The Pharmaceutical Journal
Vol 269 No 7214 p343-344
7 September 2002

"Wholly unsatisfactory" Viagra transactions lead to striking-off A London pharmacist who made supplies of Viagra (sildenafil) that could not be accounted for and did not keep proper records of the supplies or endorse prescriptions properly has been struck off the register by the Statutory Committee [more]

Reprimands for pharmacists who had "taken on too much" Two pharmacists who had "taken on too much", and in consequence neglected to observe required standards in running their pharmacies, have been reprimanded by the Statutory Committee [more]

"Wholly unsatisfactory" Viagra transactions lead to striking-off

A London pharmacist who made supplies of Viagra (sildenafil) that could not be accounted for and did not keep proper records of the supplies or endorse prescriptions properly has been struck off the register by the Statutory Committee.

Giving the committee's decision, the chairman said that the pharmacist had manifestly failed to co-operate with the investigation into his conduct, and warned that the committee would look bleakly on any future in which there was any comparable attempt to hinder investigations properly undertaken on behalf of the Society.

At a three-day hearing on 10, 11 and 12 September 2001, the committee inquired into the case of Shiraz R. J. Panjawani, proprietor of a pharmacy at 12 Golders Green Road, London NW11. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mr Panjawani had

• Failed to account for supplies of Viagra made from the pharmacy

• Failed to ensure that prescriptions ordering Viagra, against which the product had been supplied, were correctly written

• Failed to identify and remedy the poor practices relating to the recording and supply of prescription-only medicines from the pharmacy

• Been involved in arrangements whereby medicines liable to misuse dispensed against prescription, had been collected by the doctor for transmission to the patient without further involvement of the pharmacist

• Failed to endorse prescriptions for Controlled Drugs with the date of supply

• Failed to ensure that prescriptions ordering Controlled Drugs had been dispensed within their period of validity.

David Bradly, of counsel, instructed by Penningtons (solicitors), appeared in order to present the facts of the case to the committee.

David Aaronberg, of counsel, instructed by Kingsley Napley (solicitors), represented Mr Panjawani, who was present at the hearing.

Investigation

The committee heard that two of the Society's inspectors had visited Mr Panjawani's pharmacy on 23 September 1999 in connection with an investigation into the sale and supply of Viagra tablets. They found inadequacies in record keeping in the prescription-only medicines register in respect of supplies of Viagra. There were also errors in endorsing prescriptions and in Controlled Drugs register entries in respect of the supply of Tenuate Dospan tablets.

On examining the stock in the pharmacy the inspectors found a total of seven 25mg Viagra tablets, 28 50mg tablets and 35 100mg tablets. Receipts from wholesalers showed that 12 25mg tablets, 370 50mg tablets and 3,064 100mg tablets had been supplied to the pharmacy.

According to figures calculated by the Society, based on receipts from wholesalers, and on the quantities of Viagra tablets supplied on prescriptions, signed orders or by way of wholesale, there was a discrepancy between what had been received and what had been supplied. The discrepancy arising was that three more 25mg tablets had gone out of the pharmacy than records indicated, and 66 50mg tablets and 339 100mg tablets were not accounted for.

The major discrepancy in stock of Viagra concerned the 100mg tablets. Mr Panjawani had claimed that 360 Viagra tablets 100mg had been separated from the rest of the stock and put in an upstairs stockroom by him for future supply to a local doctor. These had not been found by the inspectors.

Mr Panjawani had previously appeared before the Statutory Committee in 1996 after being convicted of three offences of selling medicinal products without a wholesaler's licence, for which he had been fined £4,600. On that occasion, he had been reprimanded.

Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC), said that the committee found the allegations against Mr Panjawani had been established and that they amounted to conduct such as to render him unfit to be on the register.

Giving the reasons for the committee's decision on 11 October, the chairman said that Mr Panjawani's explanation as to why he had separated out the 360 tablets was opaque. The committee did not believe they had existed. The inspectors' notes showed that all drawers and cupboards had been searched and nothing found. Mr Panjawani's explanation for this was that the Viagra tablets had been in unmarked boxes on the floor. Far from enhancing his credibility on the matter, said the chairman, it simply punctured it further. Mr Panjawani had not mentioned the existence of this substantial quantity of Viagra tablets until, months later, he had ascertained the shortfall alleged by the Society. Prescriptions from the doctor for whom he said the tablets had earlier been set aside were dated 12 October 1999 for 192 tablets, 19 October for 68 tablets and 26 October for 100 tablets, a total of 360. The committee believed that that was simply an attempt to give greater credibility to his account.

The transactions between Mr Panjawani and the doctor were casual, confused and wholly unsatisfactory. For example, signed orders dated 25 August, 1 September and 17 September 1999 had not been entered up at the time of the inspectors' visit on 23 September and were not disclosed until March 2000.

Failure

It had been accepted that there had been a failure to ensure that prescriptions for Viagra against which the product was supplied had been correctly written; that there had been a failure to ensure that accurate records of Viagra supplied were made, and failure to identify and remedy poor practices relating to the recording of supply of POMs. Mr Panjawani had been involved in arrangements whereby medicines liable to misuse, dispensed against prescription, had been collected by the doctor for transmission to the patient without further involvement of the pharmacist, and failure to endorse with date of supply prescriptions for Controlled Drugs. It had been partially accepted that there had been failure to ensure that prescriptions ordering Controlled Drugs were dispensed only within their period of validity.

The failure to account for supplies of Viagra from the pharmacy was the principal complaint against Mr Panjawani, said the chairman. If the committee had accepted that there had been 360 tablets stored in the upstairs stockroom the picture would have been different; but they did not accept that.

The chairman concluded: "The Royal Pharmaceutical Society is a body that has powers and privileges conferred upon it by statute. It is entitled to expect those on the register to meet the high standards of professional practice it sets. It is also entitled to expect that when investigation is made on its behalf into conduct that might fall short of those standards, that pharmacists will co-operate in those investigations. That is the mark of the professional. Mr Panjawani manifestly failed to co-operate. As the inspectors attempted to unravel the tangled and serious set of deficiencies, he sought only to obfuscate and make their task more difficult. It is a mark of our disapproval of that unprofessional attitude that we had no hesitation in coming to the conclusion that the direction to remove should be given. I should emphasise that in any future case where there is any comparable and obvious attempt to hinder investigations properly undertaken on behalf of the Society, we shall look upon that attempt very bleakly indeed."

Mr Panjawani had three months in which to appeal.

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Reprimands for pharmacists who had "taken on too much"

Two pharmacists who had "taken on too much", and in consequence neglected to observe required standards in running their pharmacies, have been reprimanded by the Statutory Committee. No action was taken against a company that was party to the inquiry.

At its meeting on 11 December 2001 the committee inquired into the case of Farida Chakera and Nishit A. Varia, both of 108 Stonegrove, Edgware, Middlesex, and Kenmo Chemists Ltd. Mr Varia is superintendent pharmacist of the company, which operates pharmacies trading as Christopher White & Jones, 54 Park Street, Luton, Bedfordshire, and Goldhawk Chemists, 41–43 St Peter's Street, Bedford. Miss Chakera is a director of the company and pharmacist in charge of Christopher White & Jones; Mr Varia is pharmacist in charge at Goldhawk Chemists. Mr Varia and Miss Chakera, who are married, also own in partnership Ashcroft Pharmacy, 260 Ashcroft Road, Stopsley, Luton.

A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that a number of breaches of the regulations, including controlling the supervision, storage and labelling of medicines at the pharmacies, had been drawn to the attention of Miss Chakera and Mr Varia by the Society's inspectors but had not been addressed on subsequent visits.

Geoff Hudson, of Penningtons (solicitors) appeared in order to present the facts of the case to the committee.

Miss Chakera was represented by Phillip Gray, of counsel, instructed by Charles Russell (solicitors), and Mr Varia and Kenmo Chemists Ltd were represented by Sarah Wood, of counsel, instructed by Turner & Debenham (solicitors). Miss Chakera and Mr Varia were both present at the hearing.

No pharmacist

The committee heard that the sequence of events giving rise to the complaints had begun after a routine visit by one of the Society's inspectors to the Christopher Wood & Jones pharmacy on 22 February 2000. He had arrived before 9am to find the pharmacy open and trading with no pharmacist present. Miss Chakera had arrived at about 9.10am. Following an inspection of the premises, the inspector had advised that stock should not be stored on the stairs; that temazepam elixir was being stored otherwise that in accordance with the Misuse of Drugs (Safe Custody) Regulations 1973; that entries in the Controlled Drugs register must be made on the day of supply or the day following; that all medicines in dispensary stock must be labelled; and that under no circumstances should medicines returned by patients be reused or kept in the dispensary.

On the same day, the inspector also visited the Ashcroft Pharmacy and, after a routine inspection, advised that all register entries should include the date of dispensing and the date of the prescription; that temazepam is subject to safe custody regulations, even if in monitored dosage system blisters returned by patients; that patient-returned strips must not be reused or stored in the dispensary but put into disposal bins at the earliest opportunity. The inspector had added that the storage of returned medicines strips in a box in alphabetical order according to drug name was indicative of an intention to reuse.

CD cabinet open

Then, on 1 June 2000, another inspector had visited the Goldhawk Chemists premises. It had been noticed that the Controlled Drugs cabinet was open and that quantities of Controlled Drugs were positioned on top of the drugs refrigerator and that there were loose strips of capsules and tablets on the dispensary shelves. Mr Varia had been present and had been given advice about those matters.

On a follow-up visit to Christopher White & Jones on 14 July 2000 the inspector had again found a number of irregularities, including inadequately labelled stock, loose strips of tablets and capsules, patient-returned medicines to be disposed of and stock left on the floor.

Later the same day the inspector had visited Ashcroft Pharmacy and advised on a number of matters, including an accumulation of patient-returned medicines.

On 23 November 2001, acting on information received, two inspectors had visited Christopher White & Jones in the morning and observed that the premises were opened at about 8.30am by unqualified staff. Shortly after, two customers entered and were both handed dispensing bags which, it was later admitted, contained methadone. One of the inspectors was sold Solpadeine capsules by an unqualified assistant. When the pharmacist (Miss Chakera) arrived at about 8.45am she was asked where the key to the Controlled Drugs cabinet was kept. She showed the inspectors that it was in a pot and admitted that it was routinely left there overnight. On examination of the Controlled Drugs register, it was found that some entries had been made out of chronological order and others had been amended. Again, loose strips of tablets were found, stock was stored on the stairs and temazepam elixir was stored other than in the Controlled Drugs cabinet.

When, on the same day, the inspectors visited Ashcroft Pharmacy, they found temazepam not stored in accordance with the regulations.

Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said that the defects found by the inspectors on repeated occasions amounted to misconduct liable to render both Miss Chakera and Mr Varia unfit to be on the register. There was a protracted period during which they had ample opportunity to correct what was going wrong in the pharmacies but they had taken little or no action to correct matters.

However, after 23 November 2001, Mr Varia and Miss Chakera had, at long last, appeared to appreciate that the way they had been running the three pharmacies was unacceptable. The committee had been advised that there had now been significant improvements in their conduct of their business, including the preparation by Mr Varia of a procedural manual.

It was clear, said the chairman, that Mr Varia and his wife were a hard working young couple, with a young family, who had simply taken on too much. The committee was informed that the two pharmacies in Luton had been put up for sale and strongly advised them to proceed with that sale so as to allow Mr Varia to give his wholehearted attention to the remaining pharmacy. Mr Varia and Miss Chakera were ordered to be reprimanded. No direction was made in respect of the company.

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