A Sydney doctor whose prescribing of compounded stimulants to at-risk patients was described as ‘reprehensible’ has been struck off the register, while a compounding pharmacist will front the tribunal
A doctor who was found guilty of professional misconduct in August last year has had his registration cancelled.
Dr Thomas Goyer was prosecuted based on 26 complaints brought before the NSW Civil and Administrative Tribunal, relating to a period between 2015 and 2017 when he was the medical director of the Medical Weight Loss Institute (MWI).
MWI provided weight loss services using a telemedicine model where patients were not seen in person but conferred with staff by telephone or online.
MWI was placed into voluntary liquidation in 2017.
The finding of professional misconduct related to Dr Goyer’s treatment and prescribing for 25 patients who were seeking to lose weight.
Between 1 January 2015 and 26 February 2016, the practitioner prescribed approximately 462 prescriptions for compounded phentermine capsules to assist with weight loss without a recognised evidence-based therapeutic purpose, the tribunal found.
During this same time, he also prescribed approximately 232 prescription for diethylpropion capsules and compounded diethylpropion capsules, where the tribunal found the doctor failed to consider likely risks.
Diethylpropion was not listed on the ARTG at the time of the complaints in this matter and had also been removed from sale in Europe because of adverse side effects.
Additionally he prescribed approximately 319 scripts for sublingual drops of Human Chorionic Gonadotrophin (hCG) and five prescriptions for injections of hCG to assist patients with weight loss in circumstances where there was no evidence to support its use as a weight control medication.
An expert witness told the tribunal that hCG “should not have been prescribed at all”, being associated with an increased risk of strokes, coronary artery dissection due to fibromuscular hyperplasia, lower extremity deep vein thrombosis and pulmonary embolism, and the induction of psychosis.
The practitioner’s prescribing of phentermine, diethylpropion and hCG invited the expert’s strong criticism.
Dr Goyer conceded his conduct constituted unsatisfactory professional conduct, however the tribunal rejected his counsel’s submissions that his conduct did not amount to professional misconduct.
Individual complaints were also brought against the doctor by 25 former patients, with the tribunal finding that for most of these the practitioner failed to adequately examine them prior to prescribing the medicines.
Dr Goyer was found to have failed to test several women for pregnancy or ask about contraception or family planning before prescribing phentermine, which is contraindicated in pregnancy.
He also failed to appropriately monitor several patients’ vital statistics after prescribing phentermine.
“We find that the practitioner’s conduct in prescribing compounded stimulant medication for this cohort of particularly vulnerable patients, without a physical examination, was totally inappropriate,” the tribunal deemed.
“Further, his conduct in prescribing was particularly reprehensible in the case of those patients whose own disclosure in nurse consultations revealed medication conditions which contraindicated such prescribing, such as Patients I and S who suffered from hypertension.”
The tribunal found the doctor guilty of professional misconduct.
In a decision passed down in late December, the tribunal held that cancellation of the practitioner’s registration was necessary to uphold the integrity of the profession.
Mr Goyer is prohibited from applying for a review of the decision for 12 months.
He was also ordered to pay 80% of the Health Care Complaints Commission’s (HCCC) costs incidental to the proceedings.
Compounding under the spotlight
The pharmacist that oversaw the dispensing of some compounded medications to the MWI is also being pursued by the HCCC.
In 2016 Dr Ken Harvey, from Monash University’s School of Public Health, submitted a complaint regarding a Sydney compounding pharmacy and its dispensing of the appetite suppressant, diethylpropion.
Capsules that included diethylpropion were prescribed by a medical practitioner working for the MWI and dispensed by this pharmacy.
Patients reported to Dr Harvey that the medications arrived by mail from the compounding pharmacy.
The HCCC has confirmed to AJP that it is currently prosecuting a complaint against the owner of the compounding pharmacy before the NSW Civil and Administrative Tribunal.
A directions hearing is scheduled for this Friday. As the matter is currently subject to legal proceedings, the Commission was unable to provide any further comment.
The pharmacist has strenuously denied any allegations of wrongdoing and previously noted that his company “imports diethylpropion through its agent under the strict requirements of a TGA Import Permit”.