The Medical Board of Australia has placed fifteen limitations on the practice of Dr. Stuart Reece of Highgate Hill QLD. The conditions, enforced on 21 December 2022, have resulted in the temporary closure of the Southcity Medical Centre where Reece practices.
Reece (pictured) is a controversial figure in addiction medicine and a vocal critic of Australia’s successful policy of harm minimisation. He holds no formal qualifications in addiction medicine, but has authored or coauthored extensively on the subject, presently as an adjunct professor at UWA. Almost exclusively, his writings link illicit drug use, methadone and medical cannabis to death and disease.
Experts have refuted certain works as “reefer madness”. Reece has long associated his Christian faith with treating addiction. His book, titled “Let My People Go: A Theology of Addiction”, was published in 2016. His work is favoured by extreme anti-drug pressure group, Drug Free Australia, and frequently cited by them in lobbyist material, media replies and parliamentary submissions.
This is not the first time regulators have acted to ensure the safety of his patients. An article published on this blog in December 2011 examined his use of unapproved naltrexone implants and the deaths of 25 patients who had undergone the treatment. In 2009 Reece was suspended from practice for supplying morphine to opiate dependent patients and falsifying records to disguise the fact. This was because of his ideological opposition to evidence backed methadone maintenance therapy. That suspension was in turn suspended for three years.
The Medical Board of QLD, Health Practitioners Tribunal observed at the time that Reece:
… has a somewhat evangelical approach to this area of medicine and because of that he does appear to lack a degree of insight and objectivity in relation to the treatment of his patients. Furthermore, he seems to feel that the ends justify the means in terms of treatment of patients.
Today, the catalyst for intervention includes the number of patients being bulk billed per hour and quality of care. This is reflected in the limitations on practice (complete list in slideshow below).
1. The Practitioner must not exceed four (4) of patient consultations in any one hour (60 minutes). […]
5. The Practitioner must only practise as a general practitioner when supervised by another registered medical practitioner with knowledge and experience in addiction medicine (the supervisor).
For the purposes of this condition, ‘supervised’ is defined as:
The Practitioner must consult with the supervisor who is always physically present in the workplace and available to observe and discuss the management of patients and/or performance of the Practitioner when necessary and otherwise at weekly intervals. […]
7. In the event that no approved supervisor is willing or able to provide the supervision required the Practitioner must cease practice immediately and must not resume practice until a new supervisor has been nominated by the Practitioner and approved by the Board.
A search for general practitioners providing services in addiction medicine in the Brisbane area yields modest results. There just isn’t enough practitioners providing these select services across Australia. If one adds the fact that such providers have often taken on all the patients they can, it isn’t beyond comprehension that Dr. Reece is unable to find a supervisor. Reece has loyal supporters amongst his patients, who have a Facebook page here. They have argued in a petition that finding a supervisor is “an impossibility”. The petition, “Reinstate Dr. Stuart Reece Immediately”, contends that the predictable lack of a supervisor indicates that the action taken is about the control of services offered under bulk billing.
AHPRA is also advising that Dr Reece must have another Doctor with him for consultations into the future to oversee his work to their satisfaction. This requirement is an impossibility. AHPRA and Dr Reece both know that this doctor does not exist. There is not a ‘spare doctor’ lying around that is available for this. […]
THIS IS NOT ABOUT PATIENT CARE OR BETTER HEALTH OUTCOMES. THIS APPEARS TO BE ABOUT CONTROL OF THE TYPE OF SERVICES OFFERED TO PATIENTS WHO NEED BULK BILLED DOCTORS.
The petition is a long heartfelt plea seeking to justify the way Reece operates his practice. It makes the point that certain appointments, particularly prescription refills, may require only five minutes. The petition also notes that Reece would be forced to close his doors in part because, “his practice would be limited dramatically by the immediate reduction of the number of patients he is able to see daily…”. Whilst I empathise greatly with these patients and find removal of any addiction treatment services troubling, one cannot escape the fact that such a huge patient load should never have eventuated. Health Practitioner Regulations state, “A Practitioner must NOT exceed four (4) patient consultations in any one hour (60 minutes)”.
There’s no doubt that Medicare is not meeting the needs of Australian General Practitioners. The patient rebate is beyond inadequate, being markedly out of step with the Consumer Price Index (CPI). This manifests in significantly fewer consultations being bulk billed, and in many practices fees now apply to concession card holders. For Australians surviving on the aged or disability support pensions a visit to their GP is now financially prohibitive. The end result is a health system under strain. However there comes a point where increased patient quantity, means decreased quality of care. Let’s remember that the Health Practitioners Tribunal observed in 2009 that when it came to treating patients Reece lacked insight and objectivity, and felt the ends justified the means. The same document notes (point 22):
He does provide care to a large number of detoxifying and drug dependent patients. In June 2009, alone, he had 409 Subutex patients in Queensland and I understand the numbers are larger at the moment. From 2001 to 2007 he was responsible for 8681 registrations of opiate withdrawal registrations in Queensland.
Arguably, Reece is the architect of his own professional distress. As noted above, in November 2009 the practice suspension applied to Reece was itself suspended for three years. Yet less than two years later there was no tone of contrition for falsifying medical records to supply opioid dependent patients with morphine. The occasion was a Senate Inquiry into the Professional Services Review (PSR) Scheme, to which Reece, representing the now defunct Australian Doctors Union, made a submission. Bear in mind Reece has today been saddled with limitations to prevent excessive bulk billing at the expense of Medicare. The PSR “aims to protect the Australian public from the risks and costs associated with inappropriate practice within Medicare…”. Reece began his submission:
Prof. Reece: The Australian Doctors Union is a nascent union which has come together to support each other through the nightmare experience of PSR’s incompetence, lies, intimidation and bullying. In addition to doctors damaged by—
CHAIR: Hang on please. That is making accusations and it is not the way that we take evidence. If you could please refrain from using that sort of language, that would be appreciated.
Reece continued for a full five minutes explaining why he believes the PSR “has been shown to be waging a very successful war against general practice in this country”. He blamed the PSR for doctor suicides, marriage breakdowns, a lowered bulk billing rate, marginalisation of women, being racist, sexist and for damaging “many excellent doctors”. One of these was his ideological colleague, “Dr George O’Neil of naltrexone implant and detox fame”. Despite the fact naltrexone implants are not TGA approved Reece felt O’Neil should have been assisted by Medicare. Perhaps most alarming was when Reece included himself as one of those excellent doctors. Referring to himself in the third person, he humbly submitted:
Associate Professor Stuart Reece, one of the foremost detox doctors in the nation and a world authority on the long-term effects of opiate addiction.
This dear reader, is the crux of the matter. Stuart Reece is not a world authority on the long term effects of opiate addiction. In 2007 he opposed needle-syringe programmes, methadone maintenance therapy and the policy of harm minimisation in general. He informed a parliamentary inquiry that condom use was linked to AIDS deaths. Yet in June 2009 Reece was managing 409 Subutex patients. Buprenorphine is the opioid in Subutex and today it is distributed in combination with naloxone under the brand name Suboxone. It is a successful mainstay of substitution therapy for opioid dependent patients seeking to manage addiction and eventually cease opioid use. It is a key element of harm minimisation.
Exactly how a strident opponent of harm minimisation has today found himself with so many opioid substitution patients that Ahpra require supervision and auditing of him, is baffling. It may however have something to do with the attitude toward Medicare and the PSR Scheme reflected in his 2009 submission. Or his 2012 comment, What is wrong with medicare? (p. 170) bemoaning the PSR and Medicare audits. It may also have something to do with the disdain Reece has for evidence based health policy and genuine, original research. Reece has spent a career convinced he simply knows better. Better than the bulk of his colleagues, better than global research trends and better than health authorities. In short, Stuart Reece is the cause of the dilemma faced by so many of his patients.
Having said that, one cannot deny that Reece and Southcity Medical Centre have been accomodating the needs of a great many patients. An excessive number of patients. However accounts such as this on reddit aren’t isolated. They suggest the practice is busy, waiting times are high but Reece is attentive and compassionate. Google reviews are more varied. According to the petition there are 1100 patients in need of treatment. Over the last 18 days, 224 people have signed. The goal is presently 500.
Ultimately this situation doesn’t bode well for these patients. It is doubly sad that many are not able to see that the cause of their problem is Stuart Reece himself and not Ahpra. Funnelling high numbers of vulnerable in-need, at-risk patients through the surgery is far from acceptable. The only way forward is to abide by the limitations. Anything less is to abandon his patients.
Stuart Reece must accept that the ends do not justify the means. It is time to place patients first.
Medical Board of Australia restrictions imposed on Dr. Stuart Reece
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Latest update: 3 January 2023