Articles and Case Studies

Prescribing for Self and Family – What Could Go Wrong?

01 Jun 2017

Dr Jane Deacon

by Dr Jane Deacon

prescribing

A recent decision in the NSW Tribunal1 found a doctor guilty of professional misconduct, reprimanded and ordered to undergo medical ethics education and mentoring by a Psychiatrist because she treated her family members.

Case history

The doctor provided prescriptions to her two adult children and husband. She also self-prescribed by issuing scripts in her husband’s name for medications which she consumed. The prescribing spanned five years. The doctor failed to maintain records of the prescriptions, or records of any kind.

The doctor attributed her conduct to the chaos and stress that existed in her home life during the time of her misconduct, and a misplaced sense of duty as a mother to meet the needs of her family. She felt obligated to assist her children and her husband in whatever way she could under very stressful circumstances.

One of her daughters had received treatment for a variety of addiction, mental health and other problems. Although the Tribunal found that the prescriptions to family members were issued in quantities and frequencies that fell within normal parameters, it was considered improper for a doctor to treat and prescribe medicines to family members, other than within narrow limits such as emergency or necessity.

Discussion

The Medical Board of Australia’s Code of Conduct for Doctors in Australia states:

Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient.

Difficulties may arise for both parties in traversing sensitive matters, or for the patient in making frank disclosures in relation to intimate matters such as private behaviour, giving rise to special risks. The doctor who treats a family member may be affected by subjective emotions and views which hamper his or her ability to undertake a full investigation and give the best and most appropriate treatment. The doctor may be influenced by a desire to please the family member, and not upset that person.

Research suggests that it is common for doctors to be asked for medical advice by family members, and it may be useful to discuss the reasons why this is not advisable with your family.2,3

Prescribing for self and family – state and territory legislation

  Legislation S4 Self S8 Self S4 Family S8 Family
ACT  Medicines, Poisons and Therapeutic Goods Regulation 2008 [MPTGR]
Interns not permitted to self-prescribe MPTGR r 30

Otherwise no self-prescription of restricted medicines MPTGR r 30

(Anabolic steroid and benzodiazepines)
 No self-prescription MPTGR r 30

Interns not permitted to self-prescribe MPTGR r 30

 No restriction
 No restriction
 NSW Poisons and Therapeutic Goods Regulation 2008 (NSW) [PTGR]

No restriction

Note PTGR r 33

“A medical practitioner must not issue a prescription for a restricted substance otherwise than for medical treatment”

(list includes benzodiazepines)
No restriction

Note PTGR r 78

“A medical practitioner must not issue a prescription for a drug of addiction otherwise than for medical treatment”
 No restriction
 No restriction
 NT Medicines, Poisons And Therapeutic Goods Act 2014 (NT) [MPTG]

Cannot self-prescribe Restricted S4

S90

No self prescription s4R

No self-administration

Restricted S4 unless lawful supply by other and genuine therapeutic use in emergency (notice within 7 days) where person has no access to other person who may lawfully supply or administer the substance

s 90 & 114 [MPTG]
Cannot self-prescribe S8

s 90 [MPTG]

No self-administration S8 unless lawfully supplied and genuine therapeutic use in an emergency when the person has no access to any other person who may lawfully supply or administer the substance

s 114 [MPTG]
 No restriction
 No restriction
 QLD Health (Drugs and Poisons) Regulation 1996 (QLD)
[HDPR]

 No restriction
No self-administration unless supplied by other practitioner and genuine need to appropriately treat HDPR  r 123
 No restriction
 No restriction
 SA

Controlled Substances (Poisons) Regulations 2011 (SA) [CSPR]
 No restriction
Not permitted unless “verifiable emergency” CSPR r 37(2)
$5000 Max penalty
 No restriction
Not permitted unless “verifiable emergency” for spouse, domestic partner, parent, grandparent, child, grandchild, brother or sister  CSPR r 37(1)

≤$5000  penalty
 TAS Poisons Regulations 2008 (Tas) [PR]
 No restriction
Not permitted

PR r 15(4)

“A person must not write or issue a prescription for the purpose of procuring a narcotic substance for administration to himself or herself”

≤10 penalty units
No restriction
No restriction
 VIC Drugs, Poisons and Controlled Substances Regulations 2006 (VIC) [DPCSR]

Not Permitted

DPCSR r 48(c)

Penalty 100 units
Not Permitted

DPCSR r 48(b)

Penalty 100 units
 No restriction
 No restriction
 WA Medicines & Poisons Act 2014 [MPA]

Misuse of Drugs Act
1981 [MDA]

Not S4 Reportable Poisons

(under review – none listed currently) but will be S4 drug with “high propensity for misuse, abuse or illicit use”

MPA s 77
A person who prescribes a drug of addiction for himself or herself commits an offence MPA s 78
 No restriction
 No restriction

Summary points

  • It is not advisable to treat family members, or yourself.
  • If you need to provide care to a family member in an emergency, hand over your care to another doctor as soon as possible, and document your treatment.
  • MDA National’s Professional Indemnity Insurance Policy excludes cover for claims arising from elective medical treatment provided by a Member to their immediate family.
  • State and territory legislation regarding prescribing for self and family varies significantly. However, S8 self-prescription is not generally permitted. In Victoria, S4 or S8 self-prescribing is NOT allowed under any circumstances.

Dr Jane Deacon
Medico-legal Adviser
MDA National


References

  1. Health Care Complaints Commission v BXD (No. 1) [2015] NSWCATOD 134 (7 December 2015).
  2. La Puma J, Stocking CB, La Voie D, Darling CA. When Physicians Treat Members of Their Own Families. Practices in a Community Hospital. N Engl J Med 1991;325(18):1290-4. Epub 1991/10/31.
  3. Evans RW, Lipton RB, Ritz KA. A Survey of Neurologists on Self-treatment and Treatment of Their Families. Headache 2007;47(1):58-64. Epub 2007/03/16.
  4.  

Communication with Patients, Regulation and Legislation, Anaesthesia, Dermatology, Emergency Medicine, General Practice, Intensive Care Medicine, Obstetrics and Gynaecology, Ophthalmology, Pathology, Psychiatry, Radiology, Sports Medicine, Surgery, Physician, Geriatric Medicine, Cardiology, Plastic And Reconstructive Surgery, Radiation Oncology, Paediatrics, Independent Medical Assessor - IME
 

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