Finding into death of Robert Anderson

Contributing factors

• Chronic pain requiring analgesia
• History of narcotic dependence (pethidine)
• Repeated intramuscular injections to buttock without proper monitoring
• Lack of specialist pain management input
• Absence of clear treatment plan
• Heavy reliance on IM morphine without documented clinical rationale
• No appropriate Schedule 8 permit for IM morphine
• Failure to assess local infection risk
• Drug dependence compounded by prescribing pattern

Coroner's recommendations

1. The Australian Health Practitioners Regulation Authority take whatever action it deems appropriate against Dr O'Toole in respect of his clinical management of Mr Anderson, in particular based on his long-term prescription of IM morphine for self-administration commencing in August 2005 until his death.
2. The Department of Health consider enhancement of the Schedule 8 permit scheme so as to audit permit compliance more comprehensively, ensuring at a minimum that Schedule 8 drugs are being prescribed in strict accordance with the permit and not otherwise.
3. The Department of Health consider enhancement of the Schedule 8 permit scheme so as to require all prescriptions to be dispensed only if accompanied by a copy of the relevant Schedule 8 permit, and only if prescribed in strict accordance with the permit as to strength of preparation, dose and dosing frequency, and route of administration.
4. The Department of Health initiate a dialogue with its Commonwealth counterparts about the feasibility of reconciliation of information from the Schedule 8 permit scheme on the one hand and the Medicare/PBS phone approval hotline on the other.