Disciplinary Committee

Reprimand for dispensing overprescribed medicines

NHS fraud investigation leads to reprimand

Reprimand for dispensing overprescribed medicines

The Royal Pharmaceutical Society’s Disciplinary Committee has reprimanded a Bedfordshire pharmacist for misconduct in dispensing medicines that had been inadvertently prescribed in excessive quantities.

At a hearing which began in August 2007 and concluded on 28 September 2007, the committee inquired into a complaint by the Council of the Society against Adegboyega Bolarinwa Claudius Salako (registration number 66018) of Luton. The Council alleged that Mr Salako was guilty of misconduct in that during 2002 and 2003 he had supplied a patient with excessive quantities of glyceryl trinitrate (GTN), Didronel PMO and Oramorph from the pharmacy he then owned in Luton. In doing so, the Council alleged, he had infringed key responsibility 1 of the Society’s then code of ethics, which required pharmacists, among other things, to act at all times in the interests of patient and to seek to provide the best possible healthcare.

The Council alleged that between about 30 July 2002 and 15 May 2003 Mr Salako had dispensed 18 prescriptions each calling for one GTN 400µg spray, which contained about 200 doses; between about 18 February 2002 and 24 April 2003, he had dispensed about 24 prescriptions each calling for one 90-day course of Didronel PMO tablets; and between about 30 May and 30 September 2002 he had dispensed 10 prescriptions each calling for 200ml Oramorph oral solution. For each drug, up to four prescriptions had been raised on the same date, but Mr Salako had made inadequate efforts to query the excessive quantities with the prescribers.

In evidence to the committee, three prescribing doctors said that the excessive quantities had been prescribed because the prescriptions were computer-generated and had not been adequately checked when they were signed. However, in the case of the Oramorph prescriptions, the doctor who most often attended the patient said that the quantities prescribed and supplied were not out of the ordinary.

Giving the committee’s determination, the chairman, John Burrow, said that the committee found breaches of key responsibility 1 in respect of GTN and Didronel PMO prescriptions but not in respect of Oramorph.

The supplies were lawful in that they were made in response to genuine prescriptions and there was no allegation of unjust enrichment or dishonesty, but even so Mr Salako’s dispensing was seriously deficient. The pharmacist’s duty to check prescriptions and resolve queries with the prescriber was an important one for the protection of the patient. The committee concluded that the breach of the code was serious enough to render Mr Salako unfit to remain on the Register of Pharmaceutical Chemists.

However, there were a number of mitigating factors, including Mr Salako’s insight into the matter, his attempts to remedy the situation, the small financial gain and the fact that the errors were initiated by others. The committee did not think there was a continued risk to the public or that the matters were so serious as to undermine confidence in the profession. A reprimand was, therefore, the appropriate and proportionate sanction.

NHS fraud investigation leads to reprimand

The Royal Pharmaceutical Society’s Disciplinary Committee has reprimanded a Surrey pharmacist whose wrong endorsement of NHS prescriptions led to a fraud investigation and the recovery of nearly £3,500 in overpayments.

At a hearing, which opened on 7 January and concluded on 11 January, the committee inquired into a complaint by the Council of the Society against Ashokkumar Jivandas Haridas Tanna (registration number 73497) of Kingston upon Thames. Mr Tanna is manager of a pharmacy in Kingston and is one of three pharmacist brothers who jointly own the business. (The complaint related to all three brothers but on 9 January the committee directed that the case against the other two should be stayed.)

The Council alleged that from January to March 2003 Mr Tanna dispensed large pack sizes of Gaviscon but sent the prescriptions to the Prescription Pricing Authority endorsed to indicate that small pack sizes had been dispensed. In November 2003, while the NHS Counter Fraud Security and Management Service was investigating the endorsements, Mr Tanna notified the PPA that over the previous eight to 10 months the pharmacy had overclaimed in respect of Gaviscon liquid and other items. In June 2004 the pharmacy made a repayment of £3,491.34 in respect of the overpayments.

Giving the committee’s determination, the chairman, Judge Mota Singh, QC, said that the original allegation had been one of dishonest or erroneous endorsement or both, but dishonesty was no longer alleged. The only issue was whether the admitted erroneous endorsements constituted misconduct.

Mr Tanna was alleged to have breached a code of ethics requirement that pharmacists should behave with integrity and probity, adhere to accepted standards of conduct and refrain from activities likely to bring the profession into disrepute or undermine public confidence. It was also alleged that he had breached a requirement that pharmacy owners should ensure that legal and professional requirements were observed.

The chairman said that a fundamental requirement of NHS dispensing was that payment was claimed only for what was supplied. Pharmacists had to get these matters right so that NHS funds were distributed correctly.

In the light of everything that had been put before it, said the chairman, the committee took the view that Mr Tanna’s conduct constituted misconduct that rendered him unfit to be on the Register of Pharmaceutical Chemists. However, there were several mitigating features, including the repayment of the money, Mr Tanna’s frankness throughout the investigation, his impressive references, the absence of any risk to patients or the public and the delay before the matter came before the committee. In the circumstances, removal from the Register would be disproportionate and the interest of justice would be amply served by a reprimand.