Pharmacist who made “irresponsible” supplies to patient with anorexia is ordered to be struck off
A pharmacist who was said to be lucky not to have caused the death
of a patient with anorexia nervosa through his “disgraceful and
irresponsible” behaviour
is to be removed from the Register of Pharmaceutical Chemists on the
order of the Statutory Committee.
Dinesh Parmar (registration number 74869), of Loughborough, Leicestershire,
had supplied the patient with large quantities of laxatives and diuretics,
including a prescription-only product supplied unlawfully.
In making its decision the committee also took into account a number
of other allegations of misconduct and three convictions under the Medicines
Act 1968.
The committee inquired into Mr Parmar’s case at its meeting on
26 June. The committee had received a complaint from the Council of the
Royal Pharmaceutical Society alleging that misconduct such as to render
Mr Parmar unfit to have his name on
the Register may have been demonstrated individually or cumulatively
by:
· His repeated supply of laxatives and/or diuretics to a patient who
he knew or ought to have known was vulnerable to abuse of those medicines
· His failure to ensure that his pharmacy premises were safe for the
public and/or persons working there
· His failure to ensure that all stock was stored appropriately
· His failure to heed advice given to him by a Society inspector
The committee had also received information that on 26 October 2004,
at Nottingham Magistrates’ Court, Mr Parmar had pleaded guilty
and been convicted of supplying frusemide (furosemide) without a prescription
given by an appropriate practitioner and in a container not labelled
to identify the contents and give direction as to use, contrary to provisions
of the Medicines Act 1968, for which he had been fined a total of £3,000
and ordered to pay £50 in costs. Information had also been received
that on 30 March 2006, at Carrington Street Magistrates’ Court,
Nottingham, he had pleaded guilty and been convicted of having sold five
ampoules of diamorphine 10ml which was not of the nature or quality demanded
by the purchaser in that it was out of date, contrary to Section 64(1)
of the Act, for which he had been fined £750 and ordered to pay £43
in costs.
The committee heard that Mr Parmar had owned and run a pharmacy in Nottingham
since 1985. For a period between 1988 and 20 May 2004, he had regularly
supplied laxatives, namely, Nylax, Dulcolax, glycerin suppositories and
Califig to the patient with anorexia. In the early part of the period
he made the supplies about once a week and at a later stage about twice
a week. He also regularly supplied Aquaban, used for premenstrual water
retention, and on unknown occasions within the same period he supplied
Dioctyl, a laxative.
On a number of occasions he also supplied the patient with other, unidentified,
tablets. On one occasion he supplied seven small blue tablets which he
said were water tablets and/or for heart problems. The patient took them
all at once and consequently was admitted to hospital. On another occasion
he supplied 10 unidentified blue tablets, telling her to “put them
in a safe place so no one finds them”.
Mr Parmar made all these supplies without speaking to the patient’s
GP, in circumstances where the patient was obviously emaciated and he
knew, or ought to have known, that she was suffering from anorexia.
The supplies ended after the patient’s GP visited her at home and
found a bottle containing some 500 furosemide tablets that he had not
prescribed for her. The discovery led to Mr Parmar’s first two
convictions.
The patient told the committee she had wanted to die after becoming addicted
to furosemide, taking up to 70 tablets daily. She ended up in hospital
for weeks being fed on a drip, suffering from mental and physical problems.
Mr Parmar admitted supplying the drugs, but he claimed the patient originally
asked for medicines to help with constipation and a problem passing urine.
He said that when he tried to stop supplying medicines to her she threatened
and intimidated him and said she would get people to attack him.
He also claimed that she told him she was awaiting renal dialysis and
would supply him with prescriptions for the furosemide.
Inspector’s concerns
The committee also heard that in June 2003 one of the Society’s
inspectors visited the pharmacy and found a number of matters of concern
within the premises. She left an inspection advice note giving advice
regarding these matters. In August 2003, she again visited the pharmacy
and again found a number
of matters of concern, leaving a further inspection advice note. Matters
of concern were also found during visits in December 2003, February 2004
and June 2004.
The deficiencies found during these visits included the following failures
by Mr Parmar to ensure that his pharmacy was safe for the public and/or
persons working there: dirty and cluttered dispensary benches; unclean
shop and dispensary areas; stock left on the floor of the dispensary
and other areas of the pharmacy; rubbish that needed to be cleared from
the pharmacy; flooring in an inadequate condition; dirty tablet triangles;
disposal bins for sharps and unwanted medicines left in front of the
shop counter; empty methadone bottles retained for mixing methadone solution
in; and measures used for methadone not washed promptly after use and
stored safely.
The inspector also found the following matters of concern in relation
to the storage of dispensary stock: stock not kept in the manufacturer’s
original packaging; stock past its expiry date that was not segregated
for disposal; bottles of medicines left uncapped when not in use; stock
inadequately labelled; and a failure to keep the out-of-date check record
book up to date.
In November 2004 the inspector again visited the pharmacy. She found
on that occasion that the pharmacy was tidy. However, two of the six
tablet triangles, including one that was in use, were dirty and only
three entries had been made in the out-of-date book since those noted
in December 2003.
Giving the committee’s determination on 29 June, the chairman,
Lord Fraser of Carmyllie, QC, said that although the laxatives supplied
to the anorexia patient were over-the-counter products they were well
known as potential drugs of misuse in the hands of someone suffering
from anorexia nervosa. “We are relieved to be able to report,” he
added, “that when she appeared before us, the young lady appears
to have recovered her weight, but she went down at one stage to just
over five stone. To an experienced pharmacist, this decline in her health
should have been obvious. Notwithstanding that decline, over an extended
period Mr Parmar provided her [with] a range of laxatives.”
“In our view,” said the chairman, “Mr Parmar’s conduct
was disgraceful and he is lucky that his irresponsible behaviour did not cause
her death. As indicated, we are relieved to be able to report that her physical
health at least has been restored. We have, however, seen horrendous photographs
of her condition before she began the long road to recovery.
While this was the most serious aspect of misconduct, it was not the only part
of the complaint against Mr Parmar, said the chairman. The committee had found
proved all the misconduct and the convictions, he said, and it had concluded
that Mr Parmar was guilty of such misconduct as to render him unfit to be on
the Register. “Of all his misconduct, we would regard as most reprehensible
his treatment of this vulnerable young woman. He has been a pharmacist in a
tough part of Nottingham and on a number of occasions it would appear he has
been attacked in his own pharmacy premises. But it cannot be in the public
interest that he remains on the Register and with little or no hesitation we
direct the removal of his name.”
Mr Parmar was told he had three months in which to appeal, should he wish to
do so.
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