An Auckland doctor who wrote thousands of prescriptions for ADHD medication without specialist approval has been found to have committed professional misconduct.
However, the doctor argued that he saw a need to prescribe medication to help people with ADHD, saying it often went undiagnosed and untreated, which had serious negative impacts.
The Health Practitioners Disciplinary Tribunal released its decision today and will hold a hearing to decide what penalties the GP will face.
Dr Tony Hanne was accused of professional misconduct last year for prescribing methylphenidate (Ritalin) and dexamphetamine 5662 times without properly consulting a psychiatrist first.
He was also accused of submitting false and misleading claims to Pharmac for subsidies of the drugs 214 times.
Both drugs are addictive and can be misused, the tribunal noted, which was why they were Class B controlled drugs in the Misuse of Drugs Act.
Hanne was also accused of prescribing both drugs when he should have known it was a breach of his professional obligations, and of inappropriately treating and prescribing medication for a patient who was close to him for ADHD.
General practitioners are not allowed to prescribe either drug without approval from a specialist paediatrician or psychiatrist, according to guidelines in the Ministry of Health’s Gazette Notices.
The drug subsidies he claimed required him to have approval from a psychiatrist to prescribe them, and because he didn’t, he misled Pharmac.
In defence, Hanne said he had a “supervisory relationship” with a psychiatrist, the Health Practitioners Disciplinary Tribunal’s (HPDT) finding said. He argued this kept him in line with the requirement to seek approval first.
Hanne also said “he saw the need to prescribe these drugs as sufficiently important to justify the steps he took in doing so, irrespective of the applicable restrictions”, the decision read.
The tribunal considered Hanne’s overview: “ADHD often goes undiagnosed and can have serious negative impacts on patients. A recent review of the existing studies notes that ADHD is linked to increased adverse consequences in nearly every domain of activity studied to date.
“The major risk here is uncontrolled impulsivity – road accidents are four times as common in ADHD patients. Time in jail is 20 times more likely for ADHD adults. And drug and alcohol abuse are at least double in the ADHD population compared with the general population.
“The rates of academic failure, unemployment, relationship break-up and suicide are all greatly increased in untreated ADHD. This all adds up to higher mortality risks and overall life expectancy,” Hanne said.
Most of the facts of the case were not in dispute, the tribunal said.
“There are good reasons to require a psychiatrist’s input,” the tribunal said. “The data sheet that is issued by Medicines Control for Ritalin, for example, shows that the decision to use a stimulant in adults must be based on a thorough assessment of the severity and chronicity of the presenting symptoms, and their impact on the daily life of the patient.
“The real contest at this stage is as to the culpability of Dr Hanne’s conduct: is his approach to prescribing stimulants to be assessed as being innocent ... or as conduct that is likely to bring discredit to the profession, or as malpractice?”
The tribunal concluded the relationship Hanne had with the psychiatrist “never came close” to meeting the rules for approving prescriptions.
The tribunal considered that although the doctor had made a significant contribution to the study and diagnoses of ADHD that had at times been life-changing for his patients, he was doing so without the required qualification or supervision.
“Despite multiple warnings, the doctor stubbornly refused to accept any suggestion that he might be acting improperly.”
Hanne is a Distinguished Fellow of the Royal New Zealand College of General Practice, has served on College Committees, has been an examiner for the Medical Council and once taught at the Auckland School of Medicine.
He had practised general medicine in and around Auckland since 1964.
A penalty hearing will be held at a later date to consider what consequences Hanne will face.
Raphael Franks is an Auckland-based reporter who covers breaking news. He joined the Herald as a Te Rito cadet in 2022.