‘Reprehensible’ prescribing to vulnerable patients

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A medical practitioner has been found guilty of professional misconduct after prescribing compounded phentermine, diethylpropion and hCG to assist patients with weight loss

A Sydney doctor faces potential suspension or cancellation of his registration after being found guilty of professional misconduct based on 26 complaints brought before the NSW Civil and Administrative Tribunal.

The complaints related to a period between 2015 and 2017 when the practitioner was the medical director of a business that provided weight loss services using a telemedicine model, and related to his treatment and prescribing for 25 patients who were seeking to lose weight.

Patients of the clinic were not examined in person but conferred with clinic staff by telephone or online.

Between 1 January 2015 and 26 February 2016, the practitioner prescribed approximately 462 prescriptions for compounded phentermine capsules (comprising phentermine 30mg, chromium picolinate 500mcg and 5-hydroxytryptophan 50mg) 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 (75mg) and compounded diethylpropion capsules (chromium 400mcg and diethylpropion 75mg), failing to consider likely risks.

Additionally he prescribed approximately 319 prescriptions for sublingual drops of Human Chorionic Gonadotrophin (hCG)(125iu/0.25ml) and five prescriptions for injections of hCG (150iu/0/25ml) 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”.

He said use of hCG has absolutely no benefit as a diet agent but is also potentially harmful, 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.

Individual complaints were 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.

In some cases the doctor failed to test several women for pregnancy or ask about contraception or family planning before prescribing phentermine, which is contraindicated in pregnancy.

He failed to appropriately monitor several patients’ vital statistics such as pulse, blood pressure and change in weight after prescribing phentermine, with some patients having been at increased risk of heart attack or stroke through use of the drug due to various chronic health issues.

He also failed to refer some patients for bariatric surgery in cases where this was the expected standard.

The tribunal found the doctor guilty of professional misconduct.

“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 said.

“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.

“We also find that the practitioner had, and still has, a completely inadequate understanding of what is required by the regulation.”

The tribunal found the doctor paid “scant or no regard to his obligation to obtain an informed consent from patients before prescribing stimulant medication”.

“We are satisfied for the reasons given in respect of the particulars we have found established, when considered cumulatively, those established particulars warrant a finding that the practitioner’s conduct is so serious that it could lead to the suspension or cancellation of his registration.”

A decision on orders is yet to be made.

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  1. Andrew Kelly

    So the patients seek advice from a clinic either online or over the phone, but then lodge a complaint that they were not properly examined prior to prescribing medications. What did they assume was going to happen?

  2. Brian Meier

    No mention of the supply pharmacies that were compounding it?

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