A London pharmacist who used a forged certificate in an attempt to mislead the Royal Pharmaceutical Society into believing that his business had professional indemnity insurance has been ordered by the Statutory Committee to be removed from the Register of Pharmaceutical Chemists for serious professional misconduct. The Committee stated that it was "absolutely appalling" for a pharmacist to treat his professional body in such a manner while it was performing its supervising role to protect the public.
The Committee's decision also took into account the facts that the pharmacist had conducted the business for some time without professional indemnity insurance, that he had failed to keep the Society informed about the ownership of the business, and that he had allowed three dispensing errors that in aggregate would have merited a reprimand.
The pharmacist was also reprimanded for failing to fulfil his professional responsibilities to act in the best interest of a patient who had sought his advice.
At an inquiry held on May 20, the Statutory Committee considered a number of complaints made by the Society's Council against Mr Chhaganbhai Nathubhai Mistry, of 17 South End Road, London NW3. The complaints concerned the pharmacy business trading as House of Mistry, at 15-17 South End Road, London NW3, which was owned by Mr Mistry in partnership with his son, who was also a pharmacist.
Mr Mistry was present at the inquiry hearing and was represented by Mr D. Aaronberg, of counsel, instructed by Charles Russell (solicitors).
Mr D. Bradly, of counsel, instructed by Walker Martineau (solicitors to the Society) appeared in order to place the facts of the case before the Committee.
The Council's complaints were contained in two notices of inquiry. The first began with an allegation that, on April 23, 1998, a patient had visited the House of Mistry pharmacy to seek an emergency supply of sulpiride tablets, a potent neuroleptic which was one of his regularly prescribed medicines and of which he was running short. The patient maintained that he had taken at least one prescription to the pharmacy for dispensing prior to that date, that he was included in the pharmacy's patient medication records, and that he had had with him his repeat prescription order form when requesting the emergency supply.
It was alleged that Mr Mistry had declined to make an emergency supply. Instead he had advised the patient to reduce the dose of his prescribed medication and to substitute natural products, and he had sold the patient St John's wort. As a result, the patient had been left unsure about the appropriateness of the advice and treatment given to him by the psychiatric team responsible for him.
In addition it was alleged that when the patient's mother had visited the pharmacy to buy medication to relieve an inflamed tongue caused by a jagged tooth, Mr Mistry had instead sold her a nail file to file down the tooth.
The second notice of inquiry began with an allegation concerning Mr Mistry's lack of professional indemnity insurance. In an interview with one of the Society's inspectors on December 10, 1998, Mr Mistry had been asked about insurance cover and had produced a copy of business package insurance which he had claimed provided him with professional indemnity insurance cover. However, a representative of the insurance company had later stated that the policy did not provide such cover.
In addition, the business insurance certificate produced by Mr Mistry had shown that cover had expired on May 14, 1998. He had claimed that a current insurance certificate was with his accountant, and he had subsequently provided the Society with a certificate indicating cover for one year from May 15, 1998. However, a representative of the insurance company had informed the Society that it had never provided professional indemnity insurance, that it had issued no insurance policies after March, 1998, and that the document was not genuine.
The Council's next allegation concerned the ownership of the pharmacy premises. In November, 1993, ownership had been transferred from Mr Mistry to House of Mistry Ltd, with Mr Mistry appointed as superintendent pharmacist of the company. When on June 4, 1998, the inspector had asked about ownership, Mr Mistry had responded that he owned the pharmacy in partnership with his son. He had claimed that the change had taken place at the end of April, 1998, but that he had omitted to inform the Society. However, research had shown that House of Mistry Ltd had been dissolved by notice in the London Gazette dated October 10, 1995.
It was further alleged that, when asked again about ownership on December 10, 1998, Mr Mistry had replied that the owner was a partnership of himself, his son and his wife, who was not a pharmacist. However, it was not legally possible for a pharmacy in England to be owned by a partnership including a non-pharmacist.
Mr Mistry had produced a copy of a letter dated June 8, 1998, which he had claimed had been sent to the Society. The letter purported to be notification that as from May 1, 1998, the House of Mistry had become a "partnership company". The Society had no record of receipt of such a letter.
Mr Mistry had maintained that, although ownership had been transferred to House of Mistry Ltd in November, 1993, the company had never traded and ownership had therefore remained with him. The 1998 annual retention fee form received by the Society had had "Ltd" in the company title crossed out. Despite the form clearly stating that it should not be used to notify the Society of any alterations to the premises address, he had claimed that this was notification of the change of company name and status.
The Council's final allegations related to the dispensing errors. It was alleged that on November 24, 1998, a white carton labelled as "30 paroxetine tablets 20mg" but containing 31 Prozac (fluoxetine) 20mg capsules had been supplied to a patient against a prescription calling for paroxetine hydrochloride tablets 20mg. The Prozac capsules had been in four cut strips, one bearing a batch number but no expiry date, one bearing an expiry date but no batch number and two bearing neither batch number nor expiry date.
The second alleged dispensing error related to a prescription for 200ml malathion liquid 0.5 per cent presented on December 16, 1998. The patient had been supplied with a proprietary pack of Suleo M lotion, containing malathion 0.5 per cent in an alcoholic base. The dispensed medicine had borne a shop price label but no dispensing label. The patient said that she had not been counselled and no checks had been made to ensure that she knew how to use the product. The error had come to light when the patient, who had scabies, had telephoned the prescriber to query the prescription because the pack and leaflet information referred only to the treatment of headlice. It was also alleged that the product's alcoholic base could have aggravated the patient's eczema, which the prescribed aqueous lotion would not have done.
The third alleged dispensing error related to an incorrectly labelled prescription for penicillin V tablets 250mg, one to be taken four times a day. The prescription had been labelled "Take one three times a day" and had borne an incorrect patient's name. When the patient had pointed out the name error, Mr Mistry had corrected the name by hand but had not corrected the incorrect dosage information.
After the committee had considered the evidence, the Chairman (Mr Gary Flather, QC) announced the Committee's decision but said that the reasons would be given in writing at a later date.
The reasoned decision, which considered the allegations in chronological order, began with the issue of the pharmacy's ownership. The Committee noted that, while Mr Mistry's failure to keep the Society notified of ownership changes could not be condoned, no harm had been done by the omissions. But misconduct was proved, and showed a disrespectful and contemptuous attitude towards the supervising powers of the Society. On its own, it was not such as to render Mr Mistry unfit to be on the register but its weight would have to be added to the aggregate of misconduct found proved.
On the matter of the request for an emergency supply of sulpiride, the Committee accepted the account of the event given by the patient rather than an alternative account given by Mr Mistry. The Committee also considered that evidence provided by a witness called by Mr Mistry had been fabricated. The Committee had been told that Mr Mistry's actions had resulted in the patient losing trust with his therapist and treatment. A pharmacist should never provoke that reaction. Mr Mistry had asserted himself over the prescriber in his absence, making a forced sale, and had not put the welfare of the patient first.
On the complaint by the patient's mother, the Committee again noted a dispute about the facts. However, it was such a silly episode that the Committee could not believe that the patient's mother was making it up. Her story pulled together.
Mr Mistry's attitude had been dismissive and possibly irritable as well. At best, his advice had been flippant, but it had achieved a sale because it had been taken literally. Pharmacists should be careful about how they spoke to sensitive patients who implicitly trusted pharmacists' advice.
The Committee considered that these two episodes aggregated into serious professional misconduct. The appropriate way of disposing of the first notice of inquiry was by issuing a reprimand to Mr Mistry.
Turning next to the dispensing errors, the Committee said that its concern about the dispensing of fluoxetine instead of paroxetine was hugely increased by the fact that the capsules were in four separate cut strips each missing a batch number and/or an expiry date. Batch numbers were there to identify the medication should anything turn out wrong, and expiry dates were there to ensure that the medicine supplied would be of proper quality and efficacy. Mr Mistry's explanation was that the four strips had all been "middle bits", but in such a situation it was better to discard the middle bits rather than jeopardise the patient.
In the case of the malathion error, Mr Mistry's slipshod dispensing had involved a number of errors. It was a proud boast of pharmacists that they gave counselling services; had they been given to this patient the dispensing error would have become immediately apparent.
The three errors in aggregate amounted to serious professional misconduct which, had they come to the Committee as three errors in a single notice of inquiry would have merited a reprimand.
Turning to the absence of professional indemnity insurance, the Committee noted that from May 15, 1997, and possibly earlier, until March, 1999, the House of Mistry had had no professional indemnity insurance. In a previous case (PJ, May 17, 1997, p698) the Committee had set out at length why it considered the absence of such insurance to be serious professional misconduct, and its conclusion and views had been upheld in the Divisional Court (PJ, November 22, 1997, p827). Members of the public dealing with pharmacies would presume that, in the event of a serious mistake which led to serious injury or death, there would be insurance cover.
The best that could be said for Mr Mistry was that he believed that his public liability insurance did include professional indemnity insurance. The fact that he had taken such trouble to forward to the Society a forged certificate suggested that this was a genuine belief. But he was to be severely criticised for failing to get down to the question of what insurances he needed. Even if he did believe that his public liability insurance covered him for professional indemnity, the policy was already seven months expired by the time he was interviewed on December 10, 1998.
He was particularly to be criticised for not making any inquiries about the extent of his insurance even after the issue had been raised by the inspector in the interview in December, 1998. To have no professional indemnity insurance for a period approaching two years amounted to serious professional misconduct rendering him unfit to be on the Register.
On Mr Mistry's attempt to mislead the Society by proffering a false insurance certificate, the Committee stated that what he had done had been dishonest and done with intent to deceive the Society. Through its inspectors, the Society was performing its function of protecting the public against pharmacists behaving in an irregular and potentially damaging way. To treat one's professional body in such a manner while it was performing this supervising role was "absolutely appalling".
Mr Mistry had claimed that the certificate had been provided by his personal investment adviser, However, whoever had forged it, Mr Mistry had deliberately and dishonestly sent it to the Society knowing that it was not genuine and hoping that it would persuade the Society that he had professional indemnity insurance when he had not.
Upon that one aspect of the case alone, the Committee found serious professional misconduct proved such as to render Mr Mistry unfit to be on the register. There was no other way of dealing with this misconduct than to direct the Registrar to remove Mr Mistry's name from the Register. That deceit was the worst aspect of the entire case.
In reaching its separate conclusions the Committee had carefully considered all matters that had been brought in by way of mitigation and through references, which were undoubtedly good. None the less, for the reasons given, the Committee awarded a reprimand upon the first notice of inquiry and directed the removal of Mr Mistry's name from the Register upon the second.
Mr Mistry has lodged an appeal against the Committee's decision.