SUTHERLAND Shire GP Lamorna Osborne is taking an extended break from work - but not by choice.
On Monday, her registration was suspended for six months after the NSW Civil and Administrative Tribunal found her guilty in October of errors that could have hastened the deaths of two nursing home patients at Sylvania in 2012 and 2011.
The tribunal found that Dr Osborne, 57, had prescribed excessive doses of morphine to two female patients receiving palliative care at the Pacific Heights Nursing Home.
The women, aged 64 and 92 at the time of the deaths, were both at the end stages of their lives.
Dr Osborne had been treating the two patients for eight years.
Patient A was admitted to the nursing home in 2000 at the age of 53 after suffering a stroke that left her in a "vegetative state".
In early December 2011, Patient A developed gangrene in one of her toes and a chest infection.
In consultation with the patient's next of kin a decision was taken to cease active treatment.
On December 7, 2011, Dr Osborne started Patient A on morphine.
Patient A died on December 11, aged 64.
Between December 7, 2011 and December 11, 2011, patient A received not less than 370 mg of morphine.
Patient A's death certificate records the cause of death as pneumonia (one week), cardiovascular accident (11 years) and gangrene of toe (10 days).
Patient B was admitted to the nursing home in 2001 at age 80.
She had Alzheimer's disease with problems of aggression and from osteoporosis.
In early May 2012, patient B's condition deteriorated significantly, and she could not swallow.
Until this time, patient B was given Buprenorphine and paracetamol for pain relief.
On May 3, 2012, Dr Osborne ordered that these medications cease and that morphine be commenced.
Patient B died on May 6, 2012, aged 92.
Between May 3, 2012 and May 6, 2012, patient B received 600 mg of morphine.
Patient B's death certificate records the cause of death as peripheral vascular disease (one year), renal failure (three years) and Alzheimer's's disease (12 years).
Speaking to the media for the first time about the inquiry, Dr Osborne said there was a real possibility in the beginning that she could go to jail for manslaughter or be struck off the register permanently.
Asked if she knew the levels of morphine she had prescribed were excessive, she said: "I made a mistake".
Dr Osborne said the first lawyer she spoke to told her she could be painted as the "Harold Shipman of Australia".
Shipman was Britain's most prolific serial killer: a family doctor who killed at least 250 of his patients over 23 years.
"At the time it felt like being punched or getting your legs chopped off," Dr Osborne said.
"Initially I couldn't sleep and I couldn't even go to the postbox to open my postbox because I'd get jelly knees and want to vomit . . ."
The tribunal found unsatisfactory professional misconduct was proven and that Dr Osborne was impaired as a result of a major depressive disorder.
It did not accept that Dr Osborne’s depressive disorder ‘‘was the sole cause of serious errors made by her in the prescribing of excessive doses of morphine’’.
Dr Osborne attributed the development of her depression in late 2011 to three factors including heavy workload, a serious family crisis and the unsatisfactory nature of a personal relationship.
During the winter of 2012, Dr Osborne was seeing 600 patients a month and dealing with a relative in crisis.
‘‘People make mistakes when they are tired,’’ she said.
‘‘Lorry drivers aren’t even allowed to drive for more than three hours and 20 minutes.’’
Dr Osborne agreed that some people would view deaths as a case of assisted suicide [euthanasia].
‘‘I can’t change their minds,’’ she said. ‘‘They’ll form their own opinions.’’
Dr Osborne declined to speak about her views on euthanasia, but said 92 per cent of her colleagues would not want to be kept alive in a vegetative state.
Dr Osborne said, on the whole, most people had stuck by her through the inquiry.
‘‘There’s been the odd surprise, but on the whole people are actually really supportive, which is why I’m sitting here talking to you.
‘‘I regard it [being a doctor] as a great privilege and I will hold my head up high despite this edict.’’
In a statement to investigators, the daughter of Patient B said: ‘‘I have no complaint about Dr Osborne’s treatment of my mother and wish to thank her for her care of Mum over the years’’.
‘‘I consider Dr Osborne to be a very kind, dedicated and caring doctor, who always took the time to answer my questions over the years regarding Mum’s deteriorating health,’’ Patient B’s daughter wrote.
Dr Osborne has not been in contact with the family of Patient A.
‘‘They’ve been through enough trauma being dragged through this as well,’’ she said.
The tribunal’s inquiry was into four of five complaints brought by the Health Care Complaints Commission.
The registered nurse who raised concerns about a 60-mg dose of morphine prescribed for Patient B and who works at a hospital in St George said she always thought Dr Osborne was ‘‘a pretty good doctor’’ and that it was ‘‘just that one day with Patient B when I didn’t feel that 60 mg of morphine was appropriate for her condition’’.
One complaint was that Dr Osborne had administered 5 mg of morphine intravenously to Patient A when ‘‘contrary to clinical guidelines that morphine should not be administered intravenously in a residential aged care facility’’.
Dr Osborne maintains that 2.5 mg to 5 mg of morphine can be administered intravenously in some cases.
Dr Osborne was born in Scotland in 1957 and settled in Australia in 1988.
She had been working at the Kirrawee Family Medical Practice up until last Friday, October 30. The tribunal imposed three conditions on her registration that will come into effect after the period of suspension, including that she is not allowed to undertake any nursing home consultations or palliative care work; work for more than 35 hours a week; and must regularly attend a GP, psychiatrist and psychologist.
Dr Osborne is involved with the Illawarra Beekeepers Association at Sutherland, and will continue to teach beekeeping.
‘‘My compassion is with the families who have been dragged through the investigation, and certainly the nursing staff, who got hauled over the coals.
‘‘It’s been a tough two years.’’
