Pharmacists raise alarm over doctor’s opioid prescribing

legal medical tribunal doctor overprescribing

A Victorian medical practitioner, who was suspended in the US after several pharmacists raised concerns, has had suspension of his Australian licence confirmed

Dr Mahmood Ahmad, a doctor and anaesthetist who had was until recently practising in both the US and Australia, has had his suspension maintained following a Victorian Civil and Administrative Tribunal hearing.

While not the subject of any complaints or notifications in respect of his practice in Australia, Dr Ahmad had been found to pose “a clear and immediate danger” to public health and safety by Alaska’s licensing authority in August 2016, on appeal from an initial decision by the Alaskan State Medical Board.

This led to the suspension of his Australian registration soon after.

Dr Ahmad originally trained in Pakistan before undertaking a residency in anaesthesiology at Yale University in the US from 1993 to 1997, achieving certification from the American Board of Anaesthesiology with a subspecialty certification in pain management.

Following this, Dr Ahmad practised medicine in the US state of Arkansas for approximately 19 years.

He then registered as a medical practitioner and a specialist anaesthetist in Australia in 2005, before licensing to practice in Alaska in 2013, where he opened his own practice.

During 2015 Dr Ahmad practised simultaneously in Arkansas, Australia and Alaska, spending one week per month in Arkansas and Australia, and one long weekend per month in Alaska.

It was during this time that a number of pharmacists had called or written to the Alaskan licensing division with concerns about Dr Ahmad’s prescribing.

The pharmacists described what they found to be “unusual and troubling” prescribing patterns, with new patients without a documented history of prior opioid prescriptions presenting with simultaneous prescriptions for multiple controlled substances, or high-dose opioids, or both.

Additional concerns were raised about the similarities between large numbers of prescriptions, including the same vague diagnoses – typically “chronic pain” – listed on all prescriptions.

Ultimately a total of 10 different pharmacists contacted authorities with concerns.

An investigation into Dr Ahmad’s prescribing charts found that of the 38 separate charts on record, all patients were receiving opioid prescriptions, all of which began with the patient’s very first appointment with Dr Ahmad.

He was found to have written more than 700 controlled substance prescriptions over the course of 53 two-to-four-day weekends.

“The sheer volume of controlled substance prescriptions Dr Ahmad generated during the time period in question raises significant doubts about his professional judgement,” the Alaskan licensing division found.

Many patients were receiving more than one controlled substance, and many appeared to have been prescribed that combination on the first visit.

The Alaskan Board met its burden of proof that Dr Ahmad posed a danger to the public, and in response he voluntarily and irrevocably surrendered his Alaskan medical licence on 9 August 2016.

However because he surrendered his licence, thus obviating the need for a final hearing, the allegations were never subjected to a final hearing on their merits. They remain disputed by Dr Ahmad.

Soon after, Dr Ahmad’s registration was suspended in Australia based on the Alaskan decision.

Dr Ahmad questioned his Australian suspension before the Victorian Tribunal, denying that he had engaged in any wrongdoing.

He also submitted that his practice could safely be limited to anaesthesia, as others would be present in an operating theatre room.

However the Medical Board of Australia contended before the tribunal that Dr Ahmad’s registration should continue to be suspended, submitting that this was the minimum regulatory action required to manage the risk he posed to the public.

The Tribunal agreed.

“He regards himself as a very experienced pain medicine practitioner who can reach an accurate diagnosis very quickly, considers that he is entitled to accept a new patient’s self-reported history without needing to obtain prior medical records, and considers that the fact that none of his patients have died from overdose is evidence that his prescribing is appropriate,” the Victorian Tribunal found.

It preferred expert evidence, supported by patient records, that Dr Ahmad had “engaged in reckless and dangerous prescribing practices accompanied by a serious risk of harm or fatality to his patients” and that nothing suggests he has “suddenly changed”.

“We agree that the practice of anaesthesia involved a different practice environment. Nevertheless, it involves pre-operation consultation and assessment, the administration of anaesthetic drugs and close monitoring of the patient,” the Tribunal found.

“Sound professional judgment, regard for patient welfare, proper assessment, and an absence of recklessness about risk to the patient remain integral.”

“With the primary of patient safety in mind”, the Tribunal confirmed the decision by the Board to take immediate action in the form of suspension of Dr Ahmad’s registration.

An end date to the suspension was not provided or discussed in the hearing.

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