The Pharmaceutical Journal
Vol 270 No 7232 p97-99
18 January 2003

Striking-off for £20k overpayment claims [more]

Unusual circumstances lead to decision's postponement [more]

Restoration refused after second removal from register [more]

Pharmacist given an opportunity to correct deficiencies [more]

Striking-off for £20k overpayment claims

A pharmacist who over a period of years made false claims for payment against dispensed prescriptions has been struck off the register by the Statutory Committee

At its meeting on 17 September 2002 the committee inquired into the case of Yui Pui Tsang, of 6 Oakwood Rise, Leeds. Information had been received that on 7 August 2001, at Wakefield magistrates' court, Mr Tsang had pleaded guilty to and been convicted of four counts of obtaining property by deception. Ten similar offences had been taken into consideration. He had received a sentence at Leeds crown court on 11 September 2001 of a community punishment order for 100 hours on each count, to run concurrently, and ordered to pay £167 costs.

There was also a complaint from the Council of the Royal Pharmaceutical Society that Mr Tsang had made false claims for payment against dispensed prescriptions.

Geoff Hudson, of Penningtons (solicitors) attended the hearing to present the facts of the case. Mr Tsang was present and was represented by Sara Morgan, of Brooke North (solicitors).

Police investigation

The committee heard that at the time of the offences Mr Tsang had been proprietor of a pharmacy business trading as Harehills Pharmacy at 399 Harehills Lane, Leeds, which he had acquired in September 1995. In August 2000 the Prescription Pricing Authority had become concerned about the disproportionate number of prescriptions from the pharmacy carrying small pack endorsements. After investigation, an initial 14 instances were identified. The matter was put in the hands of the police and Mr Tsang was tried on the 14 specimen cases, whose total value was £51.05.

Inquiries also revealed that Mr Tsang's pharmacy, on the basis of his prescription endorsements, had dispensed significantly greater quantities of medicines than had been purchased.

As examples, between February 1998 and October 2000, 1,172 tubes of Diprobase cream 50g had been endorsed as having been dispensed when only 78 had been purchased, and prescriptions had been endorsed for the supply of 5,563 Gaviscon 100ml, although only 17 of that size had been ordered. On a prescription for 500ml Gaviscon, for example, where a single bottle of 500ml had been dispensed, the prescription would be endorsed as if five 100ml had been supplied. With other false endorsements made during that period it was estimated that overpayment of £13,431 had been made on seven named products.

The PPA had estimated the total value of overpayments for the period from October 1995 to October 2000 at not less than £20,000. Mr Tsang had repaid that amount.

Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said that while the amount involved in the 14 offences on which Mr Tsang had been tried was the relatively small sum of £51.05, the Society's complaint against Mr Tsang indicated a significantly more serious set of false claims. It appears that Mr Tsang would supply a large size pack against a prescription calling for the same quantity but would endorse the prescription as if the medication had been dispensed via smaller packs.

In all, said the chairman, it seemed that over the years something like £25,000 had been claimed. That appeared to be accepted, as Mr Tsang had subsequently paid back £20,000 to the PPA.

Breach of trust

The chairman noted that the judge sentencing Mr Tsang had said: "People in positions of trust, particularly professional people, have to keep to that trust and when they stray from it the court views such matters as very serious indeed". That had been said in relation to the conviction, which was for £51.05. "We would echo his remarks," he said, "and would particularly emphasise them where the amount involved is just short of £25,000."

The judge had also indicated that he hoped that Mr Tsang would be dealt with in a way that permitted him ultimately to return to his profession, of which, "these matters apart", he had, according to the judge, been a fine example.

The chairman said that Mr Tsang was undoubtedly a good pharmacist, but such was the breach of trust in this case that the committee ordered his removal from the register. He added that no application for restoration would be considered in less than two years from the date of his striking off.

Mr Tsang had three months in which to appeal.

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Unusual circumstances lead to decision's postponement

The Statutory Committee has postponed its decision in the case of a pharmacist who improperly kept quantities of medicines, including Controlled Drugs, at his garage and house and failed to submit prescription forms to the pricing authority. The decision would be given in March, at the end of a two-year postponement of a decision in an earlier inquiry concerning the pharmacist's drink-related conviction.

At its meeting on 17 September 2002, the committee inquired into the case of Michael Robert Lawrie, of 3 Breton, Stony Stratford, Milton Keynes, Buckinghamshire. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mr Lawrie had been guilty of misconduct that might render him unfit to have his name on the register. It was alleged that Mr Lawrie had stored waste medicines at his home in contravention of the Special Waste Regulations 1996, that he had possessed temazepam at his home in contravention of the Misuse of Drugs Act 1971, that he had dispensed prescriptions that had not been signed by a doctor, and that he had failed to submit National Health Service prescriptions in reasonable time, or at all, to the Prescription Pricing Authority for payment.

Geoff Hudson, of Penningtons (solicitors), presented the facts of the case to the committee.

Sam Flew, of Radcliffes le Brasseur (solicitors) appeared on behalf of Mr Lawrie, who was present at the inquiry.

Superintendent's concern

The committee heard that early in 2000, Mr Lawrie was pharmacist in charge of a company's pharmacy at Neath Hill Local Centre, Milton Keynes, which he had formerly managed on a franchise basis. The superintendent pharmacist became concerned about the low numbers of prescriptions submitted for pricing for a period when there had been a considerable amount of dispensing. Mr Lawrie explained that he had taken prescriptions home to sort out queries. In March of that year, Mr Lawrie's wife, who occasionally worked at the pharmacy, had given the superintendent a bundle of about 3,000 prescriptions, and explained there were further ones which needed endorsement by prescribers. When those prescriptions had not been returned by 14 April the superintendent pharmacist decided to call the police.

Mr Lawrie's home was visited with a search warrant on 29 April 2000 and a substantial quantity of medicines was discovered in the house and the garage. There were also 434 prescription forms that had not been signed but had been dispensed. The medicines included diazepam solution and tablets and temazepam capsules and tablets. There were also five DOOP (destruction of old pharmaceuticals) containers, whose contents included Palfium tablets, in the garage.

The committee was reminded that Mr Lawrie had appeared before it on 13 March 2001, when a decision had been postponed until March 2003.

Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said that the earlier hearing involving Mr Lawrie had related to a conviction for driving with excess alcohol in his blood and dangerous driving. The committee had taken a lenient view of the matter and postponed its decision.

The present case resulted from what the police search of his home had revealed. Mr Lawrie had explained that the drugs found at his garage had been brought from the pharmacy where he worked so that he go through them and separate the packaging from the drugs, which could then be destroyed. That seemed to the committee a somewhat curious explanation.

The police had also found in his house three bottles of temazepam and some paracetamol tablets carrying dispensing labels for named patients and dating back to 1997. Mr Lawrie had said they were not intended for use by any resident in his house, said the chairman, but it seemed odd that they were the only drugs in the house.

The other part of the discovery by the police was that no fewer than 434 prescription forms were in the house. Some had yet to be submitted to the Prescription Pricing Authority and others had been returned by the PPA with requests for clarification or endorsement by the prescriber. That was odd, the committee felt, because if the prescriptions had been submitted and payment made on them, Mr Lawrie would, at least in part, have been the beneficiary.

"It cannot be an appropriate course of action for medicines to be stored in the garage", said the chairman. Mr Lawrie had acknowledged that. He should not have had the temazepam tablets in the house for the protracted period they were there and he should have made sure the prescription forms had been submitted to the pricing authority or had been clarified when so requested.

If those matters had been before the committee at the same time as they had been considering the drink driving conviction, said the chairman, there was little doubt that they would have directed that Mr Lawrie's name should be removed from the register.

The drink driving offence and the matters before the present hearing appeared to have been going on at the same time and it would have been more appropriate if they had been considered together. However, it was delay on the part of the Crown Prosecution Service (not the Society) that made it impossible for the two matters to be dealt with simultaneously.

In consequence, said Lord Fraser, the committee faced the problem that if Mr Lawrie had been removed from the register in March 2001, he would now have been about halfway through the period which had been indicated as appropriate before any application for restoration could be made. That caused an element of unfairness to Mr Lawrie.

In those unusual circumstances, said the chairman, the committee would postpone its decision until March 2003, the same date as that to which the March 2001 decision had been postponed. At that resumed hearing the committee would want to have reports and evidence that Mr Lawrie had been abstinent for that two-year period before coming to its decision.

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Restoration refused after second removal from register

The Statutory Committee has refused an application for restoration to the Register of Pharmaceutical Chemists from a pharmacist who was removed from the register two years ago for professional misconduct.

The application for restoration was made at the committee's meeting on 19 September 2002 by Michael John Wallace Haynes, who had had been removed from the register on 14 September 2000. Mr Haynes had sold 39,200 Valoid (cyclizine) tablets to one customer over a six-month period from the pharmacy he had run in St Helier, Jersey (PJ, 2 September 2000, p326).

Geoff Hudson, of Penningtons (solicitors) attended the meeting to present the facts of the case.

Mr Haynes was present at the meeting and was represented by David Reissner of Charles Russell (solicitors).

Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said that the application had been considered carefully. Mr Haynes had previously been removed from the register in March 1988 and restored on 10 February 1998. Just over a year after his restoration he had embarked on the unethical course of conduct that had led to his second removal, with effect from 14 September 2000.

Mr Haynes was now 62 years old and living in Spain. The committee recognised the difficulty he must have had in securing references. However, of those he had presented, none was particularly fulsome and one was scarcely a reference at all.

It was accepted that the matter complained of on the second occasion on which he had appeared before the committee was different to the complaint against Mr Haynes on the first occasion. However, given the protracted period he had already been off the register and the limited period that had elapsed before he had begun the course of conduct that led to his second removal, the committee could not order his restoration.

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Pharmacist given an opportunity to correct deficiencies

In a case arising from a pharmacist's errors of judgement in dispensing, the Statutory Committee has given him a 12-month opportunity to correct deficiencies in his pharmacy practice before the committee gives its decision.

At its meeting on 16 September 2002, the committee inquired into the case of Shiraz H. Mitha, proprietor of a pharmacy at 8-9 Hermitage Road, Hitchin, Hertfordshire. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mr Mitha had supplied 535ml of sucralfate liquid without a prescription. It was also alleged that he had supplied Percutol 2 per cent ointment against a prescription for glyceryl trinitrate (GTN) 0.2 per cent ointment when he knew, or should have known, that the 2 per cent ointment was not suitable for treating the patient. Having substituted the stronger ointment, he had not counselled the patient on its use. Further allegations related to breaches of the legislation applying to the supply of prescription only medicines on private prescriptions.

The facts of the case were presented to the committee by Fenella Morris, of counsel, instructed by Penningtons (solicitors).

Mr Mitha attended the meeting and was represented by Denis Keegan, of Turner & Debenhams (solicitors).

Remainder of bottle supplied

The committee heard that on 10 November 2000 a customer had presented a veterinary surgeon's prescription for her cat at Mr Mitha's pharmacy. It called for 25ml of sucralfate 0.2g/ml suspension. Mr Mitha had advised the customer that he would obtain the medicine for the following day. When the customer returned to collect the medicine on the next morning she was charged £14.50. She pointed out that she had been told the cost would be significantly lower and said she believed Mr Mitha had charged her for the whole bottle of 560ml. He agreed. The customer responded that, if that were the case she should be given the remainder of the bottle. Mr Mitha gave her the remaining 535ml but did not attach a dispensing label to the bottle. The entry in the private prescription register showed only that 25ml had been dispensed.

Then on 2 December 2000 a patient suffering from an anal fissure presented a consultant's prescription for GTN ointment 0.2 per cent to be applied twice daily. Mr Mitha did not have that strength in stock and asked the patient if 2 per cent ointment would be acceptable. The patient was not prepared to discuss dosage and suggested Mr Mitha should telephone her consultant surgeon. He went to telephone the hospital and returned to say that he had spoken to the consultant and that the 2 per cent strength "would be fine". In fact, he had not spoken directly to the consultant. He gave the patient the Percutol ointment but did not advise her as to its use. When she reached home, she read the patient information leaflet in the box. This stated that the ointment should be applied to the chest, arm or thigh every three to four hours. However, that conflicted with the instructions given her by the prescriber. For treatment of anal fissure, Percutol diluted to 0.2 per cent ointment should be applied directly to the affected area. The patient had been confused, as the dispensing label stated it should be applied twice daily, but thought she should follow the information on the leaflet. This she had done for two weeks, during which she suffered severe side effects, and a personal injury claim resulted.

When the Society's inspector had visited the pharmacy following the receipt of complaints about those matters she had found additional causes for concern. A private prescription dispensed for eight 25mg Viagra tablets, dated 5 April 2001, was a photocopy. Another private prescription, for five 2.5mg Fentanyl patches, did not give a dose. And two undated private prescriptions calling for prescription only medicines had been dispensed even though they had both been written by a doctor who was not registered with the General Medical Council.

Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said that Mr Mitha had admitted the errors and accepted the breaches of his responsibilities as a pharmacist. To have supplied the 535ml of sucralfate was clearly wrong. Pharmacists should know that they could not dispense a greater quantity than is called for in the prescription. Mr Mitha had accepted that it was an error of judgement on his part.

The second error was clearly serious. It was regrettable that the patient who had been supplied with 2 per cent Percutol ointment had applied it in accordance with the patient information leaflet and had suffered unpleasant side effects. Any query about what had been called for should have been followed through by Mr Mitha to the original prescriber. Had he done so, it would have been explained to him why 0.2 per cent was the appropriate strength. And if he had thoroughly checked that, he would have been able to offer the correct advice.

Taking those matters together with the deficiencies that had concerned the Society's inspector, the committee concluded that, cumulatively, they amounted to misconduct such as to render Mr Mitha unfit to be on the register.

However, the inspector had stated she intended to spend some time with Mr Mitha discussing the deficiencies she had found in his pharmacy and he had indicated that he was willing to accept advice from her.

So that the committee could be confident that all that was deficient in the pharmacy was suitably remedied, a decision in the case would be postponed for 12 months. If Mr Mitha was co-operative and there was evidence that the deficiencies had been made good, he could expect that the sanction against him would be restricted to a reprimand.