Statutory Committee

Pharmacist escapes striking-off by agreeing to retire more

Admonition for making unauthorised supply to methadone addict more

Restoration application “premature” for man who stole from pharmacy employers more

Pharmacist escapes striking-off by agreeing to retire

A South Wales pharmacist who admitted failing to provide a patient with the best possible health care and failing to adhere to accepted standards of professional conduct has escaped being removed from the Register of Pharmaceutical Chemists. Following the receipt of a written undertaking by the pharmacist never to practise again, the Statutory Committee restricted its censure to a reprimand.

At its meeting on 21 February, the Statutory Committee examined a complaint by the Council of the Royal Pharmaceutical Society about John Brian Price (registration number 54597), of Cowbridge, South Glamorgan. The Council alleged that misconduct such as to render Mr Price unfit to have his name on the Register of Pharmaceutical Chemists may have been demonstrated by:

· His failure to provide the best possible health care to a patient (contrary to Key Responsibility 1 of the Code of Ethics and Standards)

· His failure to adhere to accepted standards of professional conduct and engagement in behaviour likely to undermine public confidence in the profession (contrary to Key Responsibility 3 of the Code of Ethics and Standards)

· His use of a SCENAR (“self-controlled energo neuro adaptive regulation”) device despite having no training or accreditation in the use of complementary therapies for the treatment of facial infections (contrary to Part 3 of Service Specification 12 (c) of the Code of Ethics and Standards).

Mr Price was not present at the inquiry. The committee was told that he had admitted the first two allegations but not the third.

Cold sore

The committee heard that on 12 June 2004, Mr Price was working as a locum pharmacist in Hirwaun, Aberdare. A teenage girl, accompanied by her mother, entered the pharmacy to seek treatment for a sore above her upper lip. Mr Price allegedly failed to recognise the early stages of a cold sore. He treated the patient by applying the SCENAR device, causing pain to the patient, and using WCS dusting powder (a homoeopathic preparation). He failed to explain the treatment options or the nature and purpose of the SCENAR device before starting the treatment.

The patient returned twice in the next three days at Mr Price’s request and was again treated with the same device, despite there being no improvement in her condition. At no time did Mr Price recommend conventional treatment or refer the patient to a doctor. By 16 June 2004 the patient’s cheeks were oedematous, with lymphoedema beneath the eyes and she had an obvious infected lesion, which the following day tested positive for Staphylococcus aureus.

The committee also heard that Mr Price had cleaned the SCENAR device between uses only with surgical spirit when in the circumstances it required sterilising with specialist equipment.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that Mr Price did not deny any of the substance of the Council’s complaint and he had admitted the first two allegations. The committee would make no finding on the third allegation because it had heard no evidence and did not regard it as being of great significance.

So far as the first two allegations were concerned, the committee found Mr Price guilty of such misconduct as to render him unfit to be on the Register. However, the committee understood that Mr Price had now retired — after 46 years in practice — and was willing to give a written undertaking that he would not practise again. “We will require that written undertaking and if, as promised, it is forthcoming, we shall restrict our censure to that of a reprimand,” the chairman said.

The committee then adjourned the inquiry for a month to allow the required undertaking to be agreed between Mr Price’s legal representatives and the Society.

When the inquiry reopened on 20 March, the chairman said that the committee had now received a letter from Mr Price in which he undertook to retire forthwith. He would not seek to be readmitted to the Register and understood that if he did the matter would be automatically referred to the Statutory Committee.

“ Given that undertaking,” the chairman said, “we will conclude this case, as we indicated at the time, by restricting the censure to

Admonition for making unauthorised supply to methadone addict

A pharmacist who was intimidated by a methadone addict into supplying an additional unprescribed quantity of methadone mixture has been admonished by the Statutory Committee.

On 22 February, the committee inquired into the case of Hassan Pyarali Mohammedali Merali (registration number 69675), who was a director, shareholder and superintendent pharmacist of a company that owned a pharmacy in Portsmouth.

The inquiry arose from a complaint by the Council of the Royal Pharmaceutical Society, which alleged that a supply of methadone mixture made without the authority of a prescription may demonstrate such misconduct as to render Mr Merali unfit to have his name on the Register of Pharmaceutical Chemists.

The committee heard that in December 2004, Mr Merali had received a prescription for methadone mixture 1mg/1ml. Adjusted to allow for bank holidays, the prescription called for the supply of 70ml on 21 December, 235ml on 23 December and 150ml on 30 December.

The Council alleged that, on 30 December 2004, in addition to the prescription 150ml methadone mixture, Mr Merali supplied a further 35ml, for which no prescription had been written, for the addict to consume in his presence. He endorsed the prescription to the effect that 150ml had been supplied on that date. He also made two entries in the pharmacy’s Controlled Drugs register recording both the 150ml supply and the 35ml supply.

At a subsequent interview with one of the Society’s inspectors, Mr Merali had admitted supplying 35ml methadone mixture without the authority of a prescription.

Confusing prescription

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the prescription had been far from clear, as the inspector had acknowledged. It had confused not only Mr Merali but also a locum pharmacist. It appeared that the patient was on a reducing methadone dose and should have taken 35ml for five days from 23 December followed by 30ml a day. This was clear from a subsequent prescription in January, which reduced the dose further to 25ml a day and then 20ml a day.

The chairman said: “If an addict is put on a reducing programme, the point of reduction should be far more clearly set out than is the case here. It would appear that the problem has already been addressed, but we nevertheless emphasise that the point of reduction should always be clearly set out, not just to avoid any confusion in the pharmacist’s mind but to limit the addict’s range of behaviour and argument in seeking to bully the pharmacist.”

Although the committee had sympathy for Mr Merali, he had acknowledged making a mistake classed as an act of serious professional misconduct. “No pharmacist,” said the chairman, “experienced or otherwise, should ever dispense without the authority of a prescription. This, on his own admission, Mr Merali did, and we consider his actions amount to such misconduct as to render him unfit to be on the Register.”

However, the committee had concluded that Mr Merali should not be removed from the Register because of a number of important mitigating factors. The first was that Mr Merali had had an exemplary career as a pharmacist for nearly 30 years. Secondly, the inquiry had arisen from a single isolated incident in this long career. Thirdly, Mr Merali had notable references for his work in the community in Portsmouth.

A fourth factor was aggression on the part of the addict. This aggression, which was wholly unacceptable, had been directed at two elderly ladies rather than at Mr Merali himself. “It was this last feature that appeared particularly to have influenced Mr Merali,” said the chairman. “Had the aggression been addressed solely to him, he told us he would have been better placed to resist it.

“Such aggression is quite unacceptable and the counsel of perfection we acknowledge as the only counsel we can offer would be to say to Mr Merali that what he should have done was to contact the police.

“So long as society expects community pharmacists to deal with drug addicts in their pharmacies, they should not be exposed to such aggression. However, having said that, as we have indicated previously, we would not ordinarily regard intimidation, or failure to resist intimidation or threats, as a mitigating feature.

“Nevertheless, we do so here. Mr Merali was concerned not for his own personal safety, but that of elderly patients.”

Mr Merali had also been frank and straightforward in making contact with the Society, the chairman said, and he had taken steps to prevent any repetition of such an incident.

“In these exceptional circumstances, we restrict our sanction on him to that of an admonition, but we must repeat: pharmacists across the country faced with the gross conduct from addicts should not surrender to them, and if they do, we may not always be able to take, in other circumstances, a sympathetic line.”

Restoration application “premature” for man who stole from pharmacy employers

A Worcestershire man who has twice appeared in court for stealing from pharmacy employers has been told by the Statutory Committeee that his application for restoration to the Register of Pharmaceutical Chemists is premature.

Hearing an application for the restoration of John Colin Hodges (former registration number 61745) at its meeting on 23 February, the committee was reminded that it had reprimanded Mr Hodges in 1984 after his conviction for two offences of theft and one of conspiracy to defraud (PJ, 26 May 26 1984, p644).

At that inquiry, Mr Hodges had pledged never again “to be dishonest or to drift into dishonesty” but in 2003 the committee had ordered a further inquiry after Mr Hodges had pleaded guilty and been given a conditional discharge for stealing prescription-only medicines from a pharmacy in which he had been employed as a locum (PJ, 8 November 2003, p660). He had stolen the medicines for use in a pharmacy owned by his pharmacist wife. On that occasion the committee ordered the removal of Mr Hodges from the Register.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that the application for restoration was premature. He added: “If Mr Hodges wishes to renew his application for restoration at an appropriate time, we would expect further references and would also want a written undertaking from him that, if restored, he would work only in the Village Pharmacy owned by his wife and not elsewhere.”