St. John’s psychiatrist Dr. Mohamed Mekawy fought back tears Thursday at a medical board disciplinary tribunal hearing while apologizing to his family, patients and colleagues for causing them shame.
Mekawy, who admitted to prescribing medications online to patients in the United States without seeing or assessing them, was given a four-month suspension, dating back to March 7 when his licence was suspended by the College of Physicians and Surgeons of Newfoundland and Labrador (CPSNL).
He’s also been ordered to complete a prescribing course, sign a written undertaking that he will not prescribe medications via the Internet and pay a portion of the costs for Thursday’s hearing, in an agreed amount of $10,000.
These sanctions, which were proposed in a joint legal submission by his lawyer Peter Browne and the college’s lawyer Lewis Andrews, were accepted Thursday afternoon by the disciplinary tribunal.
The full decision will also be published by the CPSNL.
After the tribunal’s decision, Browne asked if Mekawy could make a statement. The doctor said he was “ethically blinded” by assurances he was given by an Internet drug company that he could prescribe to patients in this manner.
Mekawy had his medical licences suspended in Indiana, Michigan and South Carolina in 2007, but failed to report that to the Newfoundland board and falsely answered no to questions regarding any suspensions, reprimands, restrictions or disciplinary actions in other jurisdictions in a 2008 application for licence renewal in this province.
In a letter of response to the Newfoundland board in 2010, after it discovered he provided false answers on the applications, Mekawy said his “profound sense of shame” affected his judgment to the point that he chose not to mention the incident with the U.S. medical authorities.
He told the tribunal Thursday he takes full responsibility for his actions, has learned some serious lessons and promises to never engage in such unethical practices again.
The tribunal, chaired by Dr. Jody Woolfrey, with members Dr. Ed Collins and John Whalen, heard that Mekawy began practising medicine in Newfoundland in 2003. He also held licences in the U.S. states of Indiana, Michigan and South Carolina.
The Newfoundland medical board received information from the Federation of State Medical Boards of the United States in August 2010, providing a summary of reported actions regarding Mekawy’s medical licences in Indiana, Michigan and South Carolina. His licence was temporarily suspended in Indiana in late 2007, after which he voluntarily withdrew his Indiana licence prior to or in lieu of an inquiry and agreed to never again apply for a licence in that state.
Mekawy’s licences in the two other states were subsequently suspended.
Mekawy explained in his letter to the Newfoundland board, he received correspondence in 2007 from a company expressing interest in having him provide prescribing services to its Internet pharmacy, USACHOICEMEDS.com.
He said he spoke to a man by phone who said the company provided assistance to people in the U.S. who had difficulty obtaining health insurance.
Mekawy agreed to issue prescriptions for a fee and said he provided this service for about two months in July and August, 2007.
“The general protocol I followed involved the receipt of a completed questionnaire by a patient on my home computer which contained pertinent medical information along with a request for medication. I would review this information and either agree or disagree with the request,” Mekawy said.
He also said he didn’t knowingly prescribe controlled medications because he was not aware that one drug he prescribed, Soma, was considered a controlled drug in some U.S. states.
After the Indiana medical board informed him his licence was being suspended, Mekawy said the Internet drug company provided him with no support or assistance.
He said his licences in Michigan and South Carolina were also suspended, “likely due to a reciprocity agreement with the Indiana Medical Board,” but Mekawy said he didn’t use his licence in either of these two states when issuing prescriptions for the online company.
Documents filed with the Medical Licensing Board of Indiana say the investigation into Mekawy began when the Office of the Attorney General initially contacted an investigator with the Arkansas State Police who interviewed people who had obtained prescription drugs over the Internet.
In one case, a wife admitted she used her husband’s credit card to obtain the drug Soma from the online Internet pharmacy to feed her drug addiction. She admitted she never saw the doctor prior to receiving the medication. Another patient obtained Soma with his personal credit card without ever seeing Mekawy.
Indiana documents also note that Mekawy is under investigation by the Medical Board of California after an individual that he prescribed Soma to was hospitalized after overdosing on this medication.
Other drugs he was reported to have prescribed included pain medications, sleep aids and drugs to treat sexual dysfunction. Tramadol, Butalbital, Viagra, Rozerem, Ultracet, Cialis and Levitra are cited in one of the documents.
The Indiana board concluded that Mekawy’s actions represented a clear and immediate danger to public health and safety.
His lawyer, Peter Browne, expects Mekawy’s Newfoundland licence to be reinstated in July. He said he has enrolled in a two-day prescribing course in Ontario in September.
Brown also presented to the tribunal two letters of support from Eastern Health managers, Dr. Kevin Hogan, a former clinical chief of mental health and addictions and Dr. David Atwood, the current clinical chief.
Atwood said Mekawy’s online prescribing didn’t “creep” into his psychiatry practice and he had no issues with his competency. In fact, Atwood said his prescribing of psychopharmacology drugs was on a “more conservative range.”
Praising his clinical skills, Atwood said Mekawy has “strong character and reliability” and he has high personal and professional regard for him. He said if Mekawy’s licence is reinstated, he would have no problem returning him to his position at Eastern Health.