Medical Board of Australia v Grant
[2012] QCAT 285
•2 July 2012
| CITATION: | Medical Board of Australia v Grant [2012] QCAT 285 |
| PARTIES: | Medical Board of Australia (Applicant) |
| v | |
| Dr Peter Joseph Grant (Respondent) |
| APPLICATION NUMBER: | OCR247-11 |
| MATTER TYPE: | Occupational regulation matters |
| HEARING DATE: | On the papers / 18 June 2012 |
| HEARD AT: | Brisbane |
| DECISION OF: | Judge Fleur Kingham, Deputy President Assisted by Mr Murray Green Dr Harpreat Moudgil Dr John Waller |
| DELIVERED ON: | 2 July 2012 |
| DELIVERED AT: | Brisbane |
| ORDERS MADE: | 1. The parties are invited to provide an agreed form of orders that achieves the Tribunal’s intentions by 20 July 2012. |
| CATCHWORDS: | OCCUPATIONAL REGULATION – HEALTH PRACTITIONER – MEDICAL – DISCIPLINARY PROCEEDING – where the registrant prescribed drugs in quantities and combinations in excess of therapeutic use – where the registrant prescribed drugs without endorsement – where the registrant admitted the conduct – where the registrant assisted the Tribunal – where the parties were in agreement on proposed sanction – whether the Tribunal may impose a sanction other than that proposed by the parties – whether the proposed sanction is appropriate Health (Drugs and Poisons) Regulation 1996 Queensland Civil and Administrative Tribunal Act 2009 Therapeutic Goods Administration Act 1989 (Cth) Australian Competition and Consumer Commission v Colgate-Palmolive Pty Ltd [2002] FCA 619 Medical Board of Australia v Saykao [2011] VCAT 1338 Nursing & Midwifery Board of Australia v Brereton [2011] QCAT 578 Pharmacy Board of Victoria v Danigelis [2010] VCAT 1276 Secretary to the Department of Planning and Community Development v Muto [2011] VCAT 328 |
APPEARANCES and REPRESENTATION (if any):
| APPLICANT: | Mr McGowan, McInnes Wilson, for the Medical Board of Australia |
| RESPONDENT: | Mr Diehm SC, instructed by Quinlan Miller & Treston, for Dr Grant |
REASONS FOR DECISION
Dr Grant, a member of the Royal Australian College of General Practitioners, has practised as a general practitioner in Queensland since 1985. He holds both general and specialist registration as a medical practitioner. The Board brought these proceedings after Queensland Health cancelled Dr Grant’s endorsement to prescribe certain classes of restricted drugs.
Queensland Health took that action after investigating Dr Grant’s practice of prescribing anabolic steroids and other restricted drugs, in the main, for body building rather than therapeutic purposes.
The parties filed an agreed statement of facts and made submissions supporting a joint position on sanction. In brief, the sanction proposed involved a reprimand of Dr Grant and conditions being imposed on his registration. The proposal was directly negotiated by the parties. The Tribunal encourages parties to disciplinary proceedings to endeavour to find common ground, with or without intervention or assistance by the Tribunal (such as through a compulsory conference). Nevertheless, the Tribunal fulfils a public interest function in the disciplinary process and parties cannot bind it by their agreement on sanction.
Initially the Tribunal convened an on the papers[1] hearing. After considering the joint submission on sanction, the Tribunal convened an oral hearing. Although the Tribunal had earlier questioned whether the proposed sanction was adequate, the parties maintained their support for it. For the reasons that follow, the Tribunal has determined to make different orders than those proposed. Before turning to Dr Grant’s conduct and the view the Tribunal took of it, it is necessary to dispose of a preliminary issue about what law applies to this matter.
[1]The Tribunal convenes in chambers and considers the matter on the basis of the evidence and written submissions filed by the parties, and without an oral hearing: Queensland Civil and Administrative Tribunal Act 2009, s 32.
Had the Board started to deal with the matter before the national scheme commenced?
In October 2009, the Medical Board of Queensland, as it then was, received notice from Queensland Health about the action it had taken about Dr Grant’s endorsement. At that time, medical practitioners in Queensland were regulated under a state based scheme. On 1 July 2010, before the Medical Board of Queensland had referred the matter to the Tribunal, a national system for the regulation and discipline of health practitioners commenced.
The transition from a state to a national scheme is provided for by two Acts. The Health Practitioner Regulation National Law Act 2009 introduced the Health Practitioner Regulation National Law (Queensland) that governs the operation of the national scheme in Queensland. The Health Practitioners (Professional Standards) Act 1999 governed discipline of health practitioners in Queensland before the national scheme commenced. It continues to apply to disciplinary and registration matters in Queensland, in an amended form.
The parties do not agree how the complaint must be dealt with under the transitional provisions of the two Acts. Those provisions determine whether a complaint or notification should proceed under the national scheme or under the law as it stood before the national scheme commenced.
The effect of the transitional provisions[2] is that the National Law (Queensland) applies to a complaint or notification that the former Board had received but not started dealing with. The Professional Standards Act as it stood before the national scheme commenced, applies if the former Board had started but not completed dealing with the complaint or notification.
[2]Health Practitioner Regulation National Law (Qld), ss 288, 289; Health Practitioners (Professional Standards) Act 1999, s 405N.
So, the question is whether the Board had started dealing with the notification by Queensland Health by 1 July 2010. The evidence about that is contained in the affidavit of Maree Hill, the Acting Director of Notifications.
[10]The Board’s solicitor argued the Board had started dealing with this matter because it had logged the complaint and opened a file. He relied on a reference in the Board’s file form (MKH 22) to s 53 (of the Professional Standards Act). That section describes a number of processes the Board could have undertaken in relation to the complaint, although he did not point to any evidence to suggest the Board had commenced any of those processes.
[11]He also argued that the requirement that the Board had started dealing with the notification did not mean the Board had to have concluded dealing with it by that date. That is not in issue.
[12]Counsel for Dr Grant submitted that until the Board started taking action by doing something, it could not be said to be dealing with the complaint. Acknowledging receipt is not enough. The Tribunal accepts that submission.
[13]The distinction between receiving and dealing with a matter is drawn in the transitional provisions. That would suggest the Board would have to demonstrate that it was actively investigating or considering the complaint.
[14]That interpretation is also consistent with the natural and ordinary meaning of the phrase deal with – “to take action on”.[3]
[3] Collins Australian Dictionary (Harper Collins, 7th Ed 2005), pg 428.
[15]On the evidence before the Tribunal, the only thing done by the Board before the national scheme commenced was to open a file and acknowledge receipt of the notice from Queensland Health. In a Complaint Assessment Audit form of an audit of this matter conducted on 1 June 2010 (MKH 2012) the status of the file was recorded as: Initial review or file review (no action to date except ack letter). There is no other evidence to indicate some action was taken between 1 June 2010 and 1 July 2010.
[16]When the national scheme commenced, the former Board had not started dealing with this matter. Accordingly, the National Law (Queensland) applies to it.
The conduct
[17]Dr Grant’s prescribing practices came to light as a result of investigations by the Drugs and Poisons Policy and Regulation Unit of Queensland Health. It conducted a state wide audit of the dispensing of pseudoephedrine, and was also undertaking an ongoing investigation into anabolic steroid use in the Gold Coast area.
[18]By notice dated 12 October 2009, Queensland Health cancelled Dr Grant’s endorsement under the Health (Drugs and Poisons) Regulation 1996 to prescribe the restricted drugs Testosterone, Nandrolone, Human Growth Hormone, Human Chorionic Gonadotrophin and all scheduled drugs containing those substances as active ingredients.
[19]Dr Grant agreed he had inappropriately prescribed medications to 14 patients who attended on him at the Mermaid Beach Medical Centre. In these proceedings, the Board relied on the evidence gathered by Queensland Health.
[20]Dr Grant filed two affidavits and gave oral evidence in response to the Tribunal’s request that he answer questions about his conduct.
[21]The earliest allegation of inappropriate prescribing is February 2000, when Dr Grant started to treat the patient Maclean (charge 8). In all he treated him for more than 9 years, until April 2009. So Mr Maclean could improve his body physique (for body building purposes) and his energy levels, Dr Grant prescribed a combination of drugs: Halotestin, Sustanon, Scitropin, Andriol Testocaps, Testosterone implants, Deca-Durabolin and Proviron.
[22]There was no therapeutic basis for prescribing these drugs to him. In July 2007, he established the patient had low testosterone, which Dr Grant said was a well known side-effect of prolonged steroid use. He thereafter prescribed Sustanon on a weekly basis.
[23]Dr Grant treated other patients for extended periods, although those periods were much shorter than the 9 years he treated Maclean. He treated the patient Knipe for 4 and a half years (October 2004 to May 2009) with Deca-Durabolin, Sustanon Proviron, Prednisolone, DHEA, and Testogel. He treated the patient Anderson for 3 years 9 months (November 2005 to August 2009) with Sustanon, Scitropin, Reandron, Primoteston, and Human Growth Hormone.
[24]He treated the patient Monger (February 2006 to April 2009) with Deca-Durabolin, Primoteston and Clomid; and the patient Jovanovski (June 2006 to May 2009) with Sustanon, Deca-Durabolin, Primoteston and Andriol Testocaps, for about 3 years.
[25]For more than 2 years, he prescribed Deca-Durabolin, Sustanon, Primoteston, Arimidex, Proviron, Andriol Testocaps and Pregnyl for the patient Pardilinan (March 2007 to July 2009). He prescribed Sustanon, Deca-Durabolin, Andreaon Testocaps, Pregnyl, Clomid, Proviron, Arimidex and Human Growth Hormone for the patient Kennedy for 17 months (August 2007 to February 2009).
[26]He prescribed to the remaining 7 patients over shorter terms. Dr Grant saw 2 of them on only one occasion each. He saw another 3 patients over periods of less than 3 months.
[27]By February 2009, Dr Grant was prescribing steroids for 11 of the 14 patients involved in these proceedings. By then, it is reasonable to expect that Dr Grant would have been known by members of the body building community as a doctor who was willing to prescribe steroids for body building purposes.
[28]In his affidavit sworn on 14 June 2012, when explaining his conduct, Dr Grant referred frequently to body building protocols about the quantities and frequency of use of the medications he was prescribing. According to these protocols, he considered he was not prescribing excessively.
[29]In answer to a question from his counsel, he said that he originally thought it was acceptable to prescribe what he did. It was not clear whether he meant acceptable judged against the so-called body building protocols or some other measure. When asked to identify the protocols, he referred to articles in body building magazines. It is trite to say this is not a source of professional advice or guidance.
[30]If, by his answers to these questions, Dr Grant intended to say he thought he was authorised to prescribe as he did, the Tribunal rejects that suggestion. However, the Tribunal infers this is not what he meant. Rather it takes Dr Grant’s answers to mean that he did not consider his practices put his patients’ health at risk. As a medical practitioner, he can have been in no doubt that steroid use for body building purposes was not a therapeutic use and that to prescribe them for that purpose was outside the terms of his endorsement.
[31]Further, he had no endorsement at all to prescribe Clomid, a medication approved for use in fertility treatment of women.[4] It is also a drug promoted by body building websites post steroid therapy.[5] To prescribe medication without an endorsement to do so is a breach of the Health (Drugs and Poisons) Regulation 1999 (s 187). Dr Grant gave the Tribunal no explanation for prescribing this drug to two of his patients, Kennedy and Monger.
[4]National Prescribing Service, “Clomid(R) – clomiphene citrate: Consumer Medicine Information” for example – Bodybuildingpro.com, “All about Clomid” Grant was a reader of body building publications. He had a number of clients who competed. He also treated a cage fighter. He told the Tribunal he knew these drugs could be obtained via the internet. There was a risk that products bought this way might be impure, while those he prescribed were pure. By prescribing to his patients, he was able to keep an eye on their physical health.
[33]The same argument could be made about any medication available without restriction, albeit illegally, through the internet. The system in Australia for distribution of drugs for therapeutic use[6] is intended to minimise risks to patient and public safety. The system would be subverted if professionals felt justified in abusing their authority to prescribe, simply because their patients could source the drugs illegally.
[6]Therapeutic Goods Administration Act 1989 (Cth); Health (Drugs and Poisons) Regulation 1996.
[34]Dr Grant said he believed his patients were seeking the medications for their own use. The Board, in its meagre submissions about Dr Grant’s practices, did not seek to persuade the Tribunal that there was a risk that the drugs were being diverted. Annexed to Ms Hill’s affidavit is a report from a Queensland Health investigator about Dr Grant’s prescriptions for 5 of his patients (MKH-29). The investigator concluded the quantities and combinations exceeded any therapeutic purpose, with some prescriptions involving multiple drugs with the same active ingredients. Given this, and the excessive quantities, he questioned whether they were being diverted.
[35]Certainly, if Dr Grant prescribed these drugs with actual knowledge that he was contributing to a trade in steroids, the Tribunal would view his conduct more seriously.
[36]There is no direct evidence any of the patients were trading in the drugs. It is reasonable to assume that Dr Grant was aware, as a reader of body building magazines, of the notorious trade in steroids in the body building community and the risk that what he prescribed might be diverted. He did not demonstrate any basis for his confidence that the drugs were not being on-sold by his patients. There is no evidence that he put in place any mechanism to ensure this did not happen.
[37]Dr Grant said that he would have ceased prescribing immediately if he thought the drugs were not for a patient’s personal use. The Tribunal places little weight on that assertion.
[38]For Dr Grant to refuse to prescribe would require a strength of character that Dr Grant conceded he did not have. He told the Tribunal that, at some unspecified time, he knew he should stop doing what he had been doing, but found it difficult to say no to his patients.
[39]This was his explanation, also, for his inadequate response to concerns raised by a young pharmacist in relation to Dr Grant’s prescribing for the patient Anderson. Dr Grant prescribed a combination of Sustanon, Scitropin, Reandron, Primoteston, and Human Growth Hormone to Anderson over a period of 3 years and 9 months.
[40]Although he could not remember whether he spoke to one or two different pharmacists and when precisely the conversations took place, he conceded that a pharmacist approached him about his prescribing to Anderson and told him that the patient’s use of the drugs was excessive.
[41]Sometime after that, Dr Grant told the patient that he would be unable to continue to prescribe the drugs to him. Despite this, a little over one month later Dr Grant resumed prescribing to Anderson. Dr Grant’s explanation was that he was a longstanding patient and he was too weak to say no.
[42]He also told the Tribunal that he was trying to ask Daniel (Anderson) to reduce the quantities he was using. This demonstrates his unprofessional attitude to his responsibilities as a medical practitioner. It was not for his patients to dictate their medication. It was his responsibility to treat and prescribe to them within the professional guidelines.
[43]In some other cases of this nature, the practitioners have given evidence that they were intimidated by the patient.[7] That might well be the case for Dr Grant also, although he did not lead any evidence to that effect. Regardless, there are steps that a practitioner may take, such as voluntarily surrendering their endorsement to prescribe particular drugs, if they find themselves targeted by aggressive patients seeking to dictate their medications.
[7]Pharmacy Board of Australia v Booy [2011] QCAT 522; Medical Board of Australia v Dolar [2012] QCAT 271.
[44]Dr Grant’s conduct fell below the standard that might reasonably be expected of him by the public and his professional peers. He abused a privilege bestowed on him in his professional capacity. He facilitated access to steroids for a non-therapeutic purpose. It seems he did so because he thought it was preferable that professional or recreational body builders accessed a pure product and had their health monitored. He apparently took no steps to ensure the drugs he prescribed were not being traded. He attributed his failure to stop doing what he knew to be wrong to a weakness of character. It seems that he continued doing so until his endorsement was taken away from him.
[45]The Tribunal is satisfied that Dr Grant engaged in unprofessional conduct. It was conduct of a lesser standard than that which might reasonably be expected of him by the public or his professional peers. He provided services to his patients that were excessive, unnecessary or otherwise not reasonably required for their well being.[8]
[8]Health Practitioner Regulation National Law Act 2009, s 196(1)(b)(ii), Schedule 5, Definition of ‘unprofessional conduct’.
The sanction
[46]The parties have proposed a sanction comprised of a reprimand and conditions that would prevent Dr Grant from dealing with the relevant drugs, require him to undertake a tertiary level course in prescribing practices and authorise the Board to access his records. They propose the conditions apply for 12 months and that he cannot apply to review them within that time. They also propose that he pay the Board’s costs of the proceedings and all costs of complying with the conditions, including the Board’s costs of accessing his patient records.
[47]The Tribunal expressed its concern about the adequacy of this penalty, particularly given the sanctions that have been imposed in other cases involving steroids dispensed in excessive quantities or frequency or inappropriate combinations. One of those cases involves the young pharmacist who approached Dr Grant about the patient Anderson. The sanction imposed on that pharmacist (on the joint submission of the Pharmacy Board of Australia and the pharmacist) included an order that his registration was suspended.[9] However, the effect of the Tribunal’s orders in that case was that the pharmacist’s registration was not actually suspended, provided he complied with conditions about further training and mentoring.
[9] Pharmacy Board of Australia v Booy [2011] QCAT 522.
[48]The Tribunal must approach each case afresh and consider the particular circumstances of the case before it. It is relevant to its function, particularly in order to promote consistency of decision making within the national scheme, to take into account decisions made in comparable matters in determining what is the proper sanction.[10]
[10]Health Practitioner Regulation National Law Act 2009, s 3(3); Queensland Civil and Administrative Tribunal Act 2009, ss 3(c), 4(d).
[49]The parties proposed Dr Grant is reprimanded. A formal reprimand of a professional is not a trivial penalty. It is a matter of public record and would be viewed seriously by the professional’s colleagues, who could be expected to think less of the practitioner for it. The reprimand goes to their reputation as a practitioner. It could have significant implications for a practitioner’s career prospects.
[50]Nevertheless, it is a less significant penalty than a decision to suspend a practitioner’s registration, even if the order itself is suspended provided specific conditions are complied with. Members of the profession and the public alike could be expected to view the loss (or potential loss) of the right to practise as a clear indication that the Tribunal viewed the practitioner’s conduct more seriously than if the conduct resulted in a reprimand.
[51]The purposes of sanction in a disciplinary proceeding are well established: to maintain professional standards and public confidence in the profession and to protect the public. An important element of maintaining standards and confidence in the profession is making orders that appropriately reflect the Tribunal’s censure of the unprofessional conduct.
[52]The sanction imposed on the pharmacist was imposed with his consent. However, there is an apparent difference in sanctions proposed by the two Boards in the two cases that suggests they view similar conduct differently.
[53]It is untenable that this Tribunal would take a different view of similar conduct according to the profession to which the practitioner belongs. The Tribunal does not see there is a principled basis for drawing a distinction between the two professions in relation to supply of drugs for non therapeutic purposes.
[54]Pharmacists and doctors have independent obligations to comply with the terms of their endorsements under the Health (Drugs and Poisons) Regulation 1996. Both must ensure that drugs are supplied for therapeutic purposes only. Both must use their professional judgement in exercising their power to prescribe or to dispense medications open to abuse or diversion. If a pharmacist might be described as the last line of defence in the system to regulate access to medications, a doctor must surely be on the front line.
[55]The Tribunal has had regard to the agreed position of the parties, which they maintained in the face of the Tribunal’s concern about its adequacy. The Tribunal can be expected to impose an agreed sanction within the permissible range.[11] It is the Tribunal’s function to determine what is within the permissible range for a particular case, regardless of agreement between the parties. It must make its own assessment and scrutinise what is proposed to determine whether it is within power and appropriate.[12]
[11]Secretary to the Department of Planning and Community Development v Muto [2011] VCAT 328 at [16].
[12]Australian Competition and Consumer Commission v Real Estate Institute of Western Australia Inc [1999] FCA 18 at [3]; Australian Competition and Consumer Commission v Colgate-Palmolive Pty Ltd [2002] FCA 619 at [20]-[21]; Nursing & Midwifery Board of Australia v Brereton [2011] QCAT 578 at [3].
[56]The Tribunal appreciates the considerable effort made by counsel for Dr Grant to bring together cases involving similar conduct decided by this Tribunal and its counterparts in other states. They are summarised in a table attached to his submissions of 18 June 2012. It is not necessary to canvass them in detail. The Tribunal accepts counsel’s observations about the cases surveyed.
[57]The sanctions imposed in the Victorian cases are, generally, more severe than have been imposed in Queensland, involving periods of actual suspension. Some of those cases, though, involve aggravating factors not present in this case, such as active deceit or a patient death as a result of the practitioner’s conduct. In New South Wales, on the other hand, the cases more often involve reprimands and conditions akin to those proposed here. The previous decisions of this Tribunal have tended to involve suspension of registration, but only if conditions are not complied with.
[58]One Victorian case bears some similarities but involves only one patient. In Medical Board of Australia v Saykao[13] a medical practitioner was reprimanded and required to undertake further training and supervision for having inappropriately prescribed anabolic steroids to one patient. Another medical practitioner was reprimanded for inappropriately prescribing schedule 8 drugs to 4 patients whom he had reason to suspect were drug dependent.[14] In another case involving a pharmacist who dispensed inappropriately to 17 patients on a fortnightly basis, the practitioner’s registration was suspended for 6 months.[15] These cases provide some guidance.
[13] [2011] VCAT 1338.
[14] Medical Practitioners Board of Victoria v Stiglitz [2010] VCAT 662.
[15] Pharmacy Board of Victoria v Danigelis [2010] VCAT 1276.
[59]The New South Wales cases also provide some guidance. Only a few involve steroids. One practitioner improperly prescribed steroids to 14 patients and human growth hormone to a smaller number, including a close family member. He also self administered that medication. The period involved was much shorter, however, extending over only 2 years and 4 months. He was reprimanded, prevented from prescribing the relevant drugs and required to practice under supervision in a group practice.[16] In another case involving anabolic steroids the practitioner also inappropriately supplied himself with drugs of dependence and it must be seen to be in a different category to this one.[17]
[16]Health Care Complaints Commission v Nguyen-Phuoc [2009] NSWHT (7 December 2010).
[17] Health Care Complaints Commission v Wong [2009] NSWMT (1 April 2010).
[60]A reprimand is within the permissible range for inappropriate prescribing. However, the question is what is the permissible range for the actual conduct engaged in by Dr Grant. That requires discrimination between possible sanctions based on the peculiar features of the case. The range of sanctions applied in cases of a doctor inappropriately prescribing medications provides some context for but does not define the permissible range for Dr Grant’s case.
[61]Some potentially aggravating features are not present here. It seems no patient was actually harmed by Dr Grant’s conduct. He derived no additional financial benefit from his activities.
[62]However, because of the following factors, the Tribunal has concluded that the proposed sanction is not appropriate:
· This conduct occurred over a very lengthy period, with Dr Grant treating one patient continuously for more than 9 years with knowledge that the steroids were used for a non-therapeutic purpose.
· Dr Grant treated 14 patients overall and, at one point was inappropriately prescribing steroids to 11 patients in the same period.
· Dr Grant was aware that none of these patients needed the medications for a therapeutic purpose. For this reason he did not do the things that might be expected of a professional prescribing them for a proper purpose – tests and investigations; specialist referrals; diagnosis and treatment plans.
· Dr Grant preferred information in body building magazines to professional sources of information and guidance.
· Dr Grant breached the terms of his endorsement (and, therefore, his legal as well as professional responsibilities) by prescribing for a non-therapeutic purpose.
· Dr Grant prescribed a drug to two patients which he was not endorsed to prescribe.
· There is no evidence he sought to counsel his patients against the drug regimen they required him to prescribe, accepting information from the body building community that what he was doing was safe. He complied with his patients’ requests without demur. He did not exert his authority or exercise his professional judgement in his prescribing practices.
· He considered it was preferable to provide this service to his body builder patients than leave them to source these drugs illegally. This rationale for this protracted conduct, which he knew to be wrong, was flimsy.
· He was unable to follow through on his decision to cease prescribing to one patient after a pharmacist intervened. At the same time he continued to prescribe similar regimes to several other patients.
[63]Taking those factors into account, the Tribunal considers a reprimand is an inadequate expression of the Tribunal’s denunciation of his conduct, even with the conditions jointly proposed.
[64]The likelihood that the conduct might be repeated is very significant when considering interference with a doctor’s right to practise.[18] The Board considered Dr Grant’s co-operation indicated insight. Dr Grant said he intended to wind down his working hours towards retirement at 69 (he is now 65). The parties submitted this reduced the risk of recurrence.
[18] Mullany v Psychologist’s Registration Board [1997] VicSC 650.
[65]A reduced scope of practice might well reduce the risk of further inappropriate prescribing. In another case involving a medical practitioner, this Tribunal did not impose a suspension order because the combined effect of orders made by the Tribunal and an agreement reached between the practitioner and Queensland Health about her endorsement, left little scope for recurrence.[19] That is not the case here.
[19] Medical Board of Australia v Dolar [2012] QCAT 271.
[66]The proposed sanction does not require Dr Grant to practice in accordance with his intentions. In any case, all it involves is a progressive (but unspecified) reduction in hours. Dr Grant remains in the same practice, acting in the same capacity. Dr Grant’s own experience demonstrates there is an active body building community at the Gold Coast. While he says that he would have no trouble referring patients requesting such drugs to another doctor at the practice, his past conduct gives little assurance about that. Although Dr Grant does not have an endorsement for the relevant drugs, he has shown, in prescribing Clomid, that a lack of endorsement might not be sufficient deterrence (or provide him with adequate protection from his patients’ demands).
[67]Dr Grant said he knew what he was doing was wrong but he found it hard to say no. That suggests he lacks the necessary skills for dealing with demanding patients. That might be addressed by training. However, it also indicates a lack of professionalism and strength of character. Although Dr Grant frankly conceded this weakness, he did not say how he would address this. The Tribunal is not satisfied the proposed sanction adequately deters Dr Grant from repeating this pattern of conduct.
[68]Although Queensland Health gathered a substantial body of material that demonstrated Dr Grant’s inappropriate practices, the Tribunal has taken into account the significant co-operation shown by Dr Grant in these disciplinary proceedings. He has saved the Board and the Tribunal substantial time and cost by his attitude in these proceedings. The Tribunal accepts that is an indication of his insight about his past conduct. It also demonstrates his remorse. That is accounted for in the Tribunal’s decision that the orders should be framed so that Dr Grant’s registration will not actually be suspended if he meets certain requirements.
[69]The Tribunal proposes to make orders that achieve the following:
1. Dr Grant is reprimanded.
2. Dr Grant’s registration is suspended for a period of 12 months, but that order will not take effect if, for a period of 2 years, Dr Grant fully complies with the conditions imposed on his registration and is not the subject of further disciplinary action by the Board.
3. The conditions that will be imposed on his registration will require him to:
(a)Undertake a tertiary level course in prescribing practices (within the shortest practicable timeframe, bearing in mind when it might be available and how long it takes to complete);
(b)Undertake a course approved by the Board to develop his skills in managing difficult interactions with patients (within the shortest practicable timeframe) ;
(c)Not deal with the relevant drugs in any way, or seek the return of his endorsement to do so;
(d)Allow (and pay for) the Board to audit his patient records;
(e)Require him to nominate a mentor with whom he must meet monthly to reinforce sound prescribing practices and skills in managing interactions with patients; and
(f)Require him to provide a copy of these orders and reasons to his employer and mentor.
4. Dr Grant will not be able to apply to review the conditions within 3 years.
5. Dr Grant will pay the Board’s costs of and incidental to these proceedings.
[70]The parties are invited to provide an agreed form of orders that achieves the Tribunal’s intentions by 20 July 2012. If the parties do not do so by that date the Tribunal will proceed to finalise the orders without further consultation.
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