Doctor prescribed highly addictive painkiller from a hospital he no longer worked at

Seán McCárthaigh

A Limerick-based doctor has been accused of professional misconduct for using a prescription form from a hospital where he no longer worked to prescribe a high-strength, highly-addictive painkiller for a family friend.

The doctor appeared before a fitness-to-practise hearing of the Medical Council on Monday, where he admitted the facts of certain allegations but made no admissions on whether they constituted professional misconduct and/or poor professional performance.

The inquiry heard a complaint was made to the Medical Council after a pharmacist working at a Boots’ pharmacy in Limerick became suspicious about a prescription submitted by a woman known as Patient A on October 6th, 2021.

The fitness-to-practise committee overseeing the inquiry ruled that the identity of the doctor cannot be made public.

The inquiry heard the prescription was on notepaper from the Department of Psychiatry at St Luke’s General Hospital in Kilkenny, dated September 29th, 2021, which was signed by the doctor.

The form contained a watermark which stated: “not for MDA drugs”, although the prescription was for 28 28-day supply of OxyNorm – a strong opioid analgesic which is a controlled drug under the Misuse of Drugs Act.

Counsel for the Medical Council, Eoghan O’Sullivan BL, said the pharmacist subsequently established from the hospital that the woman had never been a patient of St Luke’s, while the doctor had not worked there for approximately a year.

Mr O’Sullivan acknowledged that the doctor had made certain admissions of fact in December 2021, including that he had written the prescription, which he accepted was inappropriate.

However, the inquiry heard that the doctor claimed he had done so for “special and substantial reasons” for a family friend who was in severe pain from a long-term condition, erosive esophagitis.

The inquiry heard the doctor had only prescribed to “tide her over a number of days.”

Mr O’Sullivan said the doctor also faced two other allegations relating to his failure to carry out an examination of Patient A and maintain adequate medical records of treating her, as well as for the unauthorised use of a HSE prescription pad.

The inquiry heard that the doctor, who qualified in 2011, has been registered to work in Ireland since 2017.

Although he was not suspended in relation to the subject matter of the inquiry, he has not practised medicine since a complaint was filed against him with the Medical Council.

An expert witness who gave evidence on behalf of the Medical Council, Fiona Fenton, said she believed the writing of the prescription for a controlled drug when he was not working at St Luke’s to someone who was not his patient constituted professional misconduct as his actions fell considerably short of the standards expected of doctors.

Prof Fenton, a consultant psychiatrist in substance misuse, said the appropriate treatment for the patient’s condition was a proton pump inhibitor and antacid medication to reduce acid in her stomach.

The witness pointed out that OxyNorm is a strong opioid painkiller, which is only recommended for advanced cancer or post-operative pain management.

She told the inquiry that the drug should only be prescribed for short-term use because it is addictive and she regarded it as “quite dangerous.”

Prof Fenton also highlighted how OxyNorm is not a drug that is used “at all” in psychiatry.

The psychiatrist said the proper reaction from the doctor when asked for pain relief by Patient A would have been to refer her to an on-call doctor service or the emergency department of a local hospital.

Prof Fenton noted that the appropriate medication for her condition could be bought over the counter in a pharmacy, while antacids could also be obtained in supermarkets.

While she felt his actions also constituted poor professional performance, Prof Fenton said she did not believe they met the threshold for making such a finding based on a legal precedent, as there had been no adverse outcome for the patient.

The doctor’s solicitor, David Higgins, said his client was genuinely remorseful and had learnt from the incident.

Mr Higgins said what happened was a “one-off incident” which had been admitted at an early stage by the doctor who had received no personal gain from what he had done.

“It was an isolated error made in stressful circumstances when a family friend was in chronic pain,” he added.

The fitness-to-practise committee made no findings against the doctor after it accepted the offer of an undertaking by him about his future conduct and to complete a continuous professional development course on prescribing in advance of resuming medical practice, as well as consenting to be censured.