Today’s question returns to the issue of the authority to carry scheduled drugs. My correspondent says the question:
… has come up serval times in my career. Who can carry and administer restricted medication (S8’s)? In NSW Ambulance Qualified Paramedics and above receive a letter as part of the Certificate to Practice. This letter is issued by NSW Ambulance and outlines which restricted medications you can carry. Under what authority is this authorisation given? Outside of NSW Ambulance who can authorise Paramedics to carry and administer restricted medications. I have been told recently by an Event Paramedic that the company’s Doctor authorises them to have and administer S8’s. How does this fit with any legal requirement?
NSW Ambulance
Carrying scheduled drugs is an offence without a relevant authority. For NSW Ambulance the authority is found in Poisons and Therapeutic Goods Act 1916 (NSW) and the Poisons and Therapeutic Goods Regulation 2008 (NSW). Regulation 129 says ‘Each person specified in Appendix C is authorised to possess and use the substances specified…’ Clause 7 of Appendix C says:
A person:
(a) who is employed in the Ambulance Service of NSW as an ambulance officer or as an air ambulance flight nurse, and
(b) who is approved for the time being by the Director-General for the purposes of this clause,
is authorised to possess and use any Schedule 2, 3 or 4 substance that is approved by the Director-General for use by such persons in the carrying out of emergency medical treatment.
With respect to Schedule 8 drugs r 101 says:
(1) The following persons are authorised to have possession of, and to supply, drugs of addiction [ie Schedule 8 drugs]:…
(g) a person:
(i) who is employed in the Ambulance Service of NSW as an ambulance officer or as an air ambulance flight nurse, and
(ii) who is approved for the time being by the Director-General for the purposes of this clause.
(The office of Director-General has been retitled the Secretary of the Ministry of Health (Government Sector Employment Act 2013 (NSW); Statute Law (Miscellaneous Provisions) Act 2014 (NSW); Administrative Arrangements Order 2014 (NSW) cl 7; Health Legislation Amendment Act 2016 (NSW); Health Administration Act 1982 (NSW) s 8)).
Therefore, the authority to allow ambulance officers to carry scheduled drugs lies with the Secretary. The Secretary, in turn, can delegate that power (Interpretation Act 1987 (NSW) s 49). I don’t know but would infer that the power may have been delegated to the Chief Executive of the Ambulance Service of NSW or some other officer holder within the Ambulance Service. Whoever holds the delegation (if anyone) can then approve the use of scheduled drugs by appropriately trained paramedics within New South Wales Ambulance.
Private providers
There are no provisions akin r 101 or cl 7 of Appendix C for the private providers. However r 170 says:
(1) The Director-General may issue authorities for the purposes of the Act and this Regulation…
(4) An authority may be issued to a particular person (by means of an instrument in writing given to the person) or to a specified class of persons (by means of an instrument published in a manner approved by the Director-General).
The Director-General (or his or her delegate) can issue authorities to people to use scheduled drugs. He or she may have delegated that authority to a person within the Department or an office holder such as the Medical Director of a private ambulance service. If that is the case then that person, ‘the company’s Doctor’, may have the authority to authorise paramedics to carry and use drugs.
Alternatively, the Secretary may have given an authority to ABC Ambulance that says, in effect, ‘Persons approved by the Medical Director of ABC …’ That would be an authority ‘to a specified class of persons’ ie the class of persons approved by the Medical Director. Exactly how it’s been done I can’t say but the authority does exist, and one assumes it has been properly done.
What is important to note is that a doctor can’t authorise people to carry drugs just because they are a doctor – they have to have some specific authority or delegation under the Poisons and Therapeutic Goods legislation. See:
- The need for a medical director in an ambulance service (May 4, 2013) and
- Doctors delegating authority to carry drugs (August 20, 2014).
Australian Emergency Law 
The law in NSW is administered by the Poisons Branch of the Health Ministry. An applicant, such as a private ambulance service or pre-hospital care provider, simply puts together their scope of practice, their guidelines and their policies and procedures and submits it to the Poisons Branch. They then audit the paperwork and conduct a visit to check the way in which the medications are accounted for and issued. If all of this complies with the regulations and Act, then the authority is issued.
One aspect of this is that the supply of the medications is directly to the paramedic by name. Thus, each paramedic receives their own medication pack and they must personally account for it. The same pack cannot be passed from one paramedic to another, but each must have their own.