On 6, 7, 10 – 14 June and 21 – 24 October 2019, the Health Practitioners Disciplinary Tribunal (the Tribunal) considered a charge laid by a Professional Conduct Committee against Dr Y, medical practitioner (the Doctor).
The particulars of the charge alleged the Doctor:
- On six separate occasions and specific amounts over a three day period, prescribed and/or administered inappropriate doses of morphine to his patient and that the dosages were excessive and/or reckless and/or were titrated contrary to accepted practice;
- On the sixth occasion, having been questioned on the appropriateness of the quantity of medication, directed a registered nurse to administer 60mg of morphine to his patient by continuous subcutaneous infusion when there was no clinical indication to do so; and/or
- Adopted administration PRN (‘when necessary’) subcutaneous morphine, in the absence of a continuous dose of morphine being administered by syringe driver at an appropriate dose, contrary to accepted practice and/or
- Failed to maintain a controlled drug register of morphine administered to his patient, contrary to the requirements of the Misuse of Drugs Regulations 1977; and/or
- Failed to keep and/or adequately keep clear and accurate patient records.
- Failed to adequately communicate with members of the community palliative care team; and/or failed to treat members of the palliative care team with respect and professional courtesy.
The Tribunal was very clear from the outset that the charge was not about the Doctor intending to hasten or that he did hasten the patient’s death. This was also emphasised throughout by counsel for the PCC. The case was also not about how a palliative care team carried out its professional obligations. The Tribunal focused on the specific particulars of the Charge.
The patient was an elderly long standing patient of the Doctor and was in the terminal phase of metastatic bowel cancer. She had discussed her medical management through her terminal phase with the Doctor and had asked him to continue to care for her during this time.
The Tribunal found particular 1 and is six sub-particulars, particular 2 and particular 7 not established.
Particular 3 was established as negligence on the Doctor’s part but not conduct bringing or likely to bring discredit to his profession. The conduct, was not sufficiently serious enough to warrant disciplinary sanction.
Particulars 4 and 5 were established as negligence but not as conduct bringing or likely to bring discredit to his profession and were sufficiently serious enough to warrant disciplinary sanction. The Tribunal indicated that it would be an order of censure.
Particular 6 was established in respect of one aspect of this particular but was not serious enough to warrant disciplinary sanction.
Submissions on penalty were considered on the papers and the Tribunal in a separate penalty decision:
- censured the Doctor;
- ordered the Doctor pay costs of $15,000;
- made permanent orders of suppression, and
- directed publication of the decision.