Practitioner fined and reprimanded over inappropriate patient management and prescribing

20 Nov 2019

A tribunal has found a general practitioner engaged in professional misconduct in relation to inadequate patient management and inappropriate prescribing of highly addictive opiate medication.

In April 2019, the State Administrative Tribunal of Western Australia (the tribunal) reprimanded Dr Aminah Simone Altaf, a specialist general practitioner, imposed auditing and mentoring conditions on her registration and required her to pay $10,000 towards the legal costs of the Medical Board of Australia (the Board).

The tribunal’s decision relates to Dr Altaf’s care of a patient who had a history of chronic pain and opiate dependency. Between 15 February 2016 to 4 April 2016, Dr Altaf prescribed Schedule 8 drugs when she was not authorised to do so. She also prescribed unacceptably high doses of Oxycodone and Fentanyl despite receiving advice not to do this from a patient’s pain management specialist and warnings from the Health Department about the patient’s drug seeking behaviour.

Dr Altaf agreed that she had failed to maintain adequate medical records for the same patient and had failed to report to the Department of Health and to notify AHPRA when a pharmacist dispensed Schedule 8 medications to the patient without a prescription or verbal authority. In fact, Dr Altaf had issued prescriptions for the medication that had been dispensed without authorisation.

In summary, the tribunal found Dr Altaf:

• prescribed Oxycodone and Fentanyl to the patient in doses that were unacceptably high, with no clinical indication for such large doses
• prescribed Oxycodone in erratic quantities
• prescribed in circumstances where she had no authorisation to prescribe Schedule 8 drugs to the patient in the period 15 February 2016 to 4 April 2016
• prescribed in circumstances where she had been advised by the Department of Health on 22 July 2015, that the patient was exhibiting drug seeking behaviour
• increased the amount of Fentanyl prescribed to the patient, in circumstances where she had been advised by a pain management specialist that she should gradually reduce the patient’s Fentanyl dose
• failed to maintain adequate clinical records for the patient on at least 38 occasions
• on eight occasions, issued prescriptions for Schedule 8 medications which had already been dispensed to the patient by pharmacist Michael Man Ho Tse in circumstances where she was aware that the Schedule 8 medications had been dispensed without a valid prescription or verbal authority from a medical practitioner; and
• failed to notify AHPRA of Mr Tse's conduct.

When making its decision, the tribunal took into consideration Dr Altaf’s cooperation with the Board’s investigation, the fact that she felt pressured by the situation in which she found herself and that since the investigation into her conduct, the practitioner has already implemented changes to the way she practices.

The full decision is published on the tribunal website.