Pill-pusher doctor who prescribed opiates online without consulting patients’ GPs suspended
A doctor who prescribed potent opiates to Northern Ireland patients online without consulting their GPs was exposed and suspended for misconduct following a complaint by a local health boss.
Dr Diana Gall was prescribing medication “with a cavalier attitude to patient safety”, a fitness-to-practice tribunal found.
“Patient safety was put at serious risk, including risk of unintentional overdose, addiction and severe side effects,” said the tribunal.
In one case, Dr Gall prescribed 800 co-codamol tablets to a Northern Ireland patient over the course of just 12 weeks, with an expert witness describing the 200 tablets per each prescription as “both excessive and dangerous”.
In another case, she prescribed doses of an opioid painkiller to a patient who was receiving the same drug from their GP.
The case against Dr Gall focused on prescriptions to six local Health and Social Care Board patients registered with Northern Ireland GPs.
The General Medical Council (GMC) suspension bars the Romania-based doctor from working in the UK, both online and in person, but she continues to practice in her own country.
She had been working for two online pharmacies, prescribing medicines remotely without meeting patients or contacting their GPs.
Concerns about Dr Gall’s activities were flagged up in Northern Ireland in 2020, leading to a 12-month suspension being imposed in 2022.
And at a review hearing in March this year, her suspension was extended by a further 12 months, with the tribunal saying it had seen no evidence she had addressed concerns to mitigate against the likelihood of repetition.
In its published determination, the Medical Practitioners Tribunal Service (MPTS) said concerns were raised about Dr Gall with the GMC by the head of pharmacy and medicines management for the Health and Social Care Board, who was identified in the tribunal decision only as ‘Mr G’.
It said that Dr Gall, who has worked as a GP in Romania since 2010 and graduated from Transilvania University of Brașov in 2006, registered with the GMC in 2019 and began working with online pharmacies Better Health Online Ltd and Med Connections Ltd, prescribing medication remotely.
It said the allegations against her was that she failed to contact GPs of the six patients or obtain adequate medical records and that she “inappropriately prescribed excessive amounts of medication”.
The tribunal heard from NI health boss ‘Mr G’ and from an expert witness and also received a witness statement from Dr Gall, who did not attend the hearing.
In its damning judgement, the tribunal said: “In relation to six separate patients, she prescribed medication, including potent opiates, without adequate knowledge of the patient’s needs.
“The tribunal concluded that her conduct would be viewed as deplorable by fellow doctors.”
It added: “The conduct involved multiple patients and cannot be viewed as a mere isolated error of judgment. She prescribed medication to patients, over a four-month period, with a cavalier attitude to patient safety.
“She failed to undertake any basic checks, including whether [the patient was] already being prescribed medication by their GP.
“This resulted in excessive amounts of medication being prescribed to patients.”
The MPTS patients received prescriptions for medication that was not suitable for remote prescribing, while patient safety was put at serious risk.
The tribunal concluded that Dr Gall fell seriously below the standard expected of a doctor undertaking the remote prescription of medication when she prescribed medication to ‘Patients A-F’.
It said she abdicated responsibility for the safe prescription of medication.
“In relation to the adequacy of the procedures, she relied on assurances given by the online pharmacy that engaged her, when she should have made an independent judgment on the adequacy and appropriateness of the prescription for the individual patient.
“Dr Gall failed to take responsibility for the prescriptions written by her and jeopardised patient safety.”
Suspending Dr Gall, the panel said that, in her statement, she had shown “a degree of insight into her actions”.
“She candidly accepts that she prescribed medication remotely without having undertaken adequate training.
“She has also accepted the conclusion reached by ‘Dr H’ [an expert witness] that she risked patients having an overdose of medication and being exposed to addiction.”
It further said she had offered an apology to, in her words, “those implicated in this process”.
But the tribunal added that she had not shown a deep level of insight into how serious her failings were.
“Dr Gall has sought to minimise the gravity of her misconduct. She seeks to explain her failings by stating that she was ‘wrongly advised’ by the pharmacy she worked for.”
In her statement, Dr Gall said she realised her judgement was wrong.
In its recent review of Dr Gall’s case, the MPTS said it had considered erasing her from the medical register.
It said it had no evidence the doctor had developed insight or remediated to sufficiently reduce the risk of her actions being repeated.
But it added: “The tribunal determined that her actions fell just short of erasure being a proportionate sanction to impose.”
It said that another 12-month suspension would allow Dr Gall a further opportunity to engage fully with the regulatory process and to take necessary action to address concerns about her practice.
In an email to the tribunal in January 2023, Dr Gall said she was aware she had put patients at risk.
She wrote: “As my professional status, there are no changes that can be significant at this point. I am fit for the practice in Romania, continuously providing medical services for out-of-hours surgeries.
“My original statement, when [the] first hearing happened and [I had] been represented by solicitor, is still valid. I am of course aware of the risks I put [upon] any patient by providing those prescriptions, hence keeping up with the regulations regarding prescriptions in my residence country.”
The tribunal said Dr Gall did not provide any other evidence or documentation for the March 2023 hearing.