Consistently poor practice standards, unimproved in spite of numerous warnings, have led to a Walsall pharmacist's name being removed from the register by order of the Statutory Committee.
At its meeting on July 14, 1999, the committee inquired into the case of Mr Mohammad Yasin Sohawon, of Nova Pharmacy, 90 Milton Street, Walsall, West Midlands. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that poor standards of premises and practices at the pharmacy including an open and unlocked Controlled Drugs cabinet, the presence of unlabelled prepacks on the dispensary shelves, the presence of plastic measures containing unidentified tablets recovered from monitored dosage system trays, and the intention to reuse tablets of which Mr Sohawon was unaware of the batch number or expiry date, amounted to such misconduct as to render him unfit to be on the register.
Mr Sohawon was present at the inquiry and was represented by Mr M. Aaronberg, of counsel, instructed by Charles Russell, solicitors.
Mr G. Hudson, of Walker Martineau, solicitors, appeared on behalf of the Council to present the facts of the case.
The committee was told that Mr Sohawon had been proprietor of the pharmacy from 1992 until July, 1998, when ownership had been transferred to a limited company, Cosmos (Midlands) Ltd, of which he was the superintendent pharmacist. Since 1993, the standards and practices at Nova pharmacy had been a matter of concern. Because of this, the pharmacy had been visited and given advice by the Society's inspector more frequently than normal, about three times a year.
Mr Sohawon had also been written to several times with regard to proper labelling of prepacks, prompt disposal of returned medicines and other poor practices. There had been some improvements in 1997 but on a visit by the inspector in May 13, 1998, standards in the dispensary had deteriorated. There were prepacks without labels on the shelves, the sink area was cluttered and the Controlled Drugs cabinet was unlocked and open, despite previous advice.
In an upstairs room used for preparing monitored dosage system trays for a nursing home, a young assistant with a dispensing triangle containing a variety of different tablets had been present. The inspector had been told she was sorting the tablets that had come out of the trays. Tablets of the same type would be sorted into containers, each containing a numbered slip.
Mr Sohawon had explained that the tablets had come from deceased patients' trays or from trays where the medication had been altered prior to delivery to the nursing home. He said they were being sorted because he was interested to know the value of wasted tablets. He offered no explanation for the numbered slips.
Following the visit, a letter from the Society's Law Department had informed him that that his procedure was "downright dangerous'' and he had been advised that a Statutory Committee investigation was pending.
When visited 12 months later, on May 26, 1999, (before the hearing took place) the inspector had found medicine cups containing loose tablets in the upstairs room. Mr Sohawon had again explained their presence by saying that he was interested in the value of wasted tablets but admitted that he kept no records of this information. He then admitted that he reused the tablets, as they had not left the pharmacy.
He explained that he had lost the business of the nursing home and had been emptying the medication trays and reusing the medicines. He said he felt that a visual identification of the tablets was satisfactory.
The inspector had also found that there were bottles of methadone without labels in the Controlled Drugs cabinet and unlabelled and loose tablets on the dispensary shelves.
Giving the committee's decision, the chairman (Mr Gary Flather, QC) said that Mr Sohawon's attention had been drawn to the deficiencies in his practice procedures many times. Yet his standards had deteriorated.
There were a number of reasons why Mr Sohawon's procedures with regard to resorting tablets were dangerous. First, the assistant should not have been doing such a job; identifying tablets was a job for a professional. Even then, different tablets might look similar and were difficult to differentiate.
Second, tablets taken out of stock and put in various containers would not have a batch number by which they could have been traced or an expiry date which could have indicated whether the medication had gone out of date.
One of the most depressing aspects of the case, said the chairman, was that after being warned that his procedure was dangerous, he had been doing exactly the same again while waiting for his case to be heard. Further, there had been unlabelled methadone and loose tablets in the dispensary.
The committee found the misconduct proved and ordered that Mr Sohawon's name should be remove from the register.
Mr Sohawon had three months to appeal against the committee's decision.