GP Tony Hanne is accused of wrongly prescribing thousands of doses of Ritalin and other medication. Photo: Supplied
A GP accused of breaking the rules for prescribing Ritalin and other ADHD drugs says patients are left stranded between a stretched public health system and an expensive private one.
Tony Hanne is an expert in attention deficit hyperactivity disorder and is before the Health Practitioners Medical Tribunal on charges of prescribing without the approval of a paediatrician or psychiatrist.
Giving evidence, he said he worried about the consequences of untreated ADHD for those who could not get help - they had higher rates of road accidents, of substance abuse and of early death.
Many ADHD patients came to him because they could not afford to get private care or could not get into an overworked public system.
"Public mental health clinics in most DHBs [district health boards] refuse to provide diagnosis and treatment for ADHD patients on the grounds that staff were either overworked or lacked sufficient knowledge of ADHD," he said.
"In light of the huge demands on mental health in New Zealand I well understand their predicament."
Hanne charged $300 for a two-hour assessment, but treated a small number of patients without charge, he said.
If a patient needed to see a private psychiatrist for confirmation medication was needed, it often cost well over $1000.
To get subsidised medication, they had to go back for a specialist sign off every two years.
Hanne was charged because he worked for years with a psychiatrist who effectively signed off patients to get the restricted medications without seeing them in person or discussing their cases with the GP.
When the psychiatrist retired, Hanne could not find anyone to take over the arrangement, so began to prescribe directly.
Hanne told the hearing he was motivated by caring for his patients - people who were undiagnosed or untreated for ADHD were at risk of many negative impacts.
"The major risk here is uncontrolled impulsivity - road accidents are four times as common in ADHD patients, time in jail is 20 times more likely for ADHD adults and drug and alcohol abuse are at least double in the ADHD population compared with the general population," he said.
He described trying to find a solution when the psychiatrist who was signing off his patients free of charge was set to retire.
He repeatedly contacted the Ministry of Health and Pharmac and the only suggestion for help was that he retrain as a psychiatrist.
"I was deeply concerned about what would happen to these patients if they were cast adrift, and overwhelmingly conscious of my ethical obligation not to abandon my patients," he said.
"I was immensely disappointed that the medical establishment did not respond to my many requests for a solution, or even to discuss the dilemma."
The prosecution had earlier argued that no matter what Hannes' intentions or expertise were, he should not have broken the rules.
The medications were class B controlled drugs under the Misuse of Drugs Act and the rules were in place to prevent abuse.
It called a witness who said Dr Hanne and the psychiatrist he worked with should have at least communicated about the patients he was giving approval to.