Medical case study: Friendly care

BACKGROUND

A local pharmacist writes to the General Medical Council (GMC) with concerns over medication being prescribed to a retired surgical nurse. Mrs R worked at a local hospital until she was forced to leave her job having developed multiple sclerosis. She is currently under the care of a GP but over the past month a former colleague and consultant surgeon – Ms S – has twice prescribed diazepam for Mrs R.

The pharmacist points out in his letter to the GMC that it is not best practice to prescribe for friends or family and provides copies of the prescriptions.

An investigation officer from the GMC writes to Ms S informing her that concerns have been raised over her fitness to practise in connection with prescriptions supplied to Mrs R.

The matter will be considered as a provisional enquiry (a triage stage to determine whether the concern raised amounts to an allegation that a doctor’s current fitness to practise is impaired and therefore requires a full investigation or not) and Ms S is asked to complete an Employer Work Details form, providing details of her responsible officer and other information about the scope of her work and where the alleged incidents took place.

The letter further advises that Ms S can provide comments on the allegations and recommends she takes advice from her medical defence organisation. A decision will then be made whether to open a full investigation into the matter.

Ms S writes back immediately to the GMC to explain the matter. She states that she had worked with Mrs R for over 20 years and remains a friend. Lately Mrs R’s condition has deteriorated and she has become effectively homebound. It was on a recent visit that Ms S was asked to issue a repeat prescription as a favour. Ms S points out that she had not initiated new treatment as Mrs R had been prescribed benzodiazepines over the years to control spasms associated with her MS.

Ms S accepts that, having now reviewed GMC guidance, she was wrong to write the prescription.

ANALYSIS/OUTCOME

Ms S contacts MDDUS a few days later and a medico-legal adviser and an in-house lawyer take on management of the case.

Ms S is advised that in future she should seek MDDUS advice before replying to GMC correspondence, as MDDUS are able to offer expert help with drafting a response. It is proposed that (given Ms S has already submitted her comments) no further comment is offered to the GMC at this stage.

The GMC writes back to inform Ms S that a decision has been made to open a formal investigation to investigate the matter more fully and she is invited to make any further comments regarding the complaint. Two case examiners (one lay and one medical) will examine all the information gathered and decide what happens next. The options include:

• close the complaint either with no action or with advice
• offer a warning
• ask Ms S to agree to undertakings
• refer the case to a hearing.

An MDDUS lawyer writes to the GMC on behalf of Ms S with additional comments on the complaint. The letter refers to the comments previously submitted in which Ms S acknowledged that she was wrong to supply the prescriptions. It further details that Ms S had on both occasions urged Mrs R to contact her GP but had agreed to provide the prescriptions as a favour to a very poorly friend.

The letter outlines steps Ms S has taken to reflect on the matter, including discussing the matter fully with her medical director and responsible officer and requesting a mentor to review the circumstances of the complaint. Part of this has involved reviewing the use of controlled drugs and the risks of addiction.

She has also reviewed and discussed with her mentor GMC guidance on Good practice in prescribing and managing medicines and devices, which states (paragraphs 67-69):

Wherever possible, you must avoid prescribing for yourself or anyone you have a close personal relationship with.

If you prescribe any medicine for yourself or someone close to you, you must:

a. make a clear record at the same time or as soon as possible afterwards; the record should include your relationship to the patient, where relevant, and the reason it was necessary for you to prescribe

b. follow the advice on information sharing and safe prescribing [within the guidance]

You must not prescribe controlled drugs for yourself or someone close to you unless:

a. no other person with the legal right to prescribe is available to assess and prescribe without a delay

b. emergency treatment is immediately necessary to avoid serious deterioration in health or serious harm.

A few months later the GMC writes to Ms S to inform her that the case examiners have considered the information provided and decided to conclude the case with no further action. An appendix to the letter provides further details on the reasoning behind the decision.

It reaffirms that the primary purpose of fitness to practise proceedings is to protect the public against future harm rather than to punish a doctor for past misdoings. The decision must take account of whether the doctor’s failings are easily remediable, whether they have been remedied (and to what extent), and whether they are likely to be repeated.

In Ms S’s case, the case examiners concluded that, given her reflections on and learning from the incident, there is unlikely to be a repetition of the complaint and no realistic prospect of establishing that her fitness to practise is currently impaired.

KEY POINTS

• Prescribing for someone close to you should be avoided except in situations requiring urgent care where there is no immediate alternative.
• Prescribing controlled medications for someone close requires even greater caution.
• Consult and adhere to GMC guidance in such circumstances and contact MDDUS for advice.
• Contact MDDUS for advice before responding to correspondence you receive from the GMC.