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19 Jan 2024
A psychiatrist has been reprimanded by a tribunal for professional misconduct that included inappropriate prescribing and inadequate clinical record-keeping.
The State Administrative Tribunal of Western Australia (the tribunal) in October 2023 found that Dr Malcolm Roberts had engaged in professional misconduct. The tribunal reprimanded Dr Roberts and imposed conditions on his registration requiring he undergo mentoring on document and clinical record-keeping and prescribing of schedule 4 and schedule 8 medicines.
The tribunal also ordered that Dr Roberts submit to a three-monthly audit of his practice, undertake a period of mentoring and pay the Board $7,000 in costs.
The Medical Board of Australia (the Board) referred Dr Roberts to the tribunal alleging professional misconduct in relation to one patient, involving:
From July 2008 to October 2016, Dr Roberts prescribed the schedule 4 weight loss medicine Duromine to manage a patient’s weight gain and also as an ‘off-label’ treatment for their Attention Deficit Hyperactivity Disorder (ADHD). From April 2010 to March 2016, he also prescribed the same patient schedule 8 medicines for their back pain.
Dr Roberts failed to record his patient’s height or weight before starting them on Duromine and did not set an objective measure of success or failure for its use. He did not consider, discuss with his patient or record the risks of taking Duromine, either as a weight loss medicine or as an off-label treatment for ADHD, and how those risks might be mitigated.
Dr Roberts also never recorded the patient’s consent to taking Duromine as an off-label treatment and did not consult with the practitioner who he knew was prescribing Dexamphetamine to the patient for ADHD.
Even though his patient had a history of benzodiazepine misuse, Dr Roberts never recorded any patient counselling on the risks of taking opioids, nor did he document their potential misuse as a risk. He did not document a pain management plan and in 13 out of the 15 times he prescribed them, he didn’t record a clinical rationale for the schedule 8 medicine.
Dr Roberts also continued to provide opioid prescriptions to the patient after they moved interstate when he should have finalised his treating relationship with them and advised the patient to seek support from a medical practitioner they could consult with in person.
In making its decision, the tribunal noted several mitigating factors. Dr Roberts understood the risk of harm to his patient because of his conduct and was profoundly sorry. He acknowledged his clinical records did not meet professional standards; that they weren’t sufficient to facilitate the continuity of his patient’s care and reflected poorly on his treatment.
Dr Roberts demonstrated remorse and insight, reducing his prescribing of scheduled 8 medicines to a single medicine which he will stop prescribing by 1 March 2024. He participated in further education, including a medical record-keeping course, and practice audits.
The tribunal also noted that there would be a negative impact on Dr Roberts’ other patients if he could not practise psychiatry. His patients have particular vulnerabilities if they cannot continue treatments and would struggle to find another psychiatrist. The tribunal said there was a significant element of public protection of these vulnerable people being able to continue accessing psychiatric services.
Read the tribunal’s full decision on the eCourts Portal of Western Australia.