Statutory Committee

Pharmacist reprimanded for unlawful MST supply more

Drink and drugs case adjournment subject to a range of conditions more

Reprimand for allowing unsupervised supply of CDs more

Contravention of CD instalment instructions leads to reprimand more

Former dihydrocodeine addict receives reprimand more

No further action taken in case arising from error in injection supply more

Decision postponed to allow pharmacist to tackle his “weaknesses” more

Pharmacist reprimanded for unlawful MST supply

The Statutory Committee has reprimanded a pharmacist who continued making a weekly supply of MST Continus 10mg tablets to a patient for several weeks after her GP stopped prescribing the product.

At an inquiry on 10 August 2004, the committee looked into the case of Peter Howard Freeman, of 14 Gateland Drive, Leeds. On 19 February 2004 Mr Freeman had been convicted of one offence of supplying a prescription-only medicine other than in accordance with a prescription from an appropriate practitioner. He had been fined £1,000 and order to pay costs of £4,000.

The committee heard that Mr Freeman was superintendent pharmacist of P. H. Freeman Ltd, which owned and ran Holbeck Pharmacy at 5a Shafton Lane, Holbeck, Leeds.

For some time in 2002 the pharmacy dispensed prescriptions for MST Continus for an elderly patient and by October 2002 the prescription had stabilised to 21 tablets of 10mg tablet weekly, with a dose of one tablet three times a day as required. After a last prescription dated 26 November 2002, the patient’s doctor stopped prescribing the drug. However, Mr Freeman’s pharmacy continued to supply 21 MST Continus 10mg in the patient’s weekly monitored dosage system (MDS) tray until February 2003, when the mistake came to light. By then the patient had accumulated 107 unused tablets.

The committee was told that the pharmacy supplied about 100 patients on a weekly basis using MDS trays. The trays were prepared in accordance with a pharmacy record card rather than against the original prescription and Mr Freeman was in the habit of checking the trays without having the prescription in front of him.

Serious procedural error

Giving the committee’s decision, the chairman, Lord Fraser of Carmyllie, QC, said that Mr Freeman’s conviction arose from a serious procedural error, but it was the only occasion on which he had been asked to include a Controlled Drug in an MDS tray. He had been upset by what had happened and had taken steps to change the process. He offered no excuses, he had been fully co-operative and he had faced a heavy fine and costs. He also had excellent references, including one from the GP spouse of the doctor who had first raised the matter.

In all the circumstances, said the chairman, the committee would restrict its sanction to a reprimand.

The chairman went on to say that his pharmacist colleagues on the committee had misgivings about the practice of including “as required” drugs in MDS trays, and he would return to the matter at a later date.

Resuming the committee’s decision on 10 October, the chairman said that the committee’s consideration of the case had revealed a problem that, post-Shipman, required careful thought. MDS trays had their advantages, but the Society and the profession “should reflect long and hard on the practice of including within an MDS tray a drug to be taken at will or as required.” The problem was exacerbated when the drug in question was a CDs.

Drink and drugs case adjournment subject to a range of conditions

The Statutory Committee has adjourned for 12 months an inquiry into the case of a pharmacist with a drink and drug problem, subject to her acceptance of a range of conditions.

Lesley Georgina Day, of 14 Larkins Close, Baldock, Hertfordshire, will have to see a psychiatrist, attend Alcoholics Anonymous meetings and keep in touch with the Royal Pharmaceutical Society’s support co-ordinator and drug treatment centre. She will be tested for drugs and alcohol at random and also if there is any suspicions of a relapse. Any adverse reports would mean her having to stop working as a pharmacist.

Theft of drugs

At an inquiry on 11 August 2004, the Statutory Committee heard that Ms Day had admitted that on various dates in 2002 while she was working in a Tesco pharmacy in Royston, Hertfordshire, she had stolen temazepam tablets and Prozac capsules. She had also admitted that on various dates in 2003 while working in a pharmacy in Bedford she had stolen co-codamol tablets and propranolol, she had consumed stolen co-codamol and propranolol while on duty and she had dispensed Fenactol 100mg SR tablets against a prescription for Fenactol 75mg SR tablets.

Ms Day told the hearing: “My drinking started to be a problem when my husband and I moved to Watford in the early 1990s. He was working all the time and I was left alone with the children and that is when I started drinking on a daily basis.” The relationship deteriorated further when her son was in a road accident. She wanted to stop work to care for him but her husband told her they needed her wages. Her problems grew when she was sacked from a job as a Boots pharmacist and her elder son began taking drugs after the death of a close friend.

The mother of two said: ‘Every time I became fearful of life my drinking would go up a notch. One day when I was working in Tesco a lady came in a returned some temazepam and I put them in my pocket. I then started taking them from Tesco. I took them on the way home from work before I started drinking and took more throughout the night as and when I woke up.”

Ms Day was subsequently admitted to a drug treatment centre and joined Alcoholics Anonymous. Her recovery ended following the breakdown of her relationship with her second husband.

She then began stealing from the Bedford pharmacy. The owner spotted her on closed circuit television taking co-codamol and propranolol tablets from their packets and putting them in her handbag. She was also seen to trying to obscure the camera with Blu-Tack and a marker pen. The pharmacy owner sacked Ms Day and contacted the Society but she did not report the matter to the police because she only wanted Ms Day to get help.

Ms Day told the hearing: “I still see the CCTV footage in my mind’s eye every single day and I am still shocked just how much an addiction can affect your life. I was totally out of control and should not have been at work.”

Giving the committee’s decision, the chairman, Lord Fraser of Carmyllie, QC, said that if Ms Day agreed to a range of conditions her case would be adjourned for 12 months to check on her progress.

He said: ‘If there are any adverse reports she will cease forthwith from working as a pharmacist. She will place herself under the medical supervision of a consultant psychiatrist and agree to attend all appointments with him. She will also undergo random drugs tests and tests for alcohol at least six times a year. She will also agree to waive her confidentiality so the psychiatrist can provide the Society with his reports.

“She must also agree to attend meetings of Alcoholics Anonymous on a regular basis. She must also keep in contact with the Society’s support co-ordinator and the drug treatment centre.”

Ms Day must also agree to be tested by the support co-ordinator if he had any suspicions of a relapse.

Turning point

Lord Fraser added: “The turning point in this case appears to be the occasion when Ms Day saw her own conduct on the CCTV videos. She was so shocked that this sent her down a course of giving up all alcohol and drug abuse. She has not had a drink since 9 May 2003 and not abused any drugs since 19 September 2003.”

The Society’s support co-ordinator, Joe Mee, earlier told the hearing that he believed Ms Day was “on course for a lifetime recovery”.

Reprimand for allowing unsupervised supply of CDs

A pharmacist whose unqualified and unsupervised wife handed out prescription only medicines, including Controlled Drugs for addicts, has been reprimanded by the Statutory Committee. On Tuesday 10 August 2004, at an inquiry resumed from 18 May 2004, Hemantkumar Chandulal Patel, of Tip Northwoods, 57 Loampit Hill, Lewisham, London SE13, was told that he had “sailed dangerously close” to having his name removed from the Register of Pharmaceutical Chemists.

Mr Patel admitted failing to ensure there was a pharmacist in control on 13 May 2002 at his pharmacy in Lewisham when eight prescriptions were handed out to six patients. The medicines included CDs for two heroin addicts.

He also accepted that he had not corrected lies told by his wife Ela to a Royal Pharmaceutical Society inspector.

Prosecuted

The committee heard that Mr and Mrs Patel had both been prosecuted. Mr Patel had been given a conditional discharge after pleading guilty to five offences relating to the supply of POMs by unsupervised and unqualified staff. Mrs Patel was fined £1,500 and ordered to pay £4,500 costs after pleading guilty to aiding and abetting and procuring the unlawful supply of POMs.

The committee was told that an inspector had visited Mr Patel’s pharmacy on 13 May 2002, after an anonymous tip-off. He spoke to Mrs Patel, who gave the name of a locum pharmacist whom she said had been there on the day.

Mr Patel was working at a pharmacy in Beckenham at the time. Mrs Patel later told him about the deception. But he did not contact the inspector to set the record straight.

Mrs Patel also contacted the locum she had named and got him to agree to say he had been present. She gave him a cheque for £148 for the shift he was supposed to have worked, signed by her husband.

Mr Patel told the hearing he had given instructions to his wife and another member of staff not to open the pharmacy if the pharmacist did not turn up. He added: “I just trusted my wife. I didn’t check with the locum that he would be there that day. I accept I should have done this.”

Mrs Patel told the committee: “I thought I had booked him for that day and I just panicked when he didn’t turn up. My husband was very angry when he found out I had opened the pharmacy. I was trying to call other locums but then gave up.”

Mr Patel said he did not come clean to the inspector because he did not want to get the locum pharmacist into trouble. But the cover-up came to light when the locum became concerned and contacted the Society’s inspector, whom he had initially misled, to reveal the truth.

Tissue of lies

Giving the committee’s decision, the chairman, Lord Fraser of Carmyllie, QC, said that the committee was not satisfied that Mr Patel had made it as clear as he could have to his wife that she should never dispense medicines without a pharmacist being in control. He knew his wife had told a tissue of lies to the inspector and that, the inspector having been misled, he would have nothing to answer for.

Mr Patel had sailed dangerously close to having his name removed from the register. However, the committee was satisfied it had been a one-off incident and that Mr Patel now had in place an improved regime to ensure a pharmacist was always present when medicines were dispensed. Mr Patel would receive a reprimand.

Contravention of CD instalment instructions leads to reprimand

A pharmacist who on a number of occasions dispensed several days’ supply of Controlled Drugs to addicts in contravention of the directions on instalment prescriptions has escaped being struck off.

In an inquiry on 10 August 2004 into the case of Mohamed Rajabali Kanani, of 131 Arnold Road, Bestwood, Nottingham, the committee determined to issue a reprimand, although in other circumstances it would have ordered a striking-off.

The committee heard that at Nottingham magistrates’ court on 20 January 2003, Mr Kanani had pleaded guilty to five charges of supplying class A drugs other than in accordance with the directions given on an instalment prescription and three charges relating to his failure to make records in a Controlled Drugs register. He was fined a total of £2,250 and ordered to pay costs of £55.

On 28 April 2004, at Nottingham Crown Court, Mr Kanani was given a 12-month conditional discharge after pleading guilty to unlawfully supplying a class C drug, buprenorphine.

The committee was told that the five charges in 2003 related to two addicts. One man should have received eight methadone tablets daily but on one occasion was given a week’s supply in one batch and on two other occasions was given five days’ supply. The second addict should have received 35ml of methadone solution daily but on two occasion was allowed to have three days’ supply.

Too close to addicts

Mr Kanani, who owns the Forest Pharmacy at 131 Arnold Road, Bestwood, Nottingham, told the hearing he had “got too close” to the two addicts. The first had asked for early supplies because he needed to go and care for sick relatives. “He was at his wits’ end and was threatening to get heroin off the street if he did not get his supply of methadone,” said Mr Kanani.

The other asked for additional supplies because he needed to go away to work. His partner had just given birth and he had been desperate to earn extra money to increase their income.

Mr Kanani admitted that he had failed to make proper entries in the register because he was under “a lot of pressure”. He claimed the business had been badly hit by another pharmacy opening nearby.

In relation to the 2004 court appearance, the committee heard that it arose from the dispensing of a week’s supply of buprenorphine to a woman who claimed she was going on holiday. She was given 21 tablets on 11 July 2003 instead of 12 on 14 July and a further nine on 18 July. The committee heard that Mr Kanani had received a fax from the addict’s key worker which led him to believe that a revised prescription would be sent, but it never arrived. Furthermore, the patient’s doctor said he would have authorised a week’s supply if asked.

A Royal Pharmaceutical Society inspector who visited Mr Kanani’s pharmacy in July 2004 told the committee there had been a “sea change” in his attitude. She did not have any worries about him now and he appeared to have learnt his lesson.

Giving the committee’s decision, the chairman, Lord Fraser of Carmyllie, QC, said: “Instalment prescriptions are allowed and are in place for a good reason, namely that addicts should only get what they need for the period in question, for example, over the weekend. This is to avoid drugs leaching out into the community or being sold illegally or the addict taking more than is necessary for him.”

He warned that pharmacists who broke the law laid themselves open to being blackmailed by unscrupulous and manipulative drug users.

The chairman said that in ordinary circumstances the committee would have been minded to order a striking-off but in this case mitigating circumstances allowed it to restrict its sanction to a reprimand. “But Mr Kanani must appreciate that if he does not observe what is set out in instalment prescriptions in the future, he cannot expect us to take such a lenient view of matters.”

Former dihydrocodeine addict receives reprimand

A pharmacist who beat an addiction to dihydrocodeine was reprimanded by the Statutory Committee at its meeting on 10 August 2004.

The inquiry into the case of James Clark, of 73 Corporation Road, Darlington, County Durham, had been resumed from 13 August 2003, when the committee determined to adjourn the case for 12 months. The committee had requested Mr Clark to provide the results of four urine tests to the Royal Pharmaceutical Society (PJ, 29 May 2004, p688) over that period.

At the resumed hearing, the committee heard that urine test results in October 2003 and in March, May and July 2004 had all been negative. In addition, one of the Society’s inspectors had visited Mr Clark in November 2003 and July 2004 and had nothing adverse to report.

Giving the committee’s decision, the chairman, Lord Fraser of Carmyllie, QC, recalled that at the first hearing he had said that if nothing adverse was reported Mr Clark would be entitled to expect no more than a reprimand when the case was resumed.

In the circumstances, said the chairman, the committee would therefore conclude the case by administering a reprimand.

No further action taken in case arising from error in injection supply

A pharmacist who denied making an error after supplying over-sized syringes of an anticoagulant has been found guilty of misconduct by the Statutory Committee, which decided to take no further action.

In an inquiry on 11 August 2004 into the case of George David John Beynon, of Fosse, Shrubbery Road, Ketley Bank, Telford, Shropshire, the committee heard that a patient had been prescribed 10 0.2ml syringes of Clexane by her doctor, but Mr Beynon supplied 1ml syringes. When the patient noticed the error and returned to the pharmacy, he denied making an error. He allegedly pretended to telephone the doctor and then advised the patient to use only 0.2ml from each syringe and throw away the rest. He told her the 0.2ml product was not available.

Mr Beynon admitted to the committee that he had made a dispensing error at Alexanders Pharmacy, 52-53 Peris, Plas Madoc, Acrefair, Wrexham, on 17 September 2003. He also admitted that when the patient returned he had denied the error and claimed that another patient was using the 1ml syringe because he could not obtain the 0.2ml version.

Expensive and clumsy

delivering the committee’s decision, the chairman, Lord Fraser of Carmyllie, QC, said that, although advising patients to use 0.2ml from a 1ml syringe was an expensive and clumsy way to dispense, it was not erroneous, in that the advice would lead to the patient receiving the volume prescribed.

On the claim that Mr Beynon had pretended to phone the woman’s doctor to confirm that the prescription was correct, the chairman said that the allegation could not be resolved because of confusion over the dates.

Concluding, the chairman said that, although it was misconduct, the single dispensing error was not sufficient to render Mr Beynon unfit to be on the register. The committee would therefore take no further action.

Decision postponed to allow pharmacist to tackle his “weaknesses”

A drink-driving pharmacist who also made a dispensing error that put a patient into hospital for several days has been given 12 months by the Statutory Committee to tackle his “weaknesses”.

On 20 September 2004, the committee inquired into the case of Rajiv Kumar Sarna, of West Lodge, Erlwood Manor, London Road, Windlesham, Surrey.

Driving offences

The committee heard that Mr Sarna had been convicted of driving offences on three occasions.

The first conviction was for the offence of driving a motor vehicle while under the influence of alcohol, for which he had been fined £1,800, ordered to pay costs of £750 and disqualified from driving for two years. On that occasion an accident had also occurred and personal injury was caused. Mr Sarna had been fined £865 for failing to stop after an accident and ordered to pay compensation of £200. He appealed against these convictions but his appeal was dismissed.

The second occasion was a conviction for driving while while having 68µg of alcohol in 100ml of breath, contrary to the Road Traffic Act. For that Mr Sarna was fined £800, was ordered to pay costs of £69 and was disqualified from driving for three years. After he satisfactorily completed a drink-driving rehabilitation course the disqualification period was reduced by nine months.

On the third occasion, Mr Sarna was convicted of driving a vehicle on the road while disqualified from holding or obtaining a driving licence. He also had no appropriate insurance.

In addition, the committee considered a complaint from the Council of the Royal Pharmaceutical Society about a dispensing error in May 2003. In response to a prescription for 28 bisoprolol tablets, to be taken one daily, Mr Sarna dispensed 28 bumetanide 5mg tablets labelled as bisoprolol with the instruction “please follow the directions given to you by the doctor”. As a result of taking the diuretic instead of the beta-blocker, the elderly patient suffered a severe angina attack and spent about nine days in hospital.

The Council also complained that Mr Sarna had failed to give an adequate explanation of the error when the patient’s daughter wrote to him about it.

Mr Sarna told the committee that he had not been drunk when he made the dispensing error at his pharmacy in Oakley, Basingstoke. He said he must have been distracted when dispensing and labelling the drug. He claimed he had responded to the letter from the patient’s daughter, but his reply must have got lost in the post.

David Bradly, for the Society, said that Mr Sarna had failed to observe basic practice rules when he gave the patient the drugs on 2 May 2002. “A check of the label on the box of drugs would have spotted the error,” he explained.

Mr Sarna admitted the error amounted to misconduct. He told the hearing he was “thoroughly ashamed” of his conduct and the incident had been a “big wake-up call”.

He claimed he was now “a more homely chap” and drinks only orange juice and tonic when he is driving.

Edward Henry, for Mr Sarna, said that he does considerable work for charities in Britain and abroad.

Social drinking

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the committee accepted that there was no evidence that alcohol consumption had led to the dispensing error. Mr Sarna’s convictions appeared to arise from social drinking rather than a serious alcohol problem.

The committee would postpone its decision for 12 months to allow Mr Sarna to address his alcohol consumption and gain an insight into his weaknesses.