Dr M
Recent dental graduate, Dr M, had been at her new practice for about four months, and was enjoying it a lot. She got on well with her dental nurse – Nurse T – who was around her age, and the pair socialised outside of work from time to time.
Nurse T had to take a few days off work to have her wisdom tooth extracted. The procedure was performed by an oral surgeon out of town, as there was not one locally. She had a lot of problems after the extraction, and on day four she was quite upset and uncomfortable – she appeared fine, but was complaining of the classic symptoms of a dry socket.
Dr M examined Nurse T and told her it was healing well, but, as she was symptomatic, Dr M irrigated and dressed the socket. Nurse T didn’t seem right for the rest of her shift, and towards the end of the day asked Dr M to prescribe her with some Panadeine Forte for the pain. Dr M advised her that Panadeine Forte was not the best choice for dental pain, but Nurse T persevered and Dr M wrote her a prescription.
The following week, Nurse T asked for another prescription, claiming she had lost the original that Dr M had given her and that she was still in pain. Dr M – who was having a particularly busy day – didn’t give it much thought, and complied.
The day after, Nurse T asked for some Temazepam as she was having problems sleeping. Dr M wrote the prescription.
The situation continued; although Dr M was becoming suspicious about Nurse T’s motives, and was conscious she was no longer prescribing for dental reasons, she was uncomfortable with the situation and felt that she couldn’t really say no to a friend. Nurse T said it wasn’t convenient to go to her doctor because Dr M made her work such long hours. She also made it apparent that she was having a number of problems outside of work. Although Dr M considered that fact that Nurse T may be self-medicating, she never explored it fully as she was mindful it was an ‘inconvenience’ to herself and her practice.
While the two were shopping one lunch time, Nurse T dropped off her most recent prescription for Panadeine Forte and Temazepam to the pharmacist. When they returned to the pharmacy to pick it up, the police were waiting for them. They were both arrested and taken to the police station.
The pharmacist had reported Nurse T to the police, and when it became apparent that Dr M had been writing the prescriptions, the police brought them both in for questioning as there were concerns the pair were drug dealing. Dr M reported feeling overwhelmed at the amount of drugs she had prescribed to Nurse T, admitting she had clearly not been keeping track.
The police informed Dr M that they would not press charges, but the pharmacist felt that the case should be pursued, and made a mandatory notification about Dr M to the AHPRA. The pharmacist also made a notification about Dr M to Medicare, and consequently Dr M had to undergo several months of investigation by both parties.
Ultimately, AHPRA accepted that Dr M had simply made a poor judgement call. They cautioned her and issued some conditions on her registration. They also compelled her to find a mentor. Nurse T’s case is ongoing.
The Dentolegal Adviser's perspective
Dr Annalene Weston, Brisbane Office
Dr M found herself in a situation that is very common for young practitioners; people taking advantage of your trusting nature whilst you have access to drugs. It goes without saying that dental practitioners should only prescribe medication for dental purposes, and they should be wary of people asking them to write prescriptions for medications outside of their dental needs - particularly S8 drugs, namely drugs of addiction.
It can be very difficult to refuse these requests, particularly from people you are friendly with or work with. If you do find yourself in a situation like this, please call our advisory service. We can help you with words or phrases that will allow you to better deal with a difficult conversation of this nature.
The conditions placed on Dr M’s registration, like having to undertake courses relevant to the primary complaint and being told to find a mentor, are relatively common for young practitioners, and by and large we find that young dentists really benefit from the mentor/mentee relationship.
Regretfully, mandatory notifications are an increasingly common way of receiving a complaint. If you feel you will be the subject of a mandatory notification, or if you feel that you should make a mandatory notification about another health practitioner, we would encourage you to read the Dental Board document on Mandatory Notifications, which can be found here.