A pharmacist independent prescriber has been struck off after issuing more than 50,000 prescriptions online including many high-risk drugs, a General Pharmaceutical Society (GPhC) fitness-to-practise (FtP) committee determined last month (July 1-12).

Naureen Amirali Walji, registration number 2066151, issued scripts for prescription-only medications (POMs) “in a dangerously transactional manner” while working for three online pharmacies, according to the hearing document.

She worked at the three pharmacies - UK Meds Direct Limited (UK Meds), MedsOnline 247 and Medexpress/Pharmica – between 2018 and 2022, it said.

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The committee found that Walji approved prescription requests just seconds after patients had submitted an online questionnaire, with records showing that she spent “very few seconds – frequently as few as two or three” - assessing questionnaires.

Walji “admitted the majority” of the allegations, expressed remorse and conceded that she had “failed to observe her professional standards”, the document said.

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She told the committee that she would “not work ever again in an online setting” since it was “just not safe” and that she hoped to work in “a community setting” instead, it added.

But the regulator stressed that Walji’s misconduct spanned many years, three workplaces and tens of thousands of prescriptions - many of which were for high-risk drugs.

 

“In the middle of the night”

 

While working as an “arms-length” contractor at UK Meds between November 2018 and September 2019, Walji received £2.50 for each prescription approval or rejection, according to the document.

In the ten months that she worked for the company, she was paid “in excess of £89,000”, although she “denied that she was motivated by financial gain over and above the patient safety”, the FtP committee heard.

Walji issued prescriptions “in the middle of the night” with such haste that she “could not have been properly assessing whether the patient questionnaires appropriately met the prescribing criteria”, it found.

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She said that she felt “uneasy about the prescribing model” at UK Meds and when she raised her concerns with the company, she was told that “processes would be updated or improved”.

And Walji told an earlier hearing that UK Meds had “informed” her not to refuse prescriptions, as other pharmacists had done.

The committee “took into account” that UK Meds had been “a high-pressure environment” and Walji conceded that she should have left the workplace sooner. 

But it found that her “eagerness to please her employer” was more than her concern for patient safety.

 

One script “every 21 seconds”

 

A few months after Walji left UK Meds, she started working for newly opened MedsOnline 247 in late January 2020 where she was the sole prescribing pharmacist, according to the document.

A GPhC inspector visiting the online pharmacy in February 2020 found that it had “supplied 199 private prescriptions since its opening and all but two of the prescriptions were for opioid-based medicines”, it said.

At MedsOnline 247, Walji “telephoned each of the patients” but “there was no attempt to contact the GP surgery” and she “failed to consider” that the medicines may have been requested “to facilitate dependence or misuse”, it added.

Read more: Pharmacist struck off after death threats, harassment and cocaine use

Walji told the committee that she had realised the process at MedsOnline 247 “was not sufficient” and had left the company “after only five weeks”.

But in March 2022, Walji then began working for another online pharmacy - MedExpress/Pharmacia.

In just three months, she issued 16,140 prescriptions, equating to one “every 21 seconds” that she was working there, the FtP committee heard.

Walji told the committee that the online pharmacies had passed GPhC inspections and “there didn’t seem to be any concern” as they had “passed in principle”, she was led to believe that the processes were “appropriate”.

 

Patient death a “slip-up”

 

Meanwhile, the committee heard that Walji was “shocked and mortified” to learn of her role in one patient’s death, which she said was a “slip-up”.

In May 2019, a patient died from “mixed drug toxicity with alcohol” and an inquest found that he had obtained 100 Dihydrocodeine 30mg tablets from UK Meds - with Walji the issuing prescriber - four days before his death.

The patient bought the opioids using a new customer discount even though he had bought drugs from the company on eight previous occasions, while Walji did not contact his GP or make any clinical reviews, the document said.

In another incident in 2018, a 16-year-old girl obtained an “inappropriate supply of ibuprofen” that was used in a suicide attempt.

Read more: Suspended sentence for pharmacist who illegally supplied 300k co-codamol pills

The patient, whose medical records stated that she had “chronic suicidal ideations” and who had made previous suicide attempts, had simply ticked a box to say that she was 18, according to the hearing document.

Walji, who was working at UK Meds at the time, approved this prescription just 29 seconds after the previous one she approved, the FtP committee heard. 

She claimed that she “went through the assessment questionnaire filled in by the patient to ensure that there were no contra-indications or cautions”.

But the committee found that she had approved this prescription despite evidence of other “failed prescriptions”.

 

“Something has got to be done”

 

Walji presented the FtP committee with evidence of insight into her misconduct, including shadowing pharmacists unpaid and attending CPD courses and a “leadership course”, the document said.

The regulator stressed that Walji had faced no previous concerns about her fitness-to-practise in 17 years as a pharmacist, was “of previous good character” and was currently working as a beauty therapist.

Her representative at the hearing submitted that “something has got to be done” about online pharmacies “run by unlicensed people hoping to make money”.

“Ultimately, it is always the small people, the little people, who get caught up in it,” they said.

 

Blaming the systems

 

An expert witness told the committee that prescribing using “a questionnaire alone is unsafe” and that remote prescribing “is only safe if the prescriber communicates directly with the patient”.

They stressed that a patient's GP “should be consulted prior to any prescription being authorised” and records sent to the practice after a prescription is issued.

But Walji did not check the patient records available to her “let alone…contact the patients’ GPs” when prescribing dihydrocodeine to patients who had received it many times prior, the committee heard.

The regulator said that Walji was attempting to “divert responsibility” by blaming “the systems within which and the organisations for whom she worked”.

Read more: ‘Overwhelmed’ locum suspended for four months over codeine payment mix-up

And it noted that she had been “dishonest” in her interactions with the regulator, as well as conducting “unsafe prescribing practices”.

It determined that Walji had “completely failed to recognise her personal professional responsibility” as “gatekeeper” of medicines, committing “seriously reprehensible” breaches of the profession’s standards and responsibilities.

It concluded that Walji’s behaviour was “fundamentally incompatible with being a registered professional” and it decided to remove her from the register.

Read the determination in full here.

 

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