In Re Dr Gregory WILCOX

[2007] NSWMT 3

New South Wales

Medical Tribunal

CITATION:	In Re Dr Gregory WILCOX [2007] NSWMT 3
TRIBUNAL:	Medical Tribunal
PARTIES:	Health Care Complaints Commission (Applicant) Dr Gregory Wilcox (Respondent)
FILE NUMBER(S):	40015 of 2006
CORAM:	Walmsley, SC DCJ - Gordon, Dr P - Pasfield, Dr M - Deveson, AO Ms A
CATCHWORDS:	Professional Misconduct - Unsatisfactory Professional Conduct
LEGISLATION CITED:	Drug Misuse and Trafficking Act 1985 Schedule 1 Medical Practice Act, 1992 s. 66(1)(b) Medical Practice Regulations 1998, Reg. 13(1) Poison and Therapeutic Goods Regulation 2002 cll 33 and 53 Poison and Therapeutic Goods Regulation 1994 cll 36 and 57
CASES CITED:	Pillai v Messiter (No 2) (1989) 16 NSWLR 197; Spicer v The New South Wales Medical Board and Others (unreported decision of the Court of Appeal, on 19 February 1981)
DATES OF HEARING:	23 April 2007 24 April 2007 26 April 2007
EX TEMPORE JUDGMENT DATE :	26 April 2007
LEGAL REPRESENTATIVES:	Ms V.A. Hartstein (Applicant) Mr J Young (Respondent)
ORDERS:	Finding: The Tribunal finds Dr Wilcox’ conduct constitutes unsatisfactory professional conduct and professional misconduct; Orders:1.Pursuant to section 61(1)(a) of the Medical Practice Act 1992 the Tribunal reprimands Dr Wilcox; 2.Pursuant to section 62 of the Act Dr Wilcox is to pay a fine of $25,000 to the NSW Medical Board within 28 days of the Tribunal’s decision; 3.Pursuant to Section 61(1)(c) of the Act the Tribunal directs that the following conditions be imposed on Dr Wilcox’s registration: Practice Conditions:(i)Not to purchase or otherwise obtain, possess, take delivery of, administer, prescribe or supply any prescribed restricted substances in Schedule 4 Appendix D of the NSW Poisons List; (ii)Any future change in his prescribing authorities must be in accordance with the NSW Medical Board's protocol; (iii)To treat no more than 150 patients in any one week; (iv)To seek NSW Medical Board approval prior to any change in the nature or place of practice; (v)To consent to any exchange of information between the NSW Medical Board and Medicare Australia or the Pharmaceutical Services Branch that is necessary to facilitate the monitoring of compliance with these conditions; (vi)After 26th June 2007 all of his progress notes, test ordering, prescriptions, referrals and other notes required by Cl 13 Medical Practice Regulations 1998 be recorded by the computer programme “Medical Director” or such other programme as is approved by the Board; (vii)Dr Wilcox is to submit to an audit of his medical practice, especially the computerisation of his records, by a person or persons nominated by the Board, by 26th July 2007, and thereafter at least every 6 months. The audits are to be at Dr Wilcox’ expense; (viii)These Practice Conditions may be reviewed by the NSW Medical Board; Health Conditions:(ix)Not to prescribe for self-medication; (x)To attend for treatment by a general practitioner of choice, at a frequency to be determined by Dr Wilcox and the treating practitioner and to authorise the treating practitioner to inform the NSW Medical Board of any failure to attend for treatment, or of termination of treatment or if there is a significant change in health status (including a significant temporary change); (xi)Not to self-administer: (a)any substance detailed in Appendix D of Schedule 4 or Schedule 8 of the NSW Poisons List or ; (b)Schedule 1 of the Drug Misuse and Trafficking Act 1985 (c)any narcotic derivative, non-prescription compound analgesic or cold medication; Such medications should only be prescribed and taken at the direction of his treating practitioner; (xii)That should he be prescribed or directed to take:(a)a substance detailed in Appendix D of Schedule 4 of the NSW Poisons List, ; (b)a narcotic derivative, or (c)a non-prescription compound analgesic or cold medication, ; he must notify the NSW Medical Board-nominated psychiatrist and the NSW Medical Board. In addition, within seven days he must provide the NSW Medical Board with written confirmation from his treating practitioner of such prescription or direction ; (xiii)To attend for treatment by a psychiatrist of choice at a frequency to be determined by the treating psychiatrist and to authorise the treating psychiatrist to inform the NSW Medical Board of any failure to attend for treatment, termination of treatment or if there is a significant change in health status (including a significant temporary change); (xiv)To continue taking any medication prescribed by the treating psychiatrist; (xv)To attend for treatment by an endocrinologist of choice, at a frequency to be determined by the treating endocrinologist and to authorise the treating endocrinologist to inform the NSW Medical Board of failure to attend for treatment, termination of treatment or if there is a significant change in health status (including a significant temporary change); (xvi)To continue taking any medication prescribed by the treating endocrinologist; (xvii)To attend for review by a Board-nominated psychiatrist on a twelve-monthly basis, at the NSW Medical Board's expense; (xviii)To attend a Review Interview at the NSW Medical Board on a six-monthly basis or as otherwise directed by the NSW Medical Board; (xix)To authorise the NSW Medical Board to forward copies of Impaired Registrants Panel reports, Board Review Interview reports and other information relevant to his impairment to the Board-nominated practitioners and his treating practitioners; (xx)These Health Conditions are to be monitored by the Health Committee and may be reviewed at the discretion of the NSW Medical Board or its Health Committee; Costs:4.The practitioner to pay the costs of the Applicant

JUDGMENT:

DEPUTY CHAIRPERSON:

1 In Spicer v The New South Wales Medical Board and Others , (unreported decision of the Court of Appeal on 19 February 1981), Hope JA said this (with which the other two members of the court agreed):

“It is clear beyond argument that the proper handling and prescribing of drugs by medical practitioners are of the greatest importance to the community. If a medical practitioner handles or carries out that very great responsibility in a way which is reckless and which shows a disregard for the law, it cannot be said he is fit at such time to be a medical practitioner.”

2 In a publication by the Pharmaceutical Services Branch of the New South Wales Health Department of July 1997 called ‘Anabolic Androgenic Steroids Information for Medical Practitioners’ , the publication, amongst other things, said this:

“The use of anabolic androgenic steroids by men and women to enhance sporting performance or physical appearance is an emerging problem of drug abuse. While these drugs have had the potential for misuse in sport by competitive athletes for several years, there is evidence that a problem has arisen from the use of these drugs for recreational or cosmetic purposes. Some of the groups who use the drugs to improve their physique and self image are body builders, users of gymnasia and adolescence, bouncers and security guards.”

3 However, the use of anabolic androgenic steroids has a number of adverse effects, including on the liver and on the psyche.

4 The medical indications for prescribing anabolic androgenic steroids include androgen replacement therapy for hypogonadism. That term may be described as a medical term for a defect of the reproductive system which results in lack of function of the gonads, that is the ovaries or the testicles.

5 Relevantly for this application another significant aspect of the practice of medicine appears from regulation 13 of the Medical Practice Regulation 1998. It relates to the recording of information about patients. Regulation 13(1) says:

“A registered medical practitioner or medical corporation engaged in the provision of medical services must, in accordance with clauses 14 to 17 and sch 2, make and keep a record or ensure that a record is made and kept for each patient of the medical practitioner or corporation.”

6 Schedule 2 provides that a record must contain sufficient information to identify the patient to whom it relates and include any information known to the practitioner who provides the treatment or services relevant to the diagnosis or treatment, such as information about the medical history, the results of examinations and the like, particulars of any clinical opinions reached, any plan of treatment, and any particulars of any medication prescribed. The record must include notes about information or advice given to the patient about the treatment, and must include the date, the nature of the treatment, the name or names of the people who gave or performed it. In general terms, the level of detail contained in the record must be appropriate to the case and to the medical practice concerned. A record must include sufficient information concerning the patient’s case to allow another registered medical practitioner to continue management of the patient’s case.

7 This application concerns a complaint by the HCCC that Dr Wilcox was guilty of unsatisfactory professional conduct and/or professional misconduct in his practice as a medical practitioner in connection with the prescription and use of drugs and in connection with his records of treatment. As well, it concerns allegations that he failed to comply with certain conditions which restricted his right to practice.

8 The HCCC particularised the alleged conduct. There are six particulars to the complaint. The first is that he supplied and/or prescribed human Chorionic Gonadotrophin or Pregnyl to patients A to M on certain dates and in a quantity shown in sch B in a manner not in accordance with cll 36 and 57 of the Poison and Therapeutic Goods Regulation 1994 and cll 33 and 53 of the Poisons and Therapeutic Goods Regulation 2002 and without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions and/or supply such drugs. The second part relates to the inappropriate supply or prescription or administering of a non-steroidal anti-oestrogen, namely Clomid, to certain patients contrary to the same regulations. The third part relates to inappropriate supply prescription and the like of testosterone in various forms to certain patients there particularised and contrary to the provisions of the same regulations. The fourth says that he failed to make proper records of his treatment of patients whose particulars are there set out, contrary to the requirements of cl 13, Medical Practice Regulations 1998 to which I have earlier drawn attention; also, I should add cll 37 and 55 of the Poisons and Therapeutic Goods Regulation . The fifth particular is that on 18 August 2003 the Board imposed a number of health and employment conditions on his registration pursuant to s 66(1)(b) of the Act, condition 4 of which stated he was not to recommence in general practice prior to 18 October 2003 and that on recommencement he was not to work more than three days per week not more than one Saturday in three.

9 There were in the 5th particular three allegations made. The first was that he worked in general practice on 20 August 2003. (That allegation was withdrawn at the hearing). The second was that on the occasion set out in a schedule he worked more than three days per week. The third was that by working on 1 November 2003, 13 March 2004 and 22 May 2004, he worked more than one Saturday in three.

10 The sixth particular, one which was added recently by amending the complaint, relied on three relatively recent alleged breaches of conditions that he not prescribe sch 4D substances without authority. Those involved one on 19 October 2006 when he wrote a prescription for Androderm, which is a transdermal testosterone, one between June and 28 December 2006 when he wrote a prescription for a drug for patient N, and one on 14 February 2007 when he wrote a prescription for an anabolic androgenic steroid for another patient. All three were said to be contrary to the condition that he not prescribe sch 4 drugs.

11 Following a complaint to the New South Wales Medical Board in 2003 an inquiry was established and held under the provisions of s 66 of the Act. This occurred on 18 August 2003. It concerned his involvement with prescribed drugs. It followed an investigation of his purchases from a pharmaceutical wholesaler of large quantities of anabolic/androgenic steroids and pituitary hormones. Based on information he gave the Pharmaceutical Services Branch of the Department of Health, there was an appearance that he could not account for certain drugs in those categories. The inquiry concluded with the delegates imposing on him stringent conditions, including that he surrender to the Pharmaceutical Services Branch certain therapeutic substances, that he not buy or possess sch 4D drugs or Clomid, that he not recommence general practice until 18 October, (which effectively meant that he was not to practise for three months), that he not work more than three days per week, nor any more than one Saturday in three. He was also subjected to stringent health conditions. There was no appeal from those orders. He gave an undertaking to comply.

12 It appears Dr Wilcox had in the past developed a keen interest in what he called female androgen deficiency syndrome and androgen deficiency in males. In a lengthy and detailed response to the HCCC’s outline of complaints about his practices, he said that the various events of 2003 had caused him to have a serious reappraisal. He concluded he had taken on too much work and in isolation and that his judgment and ability to resist patient manipulation had been impaired by his workload and mental state. He conceded he had inadequate documentation, that his accounting and invoicing were inadequate, that he appreciated that the treatment of substance abuse was best conducted in large multidisciplinary centres with rigid protocols based on general consensus, and that he had made changes to his practice, including referring to other doctors patients receiving testosterone supplementation. He had also reduced the number of patients he saw to 180 per week. This allowed for better documentation and improved service. He assured the HCCC that he was complying with the various restrictions and wanted to reassure the HCCC that his mistakes were those of an overworked doctor trying to pursue a medical interest in hypogonadism and falling into traps in the field.

13 However, following the s.66 inquiry, Dr Wilcox almost immediately worked contrary to the conditions of practice. This resulted in complaint particulars 5(ii) and (iii). The breaches were particularised in a statutory declaration by Mr Dix of 2 March 2005.

14 After the HCCC became involved in the matters revealed at the s.66 inquiry in 2003, a request was made to a general practitioner, Dr Chung, for an opinion about Dr Wilcox’s conduct. He noted that there had been a prescribing of anabolic androgenic steroids to patients in large quantities and on a regular and repeated basis, that he had not recorded medical indications for much of this prescribing, that many of the patients appeared to be, and to the knowledge of Dr Wilcox, body builders, and that he had not recorded dosages, quantities of drug supplied and the like.

15 He noted Dr Wilcox’s response, being to blame the busy nature of his practice. He said concern must be expressed about his practice. He was severely critical of his failure to comply with conditions of his medical registration and said his conduct attracted his severe disapproval and, in his opinion, would attract the severe disapproval of peers of good repute.

16 Dr Wilcox in a letter of 4 August 2004, referring to those breaches, which, of course, had been by then well and truly drawn to his attention, said it was his clear intention and firm commitment to comply with the conditions imposed by the Board. He said he realised for the good of his practice and his own mental health, he must limit his workload. At the same time the Medical Defence Union, acting on his behalf, submitted to the HCCC that there was no breach of condition, but if there were it was an innocent one, and would not be regarded as ‘unsatisfactory professional conduct’.

17 The HCCC then sought an opinion from specialist endocrinologist Professor Handelsman. He reported with his views on 1 November 2004, having had a substantial quantity of records and other documents concerning Dr Wilcox’s practice referred to him for his comment. At page he said:

“As a general comment the medical records are grossly inadequate. Almost all lack any, let alone a valid written indication for treatment. The physical examinations, if performed at all, at first or later visit are rarely, if ever, recorded. The follow up information is often barely more than a stamped date. Where the notes contain any actual text they are almost unintelligible. There is no indication of monitoring, discussions, referral or clear rationale for treatment. Common features of inappropriate treatment include prescribing of both Clomid and HCG together (neither justified), both sustanon and primoteston together or testosterone implants combined with another form of testosterone.”

18 He then set out specific adverse comments about particular patients. And on the final page of his report he concluded:

“Despite his grossly inadequate records, the pattern of prescribing clearly indicated that he was prescribing androgens and related drugs outside the limits accepted as recognised therapeutic purposes.”

19 He particularised that as prescribing androgens without a valid indication or rationale, prescribing excessive doses, continuing to prescribe androgenic drugs despite recognised adverse effects, (which should have prompted cessation), and failing to record or properly investigate men with possible hypogonadism. In each case, he said it was his belief that these departures from proper practice would invite the strong disapproval of the general body of endocrinology colleagues.

20 Following the 2003 s.66 Inquiry, Dr Wilcox’s progress was reviewed from time to time by a Medical Board panel. In its report of 14 October 2004 the panel noted, amongst other things, that he was apparently working reasonably effectively towards dealing with the Board’s programme. He had come to the Board’s attention, it was noted, in 1996, for self administration of opioids and benzodiazepines, and his s 8 rights were then suspended and he was required to submit periodically to urinalysis. It was noted that there had been some anomalous results, but in general he appeared to be compliant with conditions of practice and was aware that his practice was subject to audits.

21 In a review of 22 April 2005 it was noted that he appeared to be seeing an unusually large number of patients. There was an audit however suggesting there had been an improvement in his record keeping. His attention was drawn to efficiencies which computerisation might bring about but Dr Wilcox was apparently disinclined to change the way he recorded over to the computerised system until this Tribunal had sat and made its decision.

22 There was then another audit and the panel concluded:

“Dr Wilcox appears to be progressing adequately in the programme with no lapses in compliance. He agrees he is benefiting from the reduced work hours and all concerned are agreed that by some means this reduced workload should be maintained. The ongoing role of the Board in this remains to be determined. As always the support and involvement of Dr Wilcox’s wife has been crucial.”

23 Some minor easing of conditions was recommended.

24 On 4 April 2006 there was a further panel review and it was noted that he appeared to be maintaining stability in his life and functioning as a general practitioner and there was consensus that limitation on his working days was beneficial. There was then no evidence of self prescribing or inappropriate prescribing for others. He had demonstrated a considerable period by then of clear urines. He exhibited a laconic attitude to the Board’s programme, it seems, but it concluded that he was not uncooperative. It was noted that there was an anticipated Medical Tribunal hearing, (no doubt this one), which would impose some emotional stress and possibly generate ‘outcomes’ in terms of his practice. It was recommended that the requirement for urinalysis be lifted.

25 On 19 October 2006 Dr Wilcox prescribed a sch 4D drug, namely Androderm, which is transdermal testosterone, for another doctor’s patient; however, having done so he immediately notified the Pharmaceutical Services Board and gave an explanation and an undertaking not to let that happen again. There was a response from the Board on 22 November noting that the matter had been considered by the Health Committee which expressed considerable concern about his breach of condition, and noted that he at that stage, (as he reassured them he did), did in fact have a list of s 4D medications in his office.

26 There was then a further review. It was noted that while maintaining a high volume of patients, he appeared to be getting on well in the programme, benefiting from hours limitation. It was recommended that the frequency of the Board reviews be reduced to twelve monthly.

27 On 10 January 2007 the Board wrote to him to say that in view of the reviewer’s recommendations and the Health Committee’s resolution, he was not required for review for another twelve months.

28 Over the three and a half years or thereabouts since the s.66 inquiry, various audits of the practice were performed. On 12 January 2004 it was noted that he was seeing such a number of patients as to put him in breach of conditions. An audit was performed on 28 September 2004. This was by Dr Lele. He noted that there had been a new system introduced for records; however, he did not see much of an improvement in record keeping. He said that the recording of consultations was very brief and lacked details of history, physical examination, diagnosis or treatment in most cases; however, he observed that Dr Wilcox seemed to have very good rapport with his patients and that he had appropriate clinical judgment and recording on the day of the audit. There was then another audit conducted on 29 June by the same auditor, who, in a report of 14 July 2005, concluded that he had observed considerable improvement in the record keeping as compared to the previous audit, and he received a clear impression that Dr Wilcox’s method of practice and record keeping was satisfactory. He could find no obvious faults in his conduct, mannerisms, interaction and communication with patients, which he observed appeared to be excellent.

29 The changes in record keeping which apparently satisfied the medical auditor, his counsel, Mr Young, observed on Tuesday, showed he did apparently have an ability to learn from advice and recommendations, about his practices.

30 It appears that in early 2007, and quite by accident, an officer of the Pharmaceutical Services Branch noted, while visiting an Engadine Pharmacy, a faxed prescription from Dr Wilcox for a patient for capsules containing DHEA, which is a sch 4 appendix D drug. The pharmacy also drew his attention to a prescription which he had apparently issued to another patient, also for such a drug.

31 The conduct which brings Dr Wilcox before this tribunal concerns essentially the matters revealed by the investigations in 2003 concerning inappropriate prescribing and records for events between 2000 and 2003: (see particulars 1 to 4 inclusive). Particulars 5(ii) and (iii) relate to breaches of health and employment conditions between November 2003 and August 2004. Particular 6 concerns the breaches of condition on his registration concerning prescribing sch 4D drugs. Those breaches, as I have noted, were between October 2006 and early 2007; the first of which is the one which he notified the Board of himself, the latter two being discovered by accident by pharmaceutical investigators. Particular 6 was the one which was added to this complaint some months after the complaint had been filed.

32 Dr Wilcox, through his solicitors and counsel, admitted all parts of the six complaints save for 5(i) which, as noted, was withdrawn by the HCCC at the hearing. However, Dr Wilcox’s admission of particular 1 was qualified. As to that he said:

“I consider that it is likely that an error has been made in recording the treatment details concerning the drug Pregnyl.”

33 That, Dr Wilcox said, was because he never prescribed or supplied the drug in a quantity of that which was set out in the particular, namely six times 5,000 international units. Further, he did not stock quantities of the drug consistent with the allegation. As to particular 3 he said he did not prescribe Andriol. However, he conceded that a patient, namely patient G, told him that he did on one occasion prescribe it for him. Dr Wilcox concluded:

“I would very rarely have prescribed this medication.”

34 As to particular 6(a), he claimed that he could not recall where Androderm patches were on the list at the time and discovered only later that they were on it. As to (b) he claimed that the drug was not on his list, and as to (c) he did not know DHEA was a sch 4 appendix D drug.

35 Dr Wilcox was cross-examined before the Tribunal. We took him to concede that in certain respects there had not been any noticeable improvement in his record keeping. It was put to him that the three prescriptions, the subject of particular 6, were not the subject of accidental breaches at all. It was put to him that he could have checked the PSB list or have spoken to somebody such as Mr Thompson at the PSB. He maintained that he had not prescribed androgens or anabolic steroids since 2003. But at times he had difficulty with the proposition that the particular 6 prescriptions were relevantly in breach or, alternatively, that there was any harm by them.

36 He has over the years, as he did before us, tended to blame his large workload, and his sensitivity for distressed patients. He claimed before us to have developed insight into his practising philosophy since the 2003 inquiry. He affected to disavow views he held in 2003 as “pure paranoid gibberish” . He affected to see his past treatment philosophies as “grandiose and delusional” and said he no longer wanted to treat patients he had treated in the past with sch 4 appendix D drugs. In re-examination he said that he now enters details of all new patients on computer.

37 To the Tribunal his answers in cross-examination suggested that he does have some difficulty in adapting to the concept of computerised records. Overall, his attitude in cross-examination was not an attitude, we thought, inspired to give the Tribunal the confidence that he truly has the insight he claims. He was at times, we thought, unnecessarily offensive in his attitude.

38 Having said that, however, the Tribunal does appreciate that most of these complaints have been hanging over his head for some years and would have placed him under considerable strain. We note also, as detailed, that his conduct has been the subject of regular panel reviews over the years and that he has moved to twelve monthly reviews.

39 Notwithstanding the matters put to us by Mr Young, the Tribunal is reasonably satisfied, on the balance of probabilities, that all parts of each particular is proved. Dr Wilcox’s records are so poor that we do not accept the qualifications to his concessions.

40 Dr Wilcox concedes that his conduct warrants a finding of unsatisfactory professional conduct. As it happens, the non-exhaustive definition of ‘unsatisfactory professional conduct’ includes failing to comply with regulations, such as that which requires good records. It also includes failing to comply with conditions of practice. The concession ought be seen in that light.

41 The HCCC urges us to find also that he was guilty of professional misconduct: see s.37 of the Act. Section 37 says that for the purposes of the Act “professional misconduct” of a registered medical practitioner means unsatisfactory professional conduct of a sufficiently serious nature to justify suspension of the practitioner from practising medicine, or the removal of the practitioner’s name from the register. In Pillai v Messiter (No 2) (1989) 16 NSWLR 197, the Court of Appeal, concerning this definition in the context of the previous legislation, said this:

“[T]he statutory test is not met by mere professional incompetence or by deficiencies in the practice of the profession, something more is required, but includes a deliberate departure from accepted standards or such serious negligence as, although not deliberate, to portray indifference and an abuse of the privileges which accompany registration as a medical practitioner.”

42 Although Mr Young submitted to us that this finding was not open to us, or, alternatively, (we took it to be) that we ought not make it, we are satisfied that it is open to us and that we ought make that finding. Dr Wilcox’s attitude to the list of sch 4D drugs and as to ensuring that drugs he prescribes are or are not on that list, as alleged in particular 6, in particular, shows what we consider to be a lack of professional diligence which it is reasonable to expect from a practitioner whose attention has so decisively been drawn to the schedule and whose rights to the privilege of practice of medicine is subject to the conditions his are. His attitude, as shown by his conduct in that particular, we consider amounts to indifference of the type which the Court of Appeal referred to. The tribunal finds that his conduct amounts to professional misconduct.

43 The HCCC submitted that an appropriate order was for the removal of his name from the medical register. However, the Tribunal does not accept that submission.

44 It is important to look at Dr Wilcox’ background. He graduated with the degree of Bachelor of Science with Honours in Psychology in 1973 from the University of New South Wales. He graduated in Medicine in 1981. He did his intern training at St Vincent’s Hospital, Darlinghurst, in 1982 and was then a junior RMO at St Vincent’s. In 1983 he took over his father’s general practice. He has conducted that practice ever since, with other medical practitioners. He has been a member of various professional bodies over the years and has participated in a great deal of continuing medical education. In a statement which his counsel tendered, he said that when he took over his father’s practice it was a solo practice, well established, catering to the needs of the area which had a number of elderly patients and young families. A number of doctors have joined the practice over the years. In 1996 he suffered from depression and was self-administering pethidine, Panadeine Forte and Rivotril. His wife, who is also a medical practitioner, notified the Board about his self-administering. Then there was an impaired registrant’s panel convened, at which time certain conditions were placed on his registration. He says:

“I have no doubt that part of the reasons for my poor clinical judgment and inadequate documentation was my hours of work and the number of patients excessive.”

45 He spoke of increasing doses of antidepressants. He said he worked hard to remove and eliminate the problems which had led to his poor clinical judgment, that over the years he had developed an interest in the endocrine problems of low testosterone in isolation from his medical peers. He had done a great deal of research, but now accepted that in cases of past anabolic steroid abuse patients required treatment in a similar way to other patients who were seeking drugs of abuse. He said he had always had an interest in weight lifting and physical health at his own gym and had developed an interest in patients with difficulties with past abuse of anabolic steroids. His aim was to restore normal physiology. He said he became interested also in treating older hypogonadal males. He conceded that there were considerable discrepancies in his accounting and receipting for drugs. He asserted that the purpose of the sale, however, was not for profit. He pointed out how busy he had been at the time of the s.66 inquiry. (It is clear from what he said that he was indeed very busy and seeing a very large number of patients). He went on to note how he had reduced the number of patients, and had misinterpreted the employment conditions, for which he expressed regret.

46 His wife, in a statement tendered to us, said that she noted her husband, dealing with his interest in anabolic steroids, had come to believe that he had insights into those issues which were shared by few, if any other, medical practitioners: he had rejected conventional medical opinion and protocols. This became his passion. He had slept little, worked incessantly and was always irritable. But the s.66 inquiry had, fortunately it would seem, changed his life. He has now ceased to work so much and has established a better set of priorities for his life and practice and his moods have been far better. He has been greatly assisted and touched by the loyalty and affection of his patients and their families. She said that she never wants to see him as stressed and overworked as he was. She noted that his relationship with his family has improved and with his colleagues, and that whereas he tended to work alone in the past, he is not doing that so often.

47 From documents tendered on his behalf we conclude that colleagues and patients think very well of him as a doctor. Though we have, as noted, some concern about his insight and his capacity to learn from his past misconduct, we do consider that if appropriate conditions are imposed, the public will be protected adequately so that he can continue to practice. He is an experienced doctor, and with time and assistance, which the appropriate conditions will provide, we consider he may still make a valuable contribution to the community. He clearly has difficulty adapting to computerisation of records. So we consider it appropriate to include some conditions to deal with this issue. After two months from these orders it will be expected that all of his records will be computerised. We think it appropriate as well that there be regular audits to ensure that his records are all computerised.

48 The conduct complained of is serious. Breaches of condition are especially so. As noted, however, with the exception of the three recent matters, which are the only ones uncovered in three years, one of which he voluntarily disclosed, there has not been substantial repetition. We say “substantial”, as it is clear that his record keeping continues to be poor in some cases. We are influenced by the fact that the Board has kept his conduct under review, dropping it to twelve monthly reviews, taking him off urinalysis and being satisfied with audits carried out. We think it would in those circumstances be inappropriate to order his removal or suspension. Further, of course, considerable time has occurred since most of the matters complained of.

49 It is important that practitioners appreciate the importance of conditions and the need to comply strictly with them. In all the circumstances it is the view of the Tribunal that we permit Dr Wilcox to practise on the conditions which were handed to us by the HCCC with certain additional matters. We consider that Dr Wilcox should be reprimanded. We order that he be reprimanded. We consider that it is appropriate that he pay a fine of $25,000 to the Medical Board within twenty-eight days. We make an order to that effect. We find that his conduct constitutes unsatisfactory professional conduct and professional misconduct and that his right to continue to practise ought be subject to practise conditions in accordance with a document which we will hand to the parties.

50 The significant conditions are under “practice conditions”, namely six and seven, and that after 26 June 2007 all of his progress notes, test ordering, prescriptions, referrals and other notes required by cl 13 of the Medical Practice Regulations 1998 be recorded by the computer programme “Medical Director”, or such other programme as is approved by the Board; and seven, that he submit to an audit of his practice, especially as to the computerisation of his records, by a person or persons nominated by the Board, by 26 July 2007 and thereafter at least every six months. The audits are to be at his expense.

51 These practice conditions of themselves may, of course, be reviewed by the Medical Board. We think it appropriate that he pay the costs of the complainant. We make an order to that effect.

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