Charge

Between 10-14 and 17-19 October 2022, the Health Practitioners Disciplinary Tribunal (the Tribunal) considered a charge of professional misconduct laid by a Professional Conduct Committee against Dr Hanne, medical practitioner (the Doctor).

The charge alleged against the Doctor is summarised below:

1. Between 22 August 2014 and 2 April 2019, on at least 5,662 occasions, the Doctor prescribed methylphenidate and/or dexamphetamine in contravention of the Ministry of Health Gazette Notices;
2. Between 22 August 2013 and 1 May 2019, on at least 214 occasions, the Doctor submitted false and misleading claims to Pharmac for the subsidy of methylphenidate and/or dexamphetamine on special authority for his patients. In doing so, the Doctor made false/misleading declarations that:
   1. A paediatrician/psychiatrist had been consulted within the last two years and had recommended treatment for the patients when they had not done, and/or
   2. The details contained within the submissions were correct when they were not.
3. The Doctor prescribed methylphenidate and/or dexamphetamine and/or submitted special authority subsidy forms in the circumstances described in (1) and (2) above, when he knew or ought to have known as a result of previous inquiries in 2010 and 2014, that it was a breach of his professional obligations to do so
4. The Doctor breached his written undertaking made to the Medical Council of New Zealand to prescribe only methylphenidate and/or dexamphetamine in accordance with the Gazette Notices
5. The Doctor inappropriately treated and prescribed Patient A, being a person close to him, for ADHD.

The conduct alleged above amounts to professional misconduct in that, either separately or cumulatively, it amounts to malpractice or negligence in relation to his scope of practice; and/or has brought or is likely to bring discredit to the profession.

Background

The Doctor is a registered medical practitioner, with a general scope of practice. The charges arise from the Doctor’s inappropriate prescription of methylphenidate and/or dexamphetamine, which is used for the treatment of attention deficit hyperactivity disorder (ADHD). General practitioners do not have the authority to prescribe without the prior approval of a specialist paediatrician or psychiatrist. The Doctor’s defence was the existence of his supervisory relationship with a psychiatrist. In addition, the Doctor submitted that his actions were justified irrespective of the applicable restrictions.

Throughout his career, the Doctor has developed a particular interest in ADHD and has devoted a considerable part of his professional life to the study, centring his practice around the assessment and treatment of ADHD. He considers that ADHD is under-diagnosed and under-treated in New Zealand. It was estimated that since 1991 the Doctor has seen approximately 4,000 ADHD patients, either enrolled with him but more commonly referred by other GP’s due to his expertise. However, the Doctor is not qualified to prescribe stimulants, or apply for the subsidy on behalf of patients, without the written authority of a psychiatrist.

The majority of the factual background was not in dispute.  The Doctor had developed a relationship with a psychiatrist who would review diagnoses and treatment plans. The psychiatrist would rarely see the patients himself and would meet with the Doctor at least once a year to discuss his patients in detail. The arrangement was found to be inadequate and non-compliant with the restrictions on prescribing and dispensing stimulants. The conduct described was subject to disciplinary proceedings in 2011, although the charges were eventually withdrawn. In the present case, the Doctor gave evidence regarding the 2011 charges that indicated he had neither heeded the warning nor changed his practice since. After signing an undertaking in 2018 not to prescribe stimulants outside of the restrictions, the practitioner again failed to comply.

Finding

The Tribunal considered the pertinent question was the extent to which the practitioner was culpable for the inappropriate prescriptions, given the factual background was accepted. The Tribunal considered that although the Doctor had made a significant contribution to the study and diagnoses of ADHD that had at times been life-changing for his patients, he was doing so without the required qualification or supervision. Despite multiple warnings, the Doctor stubbornly refused to accept any suggestion that he might be acting improperly.

The charge was established and disciplinary sanction justified.

Penalty

The Tribunal ordered:

• Suspension for one year.
• Conditions imposed on practising certificate when the Doctor returns to practice.
• Censure.
• A fine of $12,500
• Payment of costs of the Tribunal and the PCC in the sum of $162,620.00.

The Tribunal directed publication of the decision and a summary.

The Doctor has appealed to the High Court against the Tribunal’s penalty decision in particular, the orders for suspension and fine.