Statutory Committee

Striking-off ordered for false NHS payment claims more

Statutory Committee confirms pharmacy company's reprimand more

Striking-off for false claims and prescription errors more

Succession of dispensing errors leads to reprimand for pharmacist more

Striking-off ordered for false NHS payment claims

A London pharmacist who submitted false payment claims to the NHS Prescription Pricing Authority has been ordered by the Statutory Committee to be removed from the Register of Pharmaceutical Chemists. The committee took no action against a pharmacy company involved in the case.

While running a pharmacy owned by The House of Mistry Ltd, Rajesh Chaganbhai Mistry (registration number 91540), of Highgate, London N6, obtained repeat prescriptions in the names of several patients and submitted them for payment without having dispensed them. He also submitted prescriptions with false pack-size endorsements. As a result, overpayments totalling more than £1,200 were made to the company.

At an inquiry held on 22 June and 21 September, the Statutory Committee considered a complaint from the Council of the Royal Pharmaceutical Society alleging that misconduct such as to render Mr Mistry unfit to have his name on the Register and to render the company liable to disqualification from owning pharmacies may have been demonstrated, individually or collectively, by:

· Between October 2000 and July 2001 dishonestly obtaining, or permitting the obtaining of, payment from the PPA in respect of repeat prescriptions that had not been requested or required by the patient and which were not dispensed, or making or causing to be made erroneous requests for such prescriptions

· Between March and July 2001 dishonestly or erroneously obtaining payment, or permitting the erroneous obtaining of payment, from the PPA in respect of prescriptions wrongly endorsed with small pack sizes when larger sizes had been dispensed

The committee heard that Mr Mistry had been a director of The House of Mistry Ltd from 25 April 2000 to 23 August 2004 and superintendent pharmacist from 9 May 2000 to 23 August 2004 and had been the regular pharmacist at the company’s pharmacy at 15–17 South End Road, London NW3.

The Council alleged that on various dates Mr Mistry had obtained repeat prescriptions for a total of 52 items in the names of four patients, without their knowledge or authority. None of the items was dispensed but the prescriptions were submitted to the PPA, resulting in overpayments totalling £1,069.26.

The Council also alleged that on various dates in 2001, Mr Mistry had dispensed 12 packs of E45 cream 500g, three bottles of Gaviscon liquid 500ml and four bottles of Oilatum Emollient 500ml but had endorsed the prescriptions as if the prescribed quantities had been dispensed using smaller packs. As a result, the company had been overpaid by a total of £143.03.

Mr Mistry admitted to the committee that he had made the dishonest claims. He also confessed to overclaiming in respect of six further patients. He said that at the time he was stressed because his father, who looked after the wholesale side of the business, had fallen ill. He added: “I was motivated by greed and that’s something as a pharmacist you can’t do.”

Mr Mistry denied that the company’s other directors — his father Chhaganbhai Mistry and mother Indiraben Mistry — had turned a blind eye to his action. He said that the overpayments were so small they would not have noticed. He said: “My mother’s attention was focused on my father and my father was concentrating on getting better, but I wouldn’t say they were turning a blind eye.” He added: “I guess subconsciously I was trying to impress my father and make him feel that he was leaving the business in good hands.”

(Chhaganbhai Mistry was struck off as a pharmacist five years ago after trying to mislead the Society with a forged professional indemnity insurance certificate. Earlier this year he lost a second bid for restoration after he again tried to deceive the Society, this time over a syringes and drugs dumped in his back garden [PJ, 16 April, p467].)

Giving evidence, Indiraben Mistry, who runs the company’s baby care range, said that losing the pharmacy would threaten the rest of a thriving business. She said: “If the community pharmacy doesn’t operate it will be a devastating effect. We will lose our good name. Twenty people will lose their jobs.”

She said she only learnt about her son’s dishonesty in August 2004. Shortly afterwards he resigned as director and superintendent.

Giving the committee’s determination on 22 September, the chairman, Lord Fraser of Carmyllie, QC, said that, although Mr Mistry had admitted that further fraud, the committee would not go beyond what was set out in the notice of inquiry. To do so would be to breach not only the regulations covering the committee but also the rules of natural justice.

The chairman continued: “Even without going beyond the terms of the notice of inquiry, there was more than sufficient admitted to enable us to conclude that the conduct of Mr Mistry in defrauding the PPA was such as to render him unfit to be on the Register and we so conclude.”

The only real issue, the chairman said, was the delay in having the matter brought before the committee. The delay had been principally caused by the PPA’s counter-fraud investigators. But the delay was not such as to cause the committee to depart from the view that Mr Mistry should be removed from the Register.

The chairman added that because Mr Mistry had had the matter hanging over his head for so long, he should consider a restoration application in the relatively near future.

Turning to the company, the chairman said that there was no complaint against it beyond those relating to Mr Mistry’s actions. Once the other directors learnt what he had been up to they took immediate action to remove him as superintendent pharmacist and as a director.

The chairman added: “We are not to be blackmailed with the argument that other activities of the company owning the retail premises might be put at risk if the company is disqualified from registering a retail pharmacy premises, and we were not impressed by that argument. Nevertheless, we will take no further action against the company in view of its instant response when apprised of Mr Mistry’s unwarranted claims on the PPA.”

Mr Mistry has three months in which to consider appealing against the decision.

Statutory Committee confirms pharmacy company's reprimand

The Statutory Committee has confirmed its decision to reprimand a pharmacy company after doubts were raised about evidence given on the company’s behalf.

In September, the committee had inquired into a case arising from offences and misconduct by Rajiv Kumar Sarna (registration number 76820) while he was a director and superintendent pharmacist of Sarna Enterprises Ltd. The committee had ordered his removal from the Register (PJ, 15 October, p496).

Mr Sarna’s wife, who now ran the company, had begged the committee not to disqualify it from owning pharmacies. After she had given an assurance that its four pharmacies were now checked regularly by inspectors from three primary care trusts, the committee decided to restrict itself to a reprimand.

However, the committee was advised that the Royal Pharmaceutical Society had some concerns about Mrs Sarna’s evidence. It decided not to consider those concerns without Mr and Mrs Sarna both having the opportunity to appear before it again.

At a resumed hearing on 19 October, the committee heard that the concern was that the pharmacies were not being monitored by three PCTs. Only one PCT was carrying out monitoring.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the committee did not consider that Mrs Sarna had intended to mislead it. From where she was positioned, it was reasonable to presume that the monitoring was on behalf of all three PCTs. In all the circumstances, the committee’s consideration was that, having removed Mr Sarna from the Register, it should simply reprimand the company.

Striking-off for false claims and prescription errors

The Statutory Committee has ordered the removal from the Register of Pharmaceutical Chemists of a Merseyside pharmacist who submitted false claims to the Prescription Pricing Authority, dispensed reboxetine tablets against a prescription for rosuvastatin tablets, supplied prescription medicines with inadequate labelling and failed to implement procedures to minimise the risk of dispensing errors.

At its meeting on 18 October the committee considered a complaint from the Council of the Royal Pharmaceutical Society alleging that Harold Lomax (registration number 55293), of Ormskirk, may have been guilty of such misconduct as to render him unfit to have his name on the Register of Pharmaceutical Chemists. It was also alleged that the misconduct may be such as to render his company, Harold Lomax Ltd, liable to disqualification from owning pharmacies.

The Council alleged that Mr Lomax had:

· Submitted prescriptions to the PPA endorsed to the effect that the full quantity of medicines prescribed had been dispensed when this was not the case, and also marking several of the prescriptions as “expensive”, resulting in an overpayment to the company of £2,895.15

· Against a prescription for rosuvastatin 10mg tablets, erroneously supplied Edronax (reboxetine) 4mg tablets labelled as rosuvastatin 10mg tablets and with the prescription endorsed to indicate that Edronax 4mg had been dispensed

· Failed to implement procedures to minimise the risk of dispensing errors, in particular failing to keep records of errors

· Supplied medicines in contravention of the requirements for labelling of dispensed medicinal products

· Submitted to the PPA for payment a prescription for 168 clozapine 100mg tablets and 56 clozapine 25mg tablets that had not been dispensed by the pharmacy and for which the company received £364.36 to which it was not entitled

The committee heard that Mr Lomax had, since 27 September 1978, been superintendent pharmacist of Harold Lomax Ltd and was at all material times a director of the company and the sole pharmacist in charge of its pharmacy at 516 Mather Avenue, Liverpool 19.

Mr Lomax had admitted the erroneous endorsement of prescriptions when interviewed by the NHS Counter Fraud Services on 22 October 2003. He had subsequently repaid the £2,895.15, together with a further £5,129 in respect of other endorsing errors. The Counter Fraud Services had taken no further action.

At interview with one of the Society’s inspectors, he had confirmed the rosuvastatin/reboxetine error, confirmed that he did not keep records of dispensing errors and admitted supplying products labelled with the address of the pharmacy but not with the patient’s name, the date of dispensing or any particulars requested by the prescribers.

Mr Lomax told the committee that he had tightened up procedures and had taken on a full-time assistant. He added that he had never intended to defraud anybody.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that Mr Lomax’s actions cumulatively demonstrated such misconduct as to render him unfit to have his name on the Register of Pharmaceutical Chemists.

The committee then heard that Mr Lomax had previously been struck off on 30 June 1977 for selling excessive quantities of Phensedyl, knowing it to be potentially a drug of abuse. He had been restored to the Register in September 1978.

Mr Lomax said that, in mitigation, he had had been overworked and doing long hours and had had no holiday for 14 years. He delivered prescriptions after the pharmacy closed and took a lot of work home. He had been treated for depression by a hospital psychiatrist but had now weaned himself off the medication. He asked the committee to be lenient with him and give him some time to sell the business and retire from pharmacy.

The chairman said that the committee’s considered view was that it should order the removal of Mr Lomax’s name from the register. However, it would take no further action against the company.

He added that Mr Lomax was concerned that the proceedings should not affect the sale of the business. But the taint of the proceedings was on Mr Lomax. It was he who erroneously endorsed the prescriptions, who made dispensing errors, who failed to record errors and who labelled wrongly. “The taint is not on the business nor on the premises and, in such circumstances, we would have hoped that that was no good reason why … any prospective purchaser should take these matters into account.”

Mr Lomax has three months in which to consider appealing against the decision.

Succession of dispensing errors leads to reprimand for pharmacist

The Statutory Committee has reprimanded an Oxfordshire pharmacist who made a succession of dispensing errors between September 2002 and September 2003.

Sanjay Janubhai Patel (registration number 76827), proprietor of Chalgrove Pharmacy, 60 High Street, Chalgrove, Oxfordshire, was reprimanded on 21 September in an inquiry that had been adjourned from 19 May 2004.

The inquiry had arisen from a complaint by the Council of the Royal Pharmaceutical Society, which alleged that misconduct such as to render Mr Patel unfit to be on the Register may have been demonstrated, individually or cumulatively, by:

· Dispensing, against a prescription for prednisolone E/C tablets 5mg, the correct tablets wrongly labelled as prednisolone (Deltacortril) 2.5mg E/C tablets

· Supplying hydrocortisone cream 2.5 per cent against a prescription for hydrocortisone cream 0.25 per cent for a baby and, after replacing the wrong strength with 0.5 per cent (authorised by the prescriber), erroneously endorsing the prescription to indicate that 1 per cent had been supplied

· Supplying chloramphenicol ear drops 10 per cent labelled as chloramphenical eye drops 0.5 per cent against a prescription for chloramphenicol eye drops for a baby

· In response to a prescription for two boxes of 30 tamoxifen tablets 20mg, dispensing one box of 20mg tablets and one of 10mg tablets, both labelled as 20mg

· Supplying 30 cetirizine hydrochloride tablets 10mg and 28 rofecoxib tablets 25mg to the wrong patient

· Failing to supply a patient with her prescribed aspirin E/C 75mg tablets in three consecutive weekly Nomad trays, erroneously endorsing her prescriptions to the effect that the aspirin had been dispensed and including aspirin E/C 75mg tablets in Nomad trays for another patient for whom aspirin had not been prescribed

· Supplying thyroxine 100µg tablets labelled as 25µg to a patient who was routinely prescribed both strengths of tablet

· Twice including Calcichew tablets in Nomad trays for a patient for whom they had not been prescribed

· Including nitrazepam tablets in a Nomad tray for a patient who had been prescribed temazepam tablets

At the 19 May 2004 hearing, the Society’s inspector for the area had reported that Mr Patel had radically improved his dispensing procedures and no further errors appeared to have occurred since September 2003.

At the 21 September hearing it was confirmed that no subsequent problems had been reported with Mr Patel’s practice.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the committee would conclude the matter, as it had indicated it would in May 2004, with a reprimand.