Tribunal cautions medical practitioner for inappropriately treating patients with ADHD

14 Oct 2019

A tribunal has cautioned a Queensland psychiatrist for unsatisfactory professional performance in relation to his diagnosis and treatment of patients with attention deficit hyperactivity disorder (ADHD).

Between 2010 and 2013 a number of notifications were received by the Australian Health Practitioner Regulation Agency (AHPRA) about Queensland psychiatrist Dr Philip Bird’s treatment of patients with ADHD.

The notifications were referred to the Medical Board of Australia (the Board), who subsequently took immediate action on 8 July 2013 imposing conditions on Dr Bird’s registration.

On 23 October 2013, Dr Bird gave undertakings to the Board which replaced the conditions on his registration. The undertakings required, amongst other things, that Dr Bird refer for a second opinion:

• all patients prescribed Dexamphetamine in excess of 40mg per day and Methylphenidate in excess of 80mg per day, and
• all patients who suffer ADHD and a current relevant comorbid psychiatric illness with the potential to be exacerbated by the commencement of stimulant medication.

The Board referred the matter to the Queensland Civil and Administrative Tribunal (the tribunal) on 18 June 2014. The initial allegations raised related to 12 patients which had been diagnosed with ADHD and treated with stimulant medication, whilst also suffering a comorbid mental disorder. The allegations were amended on 4 July 2016 and 8 March 2017 and reduced to eight patients.

The final allegations about the eight patients included:

• that the diagnosis of ADHD made by Dr Bird was not reasonably available because there was no, or not sufficient, evidence of the existence of the condition, and where the presenting symptoms were better accounted for by another mental disorder, and
• consequently, that the treatment of each patient for ADHD, particularly with Dexamphetamine, was inappropriate.

The matter was heard by the tribunal on 21 March 2017 and 29 March 2017 and proceeded by way of a statement of agreed facts concerning three of the eight patients. The statement of agreed facts recorded where the parties’ experts, through an expert conclave, had been able to reach agreement, including that:

• For one patient, the experts agreed that the diagnosis of ADHD was questionable and Dexaphetamine treatment for ADHD was inappropriate.
• For the remaining two patients, Dr Bird accepted the Board’s expert’s view that there was insufficient longitudinal history of signficant impairment in academic, social, or occupational functioning attributable to ADHD and insufficient rating scale assessments to warrant a diagnosis of ADHD. It was accepted by Dr Bird that the prescribing of Dexamphetamine to these patients was also inappropriate.

On 26 April 2019, the tribunal delivered its substantive decision that Dr Bird had behaved in a way that constitutes unsatisfactory professional performance. He was cautioned and ordered to pay the Board’s costs of the proceedings. However, due to the delay in finalising its decision, the tribunal considered it should receive further evidence and submissions to determine whether conditions should still be imposed, in particular with respect to obtaining a second opinion and mentoring. The proceedings were therefore adjourned to determine whether any, and if so what, conditions were to be imposed.

At this point the Board accepted that conditions requiring a second opinion did not need to be imposed by the tribunal, given Dr Bird had continued to comply with his earlier undertaking.

Dr Bird had also submitted extensive material about the education he had completed since the hearing which included regular participation in peer review meetings on ADHD. The Board was satisfied that the peer review meetings were sufficient to satisfy the requirements of any mentoring conditions.

On 12 June 2019 the tribunal finalised its reasons for its decision. The tribunal decided that, in the circumstances, further conditions on Dr Bird’s registration were not required.

The decision and reasons are published on the tribunal’s website.