Howman, Katie Lee

Contributing factors

• Long-standing opioid dependency on prescribed medications (oxycodone and tramadol)
• Systematic 'doctor shopping' to multiple doctors and pharmacies without detection
• Inadequate screening for oxycodone in AHPRA drug testing regime
• Lack of real-time access to prescription and doctor attendance records
• Failure of AHPRA to request prescription history despite initial Fentanyl misuse
• Incomplete communication between treating psychiatrist and psychologist regarding self-harm behaviour
• Undetected depression, anxiety, and self-harming behaviour
• Access to controlled drugs in workplace despite safeguards and restrictions
• Health professional reluctance to disclose addiction due to fear of regulatory reporting
• Insufficient escalation of escalating workplace concerns about erratic behaviour and suspicious incidents

Coroner's recommendations

1. If there is an impediment to AHPRA's access to PBS prescription records from Medicare, this issue should be urgently investigated, reviewed, and legislatively changed if required. AHPRA should then regularly monitor PBS records, especially where conditions have been imposed to attend upon only one doctor or not to obtain prescriptions for particular medications.
2. There should be statutory change to enable real time access to relevant prescription and doctor attendance history. The New Zealand model of forwarding information of concern to the treating doctor should be considered. Privacy issues should be accommodated while safeguarding patients from harm and abuse of publicly funded resources.
3. AHPRA should routinely seek doctor attendance and prescription history of health practitioners under supervision. If there are legislative restrictions impeding timely access to information, these should be reviewed.
4. Dr P.'s advice should be considered. A more limited requirement to report to AHPRA should be adopted: treating doctors should report to AHPRA that the person was being treated, was compliant with treatment, and when it is possible the person might be able to gradually return to work given their condition. Expanding and continuing education around this issue should be undertaken by AHPRA, the Office of the Health Ombudsman, the College of Psychiatrists, and the College of General Practitioners.
5. AHPRA should consider whether there is scope within their role to adopt and provide a more rehabilitative capability, such as the Nursing and Midwifery Health Program in Victoria. Alternatively, government should directly fund a dedicated rehabilitation service that is exempted from any requirement to report to AHPRA while a practitioner is receiving treatment.
6. Access to Medicare rebates for drug testing ordered by AHPRA should be considered.
7. Hospitals managing a health practitioner under AHPRA supervision should consider lessons learned from Toowoomba Hospital. Managers/team leaders should be notified verbally or in writing of concerns regarding colleague behaviour. If a staff member is maintained in a work unit with restrictions, they should agree to disclosing restrictions to other staff members as part of the agreement. Queensland Health should consider such agreements to care for co-workers' emotional wellbeing and professional reputations while protecting the practitioner under management.