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GP disqualified after overdose death of her de-facto partner

Summary: Doctors should avoid entering a doctor-patient relationship with a family member or close friend and should never become that person’s primary clinician. Even if other practitioners are involved, treating someone with whom you have a close personal relationship can make it very difficult to maintain objectivity or professional distance, as this case illustrates.

Tuesday, 1 August 2023

Key messages from the case

Doctors should avoid entering a doctor-patient relationship with a family member or close friend and should never become that person’s primary clinician. Even if other practitioners are involved, treating someone with whom you have a close personal relationship can make it very difficult to maintain objectivity or professional distance, as this case illustrates.

Details of the decision

Treating family and friends

Dr D, a general practitioner, faced disciplinary proceedings over her treatment of her de-facto partner Mr S who was drug-dependent.

Although she referred Mr S to multiple specialists, Dr D became his primary treating doctor and inappropriately prescribed and administered medication including morphine, pethidine, other injectable pain relief, antipsychotics and antidepressants.

Mr S died from an overdose of amitriptyline that Dr D had prescribed.

The tribunal concluded that Dr D’s prescribing amounted to “grossly inappropriate polypharmacy” and that she had ignored specialist advice and withheld information from most of the specialists involved in Mr S’s care.

Several of the specialists had told her she should not be her partner’s treating practitioner, which she also ignored.

Prescribing

She failed to obtain the required authority to prescribe drugs of addiction when she knew or ought to have known that her partner was drug-dependent.

Medical records

Dr D was also criticised for failing to keep adequate medical records of consultations or prescriptions.

Outcome

Dr D was not registered at the time of the proceedings.

The tribunal concluded that while her conduct amounted to professional misconduct there was no evidence she was putting other patients at risk, and that the public could be adequately protected by the imposition of conditions including education, counselling, supervision and prescribing restrictions.

The complaints body appealed the penalty. The appeal court determined that protecting the public from similar misconduct and upholding confidence in the medical profession required a period of disqualification.

It ordered Dr D be disqualified for 18 months.

Key lessons

Avoid treating family members except in an emergency.

Do not enter a doctor-patient relationship with a family member or close friend and wherever possible refer family members to another practitioner for ongoing care.

If you do need to provide care for a friend or someone with whom you have a relationship, avoid informal consultations. Ensure they see you in a clinical context and ensure that you keep appropriate records.

Never prescribe Schedule 8 medications, drugs of dependence or psychotropic medications to anyone with whom you have a close personal relationship.

References and further reading

Avant article – “But it’s just a script”: prescribing requests from family and friends

Avant factsheet – Treating family members, friends or staff

Avant factsheet – Medical records: the essentials

Avant eLearning – Prescribing principles: Part 1

Avant eLearning – Prescribing principles: Part 2

Medical Council of NSW – Guideline for self-treatment and treating family members

For more information or immediate medico-legal advice, call us on 1800 128 268, 24/7 in emergencies.

Download case study

GP disqualified after overdose death of her de-facto partner (PDF)

Disclaimers

Scenarios in this publication are based on Avant claims experience to date. Certain information has been de-identified to preserve privacy and confidentiality. This publication is not comprehensive and does not constitute legal or medical advice. You should seek legal or other professional advice before relying on any content, and practise proper clinical decision making with regard to the individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant is not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published. © Avant Mutual Group Limited 2023 riskiqcase189 07/23 (DT-3298)

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