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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 28-November-2008, Vol 121 No 1286

Professional Misconduct: forgery and practising while suspended (Med07/60P and Med07/61P)
Charge
Dr David Spencer Gilgen (the Doctor), medical practitioner of Hamilton, was charged with professional misconduct following two charges laid by a Professional Conduct Committee.
The first charge alleged that:
While the Doctor’s practising certificate was suspended, he forged the signature of Dr Deepani Perera (his Colleague) on three standard prescription forms dated 30 March 2006 and 3 April 2006.
The second charge alleged:
In the period from about 27 June 2006 whilst the Doctor’s practising certificate was suspended, he ordered the following prescription medication from Unigen Life Science Pte Ltd, 583 Orchard Road, Singapore:-
  • (a) 10mls Sustanon 250mgs/ml ampoules x 10
  • (b) 10mls Enanthate ampoules × 10
  • (c) 10mls Stanazol 10mgs/ml × 4 ampoules
  • (d) Anadrol tabs 100s × 5
Finding
The Tribunal found Dr David Spencer Gilgen guilty of professional misconduct for both charges.
Background
The Doctor was a general practitioner who had a high profile in the community as a former Waikato District Health Board member, and because of his work with Maori health.
At the time of the events under consideration the Doctor’s annual practising certificate was suspended on an interim basis by the Medical Council of New Zealand. The suspension took effect on 20 September 2005. The principal ground for the suspension was the Medical Council had reason to believe the Doctor posed a serious risk of harm to the public by practising below the required standard of competence for a general practitioner, particularly with regard to his prescribing practices.
Reasons for Finding of the First Charge
The Tribunal concluded that it was the Doctor who forged the signatures of his colleague on the three prescriptions, having regard to:
  • The fact that the Doctor was suspended, and could not use his own signature to prescribe.
  • The fact that he was a regular prescriber of anabolic steroids; presentation of scripts of this kind was common for him, and uncommon for many other practitioners.
  • The fact that his Colleague did not sign the prescriptions.
  • The fact that the three prescriptions, and signatures, appear to have been prepared at the same time, by the same person.
  • The evidence of the use a purple pen, known to have been used by the Doctor, by way of overlay of his Colleague’s signature, which suggested the Doctor was considering copying or simulating her signature.
  • The fact that he attended Barrett Pharmacy, and left the three scripts for dispensing.
  • The fact that he attended Barrett Pharmacy, in the following week, in order to uplift the prescriptions.
  • The numerous inconsistencies which were identified from the various explanations he gave in his letters.
  • The fact that three scripts were presented, all of them for anabolic steroids, and all involving excessive prescribing.
  • The fact there was no evidence implicating any other person.
When all these individual pieces of evidence were considered together, the Tribunal was completely sure to the very high standard involved in an allegation as serious as forgery, that the charge was established and the Doctor was guilty of professional misconduct.
Reasons for Finding if the Second Charge
The key factual issue with regard to the second charge was whether or not the Doctor sent the email of 27 June 2006 ordering the medication. He denied it and said that he had never sent such an email.
The Tribunal found the following facts indicated that it was the Doctor who had sent the email:
  • It was signed in his name.
  • He was suspended, and could not present prescriptions for such medications to a pharmacy. He was a person who would have a reason for presenting an email in the way that he did, addressing it in the first instance to Unigen in Singapore, to avoid, as it was put in evidence, “compliance issues”.
  • Products of a particular kind were requested (androgens and anabolic steroids), which were products that the Doctor was known regularly to request.
  • Three of the names which appeared in the mail order were those of Patients A, B and C, who were the subject of prescriptions previously written by the Doctor.
  • The giving of the Doctor’s home address, so that he could receive the medications there.
  • There was also evidence that emails had been sent by “David S Gilgen” at two earlier points prior to the placing of the email order.
The Tribunal carefully considered the evidence given by the Doctor that he detested computers. However, the Tribunal considered the following matters:
  • His Colleague stated that she had seen him use a computer at the surgery.
  • The Doctor was clearly very intelligent, and the sending of an email is a relatively straight forward process, which would be well within his competence.
  • He had the opportunity of sending just such an email, since he had a computer at home which he was able to use.
Weighing all the factors indicating that the Doctor did send the email on the one hand, against his bare denial on the other, and having regard to the adverse conclusion which the Tribunal reached as to the reliability of his evidence, the Tribunal was completely sure that he sent the email. The Tribunal was satisfied that the facts of the charge were established and that the Doctor was guilty of professional misconduct.
Penalty
The Tribunal considered that quite apart from serious prescribing issues, the Doctor had demonstrated outright dishonesty in the way in which he continued to try and obtain medications, and then denied he had done so. There appeared to be a behavioural issue in the sense that the Doctor appeared to have very limited insight as to the appropriateness of his totally unprofessional prescribing. It had occurred in 1989, to a significant and serious level; and there was a similar pattern in his offending 18 years later in 2005-2006.
The cumulative effect of these serious matters in the Tribunal’s opinion was that the public and the community clearly needed to be protected.
The Tribunal considered the Doctor undoubtedly has significant skills. It appeared that he was highly regarded by his patients, and the Maori community. He had contributed significantly to Maori health and to his local District Health Board. However, the Tribunal was satisfied, on the basis of the patient information before it, that patients would continue to try and seek him out, and have him supply inappropriate medications, which was a pressure that he could not deal with.
The Tribunal was satisfied the only responsible outcome was to order cancellation of his registration.
The Tribunal ordered the Doctor’s registration as a medical practitioner be cancelled and he pay costs of $10,000.00. The Tribunal directed that details of the decision be published in the New Zealand Medical Journal and on the Tribunal’s website.
The full decisions relating to the case can be found on the Tribunal web site at www.hpdt.org.nz Reference No: Med07/60 and Med07/61P.

     
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