From Mr C. M. Roome, MRPharmS
SIR,-The death of a baby in the Boots peppermint water case (PJ, March 11, p390) and some of the initial reaction to it raises some serious questions, which the profession needs to address.
I am concerned particularly at the statement by the Society's director of professional standards that the case raises questions over whether community pharmacists should dispense extemporaneously. If community pharmacists are not allowed to dispense extemporaneously because of the risk that they might not know what they are doing, one has to ask why we need highly (but inappropriately?) trained pharmacists manning our pharmacies. If the answer is "to fulfil new roles" than what of those pharmacists who qualified some time ago who may not have the skills or desire for new roles but who can safely dispense extemporaneously. I would venture to suggest that a large proportion of community pharmacists might fall into this group.
Such a scenario leaves me wondering what is left of the "profession of pharmacy" - reading a clearly printed, computer generated prescription, selecting a pack and reading the instructions to the patient is hardly a professional role. The recent article by Calder1 would seem to suggest that, as it is currently configured, community pharmacy cannot really be considered a profession. If this, arguably last, vestige is removed, then what is the future for the status (and remuneration) of community pharmacists. Consider also the further implications of such a ban: delays while a specials manufacturer supplies the product or the need for extra staff in the hospital sector to fulfil those extemporaneously prepared items.
I feel the statements by Professor Mackie and Dr Cooke call into question the teaching of pharmacy undergraduates. If Mr Khattab, who graduated last year, could not be expected to know about chloroform waters, then how could Miss Taylor-Lloyd, who registered two years previously, be expected to know? At what point in a pharmacist's training is one expected to acquire such knowledge and how is this assessed? If it is during the preregistration year then clearly a degree of exposure to extemporaneous dispensing is needed. As this is declining in community practice it is essential that the skills and knowledge be taught in the schools of pharmacy. The Society is responsible for setting educational standards and it can insist that sufficient time be devoted to this aspect of practice as part of the degree accreditation procedure.
I note reports in the PJ of recent high marks awarded to schools of pharmacy for the quality of teaching. It is a shame that this is not in appropriate subjects as the baby's death just might have been avoided. Academics must shoulder some of the blame as well.
There seems to be a feeling among observers of the case that a contributing factor was that the concentrate was not labelled that it should be diluted. Quite apart from the implication in the word "concentrate", I would suggest that professionals do not normally rely upon labels as a means of correctly conducting their profession.
Regarding the legal proceedings, I feel it is a shame that criminal charges were ever brought. I cannot imagine how the parents must feel now that the death of their baby has been penalised by a fine of £1,000. Clearly the manslaughter charge was totally inappropriate in the first place and I cannot believe that Parliament intended the charge actually brought to be used in circumstances such as these. It would be interesting to learn what proceedings are initiated against doctors who cause the death of a patient by action or omission.
It seems to me that, although charges were brought against two individuals in this case, in reality it is the whole profession of pharmacy and its establishment that should have been in the dock. The response of the Society and other institutions to this case will be interesting to follow.
Chris Roome
Exeter, Devon
| 1. Calder G. The remuneration of pharmacy and pharmacy as a profession. Pharm J 2000, 264:377-9. |