Ed Madden, BL
Ed Madden, BL, looks at a recent hearing in which a Fitness to Practise Panel in the UK considered the case of a doctor who used a hospital prescription pad to prescribe for two people who were not his patients and whom he did not examine.
In February 2006, Dr Abiodun Agara came to the UK from Nigeria. Between April and November of that year, he worked as a Staff Grade Psychiatrist with Five Boroughs NHS Trust. During his time with the Trust, he had access to an ‘FP 10’ prescription pad. The pad was used to issue prescriptions to psychiatric patients of the Trust.
When his employment ended in November 2006, Dr Agara retained the prescription pad. In July 2008, he used it to prescribe insulin, metformin and lisinopril in the name of his wife.
Not a patient
The medications, which are used in the treatment of diabetes and high blood pressure, were not intended for his wife but rather for a man who was not a patient of Dr Agara. The doctor continued to use the pad to prescribe for this person until April 2009.
During this period, Dr Agara also wrote prescriptions for another person for similar medications; in addition, he prescribed oral quetiapine, an anti-psychotic drug used in a variety of psychiatric conditions.
Once again, the person involved was not Dr Agara’s patient. In neither case did he carry out an examination of the person concerned, or inform their own general practitioner that he had prescribed for them.
His use of the prescription pad came to light during a routine audit in June 2009 and the matter was brought to the attention of the General Medical Council. When his case came to be considered by a Fitness to Practise Panel hearing of the GMC in April 2011, Dr Agara was not legally represented.
He told the Panel that the first person for whom he prescribed was an elderly gentleman who came from Nigeria. The man attended the same church as the doctor’s wife. She, in turn, had told him that this person needed medication for his illness. The second person had requested medication for his condition.
Dr Agara maintained that when he was working in Nigeria, “it was normal for a doctor to prescribe for anyone needing medical help”, whether they were patients of the doctor or not. He had not been fully aware of Trust guidelines in relation to the writing of prescriptions and had not realised that it was improper or inappropriate “to prescribe on request”.
Bowed to pressure
Counsel for the GMC submitted that Dr Agara had “bowed to social pressure” and issued prescriptions without consideration for the long-term care and treatment of the persons concerned. He referred the Panel to the GMC publication Good Medical Practice, which states:
“If you provide treatment or advice for a patient, but are not the patient’s general practitioner, you should tell the general practitioner the results of the investigations, the treatment provided and any other information necessary for the continuing care of the patient, unless the patient objects.”
The doctor continued to use the pad to prescribe until April 2009
Dr Agara had issued prescriptions to two people who were not his patients. He had not carried out any medical examination and had not sought to establish the cause of their problems. Using the prescription pad to issue prescriptions to people who were not patients of the Trust had been misleading. The doctor had admitted that this was the case.
Departure from principles
Counsel, while acknowledging that Dr Agara had demonstrated some insight into his behaviour, submitted that his actions nonetheless represented a significant departure from the principles outlined in Good Medical Practice. He said that the doctor’s behaviour amounted to serious misconduct and that his fitness to practise was impaired.
Giving the decision of the Panel, the Chairman said that the writing of prescriptions for two people who were not his patients and without proper examination was a significant departure from Good Medical Practice on the part of Dr Agara, which amounted to misconduct. His fitness to practise “was indeed impaired at that time”.
The Panel noted in mitigation that British practice in prescribing was “different to what you were used to in Nigeria”. They also noted that the medications prescribed “were not drugs of addiction”. Dr Agara made no monetary gain from writing the prescriptions. No evidence had been placed before the Panel to suggest that he had behaved in this way previously, or that he had done so since.
The Panel acknowledged that the doctor now appreciated the gravity of his misconduct; they accepted his expression of regret and remorse for the way he had behaved.
The Chairman said that while Dr Agara’s “previous behaviour could have impacted adversely on the public’s right to have confidence in the medical profession”, he had learned a salutary lesson from the proceedings before the Panel. There was no evidence to suggest that he was not an otherwise competent doctor.
The Panel concluded that he did not pose a significant risk of repeating this type of behaviour in the future and that his fitness to practise was not currently impaired.
He would, however, be issued with a formal written warning which would remain on his record for a period of five years.
Reference: General Medical Council: Fitness to Practise Panel Hearing 26 April 2011 — 4 May 2011
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