This matter concerns disciplinary proceedings against Benjamin Ramsey, a registered pharmacist. He admits that he has behaved in a way that constitutes professional misconduct.
The parties filed a Statement of Agreed Facts.[1] In addition, the Tribunal was provided with an Affidavit of Mr Ramsey,[2] a Book of Documents,[3] and a copy of a letter from the Australian Health Practitioner Regulation Agency (AHPRA) to Mr Ramsey dated 10 March 2021.[4] We make findings of fact in accordance with the Statement of Agreed Facts and by reference to the other documents.
[2]
Mr Ramsey was born on 21 February 1991. He obtained a degree in pharmacy in 2012. He has held registration pursuant to the National Law[5] since that time.
At all relevant times, the respondent has worked as a registered pharmacist at a pharmacy at Modbury (the pharmacy).[6]
In about November or December 2016 Mr Ramsey misappropriated from the pharmacy two partially full packets of Endone (oxycodone) 5mg tablets for his personal use. There were in total about 20-30 tablets. The packets had been returned to the pharmacy by customers (returned stock). Mr Ramsey self-administered the medication, without clinical oversight, over a period of approximately six weeks. He took the tablets approximately 1-2 times per week, taking 2-3 tablets at a time.
Mr Ramsey states in his affidavit that he was having depressive thoughts at the time and took the tablets to try to alleviate this. He states that he did not subsequently misappropriate or self-administer any such any medications until about June 2019. Nor had he done so prior to November 2016.
In or about June 2019 Mr Ramsey misappropriated from the pharmacy four packets of medication for his personal use. This included one packet of Diazepam 5mg which was full or nearly full of 50 tablets and three partially full packets of medication, each having the active ingredient Oxycodone (the medications were Endone 5mg, OxyNorm 20mg and Targin 20mg). These four packets were either returned stock or expired stock of the pharmacy.
Mr Ramsey self-administered the medication, without clinical oversight, over the period from June to August 2019, taking tablets 1-2, and sometimes 3, times per week. He took 2-4 Diazepam tablets or alternatively 2-3 Oxycodone tablets each time.
Mr Ramsey states in his affidavit that he was again having depressive thoughts and was not in a good place mentally. He thought the medications would alleviate those issues.
With respect to his conduct in both 2016 and 2019, Mr Ramsey states that he timed the administration of the medications so that he would not be affected by the medication during any of his shifts as a pharmacist. It is not suggested that he worked whilst affected or impaired.
He also states that he did not supply the medication to any other person.
He states that he eventually realized, with encouragement from friends, that he needed to get help for his mental health.
On 15 August 2019, Mr Ramsey consulted a general practitioner, Dr Connolly, concerning his mental health. He disclosed to Dr Connolly, in general terms, the conduct set out above.
On 22 August 2019, Mr Ramsey again consulted Dr Connolly. Dr Connolly advised him that a report would need to be made to AHPRA and encouraged him to self-report. Mr Ramsey self-reported to AHPRA the same day. He disclosed the conduct in 2016 and 2019. Mr Ramsey has subsequently co-operated in a candid manner with the investigation.
On 9 September 2019, Dr Connolly also made a mandatory report to AHPRA.
Mr Ramsey has continued to consult a general practitioner and has been referred to a psychologist and a psychiatrist. He has willingly cooperated in that treatment.
He states that he last used the misappropriated medication on 21 August 2019 and has not since misappropriated or self-administered any such medications.
Oxycodone is a schedule 8 drug. Diazepam is a schedule 4 drug. Mr Ramsey's conduct in misappropriating, possessing, and administering these drugs was illegal in several respects. It also constituted a gross breach of the trust of his employer.
After his notification to AHPRA, he was given notice of proposed immediate action. He gave an undertaking not to practise for two weeks whilst he formulated a response to that notice.
On 3 October 2019, the Pharmacy Board of Australia (the Board), after conducting a "show cause" process, decided to take immediate action under s 156 of the National Law. It imposed conditions on his registration. These conditions required Mr Ramsey to engage in treatment with a general practitioner, a psychologist, and a psychiatrist and to undergo random urine and hair testing.
On 15 June 2020, the Board reviewed and removed the Conditions imposed under s 156 but imposed further conditions pursuant to s 178 of the National Law. These conditions were imposed on the basis that the Board reasonably believed that Mr Ramsey had or might have an impairment. The conditions required a continuation of urine and hair testing and three-monthly reports from the treating psychologist. They required Mr Ramsey to work only at approved locations with three-monthly reports from a senior person in the pharmacy.
All drug testing has been consistent with Mr Ramsey's claims to have been abstinent since August 2019.
Dr Nabil Chherawala, Psychiatric Registrar, provided a report dated 28 April 2020.[7] He advised that Mr Ramsey had been attending the NE Community Mental Health service since 1 October 2019 on a near weekly basis. He had engaged thoroughly with treatment and was described as forthcoming and genuine in his interactions. Dr Chherawala opined that Mr Ramsey's issues were resolved and he no longer required specialist psychiatric care. He stated:
[3]
I have no hesitation in recommending Mr Ramsey be able to continue working without restriction on his registration, or weekly drug testing, and I have no concerns with respect to his fitness to practice.
[4]
Mr Ronaldo Minniti, Clinical and Health Psychologist, provided a report dated 24 June 2020.[8] He reported that Mr Ramsey expressed a commitment and motivation to remain abstinent and to improve his mental health. Mr Ramsey also reported more stable moods and self-confidence and the absence of any signs of vulnerability to relapse. He intended to continue his treatment with Mr Minniti. Mr Minniti concluded:
[5]
As such it is recommended that all monitoring requirements by AHPRA are no longer needed.
[6]
Various reports were provided by Dr Karen Hand, general practitioner. They confirmed Mr Ramsey's compliance with treatment and his continuing fitness to practice. On 17 December 2020 Dr Hand reported[9] that there was no need for ongoing therapy. She opined:
[7]
I believe Benjamin has made a full recovery from his drug use issues. There has been no concern around relapse, and he is comfortable and confident in the workplace. I feel drug testing frequency could be further reduced or ceased.
[8]
It should be noted that AHPRA had earlier obtained an independent report from Dr David Kelly, Psychiatrist, on 27 November 2019.[10] Dr Kelly recommended psychological treatment and monitoring over a two-year period. He referred to Mr Ramsey continuing to be at risk of resorting to substance abuse, at times of significant personal distress.
On 4 March 2021 the Board removed all conditions from Mr Ramsey's registration.[11]
Mr Ramsey provided statements from his employers. They spoke highly of his competence as a pharmacist and expressed support for his continued employment.[12] A statement of support was also provided by a colleague.[13]
Mr Ramsey deposed in his affidavit that he had expended $8,586.60 in complying with the testing regime required by his conditions.[14]
Mr Ramsey also expressed his regret concerning his misconduct. He stated that he appreciates that such conduct is entirely unacceptable.[15]
Mr Ramsey admits that his conduct fell substantially below the standard of conduct to be expected of a practitioner of his training and experience. He also acknowledges that it was conduct that was inconsistent with him being (at the time) a fit and proper person to be registered.[16] The Tribunal regards these admissions as appropriate. We find that Mr Ramsey has behaved in a way that constitutes professional misconduct.
[9]
The Board presented cogent submissions as to the seriousness of this conduct. It submitted that Mr Ramsey had violated the central professional responsibilities of a pharmacist with respect to dangerous drugs. In Pharmacy Board of Australia v Foo[2019] VCAT 203 at [28]- [29], the Victorian Tribunal highlighted two aspects of such behaviour:
[10]
Protection of the Public
Prescription pharmaceutical products and in particular dangerous ones are the subject of close regulation for a purpose. Unregulated or inappropriate supply has the potential to compromise safety of members of the public. The system of supply relies to no small extent on those who are given the authority to release pharmaceutical products into the community. Quite apart from the duties of the prescribers, it is the pharmacist who must ensure that the supply is appropriate.
Protection of the Reputation of the Profession
The pharmaceutical profession holds a very high status in the eyes of the public. This is because the public relies on members of the profession to play their role in protecting the health of members of the public and because this role is widely acknowledged. Failure to meet standards or act appropriately has great potential to damage the reputation of the profession.
[11]
When Mr Ramsey misappropriated schedule 4 and schedule 8 drugs, he violated safeguards established to protect him and other members of the public. He acted contrary to the wider public interest. He also acted in a way that had the potential to severely damage the reputation of his profession. He violated fundamental and significant aspects of a pharmacist's proper professional practice. He abused the trust of the owners of the Pharmacy.[17] His conduct was extremely serious. Such conduct would normally give rise, in our view, to a significant period of suspension or disqualification.
The parties agreed that Mr Ramsey should be reprimanded. We agree that such is appropriate. The Board submitted that there should also be a suspension for a period of up to four months. This was necessary, it was submitted, to bring home to the practitioner and other practitioners that such conduct will not be tolerated. Such an order would also reassure the public that standards within the profession will be maintained.
There is force in the Board's submission. The serious nature of the professional misconduct requires a firm disciplinary response. A suspension is required, in our view, to satisfy the purposes of disciplinary action.
However, there are circumstances in this case that lead us to significantly reduce the period of suspension that would otherwise have been appropriate. In particular, we note that Mr Ramsey sought medical assistance and made candid disclosures to his general practitioner. This led to him making a self-report to AHPRA. He has taken substantial and positive steps to obtain treatment for his mental health issues and has at all times cooperated with the authorities and his treating practitioners. The evidence suggests that he has been successful in making a good recovery from his previous mental health and drug-related issues. We accept the evidence of his treating practitioners in this regard. There is a significant public interest, in our view, in encouraging persons in a similar position to Mr Ramsey to come forward and get medical assistance. There is also a public interest in encouraging candour and self-reports. We have regard to these factors in our consideration of the matter.
In addition to the reprimand, we impose a suspension for a period of one month. That suspension is necessary, in our view, to bring home to Mr Ramsey and other practitioners that such breaches of the statutory and professional obligations of a pharmacist will not be tolerated and will usually give rise to a significant sanction. It is also necessary to reassure the public that standards within the profession will be maintained. It is only due to the particular circumstances of this case that we think it appropriate to reduce the period of the suspension to one month.
Finally, we consider that it is appropriate to impose a condition on Mr Ramsey's registration that he receive mentoring for a period of two years. Whilst the evidence indicates that he has made a good recovery from his drug-related issues, we are concerned that there is still the possibility of relapse if he is faced in the future by challenging life experiences. We perceive that Mr Ramsey has been somewhat isolated in his professional practice, leaving him with limited professional support structures and resources for dealing with work and life-related issues. We consider that he will benefit greatly from a suitable mentor (outside his employment situation) with whom he can discuss relevant issues and any concerns regarding his health, his career and his professional responsibilities. A mentor would hopefully encourage and assist him to broaden his sphere of professional contacts. This would be a benefit to Mr Ramsey and a further step to protect the public from any relapse into inappropriate conduct.
At our invitation, the parties have provided draft conditions for consideration by the Tribunal. We have amended paragraph 1 of those conditions to contain a more fulsome statement of the focus and purpose of the mentoring arrangement. The amendment is consistent, in our view, with the content originally suggested by the Tribunal and upon which we invited submissions. The joint submissions of the parties do not persuade us that the amended conditions are in any way inappropriate.
The conditions are to apply from the date of this order.
Mr Ramsey must also pay the costs of these proceedings.
[12]
[5] The Health Practitioner Regulation National Law (South Australia)(the National Law) is to be found in Schedule 2 to the Health Practitioner Regulation National Law (South Australia) Act 2010 (SA).
[13]
[6] He has also worked less frequently at a related pharmacy.