28 May 2020
A tribunal has banned former general practitioner Peter Tunbridge from applying for registration for two years and reprimanded him for professional misconduct in relation to inappropriate prescribing involving 20 patients.
The Medical Board of Australia (the Board) referred allegations to the South Australian Civil and Administrative Tribunal (the tribunal) in August 2019. The allegations concerned prescriptions issued by Mr Tunbridge for 20 patients between October 2009 and September 2017. These included prescriptions for Growth Hormone Releasing Peptide (GHRP), Anastrozole, Metformin, DHEA (dehydroepiandrosterone) and Testosterone.
In October 2018, the Board gave notice to Mr Tunbridge that it proposed to take immediate action. In response, Mr Tunbridge gave an undertaking not to, among other things, prescribe or administer certain medications other than while being supervised. These medications included any growth hormone-related peptides and DHEA hormone supplements not approved by the Therapeutic Goods Administration (TGA), and any medications for ‘off label use’, including but not limited to Anastrozole, T3, T4, and other oral hypoglycaemic agents, including Metformin.
Mr Tunbridge allowed his registration to lapse in September 2019 and has not been registered to practise since then.
Mr Tunbridge admitted that he had engaged in professional misconduct in an agreed statement of facts submitted to the tribunal. This included inappropriately prescribing (or administering) GHRP to 19 patients, DHEA to 10 patients, and Testosterone / Primoteston (or similar) to seven patients. He also inappropriately prescribed Anastrozole (Arimidex) to six patients, and Metformin (Diabex, Januvai) to 13 patients.
The tribunal found that Mr Tunbridge repeatedly put patients at risk of harm with his inappropriate prescribing. He often failed to advise patients that the medication he was prescribing was experimental. On occasions, he also failed to obtain patients’ informed consent for treatments that were unconventional, of unproven benefit, and potentially harmful. In some instances he failed to document informed consent, and failed to adequately monitor the treatment provided to certain patients. He also failed to keep adequate records and failed to appropriately address or investigate patients’ symptoms in some instances.
The tribunal found Mr Tunbridge’s prescribing to be a serious departure from the standard of care expected of a practitioner of his training and experience, noting he showed a serious disregard for the requirements of professional practice.
It noted Mr Tunbridge made no attempt to convince the tribunal he has gained insight into his behaviour or could be trusted to practise in a safe manner, other than acknowledgements made in the agreed statement of facts. The tribunal declared him unfit to be registered.
In its decision dated 6 May 2020, the tribunal reprimanded Mr Tunbridge and disqualified him from applying for registration for two years. He was ordered to pay $13,000 towards the Board’s costs.
The full decision will be published on the Austlii website.
The Statement of Agreed Facts briefly describes the relevant medications and the risks associated with Mr Tunbridge’s prescribing of them. In summary:
(a) Growth Hormone Releasing Peptide (GHRP) is a peptide. It is not approved by the TGA for use in Australia. It is regarded as an experimental medication. It is a drug that may be inappropriately used by, for example, bodybuilders or weightlifters other than for a therapeutic purpose.
(b) Anastrozole (Arimidex) is what is known as an aromatase inhibitor that may lead to the increased production of testosterone. While there are some limited approved circumstances in which the medication may be prescribed, it is otherwise an experimental medication. It is not approved by the TGA for the treatment of males. It is used inappropriately by people using anabolic androgenic steroids to counter the adverse effects of those drugs, for example, gynaecomastia (the development of breast tissue or breast enlargement in males).
(c) Testosterone (including Testogel) and Primoteston are anabolic androgenic steroids. These drugs can be inappropriately used off label by, for example, bodybuilders other than for therapeutic purposes. Testosterone is rarely used in the treatment of women.
(d) DHEA is an endogenous adrenal androgenic steroid. It is not approved for use by the TGA and is regarded as experimental for the use in treatment of males. It can also be inappropriately used off label by, for example, bodybuilders other than for therapeutic purposes.
(e) T3 and T4 are variations of thyroxine medications. They are used in the treatment of hypothyroidism.
(f) Metformin (Diabex) (and Januvia) may only be appropriately used in very limited circumstances, for example, the treatment of diabetes mellitus.
These medications described above, if used inappropriately, can have an adverse effect upon the health of a patient.