Statutory Committee

Striking-off for false NHS claims more

Restoration granted to man who was convicted of fraud more

Committee criticises penalty limitations of its “curious” regulations more

Pharmacist was under the influence of drink in charge of pharmacy more

Pharmacist altered prescriptions for own use more

Restoration allowed after second application for man struck off for Viagra offences more

Striking-off for false NHS claims

A pharmacist who falsely claimed payment on NHS prescriptions has been struck off the register on the order of the Statutory Committee.

On 24 February, the committee inquired into the case of Lay Ean Cheah (formerly Atkinson), of Tanjong Bungah, Penang 11200, West Malaysia, Malaysia. Information had been received that on 5 December 2002, at Derby Crown Court, Mrs Cheah had pleaded not guilty but had been convicted on 15 charges of false accounting. She had been fined a total of £3,000 and ordered to pay £17,142 costs.

Kristina Stern, of counsel, instructed by Penningtons (solicitors), appeared on behalf of the Royal Pharmaceutical Society.

Ms Cheah attended the hearing; she was not represented.

Giving the committee’s decision, the chairman (Lord Fraser of Carmyllie, QC) said that the 15 offences were all under section 17(1)(A) of the Theft Act 1968, under which an essential ingredient of an offence was dishonesty, rather than negligence or sloppy practice.

At Ms Cheah’s trial, noted the chairman, the judge had said: “The NHS, through the Prescription Pricing Authority, trusts pharmacists, as professionals, to account for the monies to which they are entitled through endorsements on prescriptions forms.” As a result of incorrect claims by Ms Cheah, the PPA had conducted an investigation and she was indicted on 21 counts. After a trial lasting six days, the jury returned guilty verdicts on 15 of them. Although the sums involved were not large, they demonstrated that Mrs Cheah, “already well remunerated” had been prepared to resort to dishonesty to obtain further reward, said the judge. That was serious dishonesty, because of the breach of trust Ms Cheah had as a professional person.

Lord Fraser said the conviction had been proved. The committee regarded the offences as being so serious that it could not avoid consideration of whether Ms Cheah should be removed from the register.

Notwithstanding a number of very good references on Ms Cheah’s behalf, in the circumstances, and in light of the observations of the trial judge, the committee directed that Ms Cheah should be struck off.

She had three months in which to appeal.

Restoration granted to man who was convicted of fraud

The Statutory Committee has restored to the register the name of a man removed from the Register of Pharmaceutical Chemists after his conviction for fraud offences.

At its meeting on 26 January, the committee heard the application for restoration from Fraser Oswin Smith, of 71 Crowhill Road, Bishopbriggs, Glasgow, whose removal from the register had been ordered at its meeting on 15 November 2000 (PJ, 14 April 2001, p503).

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

Susan Hunneyball, of Charles Russell (solicitors) represented Mr Smith, who attended the hearing.

The chairman (Lord Fraser of Carmyllie, QC) said that since Mr Smith’s striking-off he had returned to university, gained a master’s degree and found employment with a pharmaceutical company. His offence had taken place when he was a relatively young man and the committee was confident that he had well and truly learnt his lesson.

Mr Smith’s application for restoration was granted.

Committee criticises penalty limitations of its “curious” regulations

The Statutory Committee has decided to take no further action in the case of a pharmacist who made a dispensing error after insisting that Temgesic (buprenorphine) and fentanyl were the same medication. The patient concerned had become ill after taking the Temgesic supplied on a prescription for fentanyl.

The committee criticised the fact that it was unable to impose any penalty if it did not consider a pharmacist’s conduct was such as to render him unfit to be on the register.

At its meeting on 26 January, the committee inquired into the case of Clive Ivor Hodgson, of 55 Hemingford Gardens, Leven Park, Yarm, Cleveland. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mr Hodgson, while pharmacist in charge of Sunningdale Pharmacy, Sunningdale Drive, Eaglescliff, Stockton-on-Tees, had dispensed 12 Temgesic 0.2mg tablets against a prescription calling for six fentanyl lozenges. He had advised the patient before the medicines were dispensed that Temgesic tablets were the same medication as fentanyl lozenges. Subsequently, he had also given that advice to the patient’s mother.

Geoff Hudson, of Penningtons (solicitors), appeared for the Council to present the facts of the case.

Mr Hodgson, who attended the inquiry, was represented by Sara Morgan, of Brooke North (solicitors).

The committee heard that on 31 March 2003, a patient suffering from acute pancreatitis presented a prescription at the pharmacy which called for six fentanyl 400mg lozenges. Mr Hodgson had explained that he had not got fentanyl 400mg in stock and suggested she could be given twice the amount of fentanyl 200mg instead.

However, he then told the patient he did not have fentanyl 200mg in stock either and said he could give her Temgesic (buprenorphine) 0.2mg, which, he said, was “the same medication”. The patient asked him to confirm this, which he did, and told her Temgesic should be taken in the same way as fentanyl lozenges. He then dispensed 12 Temgesic 0.2mg tablets, labelled “two to be taken as directed”.

The patient did not take any Temgesic until 8 April, when she wakened at 3am, took a dose, and slept until 6am. She awoke shaking, sweating, feeling faint and vomiting and felt unwell until about 5pm.

During that day her mother had contacted the patient’s doctor and been told that Temgesic and fentanyl were different medicines. When she telephoned Mr Hodgson to query this, however, he had said they were the same, being different brands of the same drug. On being told the doctor had said they were different, he said he would find the prescription and phone her back.

When he telephoned, Mr Hodgson admitted he had made an error and apologised.

Giving the committee’s decision, the chairman (Lord Fraser of Carmyllie, QC), said that a deliberate error had been admitted by Mr Hodgson. It had not, however, been an error made in circumstances from which he would have derived any possible gain. Over a lifetime, Mr Hodgson had been an exemplary pharmacist; that had been confirmed by the fine references provided for him. After the event, he acted impeccably in apologising and taking steps to assist the patient as best he could.

The committee did not consider it was an error such as would render him unfit to be on the register. As that was the case, the committee had no option other than to take no further action against Mr Hodgson.

The chairman commented that the committee was not happy about the “curious “ way its regulations were framed. If it could not conclude that an error was one such as would render a pharmacist unfit to be on the register, that constituted a “hurdle” preventing it from taking a less severe course.

Lord Fraser continued: “Unless we surmount that hurdle, we do not even have the opportunity to reprimand or admonish a pharmacist. I have come to the very clear view, supported by the committee, that we shall ensure that if that hurdle is to be surmounted, we have a sound base on which to do it.”

The chairman indicated that he would set out the committee’s reasons for its decision at a future date.

Returning to the matter at the committee’s meeting on 19 July, Lord Fraser said that, on reflection, the case raised no point of principle and no further elaboration of the earlier decision was required.

Pharmacist was under the influence of drink in charge of pharmacy

A Swindon pharmacist who had been in charge of a pharmacy while under the influence of drink has had her case adjourned.

At its meeting on 25 February, the committee inquired into the case of Jyoti Amritlal Thakore, of 16 Edgar Row Close, Wroughton, Swindon, Wiltshire. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that on 30 January 2003, while pharmacist in charge of Knights Chemists Ltd, Burchester Place, Grimsbury, Banbury, Oxfordshire, Mrs Thakore had consumed alcohol and been unfit to be in charge. Similar allegations were made in respect of her behaviour on 15 May 2003.

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

Mrs Thakore was present, represented by Sam Flew, of RadcliffesLeBrasseur (solicitors).

The committee heard that on the first date, one of the pharmacy assistants had noted that Mrs Thakore had been acting strangely and out of character. Then on 15 May, Mrs Thakore had smelled of alcohol when she arrived at the pharmacy and had been uncharacteristically rude to the same assistant, as well as behaving inappropriately towards customers.

Later that day, the company’s superintendent pharmacist had asked Mrs Thakore whether she had been drinking that day. After initially denying this, she admitted she had been drinking and that she had a drink problem. When told she would be dismissed and asked to leave the premises, she became aggressive, began to ask a passer-by for money to pay for a taxi and then attempted to obtain a lift, offering her wedding ring as payment.

Interviewed by one of the Society’s inspectors on 31 July, Mrs Thakore had admitted consuming alcohol while in charge of the pharmacy on 30 January and being on duty when unfit to be in charge on that date and also on 15 May.

The chairman (Lord Fraser of Carmyllie, QC) said that Mrs Thakore had been open and frank in her admissions of past alcoholism. Being under the influence of alcohol in a pharmacy was thoroughly unprofessional conduct and Mrs Thakore’s behaviour had demonstrated that she was unfit to have her name on the register. “In future,” continued the chairman, “we would hope at this stage to pass the case to a health committee.” As such a committee had not yet been established, however, the Statutory Committee had to deal with it.

Mrs Thakore’s evidence, and that of her health counsellor, had been compelling. Since 15 May 2003 she had been abstinent and the strong indications were that a relapse was unlikely. But as only nine months had elapsed since she last consumed alcohol the case would be adjourned for a year. During that time, Mrs Thakore would be required to keep in regular contact with her counsellor, undergo blood tests every three months and keep to her existing, limited, number of days’ work each week. At the end of the year, the committee would wish to see a letter from her current employers confirming her suitability for employment.

Mrs Thakore had come close to having her name removed from the register, the chairman continued, but the committee regarded it as appropriate to give her the opportunity to maintain her freedom from alcohol. If the conditions laid down had been adhered to, at the end of the year the committee hoped to be able to conclude the case by administering a reprimand.

Pharmacist altered prescriptions for own use

An inquiry into the case of a pharmacist who altered prescriptions for medicine prescribed for her own use so as to increase the quantities ordered has been adjourned by the Statutory Committee.

At its meeting on 25 February, the committee inquired into the case of Beryl Wyn Jones, of “Moranedd”, Lon Gorad, Yfali, Holyhead, Gwynedd. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that Mrs Jones had altered a prescription written for her on 11 March 2003 by changing the quantity of tramadol 50mg capsules from 28 to 160. It was also alleged that she had altered the quantity of tramadol 50mg capsules on a prescription written for her on 9 April 2003 from 60 to160.

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

David Garside, of counsel, instructed by Talfryn Griffith (solicitor) appeared on behalf of Mrs Jones, who attended the hearing.

The committee was told that Mrs Jones had, in each case, altered the quantity ordered on the prescription and marked the alteration with the initials of the prescriber. She had then had the altered prescription presented to the pharmacy at which she was the manager, where it was dispensed. Mrs Jones herself had not been personally involved in the dispensing.

On 23 April 2003, Mrs Jones had told her doctor that she had “done a foolish thing”, having altered the 9 April prescription. She said she had been confused and anxious at the time. The doctor had later told one of the Society’s inspectors that he was puzzled as to why she had altered the prescription. Had she asked for a larger number of tablets he would, in view of her apparently stable mental condition at the time, have agreed to the request.

In an interview with the inspector on 9 July 2003, Mrs Jones had admitted the alterations and having had the prescriptions dispensed.

The chairman (Lord Fraser of Carmyllie, QC), giving the committee’s decision, said it was a serious matter for a pharmacist to alter the prescriber’s quantities on a prescription, as Mrs Jones had admitted having done. The committee, he said, was troubled by the case. There were odd features about it and they could not wholly understand Mrs Jones’s motivation or her mental state.

The inquiry would be adjourned for a year. During that time, Mrs Jones was advised to observe the following conditions. She should be careful not to work under stressful conditions and if her health was not of the best, she should take time off until she was wholly fit. When she returned to the committee, she should produce evidence that she was completely free from any addiction; blood tests could be appropriate for this. Finally, she should present a report from her own doctor and a psychiatric report that she was a fit and proper person to be able to continue in the profession of pharmacy.

If those conditions were fulfilled, Mrs Jones could expect that the case would be dealt with by way of a reprimand. But if anything further, or adverse, was reported, the committee might have to resort to a much more serious course of action, Lord Fraser warned.

Restoration allowed after second application for man struck off for Viagra offences

An application for restoration to the Register of Pharmaceutical Chemists by a man who had been struck off for a series of offences involving the supply of Viagra (PJ, 7 September 2002, p343) has been allowed by the Statutory Committee.

At its meeting on 23 February the committee heard the application from Shirazali Rajabali Jetha Panjawani, of 120 Golders Green Road, London NW11.

Geoff Hudson, of Penningtons (solicitors), represented the Royal Pharmaceutical Society at the hearing.

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

A previous application for restoration had been heard on 21 January 2003; it had been disallowed as “premature”.

Lord Fraser of Carmyllie, QC, the chairman, giving the committee’s decision, said that in refusing the earlier application, it had ruled that if Mr Panjawani were to come back in a year’s time — still less than the two years’ which was the lower limit of the norm for applications for restoration — the committee would look favourably on his restoration.

It was now 13 months after that first application for restoration; nothing adverse had come to light during that period.

Mr Panjawani’s application for restoration to the register was granted.