A Melbourne general practitioner, Dr. Michael Glasby, has been found guilty of professional misconduct and unprofessional conduct by the Victorian Civil and Administrative Tribunal (VCAT) for his treatment of four patients between 2015 and 2018.
Glasby's actions at the Tyabb Health Centre in outer Melbourne included prescribing escalating doses of addictive opioids, failing to adequately assess patients' drug dependence, and blurring professional boundaries with a vulnerable family he was treating.
Patient D's Death and Opioid Prescribing
In March 2018, Glasby began treating a patient identified as Patient D, who was described as highly complex and opioid-dependent. Over an eight-day period, Glasby prescribed escalating opioid doses without a thorough mental state examination or consultation of prior medical records. On one occasion, he delegated a consultation with Patient D to a junior doctor inexperienced in Schedule 8 prescribing. This resulted in a dangerous drug combination of oxycodone and pregabalin being prescribed without Glasby's review. Glasby also prescribed Patient D two sedatives, temazepam and diazepam, alongside the antidepressant fluoxetine, despite the patient already taking another antidepressant. Tragically, Patient D died from combined drug toxicity at home less than two weeks after his initial appointment with Glasby. While the Medical Board of Australia did not allege Glasby directly caused the death, the Tribunal ruled his conduct placed the patient's safety at risk and constituted professional misconduct.
Substandard Care of Patient A and Her Children
The Tribunal also found Glasby engaged in substandard care regarding Patient A, who began treatment in August 2015 for complex physical and mental health issues. Glasby prescribed her a significant amount of opioids, failing to adequately assess her dependence or act on clear signs of it. He continued prescribing a cocktail of restricted opioids and sedatives for over two and a half years, despite no sustained improvement in her condition. The Tribunal noted Glasby did not appear to have a correct diagnosis, as Patient A repeatedly returned with uncontrolled symptoms and varying pain, leading Glasby to continually increase her opioid doses. Her prescription for Endone increased from one tablet twice daily to four to six tablets daily over this period. Glasby's delayed referral of Patient A to a pain specialist in February 2018, more than a year after attempting to cease her opioid use, also constituted professional misconduct. He conceded he did not adequately assess her drug dependency and 'should have known,' though he maintained he appropriately treated her chronic pain.
Furthermore, the Tribunal found Glasby did not hold the required authorization to prescribe highly restricted Schedule 8 medications, mistakenly believing the clinic possessed one, which was deemed particularly important given Patient A's complex history.
Glasby also provided substandard care to Patient A's teenage daughter, who had diagnoses of post-traumatic stress, bipolar disorder, anxiety, and depression. The Tribunal found Glasby failed to adequately verify her diagnoses or consult a child psychiatrist before prescribing psychotropic drugs. An associate professor testified that Glasby's acceptance of the diagnoses was below professional standards, and he seemed unsure of his treatment.
Transgressing Professional Boundaries
Beyond his medical practice, Glasby engaged in conduct that crossed appropriate physical and professional boundaries with the family. In June 2016, he took the children on his boat, during which the youngest child fell overboard and required rescue. The child was observed to be in shock and later diagnosed with pneumonia. The Tribunal rejected Glasby's assertion that it was a 'water event' rather than a potential drowning, ruling the child should have been taken to the hospital for observation.
Additionally, Glasby was found to have transgressed professional boundaries by rubbing and massaging the children's backs during appointments, sitting them on his lap, and offering to massage their mother or pay for her to receive one. While Glasby stated he could not recall some of these actions, he accepted they were possible. The Board noted that while the conduct was inappropriate, Glasby acted with 'best intentions' and there was no evidence of predatory intent. The Tribunal concluded that Glasby acted 'genuinely, but in a misguided way' in his attempts to assist the vulnerable family.
Glasby was found guilty of seven counts of professional misconduct and one count of unprofessional conduct. The Tribunal will determine appropriate disciplinary action in a future hearing.