Statutory Committee

Reprimand for pharmacist who endorsed erroneous scripts for £3,700 overpayment more

Dispensing errors result in reprimand more

Admonition for pharmacist who worked after striking-off more

Reprimand for pharmacist who falsified claim for emergency contraception supply more

Foreign pharmacist's registration granted on second application more

Reprimand for pharmacist who endorsed erroneous scripts for £3,700 overpayment

A Glasgow pharmacist who dispensed a week’s supply of medicines on prescriptions erroneously made out for a month but claimed for the larger quantity has been reprimanded by the Statutory Committee.

At its meeting on 18 February, the committee inquired into the case of Rosemary Stella Telford, of 76 Newton Drive, Newton Mearns, Glasgow. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that between 1 December 1999 and 30 June 2000, while Mrs Telford was manager and pharmacist in charge of McGovern’s Chemist, Houston Square, Johnstone, Renfrewshire, she had operated a system whereby erroneously written prescriptions had been dispensed, without the prescriber having had the opportunity to correct them. Such prescriptions had subsequently been endorsed as if they had been dispensed in full when that was not the case, and the endorsed prescriptions had been submitted to the pharmacy practice division (PPD). As a result, an overpayment of £3,729.81 had been made.

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

Paul Cullen, QC, instructed by Harper Macleod (solicitors), represented Mrs Telford, who was present at the inquiry.

The committee heard that in July 2000 the pharmacy practice division of Renfrew and Inverclyde Primary Care NHS Trust had noticed an unusual pattern of prescriptions being submitted for payment by McGovern’s Chemist. The prescriptions were for elderly patients who used compliance aids for their medicines. It transpired that the initial practice of the prescribing doctors had been to issue prescriptions for a month’s supply of medicines, endorsing the prescription form “dispense weekly”. In late 1999, however, this was changed: prescriptions were issued weekly. However, the prescribers failed to change the quantities ordered on the prescriptions, so each week’s prescription called for a month’s supply. The weekly prescriptions were endorsed by the pharmacy as if the excess quantities had been supplied. The PPD concluded that either the patients were receiving quantities of medicines far in excess of what would be expected or the pharmacy was endorsing and submitting them for payment in respect of quantities that had not been supplied. It was established that that was what had happened. The overpayment resulting was £3,729.91.

Investigation

The PPD fraud investigation unit found no evidence to substantiate a charge of fraud but a number of matters were identified from which it was apparent that Mrs Telford’s dispensing practices had fallen below accepted professional standards. Her practice had been to dispense the medicines without reference to the prescriptions, relying instead on the records kept by the pharmacy with the patients’ medication trays. Nor had she brought the errors on the prescriptions to the prescribers’ attention or had the scripts corrected. The incorrect prescriptions had subsequently been endorsed and submitted for payment.

Mrs Telford admitted she had been working in isolation and had not attended any continuing professional development courses appropriate to compliance aids. The resulting overpayment had since been repaid.

Giving the committee’s decision, the chairman (Lord Fraser of Carmyllie, QC) said that the allegation that erroneously written prescriptions had been dispensed without the prescriber being given the opportunity to correct the error appeared to be only partly true. GPs’ errors of putting monthly quantities on each of four weekly prescriptions had not been drawn to their attention and to that extent the assertion was correct. The committee had initially understood that, in some instances, erroneously written prescriptions had been dispensed to individual patients. If that had been the case, it would have been a serious error, with potentially damaging consequences for patients. In fact, the patients received, in all cases, exactly what the prescriber had intended.

There remained a substantial complaint against Mrs Telford. She had followed practices that were intrinsically defective and made it almost inevitable that claims for payment would be made for supplies that had not in fact been dispensed. This failure on her part to observe proper systems within the pharmacy amounted to misconduct such as to render her unfit to be on the register.

Clearly, said the chairman, one could not have in place a system where, even without fraudulent intent or dishonesty the NHS was at risk of making substantial overpayment on claims submitted by pharmacists.

Mrs Telford had been frank at all stages of the inquiry and had remorsefully faced up to the deficiencies for which she had been responsible.

However, there had been no dishonest or fraudulent intent and there was no suggestion that inappropriate doses had been dispensed; patient safety was never in danger. The systems had been changed and there was no real risk of repetition. Exceptionally supportive character references had highlighted her integrity and her strong commitment to the housebound, frail and elderly.

The committee ordered that Mrs Telford should be reprimanded

Dispensing errors result in reprimand

A pharmacist who had made a series of dispensing errors, following one of which a patient with angina was admitted to hospital, has been reprimanded by the Statutory Committee.

At its meeting on 17 February, the committee inquired into the case of Scott Andrew Lawson, of 22 Greenfield Park, Monktonhall, Musselburgh, Midlothian. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that on 6 February 2002, Mr Lawson had dispensed 28 amitriptyline 25mg tablets on a prescription calling for 28 atenolol 25mg tablets, one to be taken in the morning; the tablets had been labelled as atenolol 25mg tablets. At the time the error occurred, Mr Lawson had been the proprietor, and pharmacist in charge, of Stephensons Pharmacy, 25 High Street, Dunbar. It was also reported that between June 1999 and November 2001 Mr Lawson had received four letters from the Society’s Infringements Committee following dispensing errors that had occurred while he was pharmacist in charge.

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

David Reissner, of Charles Russell (solicitors) appeared on behalf of Mr Lawson, who was present at the inquiry.

The committee heard that the patient who had received the amitriptyline tablets suffered from angina, and atenolol was one of the medicines she was prescribed regularly. She started to take the amitriptyline tablets from about 17 February and on 22 February she saw her GP, complaining of chest pains. On 24 February the patient was admitted to hospital because of continuing chest pains and discharged after three days. The dispensing error was identified two weeks later during a visit to her doctor.

Mr Lawson had admitted he had been the pharmacist responsible for checking the prescription.

Warning letters

The first warning letter had been sent to Mr Lawson on 29 June 1999 concerning the transposition of labels on thioridiazine tablets and penicillin.

The second letter, sent on 3 March 2000, was about an error made on 3 February 2000, when labels for simple linctus and Betnovate ointment had been transposed.

A third letter had been sent on 7 June 2001 in respect of an error in December 2000, when Kliofem tablets had been supplied against a prescription for Kliovance tablets.

The fourth letter, sent on 1 November 2001, had concerned the supply in August 2001 of six lots of Loestrin 20 tablets and one lot of Loestrin 30 tablets when seven lots of Loestrin 20 tablets had been ordered. In each case, one of the Society’s inspectors had visited the pharmacy and made suggestions to Mr Lawson as to how to improve his dispensing procedures.

Giving the committee’s decision, the chairman (Lord Fraser of Carmyllie, QC) said that the angina suffered by the patient who had received amitriptyline instead of atenolol had been brought on again as a result of the wrong medication, or at least aggravated by the error. Mr Lawson had admitted that he was the pharmacist responsible for checking the medicines and that he had not done so accurately.

Mr Lawson had made no attempt to conceal his involvement in the error but explained that he had undergone painful dental surgery earlier that day. He had acknowledged that, although systems were in place, there had been a significant lapse of concentration on his part. The committee found the dispensing error proved.

The four previous dispensing errors for which he had had written warnings were not identical but the present error had to be set in the context of those earlier warnings. It amounted to misconduct such as to render Mr Lawson unfit to be on the register. However, there was evidence from the Society’s inspector for the area that Mr Lawson had been running a tidy, well laid out pharmacy. He had co-operated with her throughout this and the earlier incidents. Additionally, he had a good set of references. He had now sold the business.

Mr Lawson appeared to have undergone a crisis of confidence in his own ability as a pharmacist, said the chairman. In the committee’s experience, such a lack of confidence could lead to dispensing errors quite as readily as overconfidence and an unduly casual attitude. He would need to work hard on recovering his confidence, coupling that with concentrating on the task in hand to avoid any further errors.

The committee ordered Mr Lawson to be reprimanded

Admonition for pharmacist who worked after striking-off

The Statutory Committee has admonished a pharmacist who worked as a locum on 43 occasions after her name had been removed for non-payment of fees. Pharmacists were warned of the potential consequences of continuing to practise after their name had been removed.

At its meeting on 17 February the committee inquired into the case of Stella Mary Kalembe Zikulabe Luwaga, of 19 Grace Path, Sydenham, London SE26. A complaint had been received from the Council of the Royal Pharmaceutical Society that, although Mrs Zikulabe Luwaga had been struck off the register on 14 May 2001 for non-payment of her retention fee, she had been employed as a pharmacist on 43 occasions between that date and 27 October 2001.

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

Mrs Zikulabe Luwaga attended the inquiry; she represented herself.

The committee heard that in December 2000 Mrs Zikulabe Luwaga had left the United Kingdom to visit Ghana. The customary request for payment of retention fees was sent to her registered address at the time, in London. A reminder was sent by recorded delivery on 12 March 2001 advising her that her name would be removed in two months if her fee remained unpaid, and also of the penalty payable for restoration in addition to the retention fee. There was no response and her name was duly removed on 14 May. Mrs Zikulabe Luwaga was advised of the removal by letter to her registered address in London.

On her return from Ghana in June 2001 Mrs Zikulabe Luwaga was unable to gain access to her original (registered) address. She obtained locum employment through an agency at a number of pharmacies in the London area. The fact that she was no longer on the register came to light when one of her employers queried her qualification with the locum agency. Her name had been restored on 29 April 2002 after retention and penalty fees had been paid.

Giving the committee’s decision, the chairman (Lord Fraser of Carmyllie, QC) said Mrs Zikulabe Luwaga had openly admitted working as a locum on 43 occasions while she was not registered. She had apologised to the committee and explained that although she knew she would have to pay a penalty she had not appreciated that she would be struck off. That appeared to show some naivety on her part, said the chairman, but the committee was satisfied that she had not worked deliberately knowing that she was no longer on the register nor with any intent to deceive.

The committee ordered Mrs Zikulabe Luwaga to be admonished.

The chairman added that pharmacists must appreciate that a failure to pay the retention fee, leading to removal from the register, and then continuing to work might have the consequence of invalidating their professional liability insurance. There could, in such a case, potentially be serious consequences for the public if, for example, a dispensing error were made. The committee would take a dim view if that were to happen and the pharmacist was knowingly off the register and continuing to practise.

Reprimand for pharmacist who falsified claim for emergency contraception supply

A pharmacist who had “let down the profession” by making a “grubby” falsified claim for the emergency supply of contraception has been reprimanded by the Statutory Committee.

At its meeting on 19 February the committee inquired into the case of Sarwan Dass Samrai, of “Woodvale”, Vale Avenue, Walsall. Mr Samrai owns a pharmacy at 57a Holyhead Road, Wednesbury, and is the superintendent pharmacist, director and majority shareholder of Samrai Chemists Ltd, which owns a pharmacy at 71 Walsall Road, Darlaston. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mr Samrai had submitted falsified documents to Sandwell Health Authority for the purposes of claiming payment to which he was not entitled.

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

Mr Samrai was present at the meeting; David Reissner, of Charles Russell (solicitors) appeared on his behalf.

The committee heard that the case involved the supply of emergency contraception under patient group direction (PGD) by Sandwell HA and Walsall HA. The Darlaston pharmacy was in the area of Walsall HA and the Wednesbury pharmacy was in the Sandwell area. On 1 September 2001 Sandwell HA had introduced a scheme for the supply, by an accredited pharmacist in a pharmacy in its area, of emergency hormonal contraception to women aged 18 and under. In August 2000, Walsall HA had introduced a similar scheme, with the difference that the supply could be made to women of any age.

The pharmacist employed at the Darlaston pharmacy was not accredited under the Walsall emergency supply scheme until December 2001. Before that, he had informed Mr Samrai that he was having to refuse requests for emergency contraception as he was not accredited. Mr Samrai had told him to supply the contraceptive tablets using Sandwell HA forms to certify the supply and that he (Mr Samrai) would take care of the matter. The pharmacist accordingly made supplies on 25 and 28 October and 2 and 7 November. On 25 October, Mr Samrai himself had made a supply from the Wednesbury pharmacy in respect of which he completed a Sandwell HA form.

On 29 November, Mr Samrai had submitted to Sandwell HA a claim for payment in respect of the client supplied by the Wednesbury pharmacy and the four clients supplied by the Darlaston pharmacy, which was not in the Sandwell area. He had also sent in the protocols for the supplies; those should have been kept in the pharmacy.

The forms for the Darlaston pharmacy had had the pharmacy stamp obliterated and the Wednesbury stamp superimposed. The ages of the Darlaston clients had also been changed to 17 or 18 when in fact all those clients had been over the age of 18. Mr Samrai had also altered the age for the client he had seen at Wednesbury.

Giving the committee’s decision, the chairman (Lord Fraser of Carmyllie, QC) said that Mr Samrai had admitted what he had done. The claim he had made was false: the four patients seen at Darlaston were not the responsibility of Sandwell HA and the fifth patient was over the age limit imposed by Sandwell. Mr Samrai had known that he would only be compensated for consultation and contraception supplied to women under 18, otherwise he would not have altered the date of birth.

It was, in fact, unnecessary for Mr Samrai to have submitted the protocols but he had done so and it was clear they had been falsified, with a view to claiming payment.

The chairman said that the introduction of the emergency hormonal contraception scheme was an important development in pharmacy, allowing pharmacists to take part in both prescribing and dispensing. It was exceptionally disappointing for the committee to have before it a pharmacist who engaged in “this grubby, albeit relatively small” falsifying claim under the scheme. The scheme had been introduced not without some national controversy and the committee was dismayed that the profession had been let down in this way. It would maintain a close scrutiny on the responsible participation of pharmacists in the scheme and would take a stern view of any substantial abuse of the trust vested in the profession under it.

The committee ordered Mr Samrai to be reprimanded.

Foreign pharmacist's registration granted on second application

The Statutory Committee has granted a Nigerian pharmacist’s application for registration in Britain, having refused an earlier application because she had made claims for income support to which she was not entitled.

At its meeting on 18 February, the committee considered an application for registration as a pharmaceutical chemist by Valerie Onoriode Esievo, of 94 Burrow House, Stockwell Park Road, London SW9.

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

David Reissner, of Charles Russell (solicitors) appeared on behalf of Ms Esievo, who was present.

The committee heard that Ms Esievo was a pharmacist from Nigeria who had come to the United Kingdom as an asylum seeker in 1995. She had passed the overseas pharmacists examination, completed 12 months’ approved employment and passed the Society’s registration examination. However, her previous application for registration in 2000 had been refused after the committee learnt that she had made false declarations to the Department of Social Security between July 1998 and 1999 in support of claims for income support to which she was not entitled (PJ, 24 June 2000, p947). Since that inquiry, she had been convicted of the matters that had been the subject of the misconduct allegation and sentenced to 60 hours of community service.

Giving the committee’s decision, the chairman (Lord Fraser of Carmyllie, QC) said Ms Esievo had repaid the amount she had falsely claimed and accepted that what she had done was a bad thing. She had been upset by the shame it had brought on her family and had clearly taken steps to demonstrate an improvement in her moral attitude towards the responsibilities of life.

Ms Esievo’s application for registration was granted.