Ombudsman v Kirkman [2023] QCAT 541

Medical Board of Australia v Torres [2024] QCAT 459

Health Ombudsman v Alinia [2021] QCAT 43

[2025] QCAT 251

4 June 2025 (decision) 19 September 2025 (reasons)