'Misbehaving' doctor numbers spike

AUSTRALIAN doctors investigated for improper use of Medicare, over-prescribing drugs and performing unnecessary procedures more than tripled in number in just six years.

The Professional Service Review (PSR), which is responsible for investigating alleged bad practice among health professionals, received 136 requests from Medicare Australia for scrutiny in 2008/09.

This was a 357 per cent increase on 38 requests in 2003/04, the PSR says in its fifth report, released on Monday.

Poor record keeping, over-prescription of pain killers and antibiotics and the over-referral of diagnostic imaging were among the problems commonly encountered by the PSR, the report says.

The report highlights excessive use of CT scans by doctors for patients complaining of back pain, noting the number of CT scans performed in Australia between 1992 and 2006 rose 140 per cent.

It says doctors referred such patients for CT scans despite the patient not displaying any of the `red flags' detailed in guidelines, needlessly exposing them to ionising radiation which can increase the risk of cancer.

PSR director Dr Tony Webber says a number of the problems highlighted in the report are not only breaches of Medicare claiming procedures but could also have a serious effect on patient's health.

"Some doctors continue to consider the keeping of medical records as just a note for their recollection when in fact a medical record needs to be comprehensive and complete so that any new doctor taking over the care of a patient would be fully across the medical history of patients," Dr Webber said in a statement.

"Many doctors investigated provided patients with multiple prescriptions of potentially dangerous medicines, including benzodiazepines, narcotic pain medications and even antibiotics, without careful clinical monitoring," Dr Webber said in a statement.

Of the 136 cases referred to the PRS in 2008-09, 42 led to negotiated agreements between the practitioner and the PRS.

As a result, 26 practitioners were reprimanded, 18 were partially disqualified from Medicare, two were fully disqualified, and 30 were ordered to pay back benefits in amounts of $4000 to $178,994, totalling more than $1.2 million.

Seven practitioners were referred to relevant state medical registration boards in 2008-09 because they had caused, were causing or were likely to cause a significant threat to the life or health of patients.

One South Australian doctor was referred to the state medical board after being found to have prescribed narcotics and benzodiazepine - psychoactive drugs used to treat anxiety, such as Valium or Diazepam - at a rate far exceeding that of his peers.

The doctor issued 1207 scripts for Diazepam in the period 2003-09, more than double the scripts written by the next most frequent prescribers of the drug. The same doctor gave out 822 scripts for codeine phosphate with paracetamol, sold under the brand name Panadeine Forte, 236 more than other big prescribers.

Seven practitioners are named in the report for misuse of Medicare services, including initiating unnecessary pathology services, over-prescription of drugs and unnecessary procedures.

Among them, a Victorian doctor was reprimanded and fined after being found to have performed unnecessary nasal surgery, known as alar rhinoplasty, on 39 patients since 2000 without any evidence that the procedures were effective in improving their nasal function.

The doctor had performed more alar rhinoplasty procedures than any other doctor in Australia.

Other areas of concern include the claiming of multiple Medicare benefits for single consultations or procedures, the over-use by optometrists of computerised perimetry tests and the lack of comprehensive history-taking by doctors.