A former medical practitioner who accumulated red flags like a frequent flyer collecting stamps has been found to have played a direct role in the deaths of two patients through what a coroner called 'grossly irresponsible' drug prescribing.
Between September 2016 and August 2017, Nicholas Brown, Matthew Winwood, Toni Wiki, and Belinda Kemp - all drug dependent - died in Tasmania while under the care of Dr David Jackson, who prescribed them methadone and benzodiazepines as part of opioid replacement therapy. Brown, 35, succumbed to combined methadone and benzodiazepine intoxication, while Winwood, 47, died of mixed prescription drug toxicity involving methadone and multiple sedatives.
Coroner Olivia McTaggart found that Jackson put Brown - a lifelong drug user - in danger by prescribing methadone three times without verifying his recent prison prescriptions. For Winwood, Jackson provided 'effectively an unlimited supply for a drug binge' despite the patient being clearly unstable and warnings from his mother. 'He may have died by drug overdose eventually, such was his high risk, but that is not to the point,' McTaggart said. 'He was deprived of a chance to live at that time.'
The coroner concluded Jackson exhibited a 'dangerous manner of treatment and prescribing' regarding all four patients, with his 'grossly irresponsible prescribing' playing a direct causative role in the deaths of Brown and Winwood, though not Wiki or Kemp.
Jackson, who worked in Tasmania from 1986 to 2018, was the subject of a large-scale criminal investigation but was never charged. Tasmania's director of public prosecutions determined in 2021 that evidence could not sustain manslaughter convictions, even if his prescribing was dangerous or negligent, McTaggart noted.
Red flags had been waving for decades. In 1992, senior health staff at a Hobart hospital flagged concerns about his excessive opioid prescribing. The chief pharmacist raised alarms in 1995 about excessive methadone prescribing. In 2007, a colleague noted Jackson kept limited notes, making it hard to understand his logic behind high doses. The national regulator finally prohibited Jackson from prescribing certain drugs in January 2018 after police notified them; he stopped practising later that month.
McTaggart made 10 recommendations for reform, including that Tasmania's health department establish a robust strategy to refer prescribing breaches for prosecution. Wiki died of cardiac arrest; Kemp died of pneumonia with mixed drug toxicity and other issues contributing.
For those struggling with addiction, Australia's Opioid Treatment Line is 1800 642 428, the National Alcohol and Other Drug Hotline is 1800 250 015, the UK's Action on Addiction is 0300 330 0659, and the US SAMHSA National Helpline is 988.