Statutory Committee

Admonition for pharmacist who dispensed unsigned prescriptions more

Pharmacist reprimanded over erroneous prescription endorsements more

Admonition for pharmacist who dispensed unsigned prescriptions

A Wolverhampton community pharmacist who dispensed prescription-only medicines against prescription forms that were awaiting the prescriber’s signature has been admonished by the Statutory Committee. The committee decided that three further allegations of misconduct had not been proved. No action was taken against a s gations.

On 28 June, the Statutory Committee enquired into the case of James Dyan Laurence (registration number 84262) and his wife Julia Ruth Harrison (registration number 85697), who jointly owned a pharmacy in Wolverhampton. The inquiry had arisen from a complaint by the Council of the Royal Pharmaceutical Society, which alleged that misconduct rendering Mr Laurence and Ms Harrison unfit to have their names on the Register of Pharmaceutical Chemists may have been demonstrated, individually or cumulatively, by: a failure to have in place a suitable system for the delivery of medicines other than on the pharmacy premises; a failure to contact and/or apologise to a person who received a delivery of methadone not intended for her; the supply of prescription-only medicines (POMs) without the authority of valid prescriptions; and having a system in place which permitted the supply of POMs to patients in circumstances where the prescriptions had not been signed by the time of supply.

The committee heard that Mr Lawrence and Ms Harrison were joint owners of Brooklands Pharmacy, Wolverhampton. On 25 May 2004, a locum pharmacist prepared a prescription for methadone mixture for a regular patient and labelled it with the address given in the patient medication record (PMR), although the prescription bore a new address. When the patient failed to collect her methadone, it was placed in the Controlled Drugs safe for safe custody. On the following day, a driver employed by the pharmacy attempted to deliver the methadone by posting it through the letterbox of the patient’s old address. When the new occupant found the methadone she took it for safe-keeping to a different pharmacy, which contacted Brooklands Pharmacy about the error.

The committee also heard that on 17 June 2004, during a visit to the pharmacy to investigate the matters described above, a Society inspector found 13 unsigned prescription forms, each endorsed to show that they had been dispensed on 4 June 2004. She also noted a further 24 unsigned forms, each of which had placed on it the medicines called for on the form, duly labelled for the patient named on the form.

When interviewed on 9 September 2004, Mr Laurence said that he had personally collected from the surgery the 13 prescriptions dispensed on 4 June 2004. The request to dispense against unsigned forms had come from reception staff at the doctor’s surgery.

When Ms Harrison was interviewed, she explained that the prescriptions dispensed on 4 June 2004 had still not been taken to be signed by 17 June 2004 because neither driver had been at work, one having had a fractured skull and the other being on honeymoon.

Giving the committee’s determination, the chairman of the Statutory Committee, Lord Fraser of Carmyllie, QC, said that, in essence, the complaint fell into four parts — the delivery of methadone to a wrong address, the failure to apologise, the supply of POMs without a valid prescription and making up prescriptions against unsigned forms. The committee believed that Ms Harrison should carry no responsibility for any of the four incidents and in her case it had come to the simple conclusion that no further action should be taken.

Going through the four complaints against Mr Laurence, the chairman said that the starting point was the locum’s mistake in labelling with the wrong address. Mr Laurence was not to be criticised for a failure to update the PMR, since he had not yet received any prescription bearing the new address. It was a mystery how the methadone got into the delivery box, but the bag was not marked to indicate that it contained a Controlled Drug. The driver had admitted putting the medicine through the letterbox despite having read and signed a “Prescription collection and delivery protocol” that concluded by saying: “If there is no reply from a particular address leave a card and return the medication to the pharmacy.”

The next matter was the failure to apologise to the woman who had received the methadone. It might have been a common courtesy to call on her to thank her for returning the methadone but, in the circumstances, the committee did not see there was any professional duty to apologise.

Mr Laurence had admitted that on 4 June 2004 he dispensed and supplied a number of medicines against prescription forms that were not signed. Although 13 were listed in the notice of inquiry, the committee would restrict the number to 12 because, although the allegation referred to POMs, one of the prescriptions was for aspirin, which cannot properly be described as a POM.

Finally, there were the further 24 unsigned prescriptions for which the medicines had been prepared. It was contended that the medicines would not have left the premises with the prescriptions unsigned. “It is possibly not a best system to have in a pharmacy but we cannot see that there was any professional error and the law was not breached, although that might have happened shortly afterwards.

“Accordingly, we find only the third of the four complaints was misconduct by Mr Laurence. He is an experienced pharmacist who well appreciated that he should not supply without a validly signed prescription, even if he did so in the best interests of the patient or if requested to do so by surgery staff.

“In our view, it is such misconduct as to render him unfit to be on the Register.

I should observe that we have read his very good references. He is clearly a responsible citizen and a responsible pharmacist and we would not want to direct the removal of his name. … The view of the committee is that Mr Laurence’s conduct warrants no more than an admonition.”

Pharmacist reprimanded over erroneous prescription endorsements

A Sheffield-based pharmacist who submitted erroneously endorsed prescriptions to the Prescribing Pricing Authority for payment has been reprimanded by the Statutory Committee.

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, criticised the NHS Counter Fraud and Security Management Service for its delay in reporting the matter to the Royal Pharmaceutical Society. He said that the committee was becoming increasingly worried about delays.

On 25 May, the committee considered a complaint from the Council of the Society about Ruxana Munshi (registration number 82341). The Council alleged that misconduct such as to render Ms Munshi unfit to have her name on the Register of Pharmaceutical Chemists may have been demonstrated individually or cumulatively by:

· The erroneous certification of prescription forms by Ms Munshi and/or her employees between about 30 September 2002 and 6 March 2003

· The submission of such erroneously certificated prescription forms to the PPA for payment, resulting in an overpayment of £440.20

· The additional erroneous certification of prescription forms by her and/or her employees in the two-year period of overpayment agreed with a representative of the NHS Counter Fraud and Security Management Service pharmaceutical fraud team

· The submission of such additional erroneously certificated prescription forms to the PPA for payment, resulting in an overpayment of about £4,300

· Her failure to ensure that staff had the requisite knowledge, skills and fitness to perform work delegated to them

Sole proprietor

The committee heard that between 1 March 1991 and 17 March 2003 Ms Munshi had been sole proprietor of Abbeydale Pharmacy at 338 Abbeydale Road, Sheffield. Since 1 March 2003 she had been sole proprietor of Sharrow Pharmacy at 15 Wostensholme Road, Sheffield. The Council alleged that, between about 30 September 2002 and 6 March 2003, she or her staff had completed certificates on the reverse of 54 prescription forms erroneously claiming exemption from payment of prescription fees. Each certificate signed in this way contained a declaration, including “I declare that the information I have given on this form is correct” and “I confirm proper entitlement to exemption”, even though the patients concerned were not exempt from payment and had paid the required prescription fee.

The prescriptions had subsequently been submitted to the PPA for payment, as a result of which the PPA paid Ms Munshi approximately £440.20 to which she was not entitled.

On 5 May 2004, at a meeting with an officer of the NHS Counter Fraud and Security Management Service pharmaceutical fraud team, Ms Munshi had accepted that procedures had not been in place to ensure the correct completion of prescription forms and the collection of patient fees, had accepted that mistakes had been made resulting in an overpayment made to her account, had estimated that the degree of overpayment was in the region of £10,000, had been unable to say how long the errors and overpayments had been going on, and had agreed to repay the PPA the sum of £4,800 based on the counter fraud team officer’s suggestion that a reasonable assumption for the length of time the overpayments had been made might be two years with overpayments running at the rate of approximately £200 per month.

On 6 May 2004, Ms Munshi had sent a cheque payable to the PPA for the agreed sum of £4,800.

It was further alleged that, at interview with one of the Society’s inspectors on 26 January 2005, Ms Munshi had admitted that the backs of the prescription forms in question had been filled in either by her or by her staff, that her staff had received no training on prescription handling, and that, because no record had been made of prescription fees received from patients, she had assumed when completing the details on the prescription that the patient had in each case been exempt.

Determination

Giving the committee’s determination on 25 May, the chairman, Lord Fraser of Carmyllie, QC, said: “I can indicate immediately that we will be restricting the case against Ms Munshi to the first, second and fifth of the bullet points in the summary on behalf of the Society, omitting bullet points 3 and 4.

“However, what remains in our view amounts to such serious misconduct as to render her unfit to be on the Register. As I have already indicated, there is a measure of artificiality in that unless we come to a view that her misconduct surmounts that hurdle, it is only then that the other options that are open to us beyond a direction to remove are lost.

“So what I would indicate now is that we are giving no direction for the removal of Ms Munshi’s name from the Register and will restrict our censure to that of a reprimand. … That is all I propose to say at the present time and, as I have indicated before earlier on, I am not best impressed with some of the actions, not by the Society, but others who have acted in this case, and I would like to reflect on that a bit further. We will accordingly adjourn now and I hope to deliver that final full determination in June.”

Giving the committee’s final determination on 29 June, the chairman confirmed that the committee would restrict its censure to that of a reprimand and would not direct Ms Munshi’s removal from the Register.

He continued: “Essentially we were influenced by two factors. First, the complaint against her was more than three years old before the case reached us. That is stretching tolerance and comes perilously close to a breach of the European Convention on Human Rights.

Delay

“The delay is not the fault of the Royal Pharmaceutical Society, which appears to me to have acted with all due expedition, once made aware of the complaint, but I must record that the Statutory Committee is becoming increasingly worried about delays.

“The Society is not yet to be concerned that it is to blame. Delays occur earlier when it still remains in ignorance of any problem. Too often what comes before us reveals that, having taken its time, the counter fraud team of the Prescription Prescribing Authority is advised by the Crown Prosecution Service that it is doubted whether a fraudulent intent can be established, and the matter only at that stage is passed to the luckless Society. In our view, that will not do.

“I was relieved to hear from the Secretary and Registrar to the Society that there is now in place a concordat or agreement that the Society should be advised, more or less as soon as the counter fraud team set out on a serious investigation. I hope that I have got that right, but if I have not I strongly urge the Society to come to such a concordat, and I urge the counter fraud team to observe it. Otherwise they will suffer the risk that we will unceremoniously dump the complaint as being too elderly.

“The second point is a related one. North of the border we are well trained in alternative pleading. I know that is not an unknown forensic skill this side of the border, but it does not appear to me to be much practised by the Society. The case against Ms Munshi was that she had ‘completed forms erroneously claiming exemption’. I have no idea whether the Society had evidence to support a case of fraudulent intent but, as no alternative was offered, I, as the legally qualified chairman, had to advise my colleagues that we could only approach the case on the basis of an erroneous submission.

“For obvious reasons, I make no comment on this case, as I simply do not know, but we might welcome a greater boldness on the part of the Society if it were felt that the evidence might justify an alternative of fraudulent intent. As it is, I have had to rule out any attempt … to sneak the complaint higher up the order from ‘erroneous’ to ‘fraudulent’. I do not believe that we can go outside the four corners of the notice of inquiry. If the Society uses the word ‘erroneous’, that is the highest point at which we will pitch it.”