Prescribing for Self and Family – What Could Go Wrong?
01 Jun 2017
Case history
The doctor provided prescriptions to her two adult children and husband. She also self-prescribed by issuing scripts in her husband’s name for medications which she consumed. The prescribing spanned five years. The doctor failed to maintain records of the prescriptions, or records of any kind.
The doctor attributed her conduct to the chaos and stress that existed in her home life during the time of her misconduct, and a misplaced sense of duty as a mother to meet the needs of her family. She felt obligated to assist her children and her husband in whatever way she could under very stressful circumstances.
One of her daughters had received treatment for a variety of addiction, mental health and other problems. Although the Tribunal found that the prescriptions to family members were issued in quantities and frequencies that fell within normal parameters, it was considered improper for a doctor to treat and prescribe medicines to family members, other than within narrow limits such as emergency or necessity.
Discussion
The Medical Board of Australia’s Code of Conduct for Doctors in Australia states:
Whenever possible, avoid providing medical care to anyone with whom you have a close personal relationship. In most cases, providing care to close friends, those you work with and family members is inappropriate because of the lack of objectivity, possible discontinuity of care, and risks to the doctor and patient.
Difficulties may arise for both parties in traversing sensitive matters, or for the patient in making frank disclosures in relation to intimate matters such as private behaviour, giving rise to special risks. The doctor who treats a family member may be affected by subjective emotions and views which hamper his or her ability to undertake a full investigation and give the best and most appropriate treatment. The doctor may be influenced by a desire to please the family member, and not upset that person.
Research suggests that it is common for doctors to be asked for medical advice by family members, and it may be useful to discuss the reasons why this is not advisable with your family.2,3
Prescribing for self and family – state and territory legislation
| Legislation | S4 Self | S8 Self | S4 Family | S8 Family | |
| ACT | Medicines, Poisons and Therapeutic Goods Regulation 2008 [MPTGR] |
Interns not permitted to self-prescribe MPTGR r 30 Otherwise no self-prescription of restricted medicines MPTGR r 30 (Anabolic steroid and benzodiazepines) |
No self-prescription MPTGR r 30
Interns not permitted to self-prescribe MPTGR r 30 |
No restriction |
No restriction |
| NSW |
Poisons and Therapeutic Goods Regulation 2008 (NSW)
[PTGR] |
No restriction
Note PTGR r 33 “A medical practitioner must not issue a prescription for a restricted substance otherwise than for medical treatment” (list includes benzodiazepines) |
No restriction
Note PTGR r 78 “A medical practitioner must not issue a prescription for a drug of addiction otherwise than for medical treatment” |
No restriction |
No restriction |
| NT | Medicines, Poisons And Therapeutic Goods Act 2014 (NT) [MPTG] |
Cannot self-prescribe Restricted S4
S90 No self prescription s4R No self-administration Restricted S4 unless lawful supply by other and genuine therapeutic use in emergency (notice within 7 days) where person has no access to other person who may lawfully supply or administer the substance s 90 & 114 [MPTG] |
Cannot self-prescribe S8
s 90 [MPTG] No self-administration S8 unless lawfully supplied and genuine therapeutic use in an emergency when the person has no access to any other person who may lawfully supply or administer the substance s 114 [MPTG] |
No restriction |
No restriction |
| QLD | Health (Drugs and Poisons) Regulation 1996 (QLD) [HDPR] |
No restriction |
No self-administration
unless supplied by other practitioner and genuine need to appropriately treat HDPR r 123 |
No restriction |
No restriction |
| SA |
Controlled Substances (Poisons) Regulations 2011 (SA) [CSPR] |
No restriction |
Not permitted unless “verifiable emergency” CSPR r 37(2) $5000 Max penalty |
No restriction |
Not permitted unless “verifiable emergency” for spouse, domestic partner, parent, grandparent, child, grandchild, brother or sister CSPR r 37(1) ≤$5000 penalty |
| TAS | Poisons Regulations 2008 (Tas) [PR] |
No restriction |
Not permitted
PR r 15(4) “A person must not write or issue a prescription for the purpose of procuring a narcotic substance for administration to himself or herself” ≤10 penalty units |
No restriction |
No restriction |
| VIC |
Drugs, Poisons and Controlled Substances Regulations 2006 (VIC) [DPCSR]
|
Not Permitted
DPCSR r 48(c) Penalty 100 units |
Not Permitted DPCSR r 48(b) Penalty 100 units |
No restriction |
No restriction |
| WA |
Medicines & Poisons Act 2014 [MPA]
Misuse of Drugs Act 1981 [MDA] |
Not S4 Reportable Poisons
(under review – none listed currently) but will be S4 drug with “high propensity for misuse, abuse or illicit use” MPA s 77 |
A person who prescribes a drug of addiction for himself or herself commits an offence
MPA s 78 |
No restriction |
No restriction |
Summary points
- It is not advisable to treat family members, or yourself.
- If you need to provide care to a family member in an emergency, hand over your care to another doctor as soon as possible, and document your treatment.
- MDA National’s Professional Indemnity Insurance Policy excludes cover for claims arising from elective medical treatment provided by a Member to their immediate family.
- State and territory legislation regarding prescribing for self and family varies significantly. However, S8 self-prescription is not generally permitted. In Victoria, S4 or S8 self-prescribing is NOT allowed under any circumstances.
Dr Jane Deacon
Medico-legal Adviser
MDA National
References
- Health Care Complaints Commission v BXD (No. 1) [2015] NSWCATOD 134 (7 December 2015).
- La Puma J, Stocking CB, La Voie D, Darling CA. When Physicians Treat Members of Their Own Families. Practices in a Community Hospital. N Engl J Med 1991;325(18):1290-4. Epub 1991/10/31.
- Evans RW, Lipton RB, Ritz KA. A Survey of Neurologists on Self-treatment and Treatment of Their Families. Headache 2007;47(1):58-64. Epub 2007/03/16.
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