Medical Board of SA v Coote (No 2) No. Dcaat-98-22 Judgment No. D65

[1999] SADC 65

MEDICAL BOARD OF SOUTH AUSTRALIA V COOTE (No.2)

[1999] SADC 65

Judge C R Lee
Medical Practitioners Professional Conduct Tribunal

1 On 28 April 1999, following a hearing of a complaint by the Medical Board, we ruled that Dr Coote, as a member of an after-hours locum service known as DLS, was guilty of unprofessional conduct in relation to the practice of medicine in 1991 and 1992.
2 Dr Coote is a 39 year old general practitioner.  He graduated in 1983, and with others established DLS in 1984.  His unprofessional conduct took the form of inappropriate and excessive injections of Pethidine to seven patients, a failure in relation to each of those patients to make personal contact with the general practitioner, and a failure with others to put in place and maintain procedures for ensuring that communications from GPs were referred by clerical staff to a medical practitioner member of DLS.
3 The conduct was serious for a number of reasons.  Pethidine is a drug of dependence, and each of the patients was dependent, or at risk of becoming dependent, upon the drug.  To the extent that he sought to shelter behind GP directions and prescriptions, Dr Coote failed to recognise, both at the time and again at the hearing, that an after-hours locum doctor must be responsible for independent enquiry and clinical judgement in his treatment of such patients.  As we said in our earlier reasons, independent enquiry should have been alert to the possibility of secondary gain, chronic pain behaviour and opioid dependence, and independent judgement should have been informed by pain clinic or other advice through the patients’ GPs.
4 We take into account all the submissions that Dr Coote’s counsel has made on his behalf.  We recognise the professional, family and financial consequences for Dr Coote of the proceedings and the delay in bringing them to a conclusion.  We acknowledge that he is unlikely to offend again.
5 Those things said, our concern in the end must be to endeavour to protect the public.  We need to impose a penalty which will act as a warning to other medical practitioners that the administration of drugs of dependence should be undertaken only after careful and anxious consideration of the welfare of the patient and the risks of dependency. We do not consider that any penalty less than suspension would be appropriate in all the circumstances.
6 The order of the Tribunal is that the registration of Dr Coote as a medical practitioner be suspended by removing his name from the general register for a period of five calendar months from today.