Statutory Committee

Husband and wife struck off for catalogue of errors

Two pharmacists who made a large number of dispensing and other errors in their Dorset pharmacy are to have their names removed from the Register of Pharmaceutical Chemists, the Statutory Committee has ruled.

On 22 February, the committee inquired into a complaint by the Council of the Royal Pharmaceutical Society against Anilkumar Ishverbhai Patel (registration number 70633) and his wife Hemantika Anil Patel (registration number 71179). The Council had set out a total of 94 points of complaint against each pharmacist in their capacity as pharmacists and/or as joint proprietors and/or operators of the pharmacy. The Council alleged that, individually or cumulatively, these allegations amounted to misconduct such as to render Mr and Mrs Patel unfit to remain on the Register.

Allegations

The following is a summary of the main allegations:

• Making a number of dispensing errors and labelling errors

• Failing to take proper or sufficient steps in response to dispensing errors

• Deliberately misleading patients about the cause or nature of dispensing errors

• Making deliberately false entries in the pharmacy diary

• Altering the dosage instructions for a baby’s prescription without seeking or obtaining the prescriber’s authorisation and failing to take proper or sufficient steps in response to the mother’s enquiry about the dosage change

• Supplying a Controlled Drug other than in accordance with the Misuse of Drugs Regulations 2001

• After the supply of an unidentified product instead of Piriton syrup, falsely claiming to the patient’s mother and the GP surgery that the pharmacy had no Piriton in stock

• Attempting to persuade a patient to accept Lantus insulin cartridges in place of the Lantus insulin vials she had been prescribed

• Failing to supply full quantities of medicine to patients without explaining that more was owing or supplying an owing slip, and making inaccurate records in the patient medication record of the quantities supplied

• Failing to ensure that the pharmacy had an adequate system in place in relation to medicines owed to customers

• Failing to ensure that the pharmacy had adequate equipment and/or systems in place for the safe extemporaneous production of methadone

• Failing to ensure that extemporaneously produced methadone was adequately labelled and adequately recorded

• Supplying sugar-free methadone in response to prescriptions that did not call for the sugar-free product

• Dispensing unlicensed senna tablets

• Failing to record the dates of opening of medicines that have limited shelf-life after opening

• Failing to segregate dispensary stock that had passed its shelf-life from other dispensary stock

• Failing to implement and maintain an adequate system to control and/or monitor the temperature of the pharmacy refrigerator

• Failing to apply a system to minimise the risk of dispensing errors, such as the use of “dispensed by” and “checked by” boxes on dispensing labels

• Having within the dispensary loose capsules, loose and cut blister strips, capsules of unknown provenance, manufacturers’ boxes containing strips of tablets and capsules of brands differing from those marked on the box, and manufacturers’ boxes containing strips of tablets and capsules some of which bore no batch numbers and/or expiry dates or which bore batch numbers and/or expiry dates that differed from those on the box

• Having empty medicine bottles available for use that were uncapped and vulnerable to contamination

• Failing to heed advice given by one of the Society’s inspectors in relation to a number of the above-mentioned failings

Neither of the pharmacists was present at the inquiry and neither was represented.

The committee heard that Mr and Mrs Patel had both registered in 1978. They had jointly owned the Upton Cross Pharmacy in Poole between August 1985 and November 2004. Both had sought to resign from the Society but the Registrar had put their resignations on hold pending the inquiry.

Committee’s determination

Giving the committee’s determination, the chairman, Lord Fraser of Carmyllie, QC, said that Mr and Mrs Patel had not appeared before the committee and neither had been represented. This was not entirely surprising as both had offered the Society undertakings not to practise in the future and both had returned their practising certificates. What was odd was that although they had both undertaken not to practise in the future they had made no formal admission of the matters alleged in the notices of inquiry.

The chairman added that the Society might have argued that implicit in those undertakings and the return of the certificates were admissions that the allegations were true. But it did not, and its legal representative had methodically set out the alleged errors for the committee in a formidable performance demonstrating not just fairness and thoroughness but also an impressive attention to detail. “Those who seem to want to question a professional body’s ability to be objective in disciplinary proceedings should study her approach. No quarter was given but her essential fairness in the face of a miasma of detail should be regarded as an object lesson.”

The chairman went on to say that he had some reservations about the Society’s desire to extend its jurisdiction to co-proprietors. Both Patels were pharmacists and the Society undoubtedly owned a disciplinary jurisdiction over them, but when only one of them had been involved in an error the committee did not see it as the basis for any complaint against the other. However, where the notice of inquiry alleged only that “the pharmacy” had made a dispensing error, then the committee’s view was that both must take the responsibility. And where there has been some systemic failure in the pharmacy — where both worked for over 200 days a year — then both had to accept the responsibility. The most prominent example of this was the manufacture, make-up and dispensing of methadone, but there were also significant other failures in the pharmacy.

The chairman continued: “This is a curious case in that it appears to us Mr and Mrs Patel deny nothing and did not appear. We find the facts, in so far as they are not admitted expressly or by necessary implication, to have been established. There is more than enough against each to conclude his or her conduct was such as to render each of them unfit to be on the Register.

“Having come to that conclusion, I would ordinarily pause at this stage to have asked if anything was known. I do not do so in this case as I was in the chair of the Statutory Committee when Mr Patel previously appeared before us at which time he was lucky to escape with only a reprimand [PJ, 25 August, 2001, p277].”

The chairman said that in the main the committee found established the facts in the extensive notices of inquiry against each. The only exceptions were the allegation relating to Lantus insulin and those relating to minimising the risk of dispensing errors by using the “dispensed by” and “checked by” boxes on dispensing labels.

Concluding, the chairman said: “It cannot be in the public interest to allow either to remain on the Register, and we accordingly direct the removal from the Register of both of their names. As I indicated out the outset, so long as these cases were pending against them and before us, the Registrar refused to accept their proffered resignations and returned certificates. However, now that our determination has been delivered it would appear … that their resignations could now be accepted, unless the Patels wish to withdraw their resignations and appeal against this decision.”