In Re Dr Kitto
[2010] NSWMT 2
•9 April 2010
New South Wales
Medical Tribunal
CITATION: In Re Dr Kitto [2010] NSWMT 2 TRIBUNAL: Medical Tribunal PARTIES: Health Care Complaints Commission (Appellant)
Dr Kenneth Collingwood Kitto (Respondent)FILE NUMBER(S): 40020 of 2009 CORAM: Sidis, DCJ - Sutton, Dr V - Abouyanni, Dr G - Collier Ms A CATCHWORDS: Prescription of drugs of addiction to patient with whom in relationship - Failure to maintain proper drugs register - Failure to secure prescription pads - Previous unblemished record of long-term practice as general practitioner LEGISLATION CITED: Medical Practice Act 1992
Medical Practice Regulation 2003
Poisons and Therapeutic Goods Act 1966
Poisons and Therapeutic Goods Regulation 2002CASES CITED: Briginshaw v Briginshaw (1938) 60 CLR 336;
Pillai v Messiter (1989) 16 NSWLR 197;
Spicer v New South Wales Medical Board and Ors (NSW Court of Appeal, unreported, 19 February 1981)DATES OF HEARING: 29 March 2010 DATE OF JUDGMENT: 9 April 2010 LEGAL REPRESENTATIVES: Mr G A Farmer (Counsel for the Applicant)
Health Care Complaints Commission (For the Applicant)
Ms J Lonergan (Counsel for the Respondent)
Hicksons Lawyers (Solicitor for the Respondent)ORDERS: 1. The Tribunal finds Dr Kitto guilty of professional misconduct.; 2. The registration of the practitioner as a medical practitioner in New South Wales pursuant to the Medical Practice Act 1992 shall be subject to the conditions set out in Appendix A to this Determination.; 3. Dr Kitto is to pay the costs of the Health Care Complaints Commission, as agreed or assessed.; 4. The exhibits may be released.; 5. The Tribunal’s reasons are published.
JUDGMENT:
Pursuant to Clause 6 of Schedule 2 to the Medical Practice Act 1992 the Tribunal has made a Non Publication Order in respect of any matter capable of identifying the patient described in these reasons as Patient A
NATURE OF COMPLAINT
1 The Commissioner, Health Care Complaints Commission, complained that Dr Kenneth Kitto, being a medical practitioner registered under the Act, was guilty of unsatisfactory professional conduct or professional misconduct within the meaning of ss 36 and 37 of the Act in that he:
(i) demonstrated that the knowledge, skill or judgment possessed, or care exercised, by him in the practice of medicine was significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience; and
(ii) engaged in improper or unethical conduct relating to the practice of medicine; and
(iii) contravened the Medical Practice Regulation 2003.
2 The particulars accompanying the Complaint alleged that, at all relevant times the practitioner was a registered medical practitioner who conducted practice as a general practitioner at 348 High Street, Penrith, NSW and that between 2004 and 2006 the practitioner was involved in a personal relationship with Patient A. The particulars alleged:
Patient A
1 Between October 2004 and April 2006, the practitioner failed to transfer the medical management of Patient A to another health professional when he was in a personal relationship with Patient A.
2 Between February 2005 and March 2006 the practitioner prescribed drugs of addiction within the meaning of Section 4 of the Poisons and Therapeutic Goods Act 1966 to Patient A on the dates and in the quantities set out in the schedule attached to the Complaint and marked A:
2.1 otherwise than in accordance with recognised therapeutic standards and/or contrary to clause 79 or clause 109 of the Poisons and Therapeutic Goods Regulation 2002;
2.2 without an appropriate authority contrary to section 28 of the Poisons and Therapeutic Goods Act 1966.
3 Between February 2005 and March 2006 the practitioner prescribed benzodiazepines and analgesics to Patient A on the dates and in the quantities set out in the schedule attached to the Complaint and marked B:
3.1 in quantities exceeding recognised therapeutic standards and/or contrary to clause 33 of the Poisons and Therapeutic Goods Regulation 2002;
3.2 in circumstances where the practitioner was aware that Patient A was dependent on a drug of addiction.
4 In or about January 2006 the practitioner, upon query from a dispensing pharmacist at Tony Ferguson Chemist, Penrith, in relation to a prescription from the practitioner’s prescription pad presented by Patient A, failed to advise that pharmacist that the prescription had not been issued by the practitioner.
5 In January 2006 the practitioner, upon a query from a dispensing pharmacist at Theo’s Chemist, Penrith, in relation to a prescription from the practitioner’s prescription pad presented by Patient A, failed to advise that pharmacist that the prescription had not been issued by the practitioner.
Self prescribing
6 Between September 2005 and January 2006 the practitioner self prescribed medication on the dates and in the quantities set out in the schedule attached to the Complaint and marked C contrary to recognised therapeutic standards.
Records/Documents
7 Between October 2004 and March 2006 the practitioner failed to properly maintain a drug register contrary to clause 111 of the Poisons and Therapeutic Goods Regulation 2002.
8 Between September 2004 and March 2006 the practitioner failed to keep records in relation to treatment and prescribing in relation to Patient A and in relation to his self prescribing:
8.1 as was appropriate in the circumstances;
8.2 contrary to the requirements of Schedule 2 of the Medical Practice Regulation 2003.
9 Between September 2004 and March 2006 the practitioner failed to properly maintain his prescription pad or pads in a secure manner in order to prevent unauthorised persons from having access to them.
The schedules marked A, B and C respectively were in evidence in Exhibit A, Tab 1.
3 An evidentiary certificate issued under s 192A of the Act indicated that the practitioner remained registered as a medical practitioner in New South Wales on an unconditional basis.
Unsatisfactory Professional Conduct
4 S 36(1) of the Act relevantly defines unsatisfactory professional conduct as:
(a) Conduct significantly below reasonable standard
Any conduct that demonstrates that the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of medicine is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience.
(b) Contravention of Act or regulations
(m) Other improper or unethical conduct
...Any contravention by the practitioner (whether by act or omission) of a provision of this Act or the regulations, whether or not the practitioner has been prosecuted for or convicted of an offence in respect of the contravention.
Any other improper or unethical conduct relating to the practice or purported practice of medicine.
Professional Misconduct
5 S 37 of the Act defines professional misconduct as:
- ....unsatisfactory 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.
Onus and Standard of Proof
6 The Commissioner bears the onus of proving the particulars of the Complaint to a standard that comfortably satisfies the Tribunal on the balance of probabilities: Bannister v Walton (1993) 39 NSWLR 699
7 The Tribunal must have regard to the gravity and importance of the matters which it is deciding in accordance with the principles stated in Briginshaw v Briginshaw (1938) 60 CLR 336. At pages 361 and 362 Sir Owen Dixon stated:
Except upon criminal issues to be proved by the Prosecution it is enough that the affirmative of an allegation is made out to the reasonable satisfaction of the Tribunal. But reasonable satisfaction is not a state of mind that is obtained or established independently of the nature or consequence of the fact or facts to be proved. The seriousness of an allegation made, the inherent unlikelihood of an occurrence of a given description, or the gravity of the consequences flowing from a particular finding are considerations which must affect the answer to the question whether the issue has been proved to the reasonable satisfaction of the Tribunal. In such matters “reasonable satisfaction” should not be proved by inexact proofs, indefinite testimony, or indirect inferences.
ADMISSIONS
8 At the commencement of the proceedings the practitioner admitted the Complaint with the exception that he did not admit to particulars 4 and 5 of the Complaint.
9 Those particulars required that the Commissioner establish that the practitioner failed to advise pharmacists who contacted him concerning prescriptions presented to them by Patient A that he did not issue them.
10 In the first case, that is the inquiry made on or about 16 January 2006, the pharmacist did not directly raise with the practitioner the question of authenticity of the prescription. The pharmacist provided a statement to the effect that the prescription was for a drug of addiction, it was the first time he was asked to dispense for Patient A and, in accordance with his standard practice, he telephoned the practitioner to confirm that it was in order to proceed. The practitioner, aware that he wrote prescriptions from time to time for Pethidine for Patient A at this time, authorised the pharmacist to proceed.
11 On the second occasion, also in January 2006, another pharmacist asked the practitioner to attend at the pharmacy to confirm the authenticity of a prescription because he believed that the handwriting was different to that which normally appeared on the practitioner’s prescriptions. The practitioner said he recalled the incident. He recalled attending at the pharmacy, looking at the prescription and confirming that it was completed in his handwriting. The pharmacist was not subsequently able to locate or identify the prescription concerned.
12 The practitioner consistently denied that he was aware in January 2006 that Patient A was forging prescriptions for drugs of addiction. His unchallenged evidence was that he first became aware that she adopted this practice when he met with an officer of the Pharmaceutical Services Board in March 2006. While Patient A was charged and convicted in respect of these forgeries, no criminal proceedings were brought against the practitioner or suggested by investigating police.
13 In these circumstances, the Commissioner acknowledged that there was insufficient evidence upon which a finding might be made against the practitioner in relation to particulars 4 and 5 and they were not further considered in these reasons.
14 The Tribunal proceeded to deal with the evidence for the purpose of determining whether it was established that the practitioner was guilty of unsatisfactory professional conduct or professional misconduct and, if so, the penalty appropriate to its determination.
BACKGROUND
15 The practitioner is aged 61. He was first registered as a medical practitioner in 1972. Having spent a period of time as a medical officer while serving with the RAAF, he commenced practice as a general practitioner in 1974.
16 The practitioner did not come to the attention of the Commissioner or the Medical Board prior to the events giving rise to the Complaint.
17 The practitioner continued in general practice, initially as a sole practitioner and subsequently with an assistant until his practice was taken over by a corporation in August 2000.
18 Patient A became a patient of his practice in 1990. He became aware through his treatment of Patient A that she suffered from a bipolar disorder and that she suffered a work injury to her back in 2002 or 2003.
19 Between August 2000 and November 2003 the practitioner was engaged on a contract basis to work for the corporation that took over his practice. He worked in a medical centre with 12 other general practitioners. He described the contractual conditions as harsh. He was placed under pressure to treat excessively large numbers of patients and work for long hours. There was no provision in the contract for sick leave.
20 In March 2003 his marriage of 37 years ended.
21 In November 2003 he suffered a breakdown. He attributed the breakdown to the pressures imposed on him by the corporate practice. He said he was overwhelmed and exhausted by the unacceptably large numbers of patients he was required to service.
22 The practitioner consulted Dr Pusic, psychiatrist, and was prescribed anti-depressant medication and cognitive behavioural therapy. He did not work for three months. His illness precipitated a contract dispute that resulted in litigation in which he was unsuccessful.
23 In December 2003 the practitioner first attempted suicide. He recovered without incident. In February 2004 he resumed work at the Penrith Skin Cancer Clinic on a part time basis. He said he was feeling 70% well.
24 In May 2004 the practitioner was hospitalised after a further suicide attempt. He required treatment in intensive care after which he was transferred to the Northside West Clinic where he was treated as an inpatient for five days.
25 He continued to consult Dr Pusic until February 2005.
26 In May 2005 he became bankrupt. He was discharged from bankruptcy in 2008. He stated that he currently has no assets or savings.
The Relationship with Patient A
27 In June 2003 the practitioner entered into a relationship with Patient A. He said that at the time the relationship commenced he noted on his records that he was not to treat her further.
28 They were engaged in December 2004. They maintained separate homes but the practitioner stayed overnight at Patient A’s home several times a week.
29 The practitioner said he first prescribed Pethidine for Patient A when she was suffering a severe migraine and severe back pain that left her couch bound for one week. Regular pain killing medication was ineffective in relieving her pain. An access visit with her five year old daughter was imminent. He therefore injected Patient A with Pethidine to allow her to become sufficiently mobile to care for her daughter.
30 The practitioner believed that this injection was administered in mid-2005 although records indicated that the first prescription was written in February 2005. The practitioner stated that he realised after about two weeks of administration of the drug that Patient A was addicted to it. He attempted to reduce the dosage and wean her off the drug. He prescribed other drugs in his efforts to address the addiction. Those efforts failed. Patient A rejected the practitioner’s offer to pay for rehabilitation treatment at the St John of God Hospital.
31 The practitioner said that, having caused Patient A to become addicted, he felt responsible for treating her to address the addiction. He did not consider referring her to another general practitioner for this treatment. He denied that his reason for failing to refer Patient A to another practitioner was that he wished to conceal the problem that he created.
32 The practitioner continued to provide Patient A with prescriptions for drugs of addiction, mostly Pethidine, with significant frequency and in significant quantities. He wrote no further prescriptions after March 2006 when he was visited by an officer of the Pharmaceutical Services Board.
33 The practitioner denied that he secured any financial gain from the provision of drugs to Patient A and there was no evidence to suggest that he did so.
34 The practitioner’s relationship with Patient A ended in July 2006.
Self prescribing
35 The practitioner denied that he made personal use of the Pethidine prescribed to Patient A. He said that in 1980 he suffered an adverse reaction to the drug at the time of gall bladder surgery and he was advised against its use.
36 The practitioner acknowledged that he continued to self prescribe the anti-depressant medication formerly provided through Dr Pusic. He said this medication worked well and he did not consider that he needed to continue to consult with Dr Pusic or any general practitioner concerning his ongoing use of it.
37 He did not consult a general practitioner on his own behalf during this period.
Records/Documents
38 The practitioner acknowledged that he kept no clinical records of the drugs prescribed or the treatment provided to Patient A or himself during this period.
39 He acknowledged that he did not secure his prescription pads during this period and it was probable that Patient A removed the prescription forms that she forged from his medical bag or from his surgery with comparative ease.
PEER REVIEW
40 The peer reviewer was critical of the following conduct of the practitioner:
- prescription of S8 drugs in the absence of an appropriate management plan based on a clinical diagnosis
- failure to refer Patient A to an independent general practitioner
- prescription of benzodiazepines and analgesics in excess therapeutic quantities
- attributing some of the responsibility for his conduct to Patient A
- failing to maintain a drug register in respect of the drugs prescribed for Patient A and himself
- failing to retain control of his prescription pads
- breaching the Poisons and Therapeutic Goods Act 1966 and Regulation 2002
- poor medical self management through the use of inappropriate medication, taken in an ad hoc and random fashion.
41 The peer reviewer expressed sympathy for the circumstances in which the events that were the subject of the Complaint occurred and noted that steps had been taken to address areas of concern.
42 He concluded, however, that taken as a whole, the practitioner’s conduct demonstrated a low standard of professional conduct of which he was strongly critical.
FINDINGS
43 Having regard to the evidence and the admissions made by the practitioner the Tribunal formally finds that the particulars contained in paragraphs 1, 2, 3, 6, 7, 8 and 9 of the Complaint are proved. The part of the Complaint relating to paragraphs 4 and 5 of the particulars is dismissed.
44 The Tribunal finds that the conduct of the practitioner as detailed in the particulars of the Complaint that were proved demonstrated a lack of adequate skill, judgment and care by the practitioner in the practice of medicine and as such amounted to unsatisfactory professional conduct.
45 The remaining issue was whether that conduct was sufficiently serious to warrant a finding of professional misconduct.
46 Judicial guidance in determining this issue may be found in the following passage from the judgment of Justice Kirby when President of the New South Wales Court of Appeal in Pillai v Messiter (1989) 16 NSWLR 197 at 200 :
…the statutory test is not met by mere professional incompetence or by deficiencies in the practice of the profession. Something more is required. It 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.
47 Further, in Spicer v New South Wales Medical Board and Ors (NSW Court of Appeal, unreported, 19 February 1981) it was said:
Strict adherence to the statutory requirements relating to the use of drugs of addiction is required by medical practitioners. 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.
48 In measuring the practitioner’s conduct against these tests it was noted that the practitioner prescribed Pethidine and other drugs of addiction to Patient A over a significant period and in significant quantities. He acknowledged that at all times he was aware that what he was doing was medically and ethically improper.
49 Having regard to these factors, the Tribunal is comfortably satisfied that, taken as a whole, the practitioner’s unsatisfactory professional conduct involved conduct that was deliberate and presented a threat to Patient A’s health to the point where it was of a sufficiently serious nature to justify a finding of professional misconduct.
PENALTY
50 The Tribunal is charged with exercising powers to sanction members of the medical profession for the purpose of protecting the community. The principal consideration in the exercise of these powers is the maintenance of the standards of the medical profession and maintaining the confidence of the public in the profession. The public is entitled to the assurance that measures will be taken to address breaches of acceptable standards of practice.
Areas of Concern
51 There were a number matters arising from the evidence that concerned the Tribunal. They involved the seriousness of the practitioner’s offending behaviour and areas where the practitioner appeared to continue to lack insight into the need to manage his vulnerability to a further breakdown in circumstances of personal or professional stress.
52 The Tribunal shared the concern of the peer reviewer that the practitioner attributed some of the responsibility for events to Patient A. While stating that he accepted full responsibility and acknowledging that he was aware at the time that his conduct was medically and ethically inappropriate, the practitioner said that he continued to prescribe Pethidine in response to manipulative behaviour on the part of Patient A that included threats of suicide, physical assaults and interference with his capacity to practice. He attributed this behaviour to her bipolar disorder but did not consider referring her to another general practitioner.
53 The practitioner stated that he wrote reports at the request of insurers dealing with Patient A’s compensation claim arising out of her back injury. He expressed no appreciation of the prospect that his reports were tainted by bias.
54 Significantly, the practitioner appeared to continue to manage his mental health without reference to his general practitioner or psychiatrist. He did not consult further with Dr Pusic. He received no counselling. Having self prescribed anti-depressant medication for a number of years, he ceased taking the medication without independent advice. He said he did so because he felt that he no longer needed them after he terminated his relationship with Patient A.
55 He conceded that, although he now consulted a general practitioner in respect of aspects of his physical health, he had not discussed with any general practitioner his past psychiatric history or his current mental health.
56 The practitioner’s current general practitioner worked in the same practice. The practitioner appeared not to appreciate the difficulties that might face him if he again experienced conditions of employment that caused him stress and affected his mental health and if his general practitioner’s financial position might be affected by the practitioner’s inability to cope with the demands of those employment conditions.
Remedial actions
57 Countering these concerns was evidence of a number of positive features that addressed the problems that previously faced the practitioner.
58 At the suggestion of the Pharmaceutical Services Board, in April 2006 he relinquished his right to prescribe S8 and S4D drugs. He said he did not intend to seek restoration of those rights.
59 The practitioner said that he learned from this experience that:
- he should never prescribe for himself or his family,
- he should keep adequate continuous records of consultations,
- he should maintain records relating to prescription of drugs,
- he should be more selective in his choice of partner,
- he should continue to maintain his health.
60 He stated that he made errors of judgment over a limited period of time when he was under stress and suffering from anxiety and depression. He asserted that he was now in an excellent relationship and a supportive medical practice. He was confident that he would not repeat his past mistakes.
61 The practitioner was currently working in a group practice. His hours were limited to 42 per week. His work was audited and mentored by one of the owners of the practice, Dr Van Mai, who checked his clinical notes and provided him with feedback.
62 Prescriptions were computer generated, although a limited number of prescriptions pads were kept in a locked cupboard at the practice in the event that the computers failed.
63 The practitioner enrolled in two six month courses operated by Monash University. He is currently undertaking a course entitled Issues in General Practitioner Prescribing. Upon completion of that course he will undertake a course in Medical Ethics.
64 Dr Van Mai was one of those who provided a reference on behalf of the practitioner. He stated that he worked with the practitioner for three years and described him as a good colleague who was trustworthy and reliable. He described his practice of medicine as exceptional and said he was very popular with his patients.
65 Dr Zahra-Newman wrote positively of the practitioner’s medical and management skills and also noted his popularity with his patients. Dr Zahra-Newman said the offending conduct was out of character and was unlikely to be repeated.
66 Dr Clifford said she knew the practitioner as a colleague for 40 years. She described him as a popular, competent and reliable general practitioner. She said he was competent in his sub-speciality of skin cancer diagnosis and treatment. She noted his remorse for his conduct and also expressed confidence that he would not re-offend.
ORDERS
67 The Tribunal took account of the many positive features already outlined and had particular regard to the absence of any record of other unsatisfactory professional conduct on the part of the practitioner during a career spanning almost 40 years.
68 The Commissioner proposed that the practitioner’s registration be maintained subject to a number of health and practice conditions. The practitioner informed the Tribunal that he was willing to comply with those conditions.
69 The Tribunal was satisfied that the approach suggested by the Commissioner and agreed to by the practitioner was an acceptable means by which the Tribunal’s concerns might be addressed and the protection of the community assured.
70 The Commissioner sought an order that the practitioner pay the costs of the proceedings before the Tribunal. The practitioner resisted the application on the basis of his current impecuniosity. He requested that, if an order was considered appropriate, he be allowed a period of time within which to make payment.
71 The Tribunal considered that the circumstances were such that the practitioner should be ordered to pay the Commissioner’s costs of the proceedings. It was noted that it was indicated that the Commissioner would take into account the practitioner’s financial position and his request for assistance to allow him to comply with the order in due time.
72 Accordingly the Tribunal finds the practitioner guilty of professional misconduct AND ORDERS that:
1 The registration of the practitioner as a medical practitioner in New South Wales pursuant to the Medical Practice Act 1992 be subject to the conditions set out in Appendix A to this Determination.
2 The practitioner is to pay the costs of the Health Care Complaints Commission of the proceedings before the Tribunal as agreed or assessed.
3 The exhibits may be released.
**********************************************************************************4 The Tribunal’s reasons are published.
Health conditions
1 Dr Kitto is not to prescribe for self medication.
2 Dr Kitto is to attend on a psychiatrist nominated by the NSW Medical Board (“the Board”), for the purpose of assessment of his mental health.
- i) The Board nominated psychiatrist is to be provided with a copy of: the Tribunal’s decision; a copy of the exhibits before the Tribunal; and a copy of the transcript of Dr Kitto’s evidence in the Tribunal (if available).
- ii) The Board nominated psychiatrist is to report to the Board on his or her assessment and make any recommendations for treatment or counselling as the approved psychiatrist sees fit;
- iii) If the Board nominated psychiatrist recommends that a course of treatment or counselling Dr Kitto is to attend on a psychiatrist of his choice for the purpose of treatment or counselling for a period of twelve (12) months from the date of the first consultation at a frequency to be determined by the treating psychiatrist. The treating psychiatrist is to be provided with a copy of: the Tribunal’s decision; a copy of the exhibits before the Tribunal; and a copy of the transcript of Dr Kitto’s evidence in the Tribunal (if available).
- v) Dr Kitto is to authorise the treating psychiatrist to provide the Board with notification immediately if there are any concerns or issues in relation to Dr Kitto’s compliance with the conditions on his registration or if the treatment or counselling relationship ceases.
- vi) In the event that the treating psychiatrist is no longer willing or able to continue to provide treatment or counselling, Dr Kitto is to attend upon another psychiatrist for the treatment or counselling.
- vii) All expenses associated with the treatment or counselling as set out in this condition are to be met by Dr Kitto.
- viii) Dr Kitto is to continue psychiatric treatment or counselling in accordance with the recommendations of the treating psychiatrist and for such period as may be considered necessary by the treating psychiatrist.
3 In relation to his general health needs, Dr Kitto is to consult with a general practitioner who is not a proprietor of or engaged in any medical practice in which Dr Kitto is engaged.
Practice conditions
4 (i) Dr Kitto is ordered to complete the course Issues in General Practice Prescribing and Medical Ethics conducted by Monash University by December 2010 or by such further time as approved by the NSW Medical Board Board (“the Board”) or, if the course is not available then Dr Kitto is to complete an equivalent course, approved by the Board by December 2010 or such further time as approved by the Board. The cost of the course to be borne by Dr Kitto.
(ii) Within two weeks of completing the course, Dr Kitto is to provide evidence to the Board that he has satisfactorily completed the course.
5 Within 21 days from the date of this decision Dr Kitto must provide for approval by the NSW Medical Board the name and professional address of a senior registered medical practitioner who is not a proprietor of or engaged in any medical practice in which Dr Kitto is engaged and who has agreed to act as his professional Mentor in accordance with the NSW Medical Board’s Guidelines for Mentors for a period of 24 months from the date of the decision:
i. The nature and frequency of the contact between Dr Kitto and approved mentor is to be determined by the mentor.
- ii. Dr Kitto is to provide the mentor with a copy of the Tribunal’s decision,
- iii. The mentor and Dr Kitto are to discuss the areas of good practice in prescribing, record-keeping, regulatory compliance, treatment of relatives and self and other ethical issues in general practice.
- iv. Dr Kitto is to authorise the mentor to:
- a. provide a report in approved format on Dr Kitto's progress a six-monthly basis; and
- b. notify the Board immediately if there are any concerns or issues in relation to Dr Kitto's compliance with the mentoring requirements or any other condition of registration or if the mentoring relationship ceases.
- v. In the event that the approved mentor is no longer willing or able to continue as mentor, Dr Kitto is to nominate another mentor for approval by the NSW Medical Board within 28 days of the cessation of the original supervision/mentor relationship.
- vi. All expenses associated with the engagement of an approved mentor are to be met by Dr Kitto.
6 Dr Kitto is not to apply for the grant or restoration of authority to prescribe drugs listed in Schedule 4D or Schedule 8 of the Poisons and Therapeutic Goods Act 2008 .
7 Dr Kitto must only work in a group practice (defined as at least three practitioners) in which all practice members are aware of the conditions on his registration.
8 Dr Kitto consents to the exchange of information between Medicare Australia and the NSW Medical Board where such exchange is necessary to facilitate compliance monitoring with conditions on registration.
Other orders
9 Conditions on registration may be varied, amended or removed at the discretion of the Board.
10 Pursuant to section 93(1) of the Medical Practice Act 1992 the Board is the appropriate review body for review of these conditions.
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