The Pharmaceutical Journal
Vol 269 No 7227 p829-831
7 December 2002

Striking-off for Viagra sale to journalist [more]

Pharmacist's alcohol problems lead to striking-off order [more]

"Lackadaisical" response to advice leads to reprimand [more]

Locum did not present "acceptable face" of pharmacy [more]

Striking-off for Viagra sale to journalist

A Borehamwood pharmacist who sold Viagra to a journalist without a prescription and whose record keeping was described as "chaotic" has had his name removed from the register by the Statutory Committee.

At its meeting on 26, 27 and 28 February, the committee inquired into the case of Rajendra G. Shah, of 8 Bush Hill Road, Kenton, Harrow, Middlesex, who is proprietor of a pharmacy at 11 Leeming Road, Borehamwood. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mr Shah had on 27 October 1999 sold five 100mg Viagra tablets to an investigative reporter in the absence of a valid prescription, that he had failed to ensure that accurate records of Viagra transactions were kept, and that he had failed to ensure that emergency supplies made by him complied with the requirements for such supply. It was alleged that these deficiencies might demonstrate that Mr Shah had been guilty of misconduct such as to render him unfit to have his name on the Register of Pharmaceutical Chemists.

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

Mr Shah attended the inquiry. He was represented by Alan Landsbury, of counsel, instructed by R. R. Sanghvi & Co (solicitors).

Journalist set-up

Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said that it did not take much imagination to appreciate that the sale of Viagra tablets to an investigative journalist from the Sunday People was a set-up. This was best evidenced by the fact that, once the sale had been completed, Mr Shah had been lured with a fictitious account of a possible EastEnders filming to allow photographs of himself and his pharmacy to be taken. It had been said on Mr Shah's behalf that entrapment by the Sunday People's representatives was a mitigating circumstance. Such entrapment by a journalist, apparently based on rumour of what might be obtained from the pharmacy, was of limited application in Mr Shah's case, said the chairman.

Mr Shah had been badgered to supply one Prozac tablet, which he had refused to do. Then repeated requests were made for the supply of Viagra tablets, with the number rising from one to five, and discussions as to the price. Mr Shah had admitted supplying five 100mg Viagra tablets without a prescription and wholly failing to meet any of the conditions making an emergency supply permissible.

When interviewed by one of the Society's inspectors on 14 February 2000, Mr Shah was asked whether any supply of Viagra could be an emergency; he had made no answer. Neither could the committee understand on what basis a request made over two days for one Viagra tablet, expanding to five, during which time there was ample opportunity to consult a doctor, could possibly be described as an emergency. It was impossible to see any consideration present other than a mercenary one.

With regard to Mr Shah's alleged failure to keep accurate records of Viagra transactions, two examples could be noted. For one patient, there had been two prescriptions for Viagra 50mg alongside three entries in the prescriptions register for supply to him of anything between 12 and 21 tablets. Further, a check revealed that, while the wholesaler's records showed supplies of 80 100mg tablets, Mr Shah's records showed he had dispensed 87 tablets on private prescriptions and eight on National Health Service prescriptions, had supplied five to the Sunday People reporter and held stock of 17. Thus, there were 37 more tablets than could be accounted for.

Chaotic record-keeping

On the third complaint, of failing to ensure that emergency supplies had been made according to the requirements for such supply, Mr Shah's own evidence had revealed not merely a tale of inadequate recording. It had shown a chaotic, incomprehensible and thoroughly unprofessional record of a string of transactions under the heading "emergency". Rather than restricting emergency dispensing to the narrow circumstances allowed in 'Medicines, ethics and practice', he had allowed it to encompass dispensing of prescription only medicines in an ill-defined range of circumstances, possibly depending on whether he knew the individual demanding the product, and most regularly when a repeat prescription was anticipated.

Even more alarming, continued the chairman, was Mr Shah's attempted explanation that this so-called emergency list contained not only notes of dispensing without prescription but also medication owing to patients, patient enquiries, doctors' queries and requests to doctors for prescriptions. It was a sorry tale of page after page of entries that were at best ambiguous and at worst incomprehensible. And at times, Mr Shah had vacillated, giving his evidence unsatisfactorily.

All three complaints by the Society had been established. The committee ordered that Mr Shah's name be struck off. He had three months to appeal against the decision.

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Pharmacist's alcohol problems lead to striking-off order

A pharmacist whose neglect of his post and paperwork through alcohol abuse led to his practising while not on the register has had his name struck off.

At its meeting on 20 February, the committee resumed an inquiry into the case of David E. Bloomfield, whose registered address is 4 Westall Close, West Street, Hertford. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mr Bloomfield, as a result of admitted problems caused by alcohol and debt, had failed to deal with the administration of post and paperwork to do with his professional practice between the end of December 2000 and June 2001. It was also alleged that Mr Bloomfield had practised as a pharmacist between about 14 May and 4 June 2001, during which period his name was not on the register.

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

Mr Bloomfield was not present at the inquiry, nor was he represented.

Compliance with regulations

The chairman (Lord Fraser of Carmyllie, QC) said that the committee had decided to hear the case in Mr Bloomfield's absence; it had already been adjourned once (from 23 November 2001) and efforts made to serve the notice of inquiry on him had fully complied with the regulations.

Giving the committee's decision, Lord Fraser said it was clear that Mr Bloomfield had failed to deal with his post and paperwork and that the failure appeared to have stemmed from his problems with the excessive consumption of alcohol. Evidence had also been presented that he had indeed practised as a pharmacist between the dates referred to, when his name was not on the register.

Mr Bloomfield's name was ordered to be removed from the register.

The chairman added that the committee recognised that Mr Bloomfield had a number of personal problems to deal with and hoped that he would be given the advice and assistance that could be offered by those involved with the Society. If he sought to have his name restored at some point in the future, as was to be hoped, he was advised that his application should be supported by someone expert in the treatment of drug or alcohol problems.

Mr Bloomfield had three months in which to appeal against the decision.

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"Lackadaisical" response to advice leads to reprimand

A Northumberland pharmacist who was "remarkably lackadaisical" in implementing the Society's advice on improving his dispensary procedures has been reprimanded following a number of irregularities in medicines dispensing and storage.

At its meeting on 19 February the committee inquired into the case of Martin P. H. Merriman, of "Belvido", Aydon Road, Corbridge, Northumberland. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mr Merriman had been responsible for a number of irregularities in dispensing procedures at his pharmacy at 4 Town Hall Buildings, Corbridge, on dates between 26 January and 12 April 2001.

The alleged irregularities included the redispensing of patient-returned medicine and the presence on the dispensary shelves of patient-returned and uncollected medicines, date-expired medicines, loose foil strips of medicines, mixed batches of medicines and medicines that did not comply with the labelling regulations. It was also alleged that Mr Merriman had been the pharmacist on duty when promazine syrup 25mg in 5ml had been supplied against the balance of a prescription calling for amantadine syrup 50mg in 5ml.

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

Mr Merriman attended the hearing. He was represented by David Aaronberg, of counsel, instructed by Charles Russell (solicitors).

Procedure review requested

The committee heard that on 17 January 2001, following the supply from his pharmacy of outdated magnesium trisilicate mixture, the Society's Professional Standards Directorate had written to Mr Merriman requesting that he review his date checking procedures. An "ideal system" had been set out for his information. Mr Merriman had replied on 22 January, indicating that he had addressed the matter.

However, on 26 January a prescription had been dispensed which called for three packs of 60 Persantin Retard 200mg capsules, and one of the three packs supplied bore a label indicating that it had been dispensed on 20 December 2000 from the pharmacy at Hexham general hospital for another patient.

Then, during a visit by inspectors of the Society on 12 April, 18 items of patient-returned or uncollected medicines, 26 items of date-expired medicines and a number of inadequately labelled medicines, including loose foil strips of medicines, were found on the dispensary shelves. The loose foil strips included four strips of 14 Sotacor 160mg tablets from which the batch numbers and expiry date had been cut off. In all, a total of 71 discrepancies had been noted.

Finally, on 21 May 2001, the error in dispensing the balance of promazine syrup had occurred.

Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said that what had been revealed was a far from satisfactory state of affairs. Having dispensary shelves in the condition described was to invite errors and thus affect the safety of the public.

Mr Merriman had accepted that there was a significant number of patient-returned medicines on his shelves, where they should not have been. He had also accepted that the date expired medicines and the mixed batches of medicines should not have been in the places where they were found, although he indicated that he had not wholly understood that the different batches should not have been mixed together.

Commenting on the Sotacor tablet strips from which the batch and expiry dates had been cut off, the chairman said that in some cases that had come before the committee, there had been the implication attached to that removal that it was the intention of the pharmacist to dispense such items, concealing the fact that they were outdated. There was no such evidence in Mr Merriman's case, he noted.

In the case of the dispensing error where promazine had been supplied instead of amantadine, Mr Merriman had said he thought his preregistration trainee must have made the mistake. He accepted, however, that he had to carry responsibility for that significant error.

Remarkably lackadaisical

The committee felt that Mr Merriman appeared to have been "remarkably lackadaisical" in implementing the advice given by the Society's Professional Standards Directorate. If the pharmacy had still been in the state it was at the time of the inspectors' visit in April 2001, the committee would have directed the removal of Mr Merriman's name from the register. However, new systems had been put in place and were still being improved. Excellent references had been provided on Mr Merriman's behalf, and he had a wide range of community interests. Nevertheless, his first duty as a pharmacist was to ensure that his pharmacy was run in a smooth and efficient manner with as many opportunities for error as possible eliminated.

Mr Merriman was ordered to be reprimanded.

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Locum did not present "acceptable face" of pharmacy

A locum pharmacist who made dispensing errors and was said to have been rude and aggressive to patients has been reprimanded by the Statutory Committee.

At its hearing on 18 February, the committee inquired into the case of Victor Harari, of 17 Ilkley Drive, Davyhulme, Manchester. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that, while pharmacist in charge of Lloyds Pharmacy, The Square, Holsworthy, Devon, Mr Harari had committed a number of errors in dispensing prescriptions, had exhibited poor practice in dealing with the supply of and labelling of medicines owing on prescriptions and had been rude and abrupt in dealings with patients and staff.

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

Jack McGarva, of Hill Dickinson (solicitors) represented Mr Harari, who was present at the inquiry.

Unhelpful towards patients

The inquiry heard that the complaints related to a period between 2 and 14 October 2000, when Mr Harari had been locum pharmacist in charge of the pharmacy. Except for three days of that time he had had no dispensing assistance. The first dispensing error complained of was that, against a repeat prescription calling for Premarin tablets 1.25mg and prednisolone tablets 2.5mg, two containers each containing prednisolone tablets had been supplied. When the patient telephoned the pharmacy to query what had been dispensed Mr Harari had been unhelpful and the patient had taken the tablets to another pharmacist who had confirmed they were not as labelled. A second complaint concerned a Nomad tray filled by Mr Harari which had been returned because the patient said the medicines it contained were not as prescribed. Thirdly, a prescription for temazepam had been handed out together with the prescription form itself, which should have been retained. An additional complaint was that when patients were due to receive more than one calendar pack of medicines, he had labelled only one of them.

Giving the committee's decision the chairman (Lord Fraser of Carmyllie, QC) said that although the pharmacy had been described as "busy" it appeared that it dispensed fewer than the average number of prescriptions. However, it was felt desirable that dispensing assistance should have been available to the pharmacist. It appeared that in the absence of such assistance, Mr Harari had to undertake a wider range of duties than he was accustomed, or willing, to perform. There was also little doubt that Mr Harari had only a faint grasp of the functionality of the pharmacy computer; as a result, unnecessary duplicate orders arrived — possibly twice a day. Further, his relationship with the pharmacy staff was not good; more than one staff member described him as "rude and arrogant".

dispensing errors

It was not surprising, continued the chairman, that out of this unsatisfactory situation a number of dispensing errors occurred. With regard to the prescription calling for Premarin and prednisolone it was Mr Harari's contention that what had happened was no more than a switching of labels: Premarin had been labelled prednisolone and vice versa. The evidence, however, was that the bottle labelled Premarin and that labelled prednisolone both contained prednisolone.

In regard to the make-up of a Nomad tray for another patient, it appeared that, after an acrimonious exchange with the patient's friend who had called for it, Mr Harari reluctantly made up the tray. The friend commented that the tray did not "seem to be right" and next day the tray was returned with the complaint that the medicines were wrong. They were then correctly prepared by a dispensing assistant who had been sent from another branch.

It might have been thought that Mr Harari would have made a particular check on what was in the tray but he had simply passed it over to a dispensing technician and told her to "sort it out". Mr Harari could hardly complain that he did not know what error there was in the tray when he had not attempted to discover for himself what he had originally dispensed.

The complaint about temazepam, a Controlled Drug, arose from the fact that the prescription form had been returned to the patient with the medication. If the prescription had not been endorsed, that would have been a serious matter; as it had been endorsed, the risk was not as great.

So far as Mr Harari's alleged rudeness and aggression were concerned, the Society was properly concerned about pharmacists' attitude to members of the public. It was a serious matter if any pharmacist was so rude and aggressive that people lost confidence in the profession or became reluctant to rely on the wide range of services that pharmacists can offer. Mr Harari had clearly been rude to a number of members of the public.

Finally, Mr Harari had admitted the labelling offence.

Mr Harari had not presented an acceptable face of pharmacy to a small community in Devon, said the chairman. He hoped Mr Harari had some personal misgivings about that. He was now 74 years of age and it might be appropriate for him to reflect on how much longer he should remain in active practice.

The committee reprimanded Mr Harari.

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