Statutory Committee

False claims and declarations lead to striking-off order

A west London pharmacist who submitted false payment claims for NHS dispensing and made false fitness-to-practise declarations to a primary care trust 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 a pharmacy company that was party to the inquiry.

The case, which arose from a complaint by the Council of the Royal Pharmaceutical Society, concerned Bijal Vithalbhai Patel (registration number 84459) and his company Greenoaks Pharmacy Ltd (identification number 1003087). The Council alleged that misconduct such as to render Mr Patel unfit to have his name on the Register of Pharmaceutical Chemists may have been demonstrated individually or cumulatively by:

• Submitting wrong claims to the Prescription Pricing Authority, resulting in an overpayment to his company of £16,509.67

• Operating a system of work involving the alteration of endorsements on prescriptions by a superintendent pharmacist who was not the dispensing pharmacist, at a time and place remote from the dispensing of medicines and without consulting the dispensing pharmacist

• Relying on the statement of a prescriber’s member of staff rather than the prescriber himself in relation to his endorsement of prescriptions for contraceptive tablets

• Lacking professional knowledge in relation to prescribing for and dispensing of contraceptive tablets

• Failing to keep his knowledge up to date in relation to endorsements and the Drug Tariff

• Incorrectly instructing a dispensing pharmacist employed by the company in respect of dispensing against prescriptions for contraceptive tablets

• Dishonestly and/or erroneously completing and/or submitting untrue declarations in his applications for the inclusion of two pharmacies on a PCT’s pharmaceutical list

The Council further alleged that the first six allegations, individually or cumulatively, might also amount to such misconduct as to render the company liable to disqualification.

The inquiry opened on 24 July 2006 and continued on 25 July, 26 July and 23 October 2006. The committee heard that Mr Patel, who had registered in 1990, was at all material times superintendent pharmacist, director and main shareholder of Greenoaks Pharmacy Ltd, which owned 11 pharmacies in west and north-west London.

Endorsements

The committee was told that between about August 2000 and October 2001 Mr Patel operated a system under which all the prescriptions from the company’s pharmacies were delivered to him before submission to the PPA each month. He would examine them and alter the endorsements on some prescriptions without consulting the dispensing pharmacist.

Between about August 2000 and September 2001 he altered endorsements on prescriptions for contraceptive tablets dispensed at one pharmacy to indicate that a greater number of tablets had been dispensed than had in fact been prescribed and dispensed. He also altered endorsements on prescriptions dispensed at the company’s pharmacies to indicate that items had been dispensed as small packs when a large pack size had been dispensed. He had then submitted the said wrongly endorsed prescriptions to the PPA for payment.

In October 2000 the NHS Counter Fraud and Security Management Service began an investigation that at first concerned one of the company’s pharmacies but was then widened to include them all. Scrutiny of prescriptions submitted in the period September 2000 to September 2001 identified several thousand prescriptions on which Mr Patel had altered the endorsements. It was claimed that, as a result of his wrongly altered endorsements, the company had been overpaid by £16,509.67.

During an interview at a police station on 28 November 2001, conducted by a counter fraud specialist and a detective sergeant, Mr Patel had confirmed that he had made the alterations without knowing what had been dispensed. He said that for the previous three years he had himself only dispensed “for a couple of hours on a Saturday morning”.

Asked about endorsements on contraception prescriptions, Mr Patel had said that where a prescription provided for “6 OP” he had understood that to mean six full three-month packs rather than six months’ supply. His own practice was to provide 18 months’ supply in response to a prescription for “6 OP” and he had instructed the company’s pharmacists to dispense and endorse 18 months’ supply on such a prescription.

He had said that he considered it “normal” to issue a patient with 18 months’ supply and that a GP could prescribe a five-year supply if he wished. He did not know of a reason why it would be inappropriate to dispense more than six months’ supply.

Mr Patel had also told the investigators that when he endorsed a prescription with “PC”, be believed that it meant “previously contacted”, and not “prescriber contacted”.

He also said during the interview that he had not read the Drug Tariff “for the last few years”.

Misunderstanding of “OP”

The committee was also told that in a letter to the Society’s Infringements Committee dated 17 December 2004 Mr Patel had stated that his incorrect alterations to the prescriptions for contraceptive tablets arose out of his misunderstanding of the meaning of “OP” in relation to such products. He said that when he had telephoned a prescriber in relation to a “3 OP” prescription he spoke only to the practice manager and relied upon her assertion as to the meaning of the prescription. He also admitted instructing one of the company’s pharmacists to dispense 18 months’ supply of contraceptive tablets against prescriptions for “6 OP”.

As a result of the investigation, Mr Patel and the company were notified in letters dated 4 February 2005 that the Statutory Committee was to hold an inquiry. However, further alleged misconduct subsequently came to light. On 31 May 2005 the company applied to Ealing Primary Care Trust for inclusion on its pharmaceutical list in respect of two pharmacy premises. On both application forms, Mr Patel had completed the fitness-to-practise declaration required from each dispensing pharmacist working at the pharmacy. The declarations asked: “Are you currently the subject of any investigation by any licensing, regulatory or other body into your professional conduct or performance anywhere in the world?”, to which he had replied “no” by ticking a box on the declarations. He had submitted the company’s applications to the PCT.

Overpayment figure questionable

Giving the committee’s determination on 13 December, the chairman of the Statutory Committee, Lord Fraser of Carmyllie, QC, said that, although the Notice of Inquiry had alleged an overpayment of £16,509.67 it had been quickly ascertained that no detailed calculation had been made — or, indeed, could be made — to reach such a precise sum. Ultimately a figure half that amount was settled upon, namely, £8,254.83.

The chairman added: “We are not entirely surprised that this should now be the agreed figure. We were surprised that any attempt had been made to offer a precise calculation. … That could only be done at a disproportionate cost to the public purse, and we would be satisfied in the future if a broad minimum estimate were to be offered and agreed. It appears to us that considerable time is expended in an attempt to prove a precise sum and that effort is wasted. When it is subjected to cross-examination almost invariably the PPA departs from the calculation, as it is bound to.”

The chairman said that Mr Patel had admitted altering some endorsements and doing so without reference to the dispensing pharmacist. The committee also found proved other allegations set out in the notice of inquiry. It was true that Mr Patel had urged pharmacists working for him to use smaller packs from his own warehouse. He had referred to negotiating large discounts on small packs. However, the professional members of the committee were incredulous that pharmacists would pour out five 100ml bottles of Gaviscon into one 500ml bottle. Gaviscon was a heavy viscous liquid and it would be both a time consuming and an arguably inefficient way to work, leading to the patient receiving less than the 500ml called for. Furthermore, patients who had given evidence had failed to support Mr Patel’s claim. The committee preferred the evidence that one large bottle was dispensed but payment for five smaller bottles was claimed.

Turning to Mr Patel’s claim that in relation to contraceptive tablet prescriptions he understood “6 OP” to mean six three-month packs, the chairman said: “We were not wholly persuaded that we believe this but, giving him the benefit of the doubt, it is nevertheless an irresponsible and unprofessional practice for a pharmacist who knew, or ought to have known, that a GP should not prescribe contraceptive pills for an 18-month period without seeing the patient in the interim. We find that even if he did understand the prescription in the manner claimed, it was not good or satisfactory professional practice.”

On Mr Patel’s claim that he understood “PC” to mean “previously contacted”, the chairman said: “Again, we have some hesitation in accepting this extraordinary claim but, giving Mr Patel the benefit of the doubt again, this was irresponsible for him to rely at best on contact some years earlier, not with a prescriber but only a practice manager.”

Finally, said the chairman, the committee found that Mr Patel had indeed said during his police station interview that he had not read the Drug Tariff “for the last few years”.

Turning to the separate matter of the false fitness-to-practise declaration, the chairman said that Mr Patel had claimed that he thought he was agreeing to one form when in fact another was before him. That claim was thin and stretched the committee’s credulity. However, again with hesitation, the committee would give him the benefit of the doubt and conclude that the false declaration had been made only erroneously rather than dishonestly. “It was, however, recklessly erroneous, unprofessional and not in the public interest,” he added.

Accordingly, said the chairman, the committee found the Council’s summary of allegations all established and proved, in so far as they were not admitted, except that the overpayment was less than alleged and the declarations to the PCT were no more than erroneous.

Wholly unprofessional conduct

The committee’s conclusion was that the matters cumulatively showed that Mr Patel was unfit to have his name on the Register. They were not matters to be lightly dismissed. The committee had carefully considered the various references put before it and had taken into account the fact that Mr Patel had repaid most of what appeared to be agreed as due, although he had taken some months to do so. But even with the agreed loss restricted to some £8,000, it was not regarded as de minimis. Taking those together with Mr Patel’s wholly unprofessional conduct in relation to the abbreviations and the declaration to the PCT, the committee concluded that it should direct the removal of his name from the Register.

Mr Patel has three months in which to appeal, should he so wish.