Doctor seeks reprieve from suspension for inappropriate hormone prescribing

A Sydney doctor suspended for improper prescribing of human growth hormones and testosterone has won a temporary reprieve so he can help his practice meet huge demand for administering COVID-19 vaccines.

A tribunal found that GP Dr Bassel Abdul Rahman was guilty of professional misconduct for a list of transgressions including prescribing of drugs of addiction without authority, prescribing drugs in excessive quantities, and failing to consult with specialist physicians.

The NSW Civil and Administrative Tribunal ordered his registration be cancelled with no possibility of review for at least 12 months.

In tribunal proceedings, based on evidence from 24 patient cases, Dr Rahman admitted to allegations brought by the Health Care Complaints Commission (HCCC) regarding his prescribing of testosterone and anabolic steroids, benzodiazapines and Schedule 8 drugs of addiction.

The tribunal found he had prescribed drugs  in circumstances where he knew or should have known that the medications were being abused and where he had already been contacted by authorities in 2009 and 2013, with concerns about his legal and professional responsibilities.

“The reviewed notes reveal extensive prescribing of benzodiazepines, narcotics, hCG, testosterone and other androgens and growth hormones. The clinical decision-making prior to the prescription of these medications was universally inadequate in respect of Patients A to X,” the tribunal noted.

Records showed that Dr Rahman had prescribed Schedule 4D restricted substances – testosterone undeconate, testosterone enanthate and mesterolone – in quantities or for a purpose that did not accord with the recognised therapeutic standard.

In diagnosing testosterone deficiency, the GP had failed to undertake proper examinations and testing of patients. He did not refer to a specialist endocrinologist to confirm his diagnosis before prescribing testosterone, and also failed to monitor patients’ responses to treatment.

Similarly, Dr Rahman did not consult with endocrinologists before prescribing hCG, which the tribunal was told is usually only prescribed by specialists such as  endocrinologists following careful assessment and investigation

“He did not mention any other symptoms related to possible testosterone deficiency, nor write to an endocrinologist, Professor Terry Diamond, who had seen the patient previously, or any previous treating doctor, to obtain information to make an informed diagnosis,” it noted in relation to one patient.

“He commenced Sustanon and somatropin. It is normal and expected practice to obtain a comprehensive history and examination and refer to an endocrinologist before prescribing hormones, such as growth hormone (somatropin). Such conduct is below the expected standard and invites strong criticism.”

Drugs of addiction such as benzodiazepines and Schedule 8 drugs, including fentanyl, morphine and pethidine, were also prescribed for excessive periods and in quantities far in excess of appropriate clinical practice, the tribunal found.

However Dr Rahman has appealed against the suspension and the NSW Court of Appeal last week granted the stay after hearing an ‘all hands on deck’ request from the practice manager of the Miranda Medical Centre, where he had previously worked.

The manager, Brett Hudson, said the practice in Sydney’s south was “the busiest it’s ever been” because it was acting as a COVID-19 testing and vaccination centre and accepting patients with respiratory symptoms.

“At present the practice vaccinates more than 1000 patients per week through 22 general practitioners and eight registered nurses who have had to work extended hours to ensure that every patient who wants to receive the vaccine has access to it,” he said in a deposition.

“Because of the current demand for Covid-19 testing and vaccines, the practice is in dire need for all the doctors and nurses at the practice to be working in order to care for the community’s needs.”

Dr Rahman successfully proposed a condition that would let him practice medicine only by administering a COVID-19 vaccine to patients and ancillary services such as consulting with patients who present as close contacts or with symptoms and monitoring patients after the vaccine.

In granting the stay, Justice Richard White overrode an objection from the NSW Health Care Complaints Commission, which argued against the inclusion of “patients presenting as close contacts or with symptoms”.

Justice White said there was “nothing in the complaints” that led to the tribunal’s orders that would touch upon Dr Rahman’s suitability to perform a limited role in administering COVID-19 vaccines.

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