Claiming payments in excess of £2,400 per prescription more than the cost of the product dispensed has led to a London pharmacist being removed from the register by order of the Statutory Committee.
At its meeting on June 14, the committee inquired into the case of Mr Suryakant Narshibhai Patel, of 72 St Augustines Road, Camden Town, London. Information had been received that on October 14, 1998, at Kingston crown court, Mr Patel had been convicted of five offences of furnishing false information, contrary to section 17 of the Theft Act 1968. For these offences, to which he had pleaded not guilty, Mr Patel had been sentenced to 12 months' imprisonment and ordered to pay £1,000 costs.
Mr Patel was present and was represented by Mr R. Massey, of counsel.
Mr G. R. F. Hudson, of Walker Martineau, solicitors, appeared in order to place the facts before the committee.
The committee heard that in September, 1994, Mr Patel's pharmacy at 124 Sheen Road, Richmond, Surrey, had dispensed a prescription for 16 vials of Intron A, 3 mega units. Arrangements had been made for repeat prescriptions to be provided every month by the patient's own doctor. There had initially been some confusion over the appropriate dosage and quantity prescribed, which Mr Patel had identified and sorted out with the practice. However, although the practice then ordered the correct quantity, 16 ampoules, the computer-generated prescriptions had specified 30 mega unit vials rather then 3 mega units. Mr Patel had checked with the patient that the strength of her medication had not been changed, and she had been supplied, correctly, with the 3 mega unit vials. Mr Patel had not contacted the prescribing doctor to point out the error and the prescriptions continued to specify the higher strength product and Mr Patel's pharmacy continued to dispense 3 mega unit vials. This had continued from December, 1994, to April, 1996.
A month's supply of the 3 mega unit Intron A was priced at £271.36 while the 30 mega unit product was £2,712 .96. The prescriptions had been endorsed as if the higher strength had been supplied.
In March, 1996, Mr Patel had seen the prescribing doctor (who had been contacted by the local health aurhority about the large number of high cost prescriptions) and, he said, had realised that he should tell the health authority what had happened. By that time, 16 months' supply had been dispensed, and paid for at the higher rate. The committee was told that in May, 1997, by which time the medical practitioner responsible for issuing the prescriptions had died, Mr Patel had written to the Kingston & Richmond health authority indicating that an overpayment had been made to his pharmacy and asking what the total amount, with interest, was. Mr Patel had repaid some £39,000.
An investigation, leading to prosecution and conviction, in respect of Mr Patel's endorsement of five of those prescriptions, had followed.
Stress
In answer to questions, Mr Patel said he had been under stress at the time of the offences, working a 12-hour day, seven days a week. He agreed that he had done wrong in taking advantage of the doctor's mistake.
A large number of references from doctors and patients testifying to Mr Patel's service to his local community were presented to the committee.
Giving the committee's decision, the chairman (Mr Gary Flather, QC) said that the prescribing doctor had made mistakes that Mr Patel had identified. Mr Patel had not, however, drawn them to the doctor's attention until the local health authority had queried the amounts being prescribed. "Those discussions with the doctor, which must remain inconclusive because we have not heard his side since he has unfortunately died, really come to show what a dreadful mess Mr Patel has made of his professional duties. It is clear to us he knew what he was doing."
The endorsement of £2712.96 on a prescription would strike a very loud chord to anyone who saw it. The committee had very little difficulty in finding the case proved.
Much had been said in Mr Patel's favour and many references testified to his services as a pharmacist to his local community. It was an important point that £39,000 had been repaid. However, the conviction that had been admitted and proved was such as to render Mr Patel unfit to be on the register and the committee ordered that his name be removed.
Mr Patel had three months to appeal against the committee's desicion
A pharmacist who dispensed methadone not as directed by the prescription, and who improperly allowed one addict to collect another's prescription has been reprimanded by the Statutory Committee.
At its meeting on June 16, the committee inquired into the case of Mr Elias Adam Umarji Patel, of 245 Headfield Road, Thornhill, Dewsbury, West Yorkshire.
Information had been received that on June 22, 1998, at Sheffield crown court, Mr Patel had pleaded guilty to and had been convicted of two counts of supplying a Class A Controlled Drug. He had been fined a total of £2,000 and ordered to pay £361 costs.
Mr Patel was present at the inquiry and was represented by Ms Sara Morgan, of Brooke North & Goodwin (solicitors)
Mr G. F. R. Hudson, of Walker Martineau (solicitors), appeared in order to place the facts of the case before the committee.
No written proxy
The committee heard that on two occasions, on August 5 and August 12, 1997, Mr Patel had supplied methadone in a single quantity rather than as a series of smaller quantities, as prescribed. He had also allowed one addict to collect methadone for another, without a written proxy.
In the course of a police investigation, methadone mixture that had been dispensed at Mr Patel's pharmacy had been found at the home of two addicts. Two bottles containing 280ml and two bottles containing 350ml of methadone mixture were found. When the prescriptions were checked, it was found that each should have been dispensed in three separate lots, on alternate days. It also transpired that, at this time, one of the addicts, for whom some of the methadone had been dispensed, was believed to have been out of the country on holiday.
Interviewed
When interviewed by police, Mr Patel had explained that the prescriptions for the two addicts had been issued by the substance misuse team at Barnsley. He had dispensed similar prescriptions for those persons on a regular basis for about two years.
Giving the committee's decision, the chairman (Mr Gary Flather, QC) said: "We have a further example here of where a pharmacist can trust too extensively what a drug addict says." Mr Patel had broken the golden rule that required a Controlled Drug to be handed directly into the hands of a drug addict. "You do not give it to proxies unless you can establish without any doubt that it is going to that drug addict."
Mr Patel had made no gain from the transaction and had, however misguidedly, acted from trust. He had produced excellent references.
However, this was yet another case of a pharmacist who did not stand up to a drug addict, who did not recognise how manipulative, how untruthful and how amoral drug addicts could be.
The chairman continued: "Parliament has given pharmacists the important duty of being the guardian of dangerous drugs, of drugs of abuse, of drugs that raise money on the black market, of drugs that can ruin other people's lives.
"The regulations must be followed to the letter. It is not for the pharmacist to interpret regulations as they please, just because they have a drug addict they do not wish to displease. Likewise, what the doctor orders must be given." If there were any doubt, the doctor should be contacted. If it became known that a pharmacist was a "soft touch" among drug addicts, they would "come around you like bees to a honeypot". There was a notion that drug addicts were a nuisance in a pharmacy premises, and it was tempting to say, "let me give them a bulk supply and they will only come in once a week instead of three times a week". That had got to be resisted: the consequence of failing was that the drugs would "get out and do injury to others".
The committee found Mr Patel unfit to be on the register, but because of mitigating factors decided to order that Mr Patel be reprimanded.
A "catalogue of omissions'" in arrangements for the storage of Controlled Drugs and other medicines, and in record keeping, led to the appearance of a Yorkshire pharmacist before the Statutory Committee.
At its meeting on July 12, the committee inquired into the case of Mr Edward Peter Green, whose pharmacy is at 24 Market Place, Malton, North Yorkshire. A complaint had been received from the Council of the Royal Pharmaceutical Society which alleged that, during a visit by one of the Society's inspectors, a number of irregularities in the keeping of records, the storage of Controlled Drugs and the storage and labelling of medicines had been identified. No entries of prescriptions dispensed had been made in the private prescriptions register for the year 1998.
Wilful disregard
It was alleged that such conduct indicated a wilful disregard by Mr Green of his legal and professional duties to ensure that adequate control was exercised over medicinal products, that they were suitably stored and that appropriate records were kept, and that those circumstances might constitute such misconduct as to render Mr Green unfit to be on the register.
Mr Green was present at the hearing and was represented by Mr D. Reissner, of Charles Russell (solicitors).
Mr G. R. F. Hudson, of Walker Martineau (solicitors), appeared in order to place the facts of the case before the committee.
The committee heard that when the inspector had visited Mr Green's pharmacy on May 20, 1998, an open cardboard box on the dispensary floor had been found to contain a large number of containers of Controlled Drugs. Loose blister packs that did not comply with the labelling requirements had been found on the dispensary shelves as had an unlabelled bottle containing tablets; two unopened 2g bottles containing strychnine had also been found on the open shelves. The record of a sale of strychnine was incomplete, although there was a certificate authorising the sale. The private prescriptions record for 1998, which was in the form of a page-to-a-day diary, was empty although 26 prescriptions had been dispensed.
Questioned by the committee, The inspector said that similar deficiencies had been drawn to Mr Green's attention on five visits to the pharmacy since 1993 and verbal and written assurances had been given that they would be rectified.
References testifying to Mr Green's character were produced.
Facts admitted
Giving the committee's decision, the chairman (Mr Gary Flather, QC) said that Mr Green had admitted the facts "almost entirely". Of the charges in the inquiry, some were more serious than others. The strychnine sale was made for a legitimate reason to a known customer. None the less, the record was not filled in properly. The private prescriptions record should have been kept up to date, but there was some mitigation in that the dispensed prescriptions were to hand.
The most serious matter was that Controlled Drugs were stored in a cardboard box under the dispensing bench. That should never have taken place. One could see how serious this failure was when noting that the drugs in the box included diamorphine, morphine, pethidine, and temazepam tablets. Mr Green's explanation had been that he normally kept Controlled Drugs in a floor safe but on this occasion they had been taken out for stocktaking and left out. The matter was made much worse by the fact that the inspector had warned Mr Green about the use of the box and the lack of a proper drug cabinet on previous occasions, the first in August, 1993.
Then there was the matter of the loose blister pack strips, some with missing batch number or expiry date, the unlabelled tablets and the two bottles of strychnine.
"Bad habits, loose ends, untidy housekeeping. . . it is a worrying catalogue of omissions", which would render him unfit to be on the register, said the chairman.
On the other side, Mr Green had run his pharmacy for 13 years without previous difficulties. On a later visit, in April, 1999, the inspector had found no cause for complaint.
Illness
The chairman noted that it had come out during the inquiry that Mr Green had been suffering for some time from an illness that had not been diagnosed until 1996. It was a matter for medical judgment as to how much his symptoms had affected his approach to running his pharmacy. But Mr Green had had sufficient insight and control of his problems that no one was endangered and no doctors or patients had complained.
The committee adjourned the case for 12 months during which the inspector would be in regular contact and Mr Green's medical treatment would continue. If nothing adverse occurred, he would have a legitimate expectation of being reprimanded.
A pharmacist who was breathalysed and found to be 4.45 times over the limit while in charge of a car has been ordered to be removed from the register.
The committee heard at its meeting on June 16 that Mr Malcolm George Finch had been stopped by the police on December 24, 1998, after a member of the public had reported that he had been driving erratically. He was found to have an alcohol level of 156μg in 100ml; the prescribed limit is 35μg.
Mr Finch, whose address at the time was 69 Agnes Close, Bude, Cornwall, had been prosecuted at Bodmin magistrates court on January 4, 1999, and and found guilty under the Road Traffic Act 1988.
For the offence he had been banned from driving for five years, placed on probation for two years and ordered to pay £40 costs.
Mr G. R. F. Hudson, of Walker Martineau, solicitors, appeared in order to place the facts before the committee.
Mr Finch was not present and was not represented.
Giving the committee's decision, the chairman (Mr Gary Flather, QC) commented that the case was clearly a health problem, but under existing legislation had to be treated as one of misconduct. It was therefore ordered that Mr Finch's name should be removed from the register.
The chairman added that any application for restoration to the register would not be considered unless medical evidence was provided that Mr Finch had been free from alcohol for at least 12 months.