Medical Board of SA v Simounds No. Dcaat-91-98

[2000] SADC 44

Medical Board of South Australia v Trevor James Simounds
[2000] SADC D44

Judge C R Lee & Members Pickering, Chessell & Mills
Medical Practitioners Professional Conduct Tribunal

1. This is a complaint by the Medical Board pursuant to s58 of the Medical Practitioners Act 1983, to which Dr Simounds through his counsel has entered a plea of guilty.

2. The complaint charges Dr Simounds with unprofessional conduct in relation to the administration of Pethidine to patients in 1991 and 1992.  Dr Simounds, and certain other doctors who have already been dealt with by way of orders suspending them from medical practice, were then members of an after hours locum service, known as Doctors Locum Service or DLS. 

3. The allegations which Dr Simounds has admitted are as follows:-

   1...... The administrations of Pethidine by Dr Simounds to certain patients were excessive and inappropriate, and all the more so in light of the knowledge that he had or ought to have had of the administrations of Pethidine to the same patients by Dr Schloeffel, the relevant administrations being:-

Patient	Period	Schloefell				Simounds
Visits		Peth	Visits			Peth
Gibb	23.2.91 - 1.6.92	84		81	59			57
Pinnuck	1.9.91 - 31.3.92	32		30	32			30
Todd	1.2.91 - 30.6.92	61		27	43			7
Totals	177		138	134			94

2...... As a director of DLS, Dr Simounds failed in his duty to control the administrations of Pethidine by DLS doctors to these patients to ensure that over servicing did not occur.

3.Return visits made by Dr Simounds within 24 hours, or on the day immediately following an earlier visit, were wrongly charged by Dr Simounds under the AMA Schedule as item 627 or equivalent rather than item 625 or equivalent, the return visits being:-

Patient	Period	Return visits
Gibb	24.7.91 - 27.7.91	3
Pinnuck	9.12.91 - 14.2.92	6
Todd	1.1.92 - 26.2.92	5

4...... Dr Simounds failed to adequately liaise and communicate with the patients’ general practitioners concerning the management of the patients and to ensure that the patients were treated in accordance with a properly formulated management plan.

1. Each of the patients was dependent, or at risk of becoming dependent, upon Pethidine.

2. Pethidine is an opioid or narcotic analgesic which is short acting and has the potential to induce psychological and/or physical dependence.  It is attractive to narcotic drug seekers because of its potential mood enhancing effects when given by injection.  Pethidine may be used for short term acute pain, such as might be experienced following surgery or trauma, but it has no place in the management of non-malignant chronic pain.  It is inappropriate to treat chronic pain behaviour with opioid drugs for three main reasons:  first, the unlikelihood of continuing nociception or organic cause; second, the risk of disease reinforcement; and third, the risk of dependence.  

3. A locum doctor should not continue to administer Pethidine to a patient without doing all that he or she reasonably can to ascertain the GP’s management plan for the patient.  Even then, there must be the exercise by the locum doctor of independent enquiry and clinical judgment.  Independent enquiry should be alert to the possibility of secondary gain, chronic pain behaviour and opioid dependence, and clinical judgment should be informed by pain clinic or other advice through the patients’ GPs.

4. The item that was charged, item 627 at Level B, is described in the then AMA Schedule as “A service which requires of the general practitioner a selective history and examination of the patient, to assess and manage the problem”.  The item that should have been charged, item 625 at Level A, is described as “A service characterised by the straightforward nature of the general practitioner’s task”.

5. At the relevant time, Dr Simounds was in possession of fee schedules prepared by DLS which omitted any reference to the Level A item.  Dr Simounds relied upon those schedules, but he should have known of the existence of the Level A item and he should have known that he was misdescribing the services that he was providing to the patients.

6. Dr Simounds is 43 years of age, and married with two children.  He worked full time with DLS as a director and locum doctor between 1989 and 1993.  His area of responsibility as a director was the western suburbs, but the three patients in question were visited by him during weekly sessions in the northern suburbs.  He has been in private practice since 1993 and in his own practice as a sole practitioner at Lockleys since 1997.  Various references handed to us by his counsel attest to his conscientiousness and professionalism as a medical practitioner.  We accept that he has not transgressed since 1991 and 1992. 

7. In assessing what disciplinary action should be taken against Dr Simounds, we have kept upper most in our minds the need to achieve a proper proportion between the penalties imposed upon all of the doctors who have been charged.

8. We have been told that Dr Simounds has arranged for a locum to look after his practice from 17 April 2000. 

9. The order of the Tribunal is that the registration of Dr Simounds as a medical practitioner be suspended by removing his name from the general register for a period of 5 calendar months from and including 17 April 2000.