The prescribing of high quantities of drugs to patients with a drug addiction by a family doctor was “reckless” and “off the charts”, as well as increasing the risk that such drugs could be sold on the black market, a medical inquiry has heard.
Dr Patricia Black has been accused of professional misconduct and poor professional performance over allegations that she inappropriately prescribed benzodiazepines and other drugs to three patients in the Tallaght area several years ago.
Dr Black, of Castletown, Co Laois, faced a total of 20 allegations at the inquiry relating to the prescribing of drugs to the three unidentified patients with a drug addiction.
The GP also faced a separate accusation of failing to comply with an undertaking she had given the Irish Medical Council (IMC) in 2018 not to prescribe controlled drugs, including benzodiazepines, to patients.
The inquiry before the IMC’s fitness-to-practise committee heard evidence that Dr Black had prescribed such drugs on eight occasions between May 22nd and November 2nd, 2018.
Dr Black did not attend the three-day hearing of the IMC’s inquiry which concluded on Tuesday.
Ten other allegations relating to the failure to keep medical records and the failure to refer patients to a specialist substance misuse practitioner were withdrawn.
The GP, who qualified as a doctor in Ireland in 1991, had worked at a number of practices in the Dublin area up to 2018, including at a surgery on Knockmore Avenue in Tallaght and the Aylesbury Clinic in Old Bawn, and more recently at the Hope Medical Centre with clinics based in Mountrath and Castletown in Co Laois.
'Reckless'
The inquiry heard concerns about Dr Black’s prescribing were raised with the IMC by two community pharmacies.
An expert witness, Dr Nick Flynn, told the inquiry that some of the prescribing levels of benzodiazepines by Dr Black were “reckless” and “off the charts”.
Dr Flynn, an expert in substance abuse and GP with the MyCorkGP practice in Cork city, said it was important for doctors to limit the amount of benzodiazepines prescribed to patients with a drug addiction.
While benzodiazepines were most effective for treating individuals with anxiety, Dr Flynn said they could be dangerously addictive while also having potential side-effects, such as an increased risk of heart attack and stroke.
He said individual tablets also had a “street value”, which meant some patients could sell them on the black market.
Dr Flynn said the GP should have questioned why medical card holders were going to see her privately when they could just attend their own doctor free of charge.
He said the significant quantities of benzodiazepines prescribed to an individual known as Patient A increased the risk that he might overdose and die.
He told counsel for the IMC, Neasa Bird BL, that such a level of drugs could also result in the patient becoming intoxicated with the consequent risk of physical harm.
Dr Flynn said individual allegations made about Dr Black’s prescribing represented serious failings which he considered amounted to poor professional performance.
Cumulatively, however, he said they constituted professional misconduct because of the risk the GP’s prescribing posed to both individual patients and public health.
He told the inquiry that the maximum recommended number of 5mg tablets of benzodiazepine that should be prescribed in a month, except in exceptional circumstances, was 168.
However, Dr Flynn said Patient A had been prescribed 275 tablets by Dr Black on one occasion and was prescribed another 290 tablets 18 days later.
“It is very dangerous prescribing, and it is prescribing that is putting the patient’s health significantly at risk. If it’s been diverted to the black market, it is a significant public health risk,” he added.
Other prescriptions
Dr Flynn pointed out that the patient was also in receipt of the same drugs from his own GP because Dr Black had failed to check with the clinic or the HSE’s Primary Care Reimbursement Service if he was continuing to receive prescriptions from other sources.
Another individual known as Patient B was prescribed four times the recommended daily limit, said Dr Flynn.
He noted that Patient B was also receiving the same drug from his own GP in Tallaght.
Dr Flynn said the failure of Dr Black to check with the other GP undermined that doctor’s treatment of Patient B who was prescribing medicine “in good faith.”.
“Patients who are vulnerable and suffering from an addiction will take advantage of weaknesses in the system,” said Dr Flynn.
The witness said it was “remarkable” that Dr Black had prescribed the exact same large quantity of benzodiazepine to Patient B and another individual known as Patient H on the same date in September 2017.
“It represents a pattern of prescribing that is reckless and indefensible,” he remarked.
If proven, Dr Flynn said Dr Black’s failure to comply with the undertaking she had given the IMC not to prescribe certain controlled drugs also amounted to professional misconduct.
He agreed with Ms Bird that a breach of the undertaking represented conduct which could be considered “disgraceful and dishonourable” and which fell seriously short of the standards expected of doctors.
In December 2018, Dr Black was suspended from practising as a family doctor by order of the High Court due to patient safety concern arising from her alleged prescription practices and the breach of her undertaking to the IMC.
In a closing submission, Ms Bird said Dr Black had informed the IMC in 2018 that she was only trying to help patients but had admitted that she had given patients doses that were “colossally high” which she could not stand over as a doctor.
Dr Black had told the IMC that she was “anchored to solutions and not anchored to problems” with patients who were just looking “for a bit of kindness and compassion.”
However, the FTP committee was informed that Dr Black had made no formal admissions to the allegations.
The committee chairperson, Ronan Quirke, said its findings and any recommendations on sanction would be notified to the IMC in due course.
