Surgeon, chief doctor with drug-abuse history prescribed Tramadol for family but used it himself

A former surgeon at a North Island public hospital with a history of opioid abuse and depression inappropriately prescribed drugs to his wife and son, consuming the Tramadol himself. Photo / Getty Images

A surgeon who was being monitored for opioid and alcohol addictions and held the highest clinical role in his hospital was prescribing Tramadol and other drugs to his wife and son - but consuming them himself.

The doctor, who has name suppression, was the acting chief medical officer at a public hospital in the North Island for part of the time he was inappropriately prescribing the medicines.

He also initially misled the Medical Council and tried to dissuade a professional conduct committee [PCC] appointed by the council to investigate the allegations from laying a disciplinary charge.

According to a Health Practitioners Disciplinary Tribunal decision released in July, the specialist prescribed 169 medications in 147 prescriptions he shouldn’t have written over nine years until the Ministry of Health alerted the Medical Council to its concerns in 2017 about dispensing data for the wife and son.

The prescription drugs included the opioid Tramadol, and anti-anxiety and sleep-inducing medications lorazepam and zopiclone, which the tribunal said came with a risk of abuse and dependency.

Although there was no evidence of an addiction to Tramadol by the doctor, the tribunal said his conduct spanned a lengthy period and was premeditated, and was not a “one-off lapse in judgment”.

The tribunal heard that between 1997 and 2006 the doctor was monitored by the Medical Council’s Health Committee because he had a vulnerability to depression and was addicted to opioids.

He signed a voluntary undertaking in 1999 not to self-prescribe or obtain opiates or psychoactive substances and to continue abstaining from opiates, alcohol, and other mood-changing medications unless prescribed by his therapist.

The undertaking lapsed in 2004 in recognition of the doctor’s compliance and he was released from monitoring in 2006 and his file closed.

In 2007 the doctor was charged with an alcohol-related offence and later convicted of it. In 2008 he entered into another voluntary undertaking similar to the one in 1999 but extended to include alcohol.

The following year he seriously injured his back, requiring several surgeries, after which he suffered chronic back pain. His back pain was managed with Tramadol, among other painkillers.

From 2012 the doctor was subject to quarterly blood and liver function tests and random blood, hair, urine or breath testing, with no issues identified until the Ministry of Health raised its concerns in 2017.

When questioned by the Medical Council the doctor said he had renewed prescriptions for his wife, which wasn’t true, and that he had prescribed medication for his son because the young man did not live locally and it was almost impossible to get him seen at the local general practice.

But the son told the PCC he had never heard of the drug Tramadol and did not think he had ever taken it, and that he had not had any injuries in the past 10 years that would warrant a need for it.

The doctor prescribed his wife and son Tramadol, which he used. He also prescribed his wife psychotropic drugs that he shouldn't have. Photo / 123RF

The son had also not been in contact with his father much for several years or collected prescriptions in the region where these were prescribed.

In an interview with the PCC in July 2019, when the doctor, his lawyer and his medical insurer tried to dissuade the PCC from laying a charge, the doctor made several admissions including that the Tramadol prescriptions for his wife were actually for him and that he had misled the Medical Council on that point.

But the following year, after the PCC brought the charge of professional misconduct against the doctor and a hearing was set for September 2020, the doctor’s lawyer raised objections to the admissions and different tribunal members ruled the evidence was inadmissible.

However, the PCC appealed to the High Court, which declared the separately constituted tribunal’s ruling an error in law and quashed the decision, and a new hearing allowing the full transcript of the doctor’s interview went ahead in September 2021.

The charge included that between February 2013 and 2017, the doctor prescribed Tramadol for his own use in his wife’s name and that between May 2016 and August 2017 he prescribed Tramadol, omeprazole, ibuprofen and paracetamol for his own use in his son’s name, and that he consumed those drugs without adequate independent medical oversight and contrary to his agreement with the Health Committee.

He also inappropriately prescribed medication to his wife between September 2008 and April 2017, supplying her with psychotropic medications and drugs of dependence.

The tribunal heard the doctor was stressed by his job because there were not enough doctors in his speciality at his hospital, and he couldn’t access his GP often because the GP was unavailable and he mistakenly believed he couldn’t change GPs.

His lawyer said the Tramadol prescriptions were written when the specialist could not contact his GP.

The PCC said the conduct was in breach of the doctor’s ethical obligations and accepted standards of practice, that it amounted to malpractice or negligence, and that it brought discredit to the profession.

The doctor described his attempt to mislead the Medical Council about who the Tramadol was for as a “stupid decision” and he apologised in his PCC interview, saying: “I’m terribly sorry I’ve done what I’ve done. It’s wrong”.

He said he felt under pressure to prescribe for his wife, who he gave codeine and lorazepam for her anxiety disorder and a repeat prescription for hormone replacement therapy while her specialist was overseas.

The PCC said his attempt to mislead the Medical Council for almost two years about the extent of his prescribing and the reasons for his prescribing to family members was dishonest and fell well short of the professional standards expected of practitioners.

The tribunal found the doctor’s actions amounted to professional misconduct and censured him, fined him $7500, and ordered him to pay costs of $33,000.

The doctor, who resigned in 2020, will be subject to conditions if he resumes practice.

Natalie Akoorie is the Open Justice deputy editor, based in Waikato and covering crime and justice nationally. Natalie first joined the Herald in 2011 and has been a journalist in New Zealand and overseas for 27 years, recently covering health, social issues, local government, and the regions.