Health Care Complaints Commission v Dr Nemeth

DECISION 5The Health Care Complaints Commission ("the Complainant") brings before the Tribunal two complaints following consultation with the Medical Council of NSW ("the Council") in accordance with ss 39(2) and 90B(3) of the Health Care Complaints Act 1993 and s 145A of the Health Practitioner Regulation National Law (NSW) No 86a ("the Act") against Dr Katherine Nemeth ("the respondent") being a registered medical practitioner. 6The first complaint alleges, in the following terms, that the respondent: Has been guilty of unsatisfactory professional conduct within the meaning of section 139B of the National Law in that she has: (i)demonstrated that the knowledge, skill or judgment possessed, or care exercised, by her in the practice of medicine is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience; (ii)has contravened the Medical Practice Regulation 2003 now repealed; (iii)engaged in improper conduct relating to the practice of medicine. PARTICULARS Patient A 1.The Practitioner prescribed Oxycodone to Patient A on the dates and in the quantities set out in the schedule attached and marked A: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient A was on a methadone program; e.Without obtaining an authority to prescribe Oxycodone to Patient A from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 2.The Practitioner failed to keep proper medical records of Patient A in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Information known to the practitioner relevant to her diagnosis and treatment including: i.the patient's medical history ii.the results of any physical examination of the patient; b.particulars of any clinical opinion reached by the registered medical practitioner; c.plan of treatment for the patient; d.a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient B 3.The practitioner prescribed Oxycodone to Patient B on the dates and in the quantities set out in the schedule attached and marked B: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; c.When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient B was on a methadone program; d.Without obtaining an authority to prescribe Oxycodone to Patient B from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 4.The Practitioner failed to keep proper medical records of Patient B in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient C 5.The Practitioner prescribed Oxycodone to Patient C on the dates and in the quantities set out in the schedule attached and marked C: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; c.When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient C was on a methadone program; d.Without obtaining an authority to prescribe Oxycodone to Patient C from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 6.The Practitioner failed to keep proper medical records of Patient C in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient D 7.The Practitioner prescribed Nitrazepam, Digesic, Endone, Oxycodone and Panadeine Forte to Patient D on the dates and in the quantities set out in the schedule attached and marked D: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; c.When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient D was on a methadone program; d.Without obtaining an authority to prescribe Oxycodone and Endone to Patient D from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 8.The Practitioner failed to keep proper medical records of Patient D in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient E 9.The Practitioner prescribed Oxycodone to Patient E on the dates and in the quantities set out in the schedule attached and marked E: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.Without obtaining an authority to prescribe Oxycodone to Patient E from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 10.The Practitioner failed to keep proper medical records of Patient E in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. 11.The Practitioner contravened clause 34(1)(a) of the Poisons and Therapeutic Goods Regulation 2002 by recording a date, other than the date of issue, on a prescription issued to Patient E on 17 April 2008 for Oxycodone (Oxycontin) 80mg. Patient F 12.The Practitioner prescribed Oxycodone and Nitrazepam to Patient F on the dates and in the quantities set out in the schedule attached and marked F: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.Without obtaining an authority to prescribe Oxycodone to Patient F from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 13.The Practitioner failed to keep proper medical records of Patient F in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient G 14.The Practitioner prescribed Alprazolam, and Oxazepam to Patient G on the dates and in the quantities set out in the schedule attached and marked G: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 15.The Practitioner failed to keep proper medical records of Patient G in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Information known to the practitioner relevant to her diagnosis and treatment including: i.the patient's medical history ii.the results of any physical examination of the patient; b.plan of treatment for the patient; c.a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient H 16.The Practitioner prescribed Morphine (MS Contin), Oxazepam and Diazepam to Patient H on the dates and in the quantities set out in the schedule attached and marked H: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.Without obtaining an authority to prescribe Morphine (MS Contin) to Patient H from the NSW Health department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 17.The Practitioner failed to keep proper medical records of Patient H in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient I 18The Practitioner prescribed Oxazepam, Alprazolam and Diazepam to Patient I on the dates and in the quantities set out in the schedule attached and marked I: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 19.The Practitioner failed to keep proper medical records of Patient I in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient J 20.The Practitioner prescribed Bupenorphrine, Mersyndol Forte, Nitrazepam, Zolpidem (Stilnox) and Temazepam to Patient J on the dates and in the quantities set out in the schedule attached and marked J: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.Without obtaining an authority to prescribe Bupenorphrine to Patient J from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 21.The Practitioner failed to keep proper medical records of Patient J in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Particulars of any medication prescribed for the patient; b.A level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient K 22.The Practitioner prescribed Morphine (MS Contin) to Patient K on the dates and in the quantities set out in the schedule attached and marked K: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b. In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 23.The Practitioner failed to keep proper medical records of Patient K in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Information known to the practitioner relevant to her diagnosis and treatment including the results of any physical examination of the patient; b.A level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient L 24.The Practitioner prescribed Alprazolam to Patient L on the dates and in the quantities set out in the schedule attached and marked L: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 25.The Practitioner failed to keep proper medical records of Patient L in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Particulars of any medication prescribed for the patient; b.A level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient M 26.The Practitioner prescribed Morphine (MS Contin) to Patient M on the dates and in the quantities set out in the schedule attached and marked M: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.Without obtaining an authority to prescribe Morphine (MS Contin) to Patient M from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 27.The Practitioner failed to keep proper medical records of Patient M in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient N 28.The Practitioner prescribed Morphine (MS Contin) to Patient N on the dates and in the quantities set out in the schedule attached and marked N: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 29.The Practitioner failed to keep proper medical records of Patient N in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Information known to the practitioner relevant to her diagnosis and treatment including: i.the patient's medical history ii.the results of any physical examination of the patient iii.the results of any tests performed on the patient; b.A level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient O 30.The Practitioner prescribed Oxycodone and Panadeine Forte to patient O on the dates and in the quantities set out in the schedule attached and marked O: a.In circumstances where the practitioner had been notified that O was a known 'doctor shopper'; b.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.Without obtaining an authority to prescribe Oxycodone to Patient O from the NSW Health department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. Patient P 31.The Practitioner prescribed Oxycodone, Diazepam, Buprenorphine, Phentermine (Duromine), Morphine sulphate injection, Oxazepam, Nitrazepam, Codeine Linctus, and Pethidine to patient P on the dates and in the quantities set out in the schedule attached and marked P: a.In circumstances where P was also being prescribed drugs of addiction by another practitioner at the same practice; b.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 32.The Practitioner failed to keep proper medical records of Patient P in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient Q 33.The Practitioner prescribed Oxycodone and Diazepam to Patient Q on the dates and in the quantities set out in the schedule attached and marked Q: a.in circumstances where the practitioner failed to adequately investigate whether Patient Q may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 34.The Practitioner failed to keep proper medical records of Patient Q in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient R 35.The Practitioner prescribed Oxycodone and Diazepam to Patient R on the dates and in the quantities set out in the schedule attached and marked R: a.in circumstances where the practitioner failed to adequately investigate whether Patient R may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 36.The Practitioner failed to keep proper medical records of Patient R in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient S 37.The Practitioner prescribed Tramadol, Oxycodone, Diazepam and Temazepam to Patient S on the dates and in the quantities set out in the schedule attached and marked S: a.in circumstances where the practitioner failed to adequately investigate whether Patient S may have had a history of past or current substance abuse; and b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. Patient T 38.The Practitioner prescribed Oxycodone to Patient T on the dates and in the quantities set out in the schedule attached and marked T: a.in circumstances where the practitioner failed to adequately investigate whether Patient T may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 39.The Practitioner failed to keep proper medical records of Patient T in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient U 40.The Practitioner prescribed Morphine (MS Contin), Oxazepam and Diazepam to Patient U on the dates and in the quantities set out in the schedule attached and marked U: a.in circumstances where the practitioner failed to adequately investigate whether Patient U may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 41.The Practitioner failed to keep proper medical records of Patient U in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient V 42.The Practitioner prescribed Oxycodone, Diazepam and Panadeine Forte to Patient V on the dates and in the quantities set out in the schedule attached and marked V: a.in circumstances where the practitioner failed to adequately investigate whether Patient V may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 43.The Practitioner failed to keep proper medical records of Patient V in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient W 44.The Practitioner prescribed Codeine Phosphate and Alprazolam to Patient W on the dates and in the quantities set out in the schedule attached and marked W: a.in circumstances where the practitioner failed to adequately investigate whether Patient W may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 45.The Practitioner failed to keep proper medical records of Patient W in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient X 46.The Practitioner prescribed Morphine (MS Contin) to Patient X on the dates and in the quantities set out in the schedule attached and marked X: a.in circumstances where the practitioner failed to adequately investigate whether Patient X may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 47.The Practitioner failed to keep proper medical records of Patient X in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient Y 48.The Practitioner prescribed Temazepam, Endone and Nitrazepam to Patient Y on the dates and in the quantities set out in the schedule attached and marked Y: a.in circumstances where the practitioner failed to adequately investigate whether Patient Y may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 49The Practitioner failed to keep proper medical records of Patient Y in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient Z 50.The Practitioner prescribed Diazepam, Panadiene Forte and Temazepam to Patient Z on the dates and in the quantities set out in the schedule attached and marked Z: a.in circumstances where the practitioner failed to adequately investigate whether Patient Z may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 51.The Practitioner failed to keep proper medical records of Patient Z in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient AA 52.The Practitioner prescribed Diazepam, Temazepam and Panadeine Forte to Patient AA on the dates and in the quantities set out in the schedule attached and marked AA: a.in circumstances where the practitioner failed to adequately investigate whether Patient AA may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 53.The Practitioner failed to keep proper medical records of Patient AA in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient AB 54.The Practitioner prescribed Temazepam and Oxazepam to Patient AB on the dates and in the quantities set out in the schedule attached and marked AB: a.in circumstances where the practitioner failed to adequately investigate whether Patient AB may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 55The Practitioner failed to keep proper medical records of Patient AB in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. 7The second complaint alleges, in the following terms, that the respondent: Has been guilty of professional misconduct within the meaning of section 139E of the National Law in that she has: (i)Engaged in unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of her registration; and/or (ii)Has engaged in more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of her registration. 8The particulars are slightly at variance with each patient so it is necessary to recite them. PARTICULARS Patient A 56.The Practitioner prescribed Oxycodone to Patient A on the dates and in the quantities set out in the schedule attached and marked A: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient A was on a methadone program; e.Without obtaining an authority to prescribe Oxycodone to Patient A from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 57.The Practitioner failed to keep proper medical records of Patient A in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Information known to the practitioner relevant to her diagnosis and treatment including: i.the patient's medical history ii.the results of any physical examination of the patient; b.particulars of any clinical opinion reached by the registered medical practitioner; c.plan of treatment for the patient; d.a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient B 58.The practitioner prescribed Oxycodone to Patient B on the dates and in the quantities set out in the schedule attached and marked B: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; c.When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient B was on a methadone program; d.Without obtaining an authority to prescribe Oxycodone to Patient B from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 59.The Practitioner failed to keep proper medical records of Patient B in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient C 60.The Practitioner prescribed Oxycodone to Patient C on the dates and in the quantities set out in the schedule attached and marked C: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; c.When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient C was on a methadone program; d.Without obtaining an authority to prescribe Oxycodone to Patient C from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 61.The Practitioner failed to keep proper medical records of Patient C in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient D 62.The Practitioner prescribed Nitrazepam, Digesic, Endone, Oxycodone and Panadeine Forte to Patient D on the dates and in the quantities set out in the schedule attached and marked D: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; c.When such prescribing was contraindicated as it was known or should have been known to the practitioner that Patient D was on a methadone program; d.Without obtaining an authority to prescribe Oxycodone and Endone to Patient D from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 63.The Practitioner failed to keep proper medical records of Patient D in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient E 64.The Practitioner prescribed Oxycodone to Patient E on the dates and in the quantities set out in the schedule attached and marked E: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.Without obtaining an authority to prescribe Oxycodone to Patient E from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 65.The Practitioner failed to keep proper medical records of Patient E in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. 66.The Practitioner contravened clause 34(1)(a) of the Poisons and Therapeutic Goods Regulation 2002 by recording a date, other than the date of issue, on a prescription issued to Patient E on 17 April 2008 for Oxycodone (Oxycontin) 80mg. Patient F 67.The Practitioner prescribed Oxycodone and Nitrazepam to Patient F on the dates and in the quantities set out in the schedule attached and marked F: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.Without obtaining an authority to prescribe Oxycodone to Patient F from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 68.The Practitioner failed to keep proper medical records of Patient F in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient G 69.The Practitioner prescribed Alprazolam, and Oxazepam to Patient G on the dates and in the quantities set out in the schedule attached and marked G: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 70.The Practitioner failed to keep proper medical records of Patient G in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Information known to the practitioner relevant to her diagnosis and treatment including: i.the patient's medical history ii.the results of any physical examination of the patient; b.plan of treatment for the patient; c.a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient H 71.The Practitioner prescribed Morphine (MS Contin), Oxazepam and Diazepam to Patient H on the dates and in the quantities set out in the schedule attached and marked H: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.Without obtaining an authority to prescribe Morphine (MS Contin) to Patient H from the NSW Health department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 72.The Practitioner failed to keep proper medical records of Patient H in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient I 73The Practitioner prescribed Oxazepam, Alprazolam and Diazepam to Patient I on the dates and in the quantities set out in the schedule attached and marked I: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 74.The Practitioner failed to keep proper medical records of Patient I in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient J 75.The Practitioner prescribed Bupenorphrine, Mersyndol Forte, Nitrazepam, Zolpidem (Stilnox) and Temazepam to Patient J on the dates and in the quantities set out in the schedule attached and marked J: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.Without obtaining an authority to prescribe Bupenorphrine to Patient J from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 76.The Practitioner failed to keep proper medical records of Patient J in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Particulars of any medication prescribed for the patient; b.A level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient K 77.The Practitioner prescribed Morphine (MS Contin) to Patient K on the dates and in the quantities set out in the schedule attached and marked K: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b. In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 78.The Practitioner failed to keep proper medical records of Patient K in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Information known to the practitioner relevant to her diagnosis and treatment including the results of any physical examination of the patient; b.A level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient L 79.The Practitioner prescribed Alprazolam to Patient L on the dates and in the quantities set out in the schedule attached and marked L: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 80.The Practitioner failed to keep proper medical records of Patient L in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Particulars of any medication prescribed for the patient; b.A level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient M 81.The Practitioner prescribed Morphine (MS Contin) to Patient M on the dates and in the quantities set out in the schedule attached and marked M: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.Without obtaining an authority to prescribe Morphine (MS Contin) to Patient M from the NSW Health Department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. 82.The Practitioner failed to keep proper medical records of Patient M in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient N 83.The Practitioner prescribed Morphine (MS Contin) to Patient N on the dates and in the quantities set out in the schedule attached and marked N: a.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; b.In quantities in excess of recognised therapeutic standards of what is medically appropriate; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 84.The Practitioner failed to keep proper medical records of Patient N in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record: a.Information known to the practitioner relevant to her diagnosis and treatment including: i.the patient's medical history ii.the results of any physical examination of the patient iii.the results of any tests performed on the patient; b.A level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient O 85.The Practitioner prescribed Oxycodone and Panadeine Forte to patient O on the dates and in the quantities set out in the schedule attached and marked O: a.In circumstances where the practitioner had been notified that O was a known 'doctor shopper'; b.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused; d.Without obtaining an authority to prescribe Oxycodone to Patient O from the NSW Health department, contrary to section 28 of the Poisons and Therapeutic Goods Act 1966. Patient P 86.The Practitioner prescribed Oxycodone, Diazepam, Buprenorphine, Phentermine (Duromine), Morphine sulphate injection, Oxazepam, Nitrazepam, Codeine Linctus, and Pethidine to patient P on the dates and in the quantities set out in the schedule attached and marked P: a.In circumstances where P was also being prescribed drugs of addiction by another practitioner at the same practice; b.Without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.When the practitioner knew or ought to have known that the drugs so prescribed were being, or were likely to be, abused. 87.The Practitioner failed to keep proper medical records of Patient P in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient Q 88.The Practitioner prescribed Oxycodone and Diazepam to Patient Q on the dates and in the quantities set out in the schedule attached and marked Q: a.in circumstances where the practitioner failed to adequately investigate whether Patient Q may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 89.The Practitioner failed to keep proper medical records of Patient Q in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient R 90.The Practitioner prescribed Oxycodone and Diazepam to Patient R on the dates and in the quantities set out in the schedule attached and marked R: a.in circumstances where the practitioner failed to adequately investigate whether Patient R may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 91.The Practitioner failed to keep proper medical records of Patient R in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient S 92.The Practitioner prescribed Tramadol, Oxycodone, Diazepam and Temazepam to Patient S on the dates and in the quantities set out in the schedule attached and marked S: a.in circumstances where the practitioner failed to adequately investigate whether Patient S may have had a history of past or current substance abuse; and b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. Patient T 93.The Practitioner prescribed Oxycodone to Patient T on the dates and in the quantities set out in the schedule attached and marked T: a.in circumstances where the practitioner failed to adequately investigate whether Patient T may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 94.The Practitioner failed to keep proper medical records of Patient T in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient U 95.The Practitioner prescribed Morphine (MS Contin), Oxazepam and Diazepam to Patient U on the dates and in the quantities set out in the schedule attached and marked U: a.in circumstances where the practitioner failed to adequately investigate whether Patient U may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 96.The Practitioner failed to keep proper medical records of Patient U in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient V 97.The Practitioner prescribed Oxycodone, Diazepam and Panadeine Forte to Patient V on the dates and in the quantities set out in the schedule attached and marked V: a.in circumstances where the practitioner failed to adequately investigate whether Patient V may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 98.The Practitioner failed to keep proper medical records of Patient V in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient W 99.The Practitioner prescribed Codeine Phosphate and Alprazolam to Patient W on the dates and in the quantities set out in the schedule attached and marked W: a.in circumstances where the practitioner failed to adequately investigate whether Patient W may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 100.The Practitioner failed to keep proper medical records of Patient W in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient X 101.The Practitioner prescribed Morphine (MS Contin) to Patient X on the dates and in the quantities set out in the schedule attached and marked X: a.in circumstances where the practitioner failed to adequately investigate whether Patient X may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 102.The Practitioner failed to keep proper medical records of Patient X in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient Y 103.The Practitioner prescribed Temazepam, Endone and Nitrazepam to Patient Y on the dates and in the quantities set out in the schedule attached and marked Y: a.in circumstances where the practitioner failed to adequately investigate whether Patient Y may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 104.The Practitioner failed to keep proper medical records of Patient Y in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient Z 105.The Practitioner prescribed Diazepam, Panadiene Forte and Temazepam to Patient Z on the dates and in the quantities set out in the schedule attached and marked Z: a.in circumstances where the practitioner failed to adequately investigate whether Patient Z may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 106.The Practitioner failed to keep proper medical records of Patient Z in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient AA 107.The Practitioner prescribed Diazepam, Temazepam and Panadeine Forte to Patient AA on the dates and in the quantities set out in the schedule attached and marked AA: a.in circumstances where the practitioner failed to adequately investigate whether Patient AA may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions; c.where the practitioner ought to have known drugs were being or were likely to be abused. 108.The Practitioner failed to keep proper medical records of Patient AA in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned. Patient AB 109.The Practitioner prescribed Temazepam and Oxazepam to Patient AB on the dates and in the quantities set out in the schedule attached and marked AB: a.in circumstances where the practitioner failed to adequately investigate whether Patient AB may have had a history of past or current substance abuse; b.without exercising responsible medical judgment as to whether it was appropriate to issue such prescriptions. 110.The Practitioner failed to keep proper medical records of Patient AB in accordance with the requirements of Schedule 2 of the Medical Practice Regulation 2003, in that she failed to record a level of detail appropriate to the patient's case and/or to the medical practice concerned.