Statutory Committee

Pharmacist escapes a striking-off by undertaking not to work alone more

Striking-off ordered for false script endorsements more

Pharmacist escapes a striking-off by undertaking not to work alone

A north London pharmacist who made a string of dispensing errors during a six-day locum engagement has avoided having his name removed from the Register of Pharmaceutical Chemists by giving a written undertaking to work only under the supervision of another pharmacist for 12 months.

After an inquiry held on 24 and 26 January, the Statutory Committee adjourned the case of Andrew Mortara (registration number F357) for a month so that the terms of the undertaking could be agreed between Mr Mortara and the Royal Pharmaceutical Society. On 20 February the committee accepted the wording of the undertaking and reprimanded Mr Mortara rather than ordering a striking-off.

The inquiry had arisen from a complaint by the Council of the Society, which alleged that misconduct such as to render Mr Mortara unfit to have his name on the Register may have been demonstrated by:

His actions (ie, dispensing errors) in relation to 18 different patients
His making of disparaging comments in front of customers regarding the pharmacy and/or its owner
His making of a 30-minute personal telephone call in the pharmacy while customers were waiting for prescriptions.

The committee heard that in July 2004 Mr Mortara worked on a Thursday and Friday and the following Monday to Thursday as a locum pharmacist at a pharmacy in Highgate, London N6. The dispensing errors came to light when the pharmacy owner returned to work.

Among the dispensing errors were the following: supplying the wrong product; supplying the wrong strength of product; supplying the wrong quantity of product; labelling with incorrect dosage instructions; labelling with wrong quantities; failing to affix dispensing labels to medicines dispensed as original packs, or failing to label each pack when dispensing more than one; endorsing prescriptions with wrong quantities; endorsing prescriptions with wrong strengths; failing to record supplies in the patient’s medication record, making incorrect entries in a patient medication record; including in a patient’s bag of medicines a product that had been dispensed for a different patient; failing to issue an owing note and/or record the outstanding owing when unable to supply the full quantity on a private prescription; making an entry in the private prescription register that did not reflect accurately what had been dispensed and did not indicate that it was the first dispensing of a repeatable prescription; and failing to dispense one of three items on a prescription form.

Mr Mortara told the committee that he now realised that he had been under considerable stress while working at the pharmacy. At the time, he had a sick father at home in Italy, and had lost his job managing another pharmacy after it was bought by a pharmacist who wanted to run it himself. “I was worried about my future,” he said.

Inexplicable

Giving the committee’s determination on 26 January, the chairman, Lord Fraser of Carmyllie, QC, said that the dispensary in which Mr Mortara worked during his short locum period only dealt with “about 200 plus” prescriptions a week. From time to time he had so little to do that he had the opportunity to play cards on the computer. This made it particularly inexplicable that during such a short period Mr Mortara should have made such a series of dispensing errors.

Indeed, the chairman continued, if those few days provided a snapshot of Mr Mortara’s conduct as a pharmacist over the years, the only conclusion could have been that he was a bad and dangerous pharmacist. The oddity was, however, that his 29 previous years of work had produced no complaint about his professional conduct and nor had his subsequent locum work at more than 30 pharmacies in and about London.

The chairman said that the notice of inquiry set out a series of errors in dispensing and labelling, all of which were admitted. He would not attempt to analyse every error, but two themes seemed to run through them.

He continued: “For example, if a prescription called for more than 28, and that meant cutting off part of an otherwise complete blister pack, he preferred to dispense the new pack only. That is not a correct supply but we do see some force in that continental practice. All too often we have encountered cases where there have been part strips lying around the pharmacy and it has been difficult to match them up with batches or expiry dates.

“Mr Mortara has agreed that some of his labelling practice, such as labelling one box only and holding the additional ones together with an elastic band, were not satisfactory and he has indicated he has now changed his practice, and properly so.

“Secondly, he appeared to get into a real muddle with the Mediphase software, although he claimed he had worked earlier with other Mediphase versions. It is quite clear he has never correctly mastered the Mediphase system and this led to a number of very odd consistencies, particularly in the recording of what had been supplied.”

Not all the errors were relatively trivial, said the chairman, and one seemed incomprehensible. It related to a private prescription for two months’ supply of Depakote 250mg and 500mg, indicating that 750mg would be taken in the morning and again at night and requesting that the medicines be supplied as a repeat prescription thereafter. What Mr Mortara supplied was 90 tablets of Depakote at 500mg strength, labelled 90 x 500mg tablets, and the only note on the package was “to be taken as directed”. “We cannot understand,” the chairman said, “how a member of the public would have been able to interpret accurately what the prescriber had required.”

Another item of complaint concerned a request from a patient for 28 Cipralex 20mg tablets. Mr Mortara supplied them without a prescription but acknowledged that this could not be regarded as an emergency supply. There had been no previous prescription and he had provided more than five days’ treatment. On his departure he left in the dispensary nothing more than a Post-it note setting out the name of the patient, the address and then: “Has come in for an e-mailed script. I could find no trace of the prescription but I gave her 28 Cipralex, 20mg strength, on loan.”

However, although Mr Mortara certainly should not have supplied without a prescription, it appeared from the pharmacy owner’s statement that she had, or should have, requested a prescription from the GP for 28 Cipralax but it had not been picked up. When the patient or someone on her behalf called in to collect them, Mr Mortara had provided them in circumstances that could not be described as an emergency supply. “At best, it was a sloppy practice on his behalf, supplying without a valid prescription in his hand.”

Supervision

The chairman continued: “In all the circumstances of the admitted failures, we have little hesitation in concluding Mr Mortara’s conduct was such as to render him unfit to be on the Register.” However, the committee would not remove him from the Register but, in accordance with modern practice, would require a written undertaking to the effect that he would not work alone and would work only under the supervision of another qualified pharmacist for 12 months.

“We will allow 14 days for the terms on which this undertaking is to be refined between those acting on his behalf and the Royal Pharmaceutical Society, but the essential part of it will be that he does not work alone. We would suggest that other parts of the written undertaking should include a requirement that he will inform the secretary of this committee in writing of the positions of employment he holds, including dates, contracted hours, address, telephone number of the pharmacy premises, within 72 hours, and certainly not later than seven days after this agreement. …

“In the meantime, we will adjourn the case until the first day of our sitting next month, at which time we hope to be in a position to approve terms of a written undertaking agreed between the Royal Pharmaceutical Society and Mr Mortara or his representatives on his behalf. Otherwise, we would be left with no option but to remove him from the Register. In the immediate and short term we cannot contemplate him working alone.”

Striking-off ordered for false script endorsements

A Harrow pharmacist whose false prescription endorsements led to overpayments by the Prescription Pricing Authority totalling £5,800 is to have his name removed from the Register of Pharmaceutical Chemists on the order of the Statutory Committee. The committee took no action against the company through which the pharmacist runs his business.

At an inquiry held on 25 January, the Statutory Committee considered a complaint from the Council of the Royal Pharmaceutical Society against Ramesh Mavji Patel (registration number 90343) and Judds (Chemists) Ltd. Mr Patel is superintendent pharmacist and a director of Judds, which owns a pharmacy at 264 Kingsbury Road, London NW9.

The Council alleged that, between about March 2002 ansd September 2003, misconduct such as to render Mr Patel unfit to have his name on the Register, and Judds liable to disqualification, may have been demonstrated, individually or collectively, by:

The submission to the PPA of prescriptions erroneously endorsed to indicate that medicinal products had been dispensed in pack sizes smaller than those in which they had in fact been dispensed, for which £865.64 was subsequently repaid to the PPA
The submission to the PPA of prescription forms erroneously marked to indicate that the patient was in receipt of income support, for which £4,947.50 was subsequently repaid to the PPA
Mr Patel’s presentation of a cheque for £25 to one of the patients concerned, which was likely to bring the profession into disrepute

The committee heard that the Council’s complaint arose from an investigation by the PPA’s counter fraud unit. The investigators had found instances of prescriptions for “Oilatum Emollient 500ml” endorsed “2 x 250ml”, “Oilatum Bath Formula Emollient 300ml” endorsed “2 x 150ml” and “E45 Cream 500ml” endorsed “10 x 50g” or “4 x 125g”. In each case the quantity prescribed had been supplied as a single large pack. In one case, Mr Patel had dispensed a single 500ml tub of E45 cream against a prescription for “E45 5000g” but the prescription had been endorsed “8 x 500g, 6 x 125g, 5 x 50g”.

The investigators had also found instances of prescriptions having been marked on the reverse to indicate that the patients were receiving income support payments, and therefore exempt from prescription charges, when the patients had in fact paid the prescription charge.

During the investigation, Mr Patel had visited a patient for whom three such prescription endorsements had been made. Referring to “problems” with the three prescriptions, he had given the patient a cheque for £25.

The committee was told that, interviewed by one of the Society’s inspectors on 3 September 2003, Mr Patel had admitted operating a “hit and miss” system whereby he had left prescription endorsements until the end of the month. The pack size errors had occurred because he could not remember accurately what had been dispensed.

During the same interview, Mr Patel had also admitted operating a system whereby patients who did not indicate on the reverse of the prescription form that they had paid the charge were assumed to be exempt and their forms were marked to indicate exemption because of receipt of income support.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the most remarkable pack size endorsement concerned a prescription for “E45 cream 5000g” — a significant quantity. Although one pack of 500g was dispensed, Mr Patel claimed for eight packs of 500g, six of 125g and five of 50g.

“It strains credulity,” said the chairman, “that Mr Patel could have endorsed in this way, unless he had actual knowledge of what he had dispensed, or that he was at the very least cavalier in making it up. We know the patient received only one pot of 500g. Nevertheless, it is claimed that Mr Patel was entitled to payment for 5,000g, some of it in smaller quantities.”

On the false prescription charge exemption claims, the chairman said that at least some of the patients concerned, who had all paid the prescription charge, were distressed to discover that it was being claimed on their part that they were in receipt of income support.

“We are not surprised by that,” he added. “Firstly, it put all these patients at risk of criminal proceedings, or at least some investigation. Secondly, it would appear by signing and having that cross in the appropriate box they were consenting to scrutiny of their personal Inland Revenue papers and other papers relating to them in other departments.

“In short, by receiving payment, first from the patients and then making claims on the NHS, Mr Patel was not only making an unwarranted claim on public funds, but he was also putting a number of patients at risk of scrutiny by those entrusted with the important task in our society of ensuring that NHS funds are properly applied.”

Turning to Mr Patel’s presentation of a cheque to one of these patients, the chairman said that Mr Patel disputed that his behaviour was likely to bring the profession into disrepute. Set in the context of his admissions, the committee found it difficult to place an entirely innocent interpretation on these events. However, it would set that matter aside and come to its determination solely on the basis of the substantial admissions by Mr Patel, resulting in major unwarranted claims on the NHS without regard for the best interests of patients.

In those circumstances, the committee concluded that Mr Patel’s misconduct was such as to render him unfit to be on the Register. It had no option but to direct the removal of his name. There would be no action against the company.

Mr Patel has three months in which to appeal against the decision.