Doctor disciplined for inappropriately treating family members

Mar 23, 2016

A recent disciplinary case has reinforced the risks associated with mixing your duty as a doctor with your family obligations. A doctor specialising in mental health disorders has been found guilty of professional misconduct for treating family members.

Dr Houston* had been practising for more than 30 years in private practice and for a community mental health service, with no prior disciplinary record or conditions on their registration.

Tribunal draws the line on nature of conduct

The tribunal found that over a five-year period, Dr Houston provided wrongful and inappropriate prescriptions to their two adult children and spouse, including Schedule 4D drugs. The doctor also self-prescribed by issuing prescriptions in their spouse’s name for medication that they consumed, and failed to maintain appropriate clinical records and communicate with other treating doctors regarding the treatment.

Unusually, the conduct issues were confined to the doctor’s family members and there was no evidence of any inappropriate conduct in their day-to-day treatment of patients. The prescriptions provided to family members were also within clinical standards in terms of medication choice and dose.

Dr Houston admitted to all of the allegations and conceded that the conduct in question constituted unsatisfactory professional conduct. However, submissions were made on behalf of the doctor that the conduct did not amount to professional misconduct. Under the Health Practitioner Regulation National Law (NSW), professional misconduct is found to have occurred where the conduct is considered more serious than unsatisfactory professional conduct, warranting suspension or cancellation of the doctor’s registration, or where there are repeated instances of unsatisfactory professional conduct, amounting to sufficiently serious conduct.

Treatment of family members only acceptable in an emergency or necessity

In handing down their decision, the tribunal referred to the Medical Council of NSW’s Guidelines for self-treatment and treating family members (The guidelines) which supplement the Medical Board of Australia’s Good Medical Practice: A Code of Conduct for all Doctors in Australia (The code).

In the words of the tribunal, there are some “narrow limits” which override the impropriety of doctors treating their family members and themselves, including emergency or necessity. The guidelines recognise that:

  • Where no help is available in an emergency or isolated settings, a doctor may treat themselves or their family, but only until another doctor becomes available
  • There are circumstances where a doctor may work together with an independent doctor to maintain established treatment for themselves or their family members, but should not be their primary or regular care provider.

Misplaced sense of responsibility to family

While the tribunal acknowledged the extreme and chaotic nature of Dr Houston’s domestic situation, it ultimately found the doctor guilty of professional misconduct. The doctor’s conduct went beyond the exceptions outlined above and was seen to come from a misplaced sense of familial responsibility, which conflicted with professional obligations as a doctor. Dr Houston was reprimanded and ordered to undergo medical ethics education and mentoring by a psychiatrist.

Key lessons

Agreeing to prescribe for family members may be driven by wanting to help your family, particularly if the patients are your children, or you may feel pressure from your relatives to treat them. However, there is often an inherent conflict between your obligations as a doctor and your relationship with your family. For example, doctors who treat family members may be affected by subjective emotions which hamper their ability to provide the best treatment. So, where possible, avoid mixing the two, and remember:

  • It is not advisable to treat any family members, or yourself.
  • If there is an emergency or necessity to treat a family member, provide only the treatment required and then handover care to an independent doctor.
  • If necessary, you can collaborate with a relative’s treating doctors, but you should not be their primary doctor.
  • If you do need to provide treatment to a family member, document it and communicate with their other care providers.
  • It is a good idea to have your own independent GP.

*The doctor’s name has been changed to protect privacy.

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