A Melbourne GP could face disciplinary action after prescribing escalating doses of addictive opioids to drug-dependent patients, and repeatedly violating boundaries with a vulnerable family in his care. 

Dr Michael Glasby faced the Victorian Civil and Administrative Tribunal last week where he was found to have engaged in professional misconduct and unprofessional conduct between 2015 and 2018, while working at Tyabb Health Centre in outer Melbourne. 

Glasby was referred to VCAT by the Medical Board of Australia following investigations into his treatment of a vulnerable mother and her children, as well as a drug-dependent man who died from drug toxicity. 

In March 2018, Glasby began treating a 'highly complex, opioid-dependent' man known as Patient D for anxiety, depression and pain management. 

Over just eight days, Glasby prescribed the man escalating doses of opioids, without adequately conducting a mental state examination or consulting his prior medical records. 

On one occasion, Glasby delegated a junior doctor to undertake a consultation with Patient D, who was inexperienced in Schedule 8 prescribing.

Due to a miscommunication, the junior prescribed Patient D a dangerous drug combination of oxycodone and pregabalin, a nerve-pain medication, which was not reviewed by Glasby.

Glasby also prescribed Patient D two types of sedatives - temazepam and diazepam - and prescribed the anti-depressant fluoxetine, despite the patient already taking another anti-depressant, desvenlafaxine. 

Tragically, the man died at his home from combined drug toxicity, less than two weeks after his first appointment with Glasby.

While the Medical Board of Australia did not allege Glasby directly caused Patient D's death, the Tribunal ruled that his conduct placed the man's safety at risk.

The Tribunal found Glasby's substandard care of the man constituted professional misconduct.

The rest of the allegations from the Board refer to Glasby's treatment of a vulnerable woman known as Patient A, and her children.

Glasby began treating Patient A in August 2015 for 'complex physical and mental health issues' for which he prescribed her a 'large amount of opioids'. 

According to VCAT's decision, Glasby failed to adequately assess Patient A's narcotic dependence and failed to act on clear signs of drug dependence.

Instead, he continued prescribing her a cocktail of highly restricted and addictive opioids and sedatives, despite no sustained improvement in her condition over a two-and-a-half-year period.

It was also submitted that Glasby did not have a correct diagnosis of Patient A's condition, with the patient repeatedly returning with 'uncontrolled symptoms' and different types of pain, which Glasby would treat by continually increasing her doses.

Her initial prescription from October 2015 of up to one Endone tablet twice daily had more than tripled to 'four to six' Endone tablets a day by May 2017. 

In January 2017, Glasby unsuccessfully attempted to cease Patient A's opioid use, and it would not be until more than a year later, in February 2018, that he referred her to a dedicated pain specialist. 

The Tribunal found that Glasby's 'substandard care' and delay in referring Patient A to a dedicated pain specialist constituted professional misconduct. 

Ideally, he should have reviewed her medication history and limited her intake, and should have gradually attempted to replace the opioid medications with less harmful substitutes. However, the Tribunal was unable to establish whether Glasby actually knew she was drug-dependent despite obvious indications, which they said was a 'significant concern'. 

In closing submissions, Glasby conceded he did not adequately assess the severity of Patient A's drug dependency, and that he 'should have known', but maintained that he appropriately treated her chronic pain.

The Tribunal also found Glasby did not hold the authorisation required to prescribe highly restricted Schedule 8 medications, mistakenly believing the clinic had one.

Given Patient A's 'very complex history' and vulnerability, obtaining this permit was all the more important, the Tribunal found.

In June 2016, Glasby also began treating Patient A's teenage daughter, who had previous diagnoses of post-traumatic stress, bipolar disorder, anxiety and depression.

Notes from previous doctors also stated she had started seeing things and hearing multiple voices, noting the girl's mother had been diagnosed as schizophrenic at the same age. 

When the teen first began seeing Glasby, her symptoms were 'certainly not under control' and were 'becoming increasingly impactful on her life'.

The Tribunal found Glasby administered 'substandard care' to the teenager, by failing to adequately verify her purported diagnosis of bipolar disorder and PTSD, and failing to consult with a child psychiatrist before prescribing her various psychotropic drugs. 

An associate professor gave evidence that Glasby's acceptance of the diagnoses was 'below the standards of the profession' and he was 'not really sure what he was treating'.

Outside of his work at Tyabb Health Centre, Glasby also sought to provide non-medical assistance to the family, which 'crossed appropriate physical boundaries', the Tribunal found.

On one occasion in March 2017, Glasby took the children on his boat, with the youngest child, then aged three, falling from the vessel and having to be rescued by Glasby. The youngster was then observed to be 'pale, in shock, and vomiting'.

The Tribunal was satisfied that the youngster was likely to have been submerged, was 'floundering in the water for a few minutes', and may have ingested seawater.

The day after the boat incident, Glasby and his wife attended the family's home and offered to pay for the children's swimming lessons.

The Tribunal found that the child should have been taken to hospital for observation, but instead Glasby relied on guidance from a phone call with an unnamed paediatrician.

Three weeks after falling from the boat, the child was diagnosed with pneumonia after attending a different medical clinic.

The Tribunal also rejected Glasby's evidence that it was 'not a potential drowning' but 'a water event' - an excuse he used to justify not taking the child to hospital.

Regarding Glasby's care of the family, the Tribunal also found he 'failed to maintain, or transgressed professional boundaries', in a way that constituted unprofessional conduct. 

On various dates, he 'rubbed and massaged the children's backs during appointments' and sat the children on his lap or knee during appointments. 

He also offered to give their mother a massage or pay for her to receive a massage. Glasby said he could not recall this conduct but accepted that it was possible. 

The Board submitted that while the conduct was 'entirely inappropriate', Glasby had the 'best intentions' and there was no evidence it was predatory or ill-intentioned. 

It was ruled that Glasby acted 'genuinely, but in a misguided way' in attempting to help a vulnerable family in difficult health and financial circumstances.  

Ultimately, the Tribunal found Glasby guilty of seven counts of professional misconduct and one count of unprofessional conduct across his treatment of the four patients.

The matter has now been adjourned for a future hearing, where the Tribunal will determine appropriate disciplinary action.