Statutory Committee

Repeat prescription service “shambles” leads to reprimand more

Pharmacist reprimanded for drink-driving and possession of drugs more

Pharmacist reprimanded over unsafe and untidy MDS room more

Statutory Committee takes no action after unlawful sale of prescription-only medicines more

Repeat prescription service “shambles” leads to reprimand

A pharmacist whose repeat prescriptions service was described as a “shambles” has been reprimanded by the Statutory Committee.

On 25 May, the committee inquired into a complaint by the Council of the Royal Pharmaceutical Society against Nigel Kevin Carpenter (registration number 79595). The Council alleged that misconduct such as to render Mr Carpenter unfit to be on the Register may have been demonstrated, individually or cumulatively, by:

· The operation of a repeat medication service that failed to comply with the service specifications set out in the Society’s Code of Ethics and Standards
· A failure to maintain patient medication records in accordance with the Society’s Code of Ethics and Standards
· Submitting inaccurately endorsed prescriptions to the Prescription Pricing Authority

The allegations all related to Martins Pharmacy at 80 Tennyson Road, St Mark’s, Cheltenham, during the period between about December 2001 and August 2002. Mr Carpenter was at the time employed there as locum pharmacist in charge.

In addition, from 17 June to 17 December 2002 he was also the superintendent pharmacist of the company that then owned the pharmacy.

The Council said that, in a letter to the Society received on 21 October 2003, Mr Carpenter had accepted that there had been deficiencies in the pharmacy’s repeat medication service, including the facts that prescriptions had not always been received from the surgery by the time the patients collected their medicines, that request forms were not always completed correctly, that records of prescriptions due were inadequate and that records of medicines dispensed were inadequate.

Fenella Morris, for the Society, told the committee that Mr Carpenter’s repeat prescription system was a shambles and his record-keeping was hopelessly incomplete. The audit trail was such that it was impossible to follow any particular medicine from issue of prescription by a GP, to the request by patient or carer for a repeat, to its being dispensed and being entered in the PMR and a claim being made to the PPA. She listed a series of incidents relating to a sample of patients.

The poor systems had led Mr Carpenter to submit erroneous claims to the PPA, although the Society did not allege any dishonesty or impropriety on his part. He claimed he had not set up the systems but, as pharmacist in charge, he was responsible for them.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the various allegations were in the main admitted. Even if some disputed matters were left out of consideration, there was no escape for Mr Carpenter from the central complaint against him. To his credit, he did not seek to evade his responsibility.

Mr Carpenter having admitted his failure to operate the service in accordance with the Code of Ethics, the committee had little hesitation in concluding that he had been guilty of such misconduct as to render him unfit to be on the Register. However, it would restrict its sanction to a reprimand. Its reasons for doing so were that at the time of the misconduct Mr Carpenter had had marital and health problems and had possibly been too timid to make corrections that he knew should be made.

Mr Carpenter had now moved to Cornwall and was doing well. His current employer seemed satisfied with his professional work. Most importantly, the committee was confident that if he had to operate a repeat medication service in the future he would do it by the book, and if he found any deficiencies in any system he had to take over he would be sufficiently assertive to insist on improvements. He had been chastened by his appearance before the committee and a reprimand was sufficient.

Pharmacist reprimanded for drink-driving and possession of drugs

A Harrow pharmacist who was convicted for drink-driving and was found to be in unlawful possession of Controlled Drugs has been reprimanded by the Statutory Committee. He was told that any further appearance before the committee was likely to lead to a direction to remove his name from the Register.

On 20 June the committee inquired into the case of Sejule Shah (registration number 1069693). The committee had received information that on 27 May 2002, at Harrow Magistrates Court, Mr Shah had been convicted of driving a motor vehicle when the proportion of alcohol in his blood exceeded the prescribed limit, for which he had been fined £250 and ordered to pay £118 costs. He had also had his licence endorsed and been disqualified from driving for a period. On the same day, at the same court, he had been convicted of possessing eight tablets of diazepam, a Class C Controlled Drug, in contravention of the Misuse of Drugs Act 1971, for which he had been fined £150 and an order made for the forfeiture and destruction of the drugs.

The committee has also received a complaint from the Council of the Royal Pharmaceutical Society alleging that on 8 December 2003, in South Harrow, Mr Shah had had in his possession a quantity of cannabis, a Class B Controlled Drug, in contravention of the Misuse of Drugs Act 1971. He had subsequently received a conditional discharge from Harrow Magistrates Court.

The committee heard that on 24 February 2002 police officers had flagged down Mr Shah after a concerned member of the public had seen a vehicle driven dangerously with no tyre on the front left wheel. Mr Shah told them he had drunk two or three pints and admitted having smoked cannabis. He was found to have a blood alcohol level of 112mg, the legal limit being 80mg. The police also found four small, blue tablets in his pocket and a further four in his wallet. He claimed they were aspirin, but they were found to be diazepam.

In December 2002 police noticed a car parked with its lights on and windows steamed up. Mr Shah and another man were inside. The police noticed a strong smell of cannabis and found some of the drug in the car.

Mr Shah admitted the offences, saying that he had turned to drink and drugs to relieve stress caused by family problems.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the first incident had occurred before Mr Shah registered as a pharmacist. He was allowed to register [in October 2002] but was warned that the matter could be raised again should any other adverse information come to the committee’s attention.

The chairman said that Mr Shah accepted that his conduct could bring the profession into disrepute, and for that reason the committee concluded that his conduct was such as to render him unfit to be on the Register. He went on: “In our view there are some mitigating factors to be put forward on his behalf: there was no actual or potential harm to any patients, he made open and frank admissions, not only to the police but also to the Society and, as we heard from his employer, his conduct in a pharmacy over the past year appears to be beyond reproach. On the other hand, it would appear to us he has not really understood how seriously he should take the role of this committee and the important powers that it has, and the opportunity that it could take to deprive him of his livelihood.”

He continued: “On this occasion we will restrict our sanction to that of a reprimand. I cannot stress too heavily to Mr Shah, however, that … should he appear before us again on any matter it is extremely unlikely that we could follow any course other than to direct the removal of his name from the Register.

“I hope he will leave this committee hearing thoroughly chastened and will appreciate that if he is going to carry on in the profession as a pharmacist, he must not only perform well, as he has done within a pharmacy, but he owes responsibilities to the profession as a whole and he must not abuse that position.”

Pharmacist reprimanded over unsafe and untidy MDS room

The unsafe and untidy state of a pharmacy room set aside for the preparation of monitored dosage system (MDS) trays has resulted in a reprimand from the Statutory Committee for a Leicester pharmacist.

On 23 March, the committee opened an inquiry into the case of Shital Nilesh Popat (registration number 84548) and PIL Ltd, which owned a pharmacy at 16 Central Street, Countesthorpe, Leicester.

Mrs Popat was a director and superintendent pharmacist of the company and worked as pharmacist in charge of the pharmacy for about three-and-a-half days a week.

The inquiry arose from a complaint by the Council of the Royal Pharmaceutical Society alleging that misconduct such as to render Mrs Popat unfit to be on the Register may have been demonstrated, individually or cumulatively, by a number of deficiencies found during a visit by one of the Society’s inspectors on 14 January 2004, namely:

· The presence in the MDS room of medicines labelled with patients’ names which appeared to be either patient-returned medicines or medicines left uncollected by patients for significant periods
· The presence in the MDS room of medicines not properly labelled with batch numbers and/or expiry dates
· The presence in the MDS room of two pots of temazepam in contravention of
the Misuse of Drugs (Safe Custody) Regulations.
· The unsatisfactory working conditions in the MDS room
· The lack of an adequate system for disposing of the volume of patient-returned medicines at the pharmacy.

The committee heard that PIL Ltd had owned the pharmacy since 1 March 2002. Before that Mrs Popat had owned it as sole proprietor for several years. At the material time, the pharmacy supplied medicines to about 10 residential and nursing homes.

The committee was told that after visits to the pharmacy in April 2001 and July 2002, one of the Society’s inspectors left advice notes regarding the poor standards of the premises and poor working practices. On a visit in October 2002, she found standards much improved, but on 14 January 2004 she noted the matters of concern summarised in the Council’s complaint. In a final inspection in February this year, she found eight full drug disposal bins, 10 sacks of returned drugs and four trays returned by nursing homes.

Fenella Morris, for the Society, said that Mrs Popat had a duty to ensure that procedures and professional standards were followed to minimise the risk to patients. “The pharmacy should be clean, orderly and well maintained, to facilitate a safe system of work. The conditions of the MDS room should be just as good as in the pharmacy.”

Mrs Popat told the committee that she planned to give up the pharmacy and concentrate on raising her family.

She said that mistakes were never made when dispensing drugs for the elderly and she has never had any complaints from the homes she supplied. She or another pharmacist always checked the orders before they left the pharmacy and they were properly labelled.

Mrs Popat claimed that the pharmacy had had an unusual amount of returns from homes shortly before the April 2004 inspector’s visit. She had had trouble disposing of them. The local primary care trust arranged for collections every 13 weeks but if the rubbish built up she had to pay for an intermediate collection.

She added that the temazepam had been left out of the CD cupboard by a locum pharmacist when she was not on the premises.

Adjourning the inquiry, the chairman, Lord Fraser of Carmyllie, QC, asked for an assurance from Mrs Popat’s lawyer that the sale of the pharmacy would go ahead regardless of whether misconduct is found.

When the inquiry reopened on 25 May, the chairman indicated that the matter could be dealt with by reprimand if there was unequivocal evidence that the pharmacy had been sold in an arms’ length transaction. The committee adjourned the inquiry again until June to allow further time for the sale to be formalised.

Giving the committee’s determination on 20 June, the chairman said: “We find the case against Mrs Popat established and consider she has been guilty of such misconduct as to render her unfit to be on the Register. The situation is not entirely unfavourable to her in that since that date there have been significant improvements made in the pharmacy, not least separate rooms are now used for patient returns and making up the MDS trays.

“It was not only these improvements that caused us to hold back from directing removal of her name from the Register. The fact of the matter is that she was then, when we first heard this case, on the point of selling the premises. It took a little time to establish this, but in May 2005 we were satisfied that the premises were no longer to be owned by her and, accordingly, we could restrict our sanction to that of a reprimand.”

The committee took no further action against the company.

Statutory Committee takes no action after unlawful sale of prescription-only medicines

The Statutory Committee has decided to take no further action in the case of a Harrow pharmacist who was in charge of a pharmacy when its unqualified owner sold furosemide tablets without a prescription.

At an inquiry on 23 June, the committee decided that, although the behaviour of Jayantilal Raichand Shah (registration number 69625) had amounted to misconduct, it was not confident that the misconduct was such as to render him unfit to remain on the Register.

The committee had received a complaint from the Council of the Royal Pharmaceutical Society alleging that on 9 July 2003 Mr Shah was working as a locum in charge of a pharmacy in Mayfair, London, when one of the Society’s inspectors visited the pharmacy in the guise of a member of the public. The inspector asked the pharmacy owner, a Mr Patel, whether he could obtain frusemide (furosemide) tablets. Mr Patel informed the inspector that the cost would be £11.50 and then supplied him with 28 Lasix (furosemide) 40mg tablets in an unlabelled bottle, advising him that the tablets would not help him lose weight but would help him to expel water. Mr Patel instructed the inspector to take one tablet a day and to stop taking the tablets if he lost a lot of water over three to four days. The Council alleged that throughout the transaction Mr Shah was close enough to hear what was going on.

Mr Shah told the committee that he had been on the telephone during the inspector’s visit. He saw Mr Patel show the inspector some counter products but did not hear any mention of frusemide. He had already asked Mr Patel never to sell any prescription drugs without checking with him first. He was “shattered and shocked” by Mr Patel’s actions.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the circumstances of the case were not entirely clear and the committee found it extremely difficult to resolve exactly what the facts were. The task was made much more difficult because Mr Patel had not been present to give evidence. It seemed appropriate to conclude the matter by saying that the committee was not confident that Mr Shah’s misconduct was such as to render him unfit to be on the Register. In such circumstances, there would be no further action against him.

The chairman continued: “We regard it as nothing less than disgraceful that after making several requests to him, [Mr Patel] neither appeared for an interview nor indeed responded fully to correspondence. We would want to mark our disapproval of that.”

He went on to note that, shortly after the incident, Mr Patel had sought deregistration of the premises. “As I understand it, they no longer operate as a pharmacy at all.”