An Armidale doctor whose "prescribing fell significantly below the standard reasonably expected of a practitioner with his level of training and experience" and who failed to record his patient's addiction status and drug seeking behaviour, has been found guilty of "unsatisfactory professional conduct" by the Professional Standards Committee.
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The committee heard on January 29, 2024, that from May 2019 until June 2021, Dr Brian John Glover inappropriately issued various scripts for restricted drugs, including oxycodone and Tapentadol and Tramadol, which are used for pain management.
An experienced physician who was first registered in 1982, Dr Glover has been practising as a GP in Armidale since 2006.
The committee heard that Dr Glover had been treating the patient for a number of years before May 2019, for general care, particularly for substance disorder, primarily alcohol.
The patient had complex medical issues including ongoing pain management, but their narcotics use had escalated and Dr Glover had been unsuccessful in seeking to wean the patient, a registered pharmacist for some of the years of treatment, off codeine.
According to the findings, Dr Glover accepted and agreed that he should have "obtained advice from a pain specialist, enforced boundaries around the use of medication, documented his treatment plans and obtained the advice of colleagues".
"The question of trust had to do with Dr Glover's acceptance of the patient's stated need for restricted drugs and usage when he should have been more questioning and sceptical," the hearing was told.
"A compounding factor from late 2019 was the COVID-19 pandemic," when it was difficult to get specialist appointments.
"From this history, it is apparent that the circumstances were not so much of Dr Glover not identifying the problem or not knowing what to do but letting his trust in the patient and the pressure of his work allow him to be distracted from what he knew he ought to have done," the findings read.
Conditions imposed on Dr Glover's registration in June 2021 - that he was not able to prescribe s8 drugs and Benzodiazepine derivatives - prompted him to review his practices.
The committee heard he now takes better care of himself; he holds weekly meetings to promote discussion of challenges that he and his colleagues face; he takes time out for regular annual leave, sick leave and lunch breaks; and he has developed systems including the use of templates and patient contracts to foster practice-wide boundaries and expectations of patient behaviour.
Speaking about the "weaknesses" that led to the prescribing problems for the patient, Dr Glover admitted he should have regularly undertaken things like; a better assessment of the patient's pain and condition; taking a more thorough history; obtaining NSW Health authority for relevant prescriptions; and finding out why a patient left a previous doctor and obtaining those records.
Dr Glover has since taken a course on medical records and made changes to his e-record keeping.
The committee agreed to reprimand Dr Glover which "brings home to Dr Glover the concern that we have about his unsatisfactory professional conduct", which "had the potential to adversely affect the care and treatment of the patient".
"Restricted drugs have been so categorised precisely because they are high risk substances" and "practitioners need to be aware of the importance of being thoughtful and careful in their treatments and prescribing practices".
Submissions for a number of conditions on Dr Glover's registration, including that he should be limited to seeing no more than 30 patients in any one day; not practice for more than 40 hours a week; and be mentored by an experienced general practitioner; were found to be "not necessary" in the decision handed down on February 23, 2024.
"Nor is an other conditions necessary."
"In responding to the [Health Complaints] Commission's submission for conditions on his registration Dr Glover said he believed any condition would end his ability to supervise practitioners under various education programs. He is not currently supervising international medical graduates, but Dr Glover said he hopes and it looking towards supervising international medical graduates as part of his retirement plans. Were he unable to supervise international graduates Dr Glover said he would retire early and leave Armidale with one less general practitioner," the findings read.
But even without conditions, and with a reprimand in place, Dr Glover could still be denied the ability to supervise depending on the Medical Board of Australia's assessment of all the circumstances at the time.
Dr Glover has the right to appeal the decision to the NSW Civil and Administrative Tribunal.
