Health Ombudsman v Grigg - [2022] QCAT 266

QUEENSLAND CIVIL AND
ADMINISTRATIVE TRIBUNAL

CITATION:

Health Ombudsman v Grigg [2022] QCAT 266

PARTIES:

director of proceedings on behalf od the health ombudsman

(applicant)

v

Alan crawford grigg

(respondent)

APPLICATION NO/S:

OCR200-21

MATTER TYPE:

Occupational regulation matters

DELIVERED ON:

21 June 2022 (ex tempore)

HEARING DATE:

21 June 2022

HEARD AT:

Brisbane

DECISION OF:

Judicial Member J Robertson

Assisted by:

Dr B Manoharan

Dr J Cavanagh

Ms C Narayan

ORDERS:

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

2. Pursuant to section 107(3)(a) of the Health Ombudsman Act 2013 (Qld), the respondent is reprimanded.

3. Pursuant to section 107(4)(b) of the Health Ombudsman Act 2013 (Qld), conditions are imposed on the respondent’s registration in accordance with attachment A to this order.

4. Pursuant to section 107(3)(d) of the Health Ombudsman Act 2013 (Qld), the respondent’s registration is suspended for a period of nine months to commence from a date two weeks from the date of this order.

5. Each party must bear their own costs of the proceedings.

CATCHWORDS:

PROFESSIONS AND TRADES – MEDICAL PRACTITIONERS – DISCIPLINARY PROCEEDINGS -PROFESSIONAL MISCONDCUT – where respondent is an experienced general practitioner who over many years prescribed drugs of dependence to drug addicted patients in contravention of the law and contrary to proper medical practice

SANCTION – where the respondent had his prescribing credentials for such drugs cancelled by Queensland Health – where he has continued to practice without other restrictions – where there was some delay in referring the matter to the Tribunal – where the respondent has co-operated with the disciplinary process – where there is no up to date information relating to insight and remorse – where his insight and remorse is not comprehensive but where he agrees to a condition that permanently prohibits him from applying for the right to prescribe high risk medicines – whether because of his age a suspension on some length might end his career – where general deterrence and maintenance of professional standards are important principles in such cases

Health Ombudsman Act 2013 (Qld) s 107

Health Practitioner Regulation National Law (Queensland) s 5, 41

Health Care Complaints Commission v Arreza [2017] NSWCATOD 119

Health Care Complaints Commission v Dr Mohammed Sadiq Asar [2016] NSWCATOD 157

Health Ombudsman v Veltmeyer [2021] QCAT 77

Medical Board of Australia v Alroe [2014] QCAT 677

Medical Board of Australia v Bajpe (Review and Regulation) [2014] VCAT 1162

Medical Board of Australia v Evans [2013] QCAT 217

Medical Board of Australia v Fox (Review and Regulation) [2016] VCAT 408

Medical Board of Australia v Ridings [2021] SACAT 18

Medical Board of Australia v Sayeed [2020] VCAT 332

APPEARANCES & REPRESENTATION:

Applicant:

P Feeney, instructed by the Office of the Health Ombudsman

Respondent:

A Luchich, instructed by Avant Legal

REASONS FOR DECISION

The referral to the Tribunal filed on the 29th of June 2021 concerns the admitted conduct of the respondent, an…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

Keep reading for free

Create a free CaseChat account to read Health Ombudsman v Grigg and more:

Read every judgment in full
Ask AI and get answers linked to paragraphs
See how each paragraph was cited in later cases
Download judgments as PDF or Word

Continue with Google

One click creates your free account or signs you in.

By continuing you agree to the Terms and Privacy Policy.

Details

Case: [2022] QCAT 266
Decision Date

CaseChat Overview and Summary

The Health Ombudsman (OHO) commenced proceedings against Dr. Grigg, a medical practitioner, in the Queensland Civil and Administrative Tribunal (QCAT). The central issue in the case was whether Dr. Grigg's treatment of certain patients between 2014 and 2016 breached the Health Practitioner Regulation National Law (Queensland), specifically sections 213(1) and 122(1). The allegations included prescribing controlled and restricted drugs to vulnerable and drug-dependent patients without prior approval and providing inadequate clinical documentation.

The tribunal had to determine whether Dr. Grigg's conduct amounted to professional misconduct under the Health Ombudsman Act 2013. Key to the decision was the evaluation of the expert opinion provided by Dr. Samuel Stephens, who found that Dr. Grigg's treatment of several patients was inappropriate and unsafe. Dr. Stephens highlighted issues such as the excessive and illegal prescribing of drugs, inadequate clinical documentation, and failure to refer patients for specialist care when aberrant behaviour was noted. The tribunal had to consider whether these findings warranted disciplinary action against Dr. Grigg.

In its decision, the tribunal found that Dr. Grigg's actions constituted professional misconduct. The tribunal accepted the expert opinion that Dr. Grigg's prescribing practices were dangerous and that he failed to adhere to the standards expected of medical practitioners. The tribunal also noted that Dr. Grigg did not provide adequate clinical documentation and ignored the drugs of dependence unit. Consequently, the tribunal concluded that Dr. Grigg's conduct warranted disciplinary action.

The tribunal ordered that Dr. Grigg's registration as a medical practitioner be suspended for a period of six months. This order reflected the tribunal's finding that Dr. Grigg's actions constituted professional misconduct and warranted a significant sanction to protect public health and safety.

Orders

Orders of the court

Full text does not contain this section.

Background

Background to the litigation

The second allegation, which relates to several of the patients referred to in allegation 1, arises out of the opinions expressed by Dr Samuel Stephens, an expert who was commissioned by the OHO to review the respondent’s treatment of these patients. His expertise and opinions are not challenged in any way by the respondent.Background The respondent is presently 72 years of age. I was told today by his Counsel that he practices in a medical practice at Ipswich as one of five general practitioners and has a patient cohort of approximately 700. He holds a Bachelor of Medicine and a Bachelor of Surgery from the University of Sydney, awarded in 1997, and he first obtained general registration with the Medical Board of Queensland (as it then was) as a medical practitioner in January 1998. On the 1st of July 2010, he held registration as a health practitioner under the Health Practitioner Regulation National Law (Queensland) (National Law). He accepts that he was therefore a health service provider as defined in the Health Ombudsman Act 2013 (the Act); practised at the Ipswich Medical Centre; held an endorsement to deal with controlled and restricted drugs, pursuant to section 58 of the Regulation until cancellation of that endorsement on the 26th of April 2017; and was bound to comply with the Regulation.The Relevant Conduct It is not necessary to set out in detail the factual allegations set out in paragraphs 8 – 60 of the referral, which are admitted by the respondent. His treatment of the 29 patients the subject of allegation 1 between January 2014 and November 2016 involved repeated breaches of various sections of the Regulation, in particular sections 213(1) and 122(1), in prescribing controlled and restricted drugs to vulnerable and often drug-dependent patients (to his knowledge) without the prior approval of the Chief Executive. Although more relevant to the issue of characterisation, in relation to the seven patients the subject of allegation 2, it is worth repeating the concluding remarks of Dr Stephens, in his report to OHO:[1]I acknowledge the fact that these seven patients would have been considered by our colleagues to be extremely difficult to manage due to their demanding and manipulating personalities. As documented in textbooks, these are our “heart-sink” patients – (i.e., when you see them in the appointment list, your heart sinks) – for they are unfortunately consistently marginalised by our profession and often do not receive the complex interventions that they require for their addictions or chronic pain syndrome. These patients often know each other through the street network and have often formed relationships in jail or on various opioid treatment programs. Word spreads quickly, and it was likely identified that Dr Grigg was an “easy target” for them to access schedule 8 and restricted schedule 4 medications.However, readily prescribing at face value and acquiescing to demands from these patients is completely inappropriate and often dangerous treatment. Two scenarios ensue: (a)the patient actually takes their prescribed medications and is consistently at risk of death from misadventure; or(b)these medications make it to the “black market” and put members of the wider community at risk of death due to misadventure. Strong boundaries, firm expectations, unwavering commitment to a goal of health and healing, with a multi-disciplinary treatment team, is what these patients require. Dr Grigg did not facilitate this in any of the seven patients that I reviewed. It is admirable that Dr Grigg consulted these patients when often they were dismissed by other members of the same practice. However, in each case, these patients were inappropriately and unsafely treated and not referred for specialist care when Dr Grigg noted aberrant behaviour.Dr Grigg combined medications in a dangerous fashion leading me to believe that he was not fully aware of the indicators, contraindications and interactions between opiates and other medications. Many medication errors occurred. Prescribed quantities lacked oversight and were excessive. The drugs of dependence unit was consistently ignored, and most prescriptions issued to these patients were illegal. General practice is busy, and we have a demanding workload. This often leads us to writing short and concise notes. However, Dr Grigg provided minimal clinical documentation of history, examination, plans and clinical reasoning and was not to a standard expected by our profession. The vast majority of clinical actions taken by Dr Grigg that I have gleaned from these seven cases is not to a standard accepted by myself and other general practitioners.[1]Hearing Brief (HB) page 115.Characterisation

Evidence

Evidence Before The Court

Full text does not contain this section.

Decision

Reasons for decision

Full text does not contain this section.

Ratio Decidendi

Legal Principle Established

Full text does not contain this section.