General practitioner reprimanded for prescribing excessive amounts of testosterone

07 Jan 2020

A tribunal has reprimanded a general practitioner for prescribing clinically inappropriate and excessive amounts of testosterone.

On 4 December 2019, the Victorian Civil and Administrative Tribunal (the tribunal) found that Dr Wei Xiong Xie had engaged in professional misconduct for prescribing excessive amounts of testosterone to a patient between October 2012 and November 2014.

Routine monitoring by the Department of Health and Human Services (DHHS) identified that Dr Xie had prescribed testosterone, an anabolic steroid and drug of dependence¹, at an approximate rate of two injections per week to one patient, which is four to six times the normal therapeutic dose range for this medication. 

DHHS notified the Australian Health Practitioner Regulation Agency (Ahpra) of Dr Xie’s alleged conduct. Investigation revealed that Dr Xie:

• did not know that testosterone was a drug of dependence 
• felt pushed to continue prescribing testosterone and did not adequately inform himself of the patient’s conditions or medication before treating 
• thought the treatment was appropriate because his colleagues had previously prescribed testosterone, and
• had multiple opportunities to identify the patient as drug seeking. 

On 6 April 2017, Dr Xie was found guilty in the Magistrates Court of two charges under the Drugs, Poisons and Controlled Substances Act 1981 relating to prescribing testosterone to a patient when Dr Xie had not taken all reasonable steps to ensure a therapeutic need existed for the drug. Dr Xie was fined $6,000 and ordered to pay costs of $7,500.

On 8 November 2018, the Board decided to refer Dr Xie to the tribunal for professional misconduct.

The tribunal found that Dr Xie’s prescribing was a serious breach of the Board’s Good medical practice: A code of conduct for doctors in Australia which states that exercising good patient care includes assessing the patient, taking into account the history and ensuring you have adequate knowledge and skills to provide safe clinical care.

Dr Xie admitted that he engaged in professional misconduct and submitted that he attended three educational programs in June 2016 relating to drugs of dependence and off labelling prescribing, in response to the investigation by the DHHS.

He also submitted a reflective practice report to the tribunal which summarised the education he completed and listed changes which he has implemented in his practice. The changes include using SafeScript Software which allows him to review a patient’s prescription history and assists in identifying patients developing signs of dependence. He additionally submitted that he now writes detailed progress notes at each consultation.

Dr Xie also undertook education in October 2019 that addressed issues in Good medical practice, including the importance of recognising and working with the limits of competence and scope of practice.

The tribunal found that Dr Xie failed to identify the patient as drug seeking and that the conduct was not an isolated incident as it occurred 16 times. He failed to exercise independent clinical judgement in prescribing testosterone to the patient and therefore breached his professional obligations.

The tribunal reprimanded Dr Xie. The tribunal determined that given Dr Xie had undertaken further education regarding drugs of dependence and had made changes to his practice to avoid similar conduct in the future, any conditions to his registration were not necessary. It was satisfied that the future risk of Dr Xie prescribing a drug of dependence, without carrying out the necessary reviews, was low. It also stated that had Dr Xie not undertaken further education, it would have placed conditions on his registration requiring him to do so.

The full decision is published on the Austlii website.

¹Drugs, Poisons and Controlled Substances Act 1981 (Vic), extion 4 and Schedule 11, Part 3, Column 1