In Re Dr Geoffrey Ian Barratt and the Medical Practice Act 1992
[2004] NSWMT 7
•8 September 2004
New South Wales
Medical Tribunal
CITATION: In Re Dr Geoffrey Ian Barratt and the Medical Practice Act 1992 [2004] NSWMT 7 TRIBUNAL: Medical Tribunal PARTIES: NSW Health Care Complaints Commission
Dr Geoffrey Ian BarrattFILE NUMBER(S): 40005 of 2003 CORAM: Walmsley, SC DCJ - Brown, Dr J - Kotze, Dr B - Berglund Dr C CATCHWORDS: unsatisfactory professional conduct - professional misconduct LEGISLATION CITED: Medical Practice Act, 1992
Poisons and Therapeutic Goods Act 1966CASES CITED: Briginshaw v Briginshaw (1938) 60 CLR 336;
Bannister v Walton (1992-3) 30 NSWLR 699DATES OF HEARING: DATE OF JUDGMENT: 8 September 2004 LEGAL REPRESENTATIVES: Mr S Beckett ORDERS: 1. The Tribunal finds Dr Barratt guilty of unsatisfactory professional conduct; 2. Dr Barratt is reprimanded; 3. Should any application be made by Dr Barratt for a practising certificate, it shall be a condition of his registration that:; (a) he enter supervised employment in a public hospital for a period of 2 years to be approved by the Medical Board; (b) his authority to prescribe Schedule 8 and Schedule 4D drugs remain withdrawn; (c) he not prescribe, possess, (save for his own treatment and when prescribed by another doctor), handle, or administer, Schedule 8 or Schedule 4D drugs; (d) he provide a copy of these conditions to his employer within 7 days of commencing employment at the public hospital; (e) If he returns to private practice after the expiry of the period in (a) above, his registration will be subject to the following conditions:; (i) he not work in sole practice; (ii) he not have authority to prescribe, possess, handle or administer Schedule 8 or Schedule 4D drugs; (iii) he be supervised by a supervisor approved by the Board and at a level approved by the Board; (iv) he conduct monthly case and record reviews with a mentor approved by the Board; (v) he authorise the supervisor and mentor to report to the Board once per month; (vi) the conditions (i) to (v) continue for a period of 2 years or such longer period as the Medical Board thinks fit; (vii) he provide a copy of these conditions to all practitioners with whom he is associated in any medical practice within 7 days of commencing employment at the private practice.
JUDGMENT:
- REASONS FOR DETERMINATION
Registration Background
1. Dr Geoffrey Ian Barratt graduated from the University of Sydney with the degrees of MB, BS, in 1972. He was first registered as a medical practitioner in NSW on 23 December 1974. His name was removed from the register on 16 September 1981, and restored, subject to conditions, on 21 May 1986. Those conditions required him inter alia to obtain permission to prescribe drugs of addiction otherwise than to authorise administration to a hospital patient. Dr Barratt then practised until 9 May 2001, shortly after a Health Care Complaints Commission (the Commission) investigator visited his practice at Glenn Innes to investigate matters which formed the basis for these proceedings. He ceased practice then voluntarily and has not since practised or sought to practise. On 14 June 2002 his name was removed from the register for non-payment of the annual registration fee.
The Complaint and the Course of the Hearing
2. By an Amended Complaint, (the Complaint) filed 23 October 2003, two and a half years after Dr Barratt had last practised, the Commission made a complaint pursuant to s 51 Medical Practice Act, 1992 (the Act) that Dr Barratt had been guilty of unsatisfactory professional conduct and/or professional misconduct within the respective meanings of those expressions in ss 36 and 37 of the Act.
3. The hearing of the Complaint began before the Tribunal on 29 March 2004. The Commission was represented by Mr S Beckett of counsel. Dr Barratt appeared in person. Dr Barratt did not file any material in opposition to that served by the Commission. Dr Barratt elected rather (in his words) to “use the material that has been presented by the Commission and address that as it comes along.” However he later decided to give evidence and he was extensively cross examined.
4. Dr Barratt told the Tribunal he was unsure about whether he would ultimately return to practice. Mr Beckett, accepting Dr Barratt’s name is no longer on the register, told the Tribunal the Commission wants orders made to protect the public if Dr Barratt does later seek to return to practice. The power to make such orders in relation to a practitioner who is unregistered may be found in s 61(2) of the Act.
5. At the outset of the hearing counsel for the Commission was given leave to amend the Complaint in some minor respects. Further, as the Tribunal was taken to the factual material on which the amended complaint is based, it became apparent the evidence did not, in some respects, support the Complaint.
6. In general terms the Complaint concerns Dr Barratt’s failure, when prescribing drugs to patients, to make proper note of what drugs, quantities and dosages were prescribed, and, when prescribing certain drugs covered by Schedule 8 of the Poisons and Therapeutic Goods Act, not obtaining prior authority to do so, contrary to the provisions of s 28 of that Act, given that it was a condition of his right to practice that he do so.
7. During the first two days of the hearing it became apparent, inter alia that :
(a) the Complaint concerned a total of 17 patients;
(b) at the time he was treating those patients, Dr Barrett carried on practice in Glen Innes, and also at nearby Deepwater;
(c) a number of the patients he saw only in nursing homes or as inpatients or outpatients at the Glenn Innes District Hospital;
(d) as patients had gone to other medical practices when Dr Barratt ceased to practice, their notes had gone to those practices;
(e) the Commission had not summonsed treatment notes from nursing homes or the doctors who had taken over Dr Barratt’s patients;
(f) since the Commission was attempting in part to prove its case by proving a negative, viz an absence of records, and notwithstanding that Dr Barratt frankly conceded he did not keep proper records and had not properly complied with poisons regulations, the Commission sought an adjournment to enable it to issue and serve summonses calling for material relevant to the 17 patients. Dr Barratt did not oppose that course. The Commission adjourned the further hearing of the matter till 21 June 2004 for an additional 2 days of hearing.
8. At the resumed hearing on 21 June 2004 the Commission indicated through its counsel that there were certain parts of the Complaint in respect of which it would no longer proceed.
9. The Complaint said inter alia:
The Health Care Complaints Commission of Level 13, 323 Castlereagh Street, Sydney, New South Wales 2000, having consulted with the NSW Medical Board pursuant to Section 51 of the Medical Practice Act, 1992 (“the Act”), as amended
HEREBY COMPLAINS that Dr Geoffrey Ian Barratt, Medical Practitioner, of “8 Mile” Deepwater, New South Wales, 2371, (“the practitioner”), being a medical practitioner registered under the Act:-
COMPLAINT
- has been guilty of unsatisfactory professional conduct and/or professional misconduct within the meaning of section 36 and section 37 of the Act, in that the practitioner has:
(i) demonstrated a lack of adequate knowledge, skill, judgement and/or care in the practice of medicine; and/or
(ii) contravened a condition to which his registration was subject; and/or
(iii) has been guilty of improper or unethical conduct relating to the practice of medicine.
Patient A
1. Between about March 1999 and about January 2000, the practitioner prescribed Nitrazepam to Patient A, on the dates and in the quantities shown in Schedule A, and failed to make a record of:
(a) The name, strength and quantity of the drug prescribed; and/ or
(b) The directions for use as shown on the prescription
2. The practitioner failed to keep adequate records in respect of the treatment provided to Patient A, contrary to the provisions of Schedule 2 of the Medical Practice Act Regulation .
Patient B
3. Between about 11 March 1998 and about 6 March 2000, the practitioner prescribed Endone to Patient B, on the dates and in the quantities shown in Schedule B,
(a) without obtaining an authority to prescribe to Patient B for a period exceeding two months, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966; and
(b) contrary to the requirements of Clause 84 of the Poisons and Therapeutic Goods Regulation 1994 , failed to make a record of
(i) the name, strength and quantity in words, and/or
(ii) the date prescribed, and/or
(iii) the directions for use as shown in the prescription.
4. Between about 11 March 1998 and 6 March 2000, the practitioner prescribed Diazepam and Nitrazepam to Patient B, on the dates and in the quantities shown in Schedule B, and failed to make a record of:
(a) The name, strength and quantity of the drug prescribed; and/ or
(b) The directions for use as shown on the prescription.
contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994 .
5. Between about 2 July 1999 and 6 March 2000 the practitioner issued prescriptions for Endone to Patient B, on the dates and in the quantities shown in Schedule B,
(a) without recording the strength and quantity of the Endone in words; and
(b) prescribing other substances using the same prescription form
contrary to the requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
6. Between 2 July 1999 and 6 March 2000 the practitioner issued prescriptions for restricted substances to Patient B without recording the strength of the substance and/or recording adequate directions for use contrary to the requirements of clause 37 of the Poisons and Therapeutic Goods Regulation 1994.
7. The practitioner failed to keep adequate records in respect of the treatment provided to Patient B contrary to Schedule 2 of the Medical Practice Act Regulation .
Patient C
8. On or about 7 January 1999, the practitioner prescribed Morphine to Patient C, and failed to make a record of
(a) the name, strength and quantity prescribed; and/or
(b) the date that it was prescribed; and/or
(c) the directions for use as shown on the prescription,
contrary to the requirements of Clause 84 of the Poisons and Therapeutic Goods Regulation 1994.
9. On or about 17 May 1999, the practitioner prescribed Endone to Patient C, and failed to make a record of:
(a) the name, strength and quantity prescribed; and/or
(b) the date that it was prescribed; and/or
(c) the directions for use as shown on the prescription,
contrary to the requirements of Clause 84 of the Poisons and Therapeutic Goods Regulation 1994.
10. On 9 February 2000 and 15 February 2000, the practitioner issued prescriptions for MS Contin to Patient C without including the strength and quantity in words, contrary to Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
11. Between January 1999 and 15 February 2000 the practitioner prescribed Diazepam, Nitrazepam and Andriol to Patient C, on the dates and in the quantities shown in Schedule C, and failed to make a record of:
(a) The name, strength and quantity of the drug prescribed and the date on which it was prescribed; and/ or
(b) The maximum number of times the drug may be supplied on the prescription; and/or
(c) The directions for use as shown on the prescription.
contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
12. The practitioner failed to keep adequate records in respect of the treatment provided to Patient C contrary to the provisions of Schedule 2 of the Medical Practice Act Regulation .
Patient D
13. Between 12 October 1999 and 14 January 2000, the practitioner prescribed Morphine to Patient D, on the dates and in the quantities shown in the Schedule D, without obtaining an authority to prescribe for a period exceeding two months, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966.
14. Between 12 October 1999 and 14 January 2000, the practitioner issued prescriptions for Morphine to Patient D:
(a) without recording the strength and quantity of the Morphine in words; and/or
(b) without providing adequate directions for use
contrary to requirements of clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
15. On 21 December 1999 the practitioner prescribed Morphine Sulfate and Maxolon on the same prescription form to Patient D, contrary to clause 82(5) of the Poisons and Therapeutic Goods Regulation 1994.
Patient E
16. Between February 1999 and 8 March 2000, the practitioner prescribed Diazepam, Dextropropoxphene and Flunitrazepam to Patient E, on the dates and in the quantities shown in Schedule E, and failed to make a record of:
(a) the name, strength and quantity of the drug prescribed and the date on which it was prescribed; and/ or
(b) the maximum number of times the drug may be supplied on the prescription; and/or
(c) the directions for use as shown on the prescription
contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
17. The practitioner failed to make adequate records in respect of the treatment provided to Patient E contrary to Schedule 2 of the Medical Practice Act Regulation .
Patient F
18. On or about 25 June 1999 and on 1 July 1999, the practitioner prescribed Diazepam and Flunitrazepam to Patient F, in the quantities shown in Schedule F, and failed to make a record of:
(a) the name, strength and quantity of the drug prescribed; and/ or
(b) the maximum number of times the drug may be supplied on the prescription; and/or
(c) the directions for use as shown on the prescription.
contrary to clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
Patient G
19. Between 7 December 1999 and 10 March 2000, the practitioner prescribed Morphine to Patient G, on the dates and in the quantities shown in Schedule G, without obtaining an authority to prescribe for a period exceeding two months, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966.
20. Between 15 June 1999 and 10 March 2000 the practitioner issued prescriptions of Morphine to Patient G, on the dates and in the quantities shown in Schedule G,
(a) without recording the strength and quantity of the Morphine in words; and/or
(b) providing adequate directions for use,
contrary to the requirements of clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
Patient H
23. Between about January 1999 and January 2000, the practitioner prescribed Diazepam and Flunitrazepam to Patient H, on the dates and in the quantities shown in Schedule H, and failed to make a record of:
(a) the name, strength and quantity of the drug prescribed; and/ or
(b) the maximum number of times the drug may be supplied on the prescription; and/or
(c) the directions for use as shown on the prescription.
contrary to clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
24. The practitioner failed to make adequate records in respect of the treatment provided to Patient H contrary to Schedule 2 of the Medical Practice Act Regulation .
Patient I
25. On 3 March 1995, the practitioner prescribed Morphine to Patient I without recording the quantity and strength prescribed and the directions for use as shown on the prescription, contrary to the requirements of Clause 84 of the Poisons and Therapeutic Goods Regulation 1994.
26. Between about 26 July 1999 and 16 March 2000 the practitioner prescribed Dextropropoxphene and Flunitrazepam to Patient I, on the dates and in the quantities shown in Schedule I, and failed to make a record of:
(c) The name, strength and quantity of the drug prescribed; and/ or
(d) The directions for use as shown on the prescription,
contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
27. The practitioner failed to make adequate records in respect of the treatment provided to Patient I contrary to Schedule 2 of the Medical Practice Act Regulation .
Patient J
28. Between 15 October 1999 and 14 March 2000, the practitioner prescribed Morphine to Patient J, on the dates and in the quantities shown in Schedule J, without obtaining an authority to prescribe for a period exceeding two months, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966.
Patient K
29. Between 20 June 1999 and 18 February 2000, the practitioner issued prescriptions for Endone to Patient K, on the date and in the quantities shown in Schedule K,
(e) without recording the name , strength and quantity in words, and
(f) prescribing other substances using the same prescription form contrary to the requirements of clause 82 of the Poisons and Therapeutic Goods Regulation 1994 .
Patient L
30. On 14 February 2000, the practitioner issued prescriptions for MS Contin to Patient L without recording the strength and quantity of the MS Contin in words, contrary to the requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
Patient M
31. On 7 July 1999, the practitioner issued a prescription for Endone to Patient M without recording the strength and quantity in words, contrary to the requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
Patient N
32. On or about 12 June 1999, the practitioner prescribed MS Contin to Patient N and failed to make a record of;
(g) the name, strength and quantity of the MS Contin prescribed,
(h) the date that it was prescribed; and
(i) the directions for use as written in the prescription,
contrary to clause 84 of the Poisons and Therapeutic Goods Regulation 1994.
33. The practitioner failed to make adequate records in respect of the treatment provided to Patient N contrary to Schedule 2 of the Medical Practice Act Regulation .
Condition
34. From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules B, C, G, L, M, N, O, P and Q , the practitioner prescribed the following drugs of addiction in contravention of that condition:
- Patient B – Endone
Patient C – Morphine and Endone
PatientG – Morphine (between August 1999 and 24 November 1999 Morphine injections and between December 1999 to March 2000 all Morphine)
Patient L – MS Contin
Patient M – Endone
Patient N – MS Contin
Patient O - Morphine
Patient P – Morphine
Patient Q - Pethidine
SCHEDULE A: Prescribing for Patient A
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsMogadon 5mg x 25 Fayles Pharmacy Printout Mogadon 5mg x 25 Graydon’s Amcal Chemist Printout Mogadon 5mg x 25 Graydon’s Amcal Chemist Printout Mogadon 5mg x 25 Timbs Pharmacy Script Total
SCHEDULE B: Prescribing for Patient B
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsEndone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 Timbs Pharmacy Printout 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 60 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 50 50 Ducene 5 mg Timbs Pharmacy Printout Endone 5mg x 100 Mogadon 5mg x 100 50 Ducene 5 mg Script
Timbs Pharmacy PrintoutEndone 5mg x 100 Mogadon 5mg x 100 50 Ducene 5 mg Script
Timbs Pharmacy PrintoutEndone 5mg x 100 Mogadon 5mg x 100 50 Ducene 5 mg Script
Timbs Pharmacy PrintoutEndone 5mg x 100 Mogadon 5mg x 100 50 Ducene 5 mg Script
Timbs Pharmacy PrintoutEndone 5mg x 100 Mogadon 5mg x 100 50 Ducene 5 mg Script
Timbs Pharmacy PrintoutEndone 5mg x 100 Mogadon 5mg x 100 50 Ducene 5 mg Script
Timbs Pharmacy PrintoutEndone 5mg x 100 Mogadon 5mg x 100 50 Ducene 5 mg Script
Timbs Pharmacy PrintoutEndone 5mg x 100 Mogadon 5mg x 100 50 Ducene 5 mg Script
Timbs Pharmacy PrintoutEndone 5mg x 100 Mogadon 5mg x 100 Script
Timbs Pharmacy Printout50 Ducene 5 mg Timbs Pharmacy Printout
SCHEDULE C: Prescribing for Patient C
RE: Complaint concerning Dr Geoffrey Ian Barratt
Date Dispensed Quantity of morphine prescribed noted in the records Quantity of Endone prescribed in the records Quantity of Flunitrazepam prescribed in the records Quantity of Diazepam prescribed in the records Quantity of Nitrazepam prescribed in the records Quantity of Andriol prescribed in the records Source 07/01/99 MS Contin 60 mg x 20 Antenex 50 tabs x 5mg Alodorm 25 tabs x 5mg Graydon’s Amcal Chemist printout 07/01/99 MS Contin 30mg x 20 Graydon’s Amcal Chemist printout 19/02/99 40mg caps x 60 (5 repeats)
360 tabs
Fayles Pharmacy printout 12/02/99 Rohypnol 25 tabs x 2mg Graydon’s Amcal Chemist printout 26/02/99 Rohypnol 25 tabs x 2mg Fayles Pharmacy printout 17/03/99 Rohypnol 25 tabs x 2mg Fayles Pharmacy printout 16/04/99 Rohypnol 25 tabs x 2mg Graydon’s Amcal Chemist printout 17/05/99 5mg tabs x 20(?) Fayles Pharmacy printout 27/05/99 Rohypnol 25 tabs x 2mg Fayles Pharmacy printout 29/06/99 Rohypnol 25 tabs x 2mg Graydon’s Amcal Chemist printout 29/09/99 40mg caps x 60 (5 repeats)
360 tabs
Fayles Pharmacy printout 09/02/00 MS Contin 60mg x 20 tabs Script Timbs Pharmacy printout
15/02/00 MS Contin 60mg x 20 tabs Script Timbs Pharmacy printout
Total 80 20 (?) 125 50 25 720
SCHEDULE D: Prescribing for Patient D
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsMS Contin 10 mg x 20 Script
Graydon’s Amcal Pharmacy Printout
19/10/99*MS Contin 10 mg x 20 Script
Graydon’s Amcal Pharmacy PrintoutMS Contin 10 mg x 20 Script
Graydon’s Amcal Pharmacy Printout
02/11/99*MS Contin 10 mg x 20 Script
Graydon’s Amcal Pharmacy PrintoutMS Contin 10 mg x 20 Script
Graydon’s Amcal Pharmacy PrintoutMS Contin 10 mg x 20 Script
Graydon’s Amcal Pharmacy PrintoutKaponal 20 mg x 20 Script
Graydon’s Amcal Pharmacy Printout
16/12/99*Kaponal 20 mg x 20 Script
Graydon’s Amcal Pharmacy PrintoutKaponal 20 mg x 20 Script
Graydon’s Amcal Pharmacy Printout
29/12/99*Kaponal 20 mg x 20 Script
Graydon’s Amcal Pharmacy PrintoutKaponal 20 mg x 20 Script
Graydon’s Amcal Pharmacy PrintoutMorphine Amp 10mg Script
Graydon’s Amcal Pharmacy Printout* Date dispensed where date dispensed different to date prescribed.
SCHEDULE E: Prescribing for Patient E
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsAntenex 50 tabs x 5mg Graydon’s Amcal Chemist Printout Rohypnol 25 tabs x 5mg Graydon’s Amcal Chemist Printout Rohypnol 25 tabs x 5mg Graydon’s Amcal Chemist Printout Rohypnol 25 tabs x 5mg Graydon’s Amcal Chemist Printout Rohypnol 25 tabs x 5mg Graydon’s Amcal Chemist Printout Rohypnol 25 tabs x 5mg Graydon’s Amcal Chemist Printout Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Rohypnol 25 tabs x 2mg Graydon’s Amcal Chemist Printout Doloxene 50 caps x 100mg Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Doloxene 50 caps x 100mg Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout
SCHEDULE F: Prescribing for Patient F
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the records25/06/99 Valium 50 tabs x 5mg Rohypnol 25 tabs x 2 mg Graydon’s Amcal Chemist Printout 01/07/99 Rohypnol 25 tabs x 2 mg Timbs Pharmacy Printout
SCHEDULE G: Prescribing for Patient G
RE: Complaint concerning Dr Geoffery Ian Barratt
13/01/99# MS Contin 20 x 10 mg Timbs Pharmacy Printout 25/01/99# MS Contin 20 x 10 mg Timbs Pharmacy Printout 01/02/99# MS Contin 20 x 10 mg Timbs Pharmacy Printout 10/02/99# MS Contin 20 x 10 mg Timbs Pharmacy Printout 18/02/99# MS Contin 20 x 10 mg Timbs Pharmacy Printout 03/03/99# MS Contin 20 x 10 mg Timbs Pharmacy Printout 12/03/99# MS Contin 20 x 10 mg Timbs Pharmacy Printout 16/03/99# MS Contin 20 x 10 mg Timbs Pharmacy Printout 26/03/99# MS Contin 120 x 10 mg Timbs Pharmacy Printout 03/05/99# MS Contin 100 x 10 mg Timbs Pharmacy Printout 15/06/99 MS Contin 100 x 10mg Script Timbs Pharmacy Printout
13/07/99 MS Contin 20 x 10mg Script Timbs Pharmacy Printout
21/07/99 MS Contin 60 x 30mg Script Timbs Pharmacy Printout
11/08/99 5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
11/08/99 1 Morphine hydrochloride 2mg solution Script Timbs Pharmacy Printout
20/08/99 MS Contin 60 x 30mg Script Timbs Pharmacy Printout
27/08/99 5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
27/08/99 13/09/99*
1 Ordine Script Timbs Pharmacy Printout
31/08/99 1 Ordine Script Timbs Pharmacy Printout
13/09/99 24/09/99*
1 Ordine Script Timbs Pharmacy Printout
14/09/99 16/09/99*
MS Contin 60 x 30mg Script Timbs Pharmacy Printout
17/09/99 20/09/99*
5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
26/09/99 28/09/99*
MS Contin 60 x 60mg Script Timbs Pharmacy Printout
05/10/99# 5 Morphine sulfate injections 10mg Timbs Pharmacy Printout 20/10/99 MS Contin 20 x 60mg Script Timbs Pharmacy Printout
21/10/99 5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
21/10/99 02/11/99*
MS Contin 20 x 60mg Script Timbs Pharmacy Printout
08/11/99# 5 Morphine sulfate injections 10mg Timbs Pharmacy Printout 09/11/99 MS Contin 20 x 60mg Script Timbs Pharmacy Printout
23/11/99 5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
23/11/99 24/11/99*
MS Contin 20 x 60mg Script Timbs Pharmacy Printout
07/12/99 MS Contin 20 x 60mg 1 Ordine
Script Timbs Pharmacy Printout
14/12/99 15/12/99*
5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
15/12/99 MS Contin 20 x 60mg Script Timbs Pharmacy Printout
04/01/00 05/01/00*
MS Contin 20 x 60mg Script Timbs Pharmacy Printout
06/01/00 07/01/00*
5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
14/01/00 MS Contin 60 x 60mg Script Timbs Pharmacy Printout
14/01/00 1 Ordine Script Timbs Pharmacy Printout
31/01/00 5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
15/02/00 MS Contin 20 x 60 mg Script Timbs Pharmacy Printout
18/02/00 5 Morphine sulfate injections 10mg Script Timbs Pharmacy Printout
23/02/00 25/02/99*
MS Contin 20 x 60mg Script Timbs Pharmacy Printout
03/03/00 MS Contin 60 x 60mg Script Timbs Pharmacy Printout
10/03/00 5 Morphine sulfate injections 10mg Timbs Pharmacy Printout * Date dispensed where date dispensed different to date prescribed. # Date dispensed where the Commission does not have a copy of the prescription.
SCHEDULE H: Prescribing for Patient H
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsRohypnol 25 tabs x 5mg Graydon’s Amcal Chemist Printout Valium 50 tabs x 50mg Graydon’s Amcal Chemist Printout Valium 50 tabs x 50mg Graydon’s Amcal Chemist Printout Rohypnol 25 tabs x 5mg Graydon’s Amcal Chemist Printout Valium 50 tabs x 50mg Graydon’s Amcal Chemist Printout Rohypnol 25 tabs x 5mg Timbs Pharmacy Printout Hypnodorm 25 tabs x 2mg Graydon’s Amcal Chemist Printout Valium 50 tabs x 50mg Graydon’s Amcal Chemist Printout Flunitrazepam 2mg tablets Fayles Pharmacy Printout
SCHEDULE I: Prescribing for Patient I
RE: Complaint concerning Dr Geoffery Ian Barratt
in the records
in the recordsMS Contin Dr Barratt’s prescribing records Rohypnol 25 tabs x 5mg Paradex 100 tabs Timbs Pharmacy Printout Paradex tablets Fayles Pharmacy Printout Hynodorm 50 tabs x 2mg Timbs Pharmacy Printout Hynodorm 2 mg Fayles Pharmacy Printout Paradex tablets Fayles Pharmacy Printout
SCHEDULE J: Prescribing for Patient J
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsMS Contin 10 mg x 20 Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy Printout
24/01/00*Ordine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Fayles Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Timbs Pharmacy Printout
02/03/00*Ordine 2 Soln 2mg/ml 200ml Script
Timbs Pharmacy PrintoutOrdine 2 Soln 2mg/ml 200ml Script
Timbs Pharmacy Printout
SCHEDULE K: Prescribing for Patient K
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsEndone 5 mg x 20 Script Endone 5 mg x 20 Script Endone 5 mg x 20 Script Endone 5 mg x 20 Script
SCHEDULE L: Prescribing for Patient L
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsMS Contin 10 mg x 20 Script
SCHEDULE M: Prescribing for Patient M
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsEndone 10 mg x 20 Script
SCHEDULE N: Prescribing for Patient N
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsMS Contin 20 mg x 20 Timbs Pharmacy printout
SCHEDULE O: Prescribing for Patient O
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsMS Contin 30 mg x 60 Script Timbs Pharmacy printout
SCHEDULE P: Prescribing for Patient P
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the records1 Morphine HCL 2mg soln Timbs Pharmacy printout
SCHEDULE Q: Prescribing for Patient Q
RE: Complaint concerning Dr Geoffrey Ian Barratt
in the recordsPethidine 100mg x 5 ampoules Graydon’s Amcal Chemist printout
THE LEGISLATIVE AND REGULATORY REGIME
10. Most particulars of the Complaint are covered by the regulatory regime in force for the years 1998 to 2000. The relevant legislation and regulation consists of the Poisons and Therapeutic Goods Regulation 1994 and the Poisons and Therapeutic Goods Act 1966. One particular (paragraph 25, concerning Patient I) concerns an event on 3 March 1995.
11. The Commission alleges breaches of Regulations 37, 40, 82 and 84 of the Poisons and Therapeutic Goods Regulation 1994. The relevant sections of the Poisons and Therapeutic Goods Act 1966 are Sections 28 and 29.
12. Regulation 37 is as follows:
“Form of Prescription
37.(1) A prescription for a restricted substance must include the following details:
(a) the date on which it is issued;
(b) the name and address of the patient or (if the treatment is for an animal) the species of animal and the name and address of the animal’s owner;
(c) the name, strength and quantity of the substance to be supplied;
(d) adequate directions for use;
(e) the maximum number of times the substance may be supplied on the prescription;
….
(g) if the prescription is issued at a hospital, the name and designation of the person by whom it is issued and the name, address and telephone number of the hospital;
(h) if the prescription is issued elsewhere than at a hospital, the name and designation of the person by whom it is issued and the address and telephone number of the premises at which it is issued.
(6) A person who issues a prescription for a restricted substance must ensure that the prescription complies with the requirements of this clause.”(2) The details referred to in sub-clause (1)(a)-(f) must be made out:
(a) in the handwriting of the person by whom the prescription is issued; or
(b) in such other manner as may be approved for the time being by the Director General,
and the prescription must be signed by the person by whom it is issued.
…
(4) The person by whom the prescription is issued must confirm any dose that could be regarded as being dangerous or unusual by underlining the part of the prescription that specifies the intended dose and by initialling the prescription in the margin.
…
13. Regulation 40 is as follows:
“ Records to be Kept of Certain Prescriptions
40(1) A medical practitioner, dentist or veterinary surgeon who prescribes a prescribed or restricted substance must make a record of the following particulars:
(a) the name, strength and quantity of the substance prescribed and the date on which it was prescribed;
(b) if the substance is intended for the treatment of a person, the name and address of the person to be treated;
(c) if the substance is intended for the treatment of an animal, the species of animal and the name and address of the animal’s owner;
(d) the maximum number of times the substance may be supplied on the prescription;
…
(f) the directions for use as shown on the prescription.
(2) The record must be kept at the surgery, hospital or office of the person prescribing the substance.”
14. Regulation 82 is as follows:
“Formal Prescriptions
82(1) A person who issues a prescription of a drug of addiction must ensure that the prescription includes the following details:
(a) the date on which it is issued;
(b) the name and address of the patient or (if the treatment is for an animal) the species of animal and the name and address of the animal’s owner;
…
(d) adequate directions for use;
(e) the maximum number of times the drug may be supplied on the prescription;
(f) the intervals at which the drug may be supplied on the prescription;
(g) if the prescription is issued at a hospital, the name and designation of the person by whom it is issued and the name, address and telephone number of the hospital;
(h) if the prescription is issued elsewhere than at a hospital, the name and designation of the person by whom it is issued and the address and telephone number of the premises at which it is issued.
(2) The details referred to in sub-clause (1)(a)-(f) must be made out:
(a) in the handwriting of the person by whom the prescription is issued; or
(b) in such other manner as may be approved for the time being by the Director General,
and the prescription must be signed by the person by whom it is issued.
…
(5) A person must not issue a prescription that prescribes more than one drug of addiction or both a drug of addiction and another substance.”
15. Regulation 84 is as follows:
“ Records of Prescriptions
84(1) A medical practitioner, dentist or veterinary surgeon who prescribes a drug of addiction must make a record of the following particulars:
(a) the name, strength and quantity of the drug prescribed and the date on which it was prescribed;
(b) if the drug is intended for the treatment of a person, the name and address of the person to be treated;
(c) if the drug is intended for the treatment of an animal, the species of animal and the name and address of the animal’s owner;
(d) the maximum number of times the drug may be supplied on the prescription;
(e) the intervals at which the substance may be supplied on the prescription;
(f) the directions for use, as shown on the prescription.
(2) The records must be kept at the surgery, hospital or office of the person prescribing the substance.”
16. Regulation 86 was amended a number of times during the relevant period. The form in which it applied from 31 October 1997 was as follows:
“ Exceptions to Section 28(a) and (b)
86(1) A medical practitioner is authorised to issue a prescription for a drug of addiction for a person referred to in section 28(a) or (b) of the Act without an authority under section 29 of the Act:
(a) if the medical practitioner is of the opinion that the person requires the use of the drug in the course of treatment as an inpatient in a public hospital; and
(b) if the prescription is for a course of treatment for a period of not more than 14 days following the persons admission as an in-patient.
(2) A medical practitioner is authorised to issue a prescription for a drug of addiction for a person who is referred to in section 28(a) or (b) of the Act for a continuous therapeutic use by that person for a period of up to 12 months without an authority under section 29 of the Act if:
(a) the medical practitioner is of the opinion that the person requires the drug for the relief of pain associated with cancer; and
(b) a medical practitioner (whether or not the medical practitioner referred to in paragraph (a) and further) has qualifications in the diagnosis and treatment of cancer are recognised by the National Specialist Qualification Advisory Committee of Australia or who is approved by the Director General for the purpose of this paragraph:
(i) has made the diagnosis of cancer; and
(ii) has estimated the person’s life expectancy to be 12 months or less.
(3) Sub-clause (2) does not authorise the medical practitioner to prescribe the following drugs of addiction in the circumstances referred to in that sub-clause:
Dextrormoramide (all forms)
Fentanyl (all forms)
Pethidine (parenteral forms only).”
17. From 1 October 1999, sub-clause (2) of Regulation 86 was omitted and the following was inserted instead:
“(2) A medical practitioner is authorised to issue a prescription for a drug of addiction for a person who is referred to in section 28(a) or (b) of the Act for continuous therapeutic use by that person for a period of up to 12 months without an authority under section 29 of the Act if:
(a) the medical practitioner is of the opinion that the person requires the drug for the relief of pain associated with cancer; and
(b) the medical practitioner (whether or not the medical practitioner referred to in paragraph (a) whose qualifications in the diagnosis and treatment of cancer are recognised by National Specialist Qualification Advisory Committee of Australia, or who is approved by the Director General for the purposes of this paragraph has made the diagnosis of cancer); and
(c) whether the medical practitioner referred to in paragraph (a) or a medical practitioner referred to in paragraph (b) had estimated the person’s life expectancy to be 12 months or less.”
18. The relevant provisions of the Poisons and Therapeutic Goods Act 1966 are sections 28 and 29. The form of sections 28 and 29 as they stood on 1 March 1999 (prior to the commencement of the Health Legislation Amendment Act 1999) was as follows:
“ 28 Except as may be authorised by the regulations, a medical practitioner shall not prescribe for or supply to:
(a) any person a drug of addiction (not being a drug of addiction that may be prescribed or supplied in accordance with paragraph (c) of this section) for continuous therapeutic use by that person for a period exceeding two months or for a period which, together with any other period for which he or she has prescribed that or any other such drug or, together with any other period for which that or any other such drug has, to his or her knowledge, been prescribed or supplied by any other medical practitioner, would result in that drug, or that drug together with any other such drug being prescribed for continuous therapeutic use by that person for a period exceeding two months;
(b) any person who in his opinion is an addict any drug of addiction (not being a drug of addiction that may be prescribed or supplied in accordance with paragraph (c) of this section); or
(c) any person any drug of addiction prescribed for the purposes of this paragraph,
unless he so prescribes or supplies that drug in accordance with an authority in respect of that person given to him by the Secretary under section 29 of this Act.
…
29(1) An application for the authority of the Secretary referred to in section 28 of this Act shall:
(a) be in writing and be signed by the medical practitioner who proposes to prescribe or supply the drug of addiction;
(b) be made in or to the effect of the prescribed form;
(c) contain such information as is provided for by the prescribed form; and
(d) be enclosed in a sealed envelope marked “Confidential”, and be lodged with, or forwarded by registered mail to, the Secretary.
(2) Any such application:
(a) where it relates to a person, who is referred to in the application as not being an addict, may be referred; or
(b) where it is not made by an approved prescriber and relates to a person, who is referred to in the application as being an addict, shall be referred,
by the Secretary to the medical committee of this Act.
(3) The Secretary may give an authority for the medical practitioner by whom any such application is made to prescribe for or to supply to the person whom the application relates any drug of addiction specified in that authority for the purpose of the treatment of that person.
(4) Where the Secretary refers an application to the medical committee of this Act, it shall take into consideration any report of that committee relating to that application made before the authority is granted.
(4A) If an application has been referred to the medical committee under sub-section (2), the secretary may issue a temporary authority to the applicant expiring on a specified date that is not later than four months after its issue.
(5) An authority (whether or not a temporary authority):
(a) shall specify the quantity of the drug of addiction that may be so prescribed or supplied by the medical practitioner;
(b) shall specify the period which any such drug may be so prescribed or supplied;
(c) may be given subject to such conditions as the Secretary thinks fit and specifies as in the authority; and
(d) shall be in writing and be signed by the Secretary or by an officer of the Department of Health authorised generally or specially by the Secretary to do so unless, in a case of emergency, it is given verbally.
- (6) Any such authority given verbally shall be confirmed in writing as soon as practicable after it is given.
(7) The Secretary may revoke an authority (including a temporary authority) given under this section.”
19. The only change introduced by the Health Legislation Amendment Act 1999 was to replace the word “addict” in section 28(b) with the words “a drug dependent person”.
20. Cl 13 (1) of the Medical Practice Regulation 1998 requires a registered medical practitioner engaged in providing medical services to make and keep a record, or ensure a record is made and kept, for each patient. Cl 14 requires the record be made contemporaneously with the provision of the treatment or as soon as practicable afterwards.
CONDITIONS ON DR BARRATT’S RIGHT TO PRACTICE
21. Between 21 May 1986 and when he ceased to practice on 9 May 2001, Dr Barratt’s right to practice was subject to certain conditions. The relevant restrictions were explained to Dr Barratt by the Chief Pharmacist for NSW when he wrote to Dr Barratt on 20 July 1987 as follows:
- “ (a) Under the provisions of Regulation 53(1)(j) made under the Poisons Act 1966, the Secretary of this Department has imposed a condition that you may not take possession of, supply or administer any drug of addiction other than a drug of addiction which has been prescribed for you by another medical practitioner or which has been prescribed for a patient in hospital.
(b) Under the provisions of Regulation 62(1A)(b) made under the Poisons Act, 1966, the Secretary has issued a direction that you may not issue a prescription containing a drug of addiction without his prior authority issued in accordance with the provisions of section 29 of the Poisons Act, other than to authorise the administration of a drug of addiction to a patient in hospital.”
- This means that in respect of each patient, other than a patient in hospital for whom you wish to prescribe a drug of addiction, you must complete and submit a Form 10 application to the Pharmaceutical Services Branch and obtain the authority of the secretary of the Department of Health before you so prescribe.”
22. Many (but not all) particulars of the Complaint relate to breaches of those conditions.
PARTICULARS OF THE COMPLAINT
23. Set out below are the specific complaints relating to each patient, a summary of the relevant evidence, and the Tribunal’s findings. Where findings are made, and the Tribunal finds complaints made out, the Tribunal makes those findings having been persuaded of the relevant facts on the balance of probabilities on the Briginshaw v Briginshaw standard of proof Briginshaw v Briginshaw (1938) 60 CLR 336 ; see also Bannister v Walton (1992-3) 30 NSWLR 699 @ 712 D per Mahoney JA . At the conclusion of the proceedings Dr Barratt conceded all relevant parts of the Complaint set out below had been proved.
24. A great deal of the evidence consisted of computer printouts of drugs dispensed from one or more of the three Glen Innes pharmacies. Much of the evidence was gathered by a Mr Gilfedder, a statement from whom was in evidence. He was not cross examined on his statement. Dr Barratt does not accept all that he says in his statement. Insofar as evidence he gathered forms the basis for our findings, however, the Tribunal does not understand Dr Barratt to contest it.
Patient A
“1. Between about March 1999 and about January 2000, the practitioner prescribed Nitrazepam to Patient A, on the dates and in the quantities shown on Schedule A, and failed to make a record of:
- (a) The name, strength and quantity of the drug prescribed; and/or
- (b) The directions for use as shown on the prescription,
- contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
2. The practitioner failed to keep adequate records in respect of the treatment provided to Patient A, contrary to the provisions of Schedule 2 of the Medical Practice Act Regulation.”
25. The three pharmacies in Glen Innes, where Dr Barratt had his primary practice, are Fayles Pharmacy, Graydon’s Amcal Chemist, and Timbs Pharmacy.
26. In a printout provided by Fayles Pharmacy it is apparent that on 5 March 1999 that pharmacy dispensed Mogadon 5mg to Patient A from a script made out by Dr Barratt. In a similar patient profile printout provided by Graydon’s Amcal Chemist it appears that on 12 July 1999 and 3 September 1999 Patient A was dispensed Mogadon 5mg x 25 pursuant to a script written by Dr Barratt. Further, according to the script history kept by Timbs Pharmacy, on 16 January 2000 a further prescription for Mogadon 5mg x 25 was issued pursuant to a script from Dr Barratt. Although the documents provided by the various pharmacies do not specifically state that Dr Barratt provided scripts, the Commission submits that the Tribunal ought infer that where there are records from a pharmacy which show the dispensing of a drug by that pharmacy, and there is a doctor’s name next to the drug, the dispensing was carried out pursuant to a script endorsed with the signature of the doctor. In each of the instances referred to above, Dr Barratt appears as the prescribing doctor. Dr Barratt conceded the script histories provided by the various pharmacies were accurate. The Tribunal infers he was the doctor who issued the scripts.
27. Records relevant to the patient, as recorded by Dr Barratt, were before the Tribunal. We infer they are his only records about her. We find there are no records for the four prescriptions. Absent such records we find there is a breach of Regulation 40(1) of the Poisons and Therapeutic Goods Regulation 1994 and a failure to meet the requirements of Schedule 2 of the Medical Practice Act Regulation.
Patient B
“3. Between about 11 March 1998 and about 6 March 2000, the practitioner prescribed Endone to Patient B, on the dates and in the quantities shown in Schedule B:
(i) the name, strength and quantity in words, and/or
(a) Without obtaining an authority to prescribe to Patient B for a period exceeding two months, contrary to Section 28 of the Poisons and Therapeutic Goods Act 1966; and
(b) Contrary to the requirements of Clause 84 of the Poisons and Therapeutic Goods Regulation 1994, failed to make a record of(iii) the directions for use as shown in the prescription.
(ii) the date prescribed, and/or
4. Between about 11 March 1998 and 6 March 2000, the practitioner prescribed Diazepam and Nitrazepam to Patient B, on the dates and in the quantities shown in Schedule B, and filed to make a record of:
(a) The name, strength and quantity of the drug prescribed; and/or
(b) The directions for use as shown on the prescription,
- contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
- 5. Between about 2 July 1999 and 6 March 2000 the practitioner issue prescriptions of Endone to Patient B, on the dates and in the quantities shown in Schedule B:
- (a) Without recording the strength and quantity of the Endone in words; and
contrary to the requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
- 6. Between 2 July 1999 and 6 March 2000 the practitioner issued prescriptions for restricted substances to Patient B without recording the strength of the substance and/or recording adequate directions for use contrary to the requirements of clause 37 of the Poisons and Therapeutic Goods Regulation 1994.
7. The practitioner failed to keep adequate records in respect of the treatment provided to Patient B contrary to Schedule 2 of the Medical Practice Act Regulation.
From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules …B … the practitioner prescribed the following drugs of addiction in contravention of that condition:
Patient B – Endone.”
28. The evidence relied on in relation to this patient is primarily a printout from Timbs Pharmacy showing the dispensing of Endone 5mg x 100, Mogadon 5mg x 100 and Ducene 5mg x 50. The printout shows 23 instances of prescribing those three drugs between 11 March 1998 and 6 March 2000 (see Complaint Schedule B). There are also copies of the scripts provided to Timbs Pharmacy by Mr Costello under Dr Barratt’s letterhead and signature for the period of 2 July 1999 to 6 March 2000.
29. The medical records kept by Dr Barratt for Patient B have entries which correspond to each of the dates upon which a script was dispensed by Timbs Pharmacy. For example, on 11 March 1998 Timbs Pharmacy apparently dispensed to Patient B quantities of Endone, Mogadon and Ducene. In Dr Barratt’s records, there is an entry on 11 March 1998, with the abbreviation “Meds”. In cross-examination Dr Barratt confirmed that the word “Meds” there referred to medication prescribed to Patient B (T45.44-55). The dates on the left side of the page were, it would seem, the dates upon which Dr Barratt saw Patient B and provided him with prescriptions for those medications. It is not clear what medications were prescribed on those dates. One needs to refer to earlier entries in Patient B’s notes to ascertain what they might be (T46.23-44). It is not clear whether Dr Barratt gave prescriptions for the same drugs in the same quantities. It became apparent however once Dr Barratt gave evidence, that he did.
30. Dr Barratt’s explanation for his abbreviated note taking was that he was trying to cut corners (T47.42). He agreed that it would be difficult for another medical practitioner to understand what had been prescribed on particular dates (T45.33).
31. By reason of a summons served on the Pharmaceutical Branch of the Health Department, all authorities issued by that branch were in evidence. Dr Barratt had an authority from the Pharmaceutical Services Branch for the period of 27 October 1994 to 5 December 1994. He may have had a further authority after this date because there is a letter on file dated 22 December 1995 noting that the authority in relation to Patient B for Endone tablets 5mg expired on 1 December 1995. The only authority relevant to the period the subject of these proceedings is one dated 13 April 2000 which provides Dr Barratt with an authority to prescribe Oxycodone Hcl 5mg tablets for Patient B for the period 13 April 2000 to 1 March 2003. That authority was apparently revoked on 10 October 2000.
32. With respect to Particular 3(a), it appears that Dr Barratt exceeded the two month period permitted by s.28(1) Poisons and Therapeutic Goods Act, 1966, on 12 May 1998. The Tribunal finds he had no authority to continue to prescribe Endone for the period thereafter and accordingly, there were a further 19 occasions when he prescribed Endone without an authority. As to Particular 3(b), we find that it was inadequate to describe what he was prescribing for Patient B as “Meds”. We are satisfied this amounted to a breach of Regulation 84 of the Poisons and Therapeutic Goods Regulation 1994.
33. Particular 4 is in similar terms to Particular 3(b) but concerns Schedule 4D drugs, Diazepam and Nitrazepam, involving Regulation 40 of the Poisons and Therapeutic Goods Regulation 1994. The use of the word “Meds” inadequately described the name, strength, quantity and directions for use of those drugs.
34. Particular 5 concerns the actual script written for a Schedule 8 drug, namely Endone, between 2 July 1999 and 6 March 2000. Clause 82 of the Poisons and Therapeutic Goods Regulation 1994 requires that the medical practitioner record the strength and quantity of the Endone in words rather than just in numbers. The rationale for this appears to be to prevent fraud and aid clarity for the pharmacist. On none of the occasions in the scripts tendered did Dr Barratt record either the strength or the quantity of Endone in words. Further, in relation to Particular 5(b), Dr Barratt included scripts for a number of other drugs on the same script as that for Endone. That amounts to a breach of Regulation 82 sub-regulation (5).
35. Particular 6 was not pursued by the Commission.
36. Particular 7 concerns a separate obligation found in Schedule 2 of the Medical Practice Regulation for the keeping of adequate records by medical practitioners. The Tribunal is satisfied that the requirements of Schedule 2 in a number of respects were breached by Dr Barratt as he used only the word “Meds” to describe the prescription of certain drugs to Patient B.
37. Particular 34 is an omnibus particular which alleges that Dr Barratt breached the condition imposed by the Medical Board as to the obtaining of an authority in relation to a large number of patients, including Patient B. It is apparent that Dr Barratt had an authority for Patient B which expired on 1 December 1995. No further authorities were requested until one for 13 April 2000 to 1 March 2003. Accordingly there were 21 occasions when Dr Barratt prescribed Endone for Patient B without authority. The Tribunal finds he was in breach of the relevant condition on his right to practice in each case.
Patient C
“8. On or about 7 January 1999, the practitioner prescribed Morphine to Patient C, and failed to make a record of
(a) The name, strength and quantity prescribed; and/or
(b) The date that it was prescribed; and/or
(c) The directions for use as shown on the prescription,
contrary to the requirements of Clause 84 of the Poisons and Therapeutic Goods Regulation 1994.
- 9. On or about 17 May 1999, the practitioner prescribed Endone to Patient C, and failed to make a record of:
(a) The name, strength and quantity prescribed; and/or
(b) The date that it was prescribed; and/or
(c) The directions for use as shown on the prescription,
contrary to the requirements of Clause 84 of the Poisons and Therapeutic Goods Regulation 1994.
10. On 9 February 2000 and 15 February 2000, the practitioner issued prescriptions for Ms Contin to Patient C without including the strength and quantity in words, contrary to Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
11. Between January 1999 and 15 February 2000 the practitioner prescribed Diazepam, Nitrazepam and Andriol to Patient C, on the dates and in the quantities shown in Schedule C, and failed to make a record of:
- (a) The name, strength and quantity of the drug prescribed and the date on which it was prescribed; and/or
(b) The maximum number of times the drug may be supplied on the prescription; and/or
(c) The directions for use as shown on the prescription,
contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
12. The practitioner failed to keep adequate records in respect of the treatment provided to Patient C contrary to the provisions of Schedule 2 of the Medical Practice Act Regulation.
From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules …C … the practitioner prescribed the following drugs of addiction in contravention of that condition:
- Patient C – Morphine and Endone.”
38. There are two records of dispensing of MS Contin (Morphine) on 7 January 1999. One is for 20 tablets at 30mg and the other is for 20 tablets at 60mg. There is an entry for this patient in Dr Barratt’s records of 11 November 1998, with the next entry being 27 January 1999. There is no reference in the records to a prescription for Patient C of MS Contin or Morphine. Dr Barratt said in cross examination he may have seen the patient in Glen Innes Hospital. When the hearing was adjourned a summons was issued to that hospital for the production of records. None were produced relating to Patient C (Ex G). Dr Barratt said when that was drawn to his attention that he doubted whether there were any other documents apart from those medical records in Tab 5 (Day 3, T8.39-30). The Tribunal concludes that Dr Barratt failed to make any notation of the prescription of MS Contin to Patient C on or about 7 January 1999. Dr Barratt agreed that this was a major omission (T55.04). The Tribunal finds that Dr Barratt was in breach of Regulation 84 of the Poisons and Therapeutic Goods Regulation 1994 in the way specified in Particular 8.
39. In respect of Particular 9, it is clear from the patient history report provided by Fayle’s Pharmacy that Dr Barratt wrote a prescription for Endone 5mg for Patient C on or before 17 May 1999. The medical records show a gap between 12 May and 21 May 1999. There is no record for the 17 May 1999. Nor is there is an entry for Endone in any of the records prior to that date. The Tribunal infers that Dr Barratt failed to make any relevant notation with respect to the prescription of Endone 5mg on or about 17 May 1999. This is a breach of Regulation 84 of the said Regulations.
40. Particular 10 concerns the adequacy of the records on the scripts provided to Patient C by Dr Barratt. Those scripts are dated 9 and 16 February 2000 and each details a prescription of MS Contin 60mg and a direction for use. Particular 10 complains only that Dr Barratt failed to write the strength and quantity of the said drug in words . We are satisfied he did so fail. By failing to do so, Dr Barratt breached Regulation 82(1)(c) of the said Regulation.
41. Particular 11 concerns Schedule 4D drugs, Diazepam, Nitrazepam and Andriol. The particular states that Dr Barratt failed to make a record of certain attributes for those drugs, namely the name, strength, quantity of the drug prescribed, the date prescribed, the maximum number of times the drug may be supplied on the prescription and the directions for use. Those are all requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994. Dr Barratt wrote prescriptions for Rohypnol, according to his notes, on 16 April 1999 and 27 May 1999 and Andriol on 29 September 1999. There are corresponding records in the pharmacy dispensing records on those dates. The Tribunal concludes that the prescriptions noted on those dates were dispensed on those dates. While the name of the drug appears in the medical notes the other attributes required by clause 40 have not been included and, accordingly we find that regulation has been breached.
42. Particular 12 concerns the keeping of adequate notes under the Medical Practice Regulation. The complainant relies on the same evidence which supports particulars 8, 9, and 11. We find the particular is made out.
43. Particular 34 concerns one request for an authority for Mr Drennert. It is dated 9 February 2000, the same day MS Contin was dispensed to Patent C under Dr Barratt’s apparent authorisation. The request was rejected by the PSB in a letter dated 15 February 2000 because an authority was held by another practitioner. However, Dr Barratt appears to have issued a further script for MS Contin which was dispensed on 15 February 2000. Accordingly there were two prescriptions of a Schedule 8 drug in contravention of the practice condition, on each of 9 and 15 February 2000.
44. Dr Barratt said he suspected that Patient C may have been at risk of addiction (T53.16) but he did not inquire with the PSB as to whether it was appropriate to prescribe a Schedule 8 drug to him. Without obtaining an authority he prescribed the drug twice before he received a reply from the PSB. Dr Barratt agreed that it would have been prudent not to prescribe that drug until he received an authority (T64.31).
45. The Tribunal finds Particular 12 made out insofar as it relates to this patient.
Patient D
“13. Between 12 October 1999 and 14 January 2000, the practitioner prescribed Morphine to Patient D, on the dates and in the quantities shown in the Schedule D, without obtaining an authority to prescribe for a period exceeding two months, contrary to Section 28 of the Poisons and Therapeutic Goods Act 1966.
14. Between 12 October 1999 and 14 January 2000, the practitioner issued prescriptions for Morphine to Patient D:
(a) Without recording the strength and quantity of the Morphine in words; and/or
(b) Without providing adequate directions for use,
contrary to requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
15. On 21 December 1999 the practitioner prescribed Morphine Sulfate and Maxolon on the same prescription form to Patient D, contrary to clause 82(5) of the Poisons and Therapeutic Goods Regulation 1994.”
46. The Commission did not pursue Particular 13.
47. Particular 14 concerns the adequacy of the scripts issued for a Schedule 8 drug between 12 October and 23 November 1999. The scripts are in evidence at Tab 6. Each bears Dr Barratt’s signature, name and practice address. Of the 12 scripts for MS Contin, only the first has any directions for use noted. None contains the strength and quantity in words. We find there is a breach of Regulation 82(1).
48. Particular 15 concerns the prescription of multiple drugs including a Schedule 8 drug on the one script, in breach of Regulation 82(5) of the Regulations. The offending script is that dated 21 December 1999 which is in evidence at Tab 6. We find this particular made out.
Patient E
“16. Between February 1999 and 8 March 2000, the practitioner prescribed Diazepam, Dextropropoxphene and Flunitrazepam to Patient E, on the dates and in the quantities shown in Schedule E, and failed to make a record of:
(a) The name, strength and quantity of the drug prescribed and the date on which it was prescribed; and/or
(b) The maximum number of times the drug may be supplied on the prescription; and/or
(c) The directions for use as shown on the prescription,
contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
17. The practitioner failed to make adequate records in respect of the treatment provided to Patient E contrary to Schedule 2 of the Medical Practice Act Regulation.
49. The Commission did not pursue Particular 16.
50. The Tribunal is not satisfied Particular 17 is made out.
Patient F
“18. On or about 25 June 1999 and on 1 July 1999, the practitioner prescribed Diazepam and Flunitrazepam to Patient F, in the quantities shown in Schedule F, and failed to make a record of:
(a) The name, strength and quantity of the drug prescribed; and/or
(b) The maximum number of times the drug may be supplied on the prescription; and/or
(c) The directions for use as shown on the prescription,
contrary to Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.”
51. The prescriptions of Rohypnol noted in Dr Barratt’s notes for Patient F on 25 June 1999 and 2 July 1999 do not satisfy the requirements of Regulation 40 save that they state the drug prescribed. This particular is made out.
Patient G
“19. Between 7 December 1999 and 10 March 2000, the practitioner prescribed Morphine to Patient G, on the dates and in the quantities shown in Schedule G, without obtaining an authority to prescribe for a period exceeding two months, contrary to Section 28 of the Poisons and Therapeutic Goods Act 1966.
20. Between 15 June 1999 and 10 March 2000 the practitioner issued prescriptions of Morphine to Patient G, on the dates and in the quantities shown in Schedule G:
(a) Without recording the strength and quantity of the Morphine in words; and/or
(b) Providing adequate directions for use,
contrary to the requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
- 34. From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules …G … the practitioner prescribed the following drugs of addiction in contravention of that condition:
- Patient G – Morphine (between August 1999 and 24 November 1999 Morphine injections and between December 1999 and March 2000 all Morphine).”
52. Patient G suffered from multiple sclerosis and was bedridden during the time she was treated by Dr Barratt. During the relevant time there were three authorities:
(a) 29 December 1998 to 1 December 1999 for Morphine Sulphate oral form 10mg;
(b) 13 April 2000 to 1 March 20003 for Morphine Sulphate oral form 10mg; and
(c) 12 May 2000 to 1 March 2003 for Morphine.
53. Dr Barratt told the Tribunal the patient’s husband would come to his surgery to pick up her prescriptions. He never saw her at his rooms – only at her house or in hospital or a nursing home.
54. It is apparent that Dr Barratt had no authority for the prescription of a Schedule 8 drug during the period 2 December 1999 to 12 April 2000 inclusive.
55. Patient G was not hospitalised at the times in Particular 19, her last admission having been 17-23 December 1998 (Ex K).
56. According to the dispensing record from Timbs Pharmacy Patient G was prescribed MS Contin from 13 January 1999. The two month period was therefore exceeded on 14 March 1999 but Dr Barratt held an authority until 1 December 1999 (at least in relation to the oral form of Morphine). When the authority expired he was in breach of s.28. He gave 13 prescriptions of Morphine during the period when the authority had expired. 12 of those prescriptions are supported by a copy of the relevant script and all 13 by a summary from Timbs Pharmacy. Particular 19 is made out.
57. As to Particular 20 Dr Barratt confirmed he had no surgery notes for Patient G (Day 3, T15.13-22, T15.55-T16.02). He transferred what notes he had to Bourke Street Medical Centre. No clinical notes were contained in the material returned on summons from that medical centre (Day 3, T16.09). Although the Roseneath notes were not in evidence it is apparent that Patient G was resident there from 20 to 21 October 1999, 9 and 23 November 1999, because that is the address that appears on scripts with those dates. Otherwise Patient G was cared for at home by her husband and the address on the scripts is her residential address. There are 39 occasions remaining, when a Schedule 8 drug was prescribed by Dr Barratt, with no note being made in his medical records. (25 of those occasions are evidenced by scripts signed by Dr Barratt.) The Tribunal finds in respect of Particular 19 it is made out, save in respect of Schedule G for 20, 21 October 1999 and 9, 23 November 1999. The Tribunal finds Particular 20 made out. The Tribunal finds in relation to this patient Particular 34 made out, save in respect of Schedule G entries for 20 and 21 October 1999 and 9 and 23 November 1999.
58. Concerning Particular 34 Dr Barratt had no authority for the prescription of Morphine in injectable form (used as a topical ointment) until 12 May 2000. He prescribed such drugs on 11 and 27 August, 17 September, 5 and 21 October, 8 and 23 November 1999, 6 and 31 January, 18 February and 10 March 2000. To that extent Particular 34 as it concerns this patient, is made out.
Patient H
“23. Between about January 1999 and January 2000, the practitioner prescribed Diazepam and Flunitrazepam to Patient H, on the dates and in the quantities shown in Schedule H, and failed to make a record of:
(a) The name, strength and quantity of the drug prescribed; and/or
(b) The maximum number of times the drug may be supplied on the prescription; and/or
(c) The directions for use as shown on the prescription,
contrary to Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
24. The practitioner failed to make adequate records in respect of the treatment provided to Patient H contrary to Schedule 2 of the Medical Practice Act Regulation.”
59. Dr Barratt accepted that the totality of his notes with respect to Patient H were those at Tab 10 of Exhibit A (Day 3, T17.29-33).
60. According to the dispensing records Rohypnol and Valium were dispensed to Patient H under Dr Barratt’s name 9 times in the period 5 January 1999 to 24 January 2000. The only entries in Dr Barratt’s notes that appear to coincide are those dated 5 January 1999, 28 October 1999 and 24 January 2000. Dr Barratt conceded he did not see the patient at Glen Innes Hospital. The Tribunal concludes that Dr Barratt prescribed a Schedule 4D drug 9 times but made a note on only 3 occasions and that the notes made did not satisfy the requirements of Regulation 40. This Complaint is made out.
2. For the same reasons, the Tribunal finds Dr Barratt was in breach of Schedule 2 Medical Practice Regulation.
Patient I
“25. On 3 March 1994 the practitioner prescribed Morphine to Patient I without recording the quantity and strength prescribed and the directions for use as shown on the prescription, contrary to the requirements of Clause 84 of the Poisons and Therapeutic Goods Regulation 1994.
26. Between about 26 July 1999 and 16 March 2000 the practitioner prescribed Dextropropoxphene and Flunitrazepam to Patient I, on the dates and in the quantities shown in Schedule I, and failed to make a record of:
(a) The name, strength and quantity of the drug prescribed; and/or
(b) The directions for use as shown on the prescription,
contrary to the requirements of Clause 40 of the Poisons and Therapeutic Goods Regulation 1994.
27. The practitioner failed to make adequate records in respect of the treatment provided to Patient I contrary to Schedule 2 of the Medical Practice Act Regulation.”
61. Dr Barratt’s clinical records for Patient I of 3 March 1995 note that MS Contin was prescribed to him on that date. Contrary to Regulation 84 no detail is provided of the strength and quantity of the MS Contin prescribed.
62. Dr Barratt accepted that the totality of his medical records in relation to Patient I were those in Tab 11 of Exhibit A and that he did not see him in Glen Innes Hospital in the relevant period.
63. According to the dispensing records from Timbs and Fayles Pharmacies there were 6 occasions, 4 June 1999, 26 July 1999, 8 September, 1 December 1999 and 16 February and 16 March 2000 when Rohypnol, Paradex or Hypnodorm (Schedule 4D drugs) were dispensed, apparently, by reason of Dr Barratt’s prescription. The Tribunal finds that Dr Barratt wrote those prescriptions on or about the dates the drugs were dispensed and that he failed to make appropriate notes at all in his records, in breach of Regulation 40.
64. The same evidence is relied on in relation to Particular 27. The Tribunal finds that Dr Barratt was in breach of Schedule 2 Medical Practice Regulation.
Patient J
“28. Between 15 October 1999 and 14 March 2000, the practitioner prescribed Morphine to Patient J, on the dates and in the quantities shown in Schedule J, without obtaining an authority to prescribe for a period exceeding two months, contrary to Section 28 of the Poisons and Therapeutic Goods Act 1966.”
65. The Commission did not pursue this particular.
Patient K
“29. Between 20 June 1999 and 18 February 2000, the practitioner issued prescriptions for Endone to Patient K, on the date and in the quantities shown in Schedule K:
(a) Without recording the name, strength and quantity in words; and
(b) Prescribing other substances using the same prescription form,
contrary to the requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.”
66. Four scripts are relied on in support of this Particular: 20 June, 22 September,21 December 1999 and 18 February 2000. The Tribunal is satisfied this particular is made out.
Patient L
“30. On 14 February 2000, the practitioner issued prescriptions for MS Contin to Patient L without recording the strength and quantity of the MS Contin in words, contrary to the requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules …L … the practitioner prescribed the following drugs of addiction in contravention of that condition:
- Patient L – MS Contin.”
67. Dr Barratt kept no note of the prescription of MS Contin on 14 February 2000. Accordingly there is a failure to satisfy Regulation 82, and Particular 30 is made out.
68. Only one script is relied on in relation to this patient: one dated 14 February 2000, being for MS Contin. Dr Barratt did not have an authority at that date but applied for one on 15 February 2000. An authority was granted on 17 February 2000. Particular 34 is made out.
Patient M
“31. On 7 July 1999, the practitioner issued a prescription for Endone to Patient M without recording the strength and quantity in words, contrary to the requirements of Clause 82 of the Poisons and Therapeutic Goods Regulation 1994.
- 34. From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules …M … the practitioner prescribed the following drugs of addiction in contravention of that condition:
Patient M – Endone.”
69. Dr Barratt’s script of 7 July 1999 for Patient M for Endone 5 mg is in evidence. The strength and quantity are not recorded on that script. There is therefore a breach of Regulation 82 and Particular 31 is made out.
3. Dr Barratt conceded he had no authority to prescribe Endone to Patient M on that date (T91.25-35). An authority was applied for on 7 July 1999 but not granted until 9 July 1999. Particular 34 is made out.
Patient N
“32. On or about 12 June 1999, the practitioner prescribed MS Contin to Patient N and failed to make a record of:
(a) The name, strength and quantity of MS Contin prescribed;
(b) The date that it was prescribed; and
(c) The directions for use as written in the prescription,
contrary to Clause 84 of the Poisons and Therapeutic Goods Regulation 1994.
The practitioner failed to make adequate records in respect of the treatment provided to Patient N contrary to Schedule 2 of the Medical Practice Act Regulation.”
70. The patient was in a public hospital from 19 May 1999 to 12 June 1999. So Particular 34, in relation to this patient, is not pursued by the Commission. Although MS Contin is not referred to in the hospital notes as having been prescribed when he was an in-patient, by reason of the date of the prescription and its co-inciding with the date he was still hospitalised, albeit prior to his discharge that day, the Tribunal is not persuaded Particulars 32 and 33 are made out.
Patient O
“34. From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules …O … the practitioner prescribed the following drugs of addiction in contravention of that condition:
Patient O – Morphine.”
71. The Commission did not pursue this particular.
Patient P
“34. From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules …P … the practitioner prescribed the following drugs of addiction in contravention of that condition:
Patient P – Morphine.”
72. The Commission did not pursue this particular.
Patient Q
“34. From 6 May 1987 until 11 May 2001, the practitioner’s registration was subject to a condition that he not prescribe drugs of addiction without prior authority, otherwise than to authorise administration to a hospital patient. On the dates and times set out in Schedules …Q… the practitioner prescribed the following drugs of addiction in contravention of that condition:
Patient Q – Pethidine.”
73. Included in Tab 19 is a copy of a dispensing record from Graydon’s Amcal Pharmacy for Pethidine 100mg on 23 June 1999 under Dr Barratt’s name. No documents concerning any admission were produced by Glenn Innes Hospital (Ex G). The Tribunal finds that Dr Barratt on or about 23 June 1999 wrote a script for Patient Q for Pethidine. Dr Barratt said that he did not doubt “at all” that he had written the prescription but said he was unsure why he would write such a script as he had not administered Pethidine to Patient Q (Day 3, T43.28-36, 43.52-44.05).
74. Dr Barratt had an authority at the relevant time with respect to Patient Q but only for Methadone 10mg, a different drug. The authority was for the period 2 March 1999 to 1 March 2001. This particular is made out.
CONCLUSION
75. The Commission has substantially succeeded in proving that which it set out to do. Dr Barratt made no effort to avoid responsibility for the various ways in which his breaches of regulations were laid out before the Tribunal. He said, though, in relation to his failures to obtain approval for prescribing Schedule 8 drugs, he had assumed a “tacit approval” of the relevant authorities as he was never prosecuted or proceeded against. The Tribunal is satisfied that from time to time he told members of the Pharmaceutical Services Branch of the Department of Health that he had written prescriptions for Schedule 8 drugs without prior authorities. He conceded members he spoke to had been careful not to give any approval to such a practice. The Tribunal accepts Dr Barratt was one of a small number of doctors in a small country town, and there would have been occasions when there was no other doctor available to write a script for a patient of his in need of a Schedule 8 drug. Members and former members of the Pharmaceutical Services Branch conceded, in cross examination by Dr Barratt, this would present a problem for a doctor in his position.
76. However it is clear from the days of the week when Schedule 8 drugs were prescribed without authority, that there were few days such as weekends or public holidays when these difficulties would have arisen. And in any event the fact there was a difficulty did not give a licence to Dr Barratt to disregard the conditions on his rights to practice.
77. The Tribunal is satisfied none of the Pharmaceutical Services Branch officers who gave evidence gave Dr Barratt any licence to adopt or continue a practice where he prescribed first and sought approval later. But except insofar as he says tacit approval was given by not prosecuting him, Dr Barratt never claimed they did.
78. The Tribunal is satisfied the breaches proved were serious. We turn to consider how his conduct was regarded by his peers.
79. Dr Clare Cupitt, a country general practitioner who was asked by the Commission to express a view about his conduct, said she was “moderately” critical of him concerning breaches of conditions of registration. As to breaches of restrictions on his Schedule 8 authority and consequential breaches of regulations, she was “mildly” critical of him for writing more than one drug on one form, which she said was a mark of clinical sloppiness. That conduct fell below the accepted standard to a “mild” degree, in her view. The same comment applied to his failure to note strengths and names of drugs prescribed, quantities in words and numbers, and directions.
80. Overall, she was not greatly critical of his conduct. And of course the complaints referred to her included a number the Commission did not proceed with before the Tribunal. Dr Cupitt had before her a number of apparently glowing testimonials about Dr Barratt which unfortunately were not tendered to the Tribunal.
81. Another country general practitioner, Dr Ken Mackey, who, we infer, was given the same material, expressed considerable sympathy for Dr Barratt’s position, concluding that overall he should be “moderately” criticized for failing to comply with a reasonable standard of medical care.
82. There was little material before the Tribunal about Dr Barratt’s personal circumstances. In particular, there was little evidence about Dr Barratt’s health, though it is clear his health has at times been poor. His health was not relevant to the complaints made against him, so was not explored in evidence. He has not practised for 3 years. He lives with his wife and 2 young children on a small hobby farm some distance from Glen Innes. He was, when in practice, caring for the needs of, as he put it, the “poor end of town”. Many of his patients were elderly and had chronic conditions. His was the only practice in Glenn Innes which bulk billed. The complaint which gave rise to these proceedings has, we are satisfied, been the cause of considerable stress to Dr Barratt. It is apparent from the patient records he made and from the Tribunal’s observations of him, that he is a caring and knowledgeable doctor.
83. The Commission submitted that the Tribunal ought make a finding of professional misconduct. However by reason of the nature of the particulars proved, Dr Barratt’s ready acceptance of his shortcomings and the views of Drs Pupitt and Mackey, we are not satisfied his conduct is such that a finding of professional misconduct is warranted.
84. The Tribunal is however satisfied Dr Barratt’s conduct in the way proved by the Commission does amount to unsatisfactory professional conduct. Dr Barratt does not argue to the contrary.
85. Dr Barratt readily concedes he must have restrictions placed on him should he attempt to resume practice. In submissions, counsel for the Commission put forward for the Tribunal’s consideration a set of appropriate conditions. Dr Barratt has told the Tribunal he agrees they are appropriate.
86. The Commission submitted the appropriate punishment was a reprimand. The Tribunal agrees.
87. There was no argument addressed to us on the question of costs. An adjournment of some months was necessitated by the Commission’s not having all documents available. Dr Barratt was unrepresented. The Tribunal considers it appropriate to make no order as to costs.
FINDINGS AND ORDERS
1. The Tribunal finds Dr Barratt guilty of unsatisfactory professional conduct.
2. Dr Barratt is reprimanded.
3. Should any application be made by Dr Barratt for a practising certificate, it shall be a condition of his registration that:
(a) he enter supervised employment in a public hospital for a period of 2 years to be approved by the Medical Board.
(b) his authority to prescribe Schedule 8 and Schedule 4D drugs remain withdrawn.
(c) he not prescribe, possess, (save for his own treatment and when prescribed by another doctor), handle, or administer, Schedule 8 or Schedule 4D drugs.
(d) he provide a copy of these conditions to his employer within 7 days of commencing employment at the public hospital.
(e) If he returns to private practice after the expiry of the period in (a) above, his registration will be subject to the following conditions:
(i) he not work in sole practice;
(ii) he not have authority to prescribe, possess, handle or administer Schedule 8 or Schedule 4D drugs;
(iii) he be supervised by a supervisor approved by the Board and at a level approved by the Board;
(iv) he conduct monthly case and record reviews with a mentor approved by the Board;
(v) he authorise the supervisor and mentor to report to the Board once per month;
(vi) the conditions (i) to (v) continue for a period of 2 years or such longer period as the Medical Board thinks fit;
(vii) he provide a copy of these conditions to all practitioners with whom he is associated in any medical practice within 7 days of commencing employment at the private practice.
(Sgd) Judge S L Walmsley SC (Sgd) Dr J Brow
(Sgd) Dr B Kotze (Sgd) Dr C Berglund
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