Doctor suspended for prescribing experimental medications

A GP has been suspended for inappropriately prescribing performance and image enhancing drugs (PIED) to several patients, exposing them to a risk of harm.

This case emphasises safe prescribing habits and your responsibility to only provide medications that are clinically indicated and of therapeutic benefit.

The doctor, who practised in cosmetic and anti-ageing medicine, was initially investigated by Ahpra for his prescribing of peptides. The Medical Board of Australia took disciplinary action against the doctor in the state’s administrative tribunal alleging professional misconduct for prescribing a range of medications to eight patients in high doses over a decade.

The medications included synthetic peptides, amino acid peptides, growth releasing hormones, synthetic hexapeptides, endogenous adrenal androgenic steroids, testosterone and human growth hormones.

The tribunal found the doctor had inappropriately prescribed the medications over several years without an approved indication or evidence to support a therapeutic benefit, exposing the patients to a risk of harm.

The doctor also failed to keep adequate records or obtain informed consent before prescribing the medications. The medications were considered experimental and were not approved by the Therapeutic Goods Administration (TGA). Additionally, he breached the Medical Board of Australia’s code of conduct for doctors.

Doctor demonstrates insight

Initially, the doctor disputed the claims saying there was evidence of therapeutic benefit for the medications prescribed, denying that patients had been exposed to risk. He also claimed to be unaware the medications were not approved by the TGA and their use in these circumstances was regarded as experimental.

However, closer to the hearing, the doctor conceded there was no therapeutic basis for his prescribing, and he should not have formed the belief that the patients had provided informed consent. He expressed regret for his actions, saying, “I remain troubled that my efforts to help patients might have exposed them to some harm” and agreed his prescribing amounted to professional misconduct.

The doctor also voluntarily changed his practice. This included improving his record keeping, developing a better consent process and changing the scope of his insurance to limit his medical practice to six specific procedures. He also stopped prescribing peptides and started referring patients seeking testosterone to endocrinologists.

Significant sanctions proposed

The Medical Board of Australia referred the tribunal to factors arising from previous tribunal decisions which supported the need for more serious sanctions to be imposed on the doctor, including a significant period of suspension.

The factors included inappropriate prescribing to several patients:

• Over a significant period of time.
• Of multiple medications where the inappropriate prescribing may have caused patient harm.
• Where the doctor rationalised or justified their conduct.
• Where there had been a failure to obtain informed consent or to warn patients of potential risk and the doctor had failed to keep adequate records.

The Medical Board also highlighted that in this case the doctor had been slow to acknowledge his misconduct and had prescribed peptide and steroid medications which was a significant departure from accepted standards.

Guilty of professional misconduct

The tribunal noted the doctor’s previously unblemished record and that he had demonstrated insight into the nature of his professional misconduct. Once he became aware of the concerns, he also voluntarily stopped prescribing peptides and testosterone and expressed remorse about exposing his patients to a risk of harm.

In determining the appropriate disciplinary action, the tribunal emphasised that the aim of the sanctions was to protect the public and maintain professional standards by deterring the doctor from repeating the professional misconduct and other doctors from engaging in similar conduct.

Ultimately, the doctor was found guilty of professional misconduct and suspended for nine months. Conditions were imposed on his registration prohibiting him from accessing and prescribing endogenous adrenal androgenic steroids, testosterone or growth hormone related peptides, and he was required to undergo quarterly audits.

Consistent with the doctor’s earlier self-imposed restrictions on areas of his practice, the tribunal formally ordered him to restrict his practice to: hair restoration treatment, skin laser resurfacing, injections of dermal fillers and neurotoxins, minor skin excisions, ear lobe repair and lipodissolve therapy.

The doctor was also ordered to pay the Medical Board a $15,000 fine and its costs.

Prescribing requirements

This case highlights the importance of doctors regularly assessing their prescribing habits and only prescribing medications with an approved clinical indication or therapeutic benefit.

Doctors must obtain the patient’s informed consent when prescribing a treatment and inform the patient of any material risks of the treatment. A key aspect of the consent conversation is asking the patient about what is important to them and if there is anything they are particularly worried about.

It’s also important to document all treatment and prescribing decisions in the patient’s medical records. This includes any information given to the patient about the purpose and the benefits and risks of the medication prescribed, as well as the dosage, frequency and period of prescription.

Key lessons

• Only prescribe medications with an approved indication or evidence to support a therapeutic benefit.
• Document the clinical indication in the patient’s medical records and the dosage, frequency and period of prescription.
• If you are uncertain about whether it is appropriate to prescribe a PIED, consider referring the patient for a specialist opinion.

Useful resources

• eLearning course: Prescribing principles: Part one – general prescribing issues
• eLearning course: Informed consent and more 
• eLearning course: Medical records: Chapter one: documentation