Pharmacist Mohammed Yasir, registration number 2056174, has been suspended by the General Pharmaceutical Council (GPhC) for a year after it found he relied on online questionnaires to issue thousands of prescriptions, including to a patient who later died of an overdose.
At hearings in February, the GPhC’s fitness to practise committee heard that Yasir privately prescribed medicines “requiring ongoing monitoring” and “unsuitable to be prescribed on the basis” of online questionnaires without “adequate safety-netting in place”.
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According to the hearing document, Yasir made “extreme failures of governance, oversight and risk management” - including not obtaining “adequate information” about patients’ health before prescribing, and failing to request face-to-face or remote consultations “to adequately examine the clinical need for medication”.
It added that he prescribed propranolol to a patient who later fatally overdosed when he “knew or ought to have known” that they “had already obtained repeated orders of the medicine from the pharmacy”, and “did not adequately consider the possibility of dependence or misuse”.
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The regulator acknowledged that Yasir had accepted early on that his behaviour “amounted to misconduct”.
But it pointed out that the misconduct took place over a period of “approximately two years”.
Multiple failures
The committee noted that the misconduct occurred between January 2, 2020 and December 31, 2021, while Yasir was the superintendent pharmacist and owner of online pharmacy My Pharmacy.
The pharmacy’s main service was remote prescribing based on an online questionnaire model, it added, and the allegations against Yasir concern only “private prescriptions made through this online service”.
It said My Pharmacy came to the GPhC’s attention after a pharmacist reported that she had been able to purchase propranolol from the pharmacy “under her mother’s name”, and noted that there seemed to be “no actual online consultation by the prescriber” nor a “system put in place to verify the patient’s ID”.
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The regulator then undertook an unannounced inspection of My Pharmacy, and an “action plan” was created after it found the pharmacy had failed to meet standards relating to governance and services.
It said Yasir and the pharmacy “worked with the council on the action plan” - but a further inspection concluded that some standards remained unmet, “particularly in respect of the risks regarding online prescribing”.
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Over the two-year period, it added, Yasir issued 18,683 private prescriptions for drugs “requiring ongoing monitoring” and “unsuitable to be prescribed” on the basis of an online questionnaire. These included propranolol, orlistat, salbutamol, finasteride and sildenafil.
In prescribing these medicines, Yasir made “multiple failures” in paying “due regard” to
guidance from the General Medical Council, the Royal Pharmaceutical Society and the GPhC, the regulator said.
“Manipulable” prescribing process
The committee also heard that the pharmacy’s online prescribing process was “manipulable by patients”, who would be “notified” if they answered questions “in a manner that rendered them unsuitable” for being prescribed a medicine.
Patients could then “change the answers in order to be deemed suitable for the medications”, it said, and the pharmacy “had no oversight of these changes”.
It added that once patients had been prescribed a medication by the pharmacy, they “did not need to complete the questionnaire again” - and were only required to “complete fresh questionnaires for repeat orders” once 12 months had passed.
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The GPhC found that the pharmacy “had no safety-netting in place”, with Yasir failing to “communicate with GPs, healthcare professionals or safeguarding leads”.
The pharmacy “did not maintain stringent checks on repeat prescriptions or early prescription requests”, it said, and there “was a failure to check and maintain patient medical records” or “follow up and communicate with patients”.
“Tragic death”
The regulator noted that Yasir prescribed drugs such as propranolol “with such frequency
that it could not be possible” for him to “have read, considered and assimilated the questionnaire before issuing the prescription”.
It said there were “insufficient mechanisms in place to monitor compliance with prescribing guidelines”, with team members making manual checks of repeat and early orders and the pharmacy lacking “updated risk assessments to monitor” its “predominantly online model”.
And it added that the “failure to properly update risk assessments to reflect” the pharmacy’s prescribing model meant that it “supplied medicine outside the limits of its own medication guidelines”.
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These factors “culminated in” a patient’s “tragic death” from an overdose of propranolol, the committee heard.
It noted that the patient had “made seven orders for propranolol” between March 2, 2021 and June 16, 2021, and said the pharmacy “knew, or ought to have known” the patient’s full ordering history.
The pharmacy had also “failed to properly consider the possibility of any dependence or misuse of the medicine” by the patient, it said, and “failed to notify” the patient’s GP or “any other healthcare professional or safeguarding lead as to the risks of harm”.
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The committee recognised that Yasir had cooperated with the GPhC and cited his remorse as a mitigating factor.
Yasir also told the GPhC that he has “shown insight into his conduct” and has “undertaken significant CPD courses to address the gaps identified” by the committee.
He added that he is “no longer working within a predominantly online structure”, has “stepped away from managerial positions” and is “not prescribing”.
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But the regulator stressed the “level of harm that resulted” from Yasir’s conduct, as well as the “risk of far more widespread harm occurring”.
It said it was “only a matter of good fortune that patient harm was not more widespread”, and that Yasir “did not seem to fully grasp how he had created the conditions that allowed extreme risks” such as the patient’s death “to materialise”.
The “sheer volume” of prescriptions issued “reflects the cavalier attitude” Yasir took to patient safety, it added, and the committee is “acutely aware of the catastrophic consequences” of his choices.
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The committee concluded that the “severity of the misconduct” and the harm that resulted from it “demands no lesser outcome” than a suspension.
It imposed a 12-month suspension on Yasir, adding that removal from the register “would be an inappropriate outcome in this matter”.
Read the determination in full here.
