Disciplinary Committee

Brothers who breached Controlled Drugs legislation ordered to be struck off by Disciplinary Committee

Pharmacist brothers who breached a number of requirements of Controlled Drugs legislation have had their names removed from the Register of Pharmaceutical Chemists on the order of the Royal Pharmaceutical Society’s Disciplinary Committee.

At a hearing on 23 and 31 August 2007, the committee inquired into the case of Sunil Paul Khanna (registration number 75526) and Anil Paul Khanna (registration number 75094), both of Newcastle Upon Tyne. A complaint had been received from the Society’s Council alleging that misconduct such as to render them both unfit to have their names on the Register may have been demonstrated by the following breaches of regulations made under the Misuse of Drugs Act 1971:

• An entry by Anil Khanna in the CD register entry indicating that a prescription for methylphenidate tablets had been supplied in full to a patient when only a small number of tablets had been supplied

• Anil Khanna’s endorsement of the prescription relating to the above supply to indicate erroneously that the full amount had been supplied

• The dispensing of an additional quantity of methadone mixture to a patient by Sunil Khanna when that quantity was not due to be supplied until a week later

• An entry by Sunil Khanna in the CD register to the effect that a quantity of methadone mixture had been supplied to a patient when no such supply had been made

• Anil Khanna’s failure to ensure that methadone mixture and temazepam tablets were kept in accordance with the requirements of the CD safe custody regulations

• Anil Khanna’s action in allowing the key to the CD cabinet to be left in the lock when no pharmacist was on the premises

• The removal of the methadone register from the pharmacy by Anil Khanna

The committee heard that the brothers jointly owned four pharmacies at the relevant time but the allegations all related to premises in Grainger Street, Newcastle.

The committee was informed that on 27 May 2004, Anil Khanna had received a prescription for 180 methylphenidate 10mg tablets. He had supplied 30 tablets and given an owing slip for 150. But he had made a CD register entry for the full 180 tablets and had claimed payment for the full amount even though the balance was never collected.

The committee was also told that on 1 June 2004, Sunil Khanna had supplied a patient with 420ml of methadone mixture 1mg/ml against a prescription calling for 210ml on that date and 210ml on 8 June. He had marked the prescription and made a register entry to the effect that 420ml had been supplied on 1 June. When the patient returned on 7 June claiming to have received only 210ml on 1 June, Mr Khanna authorised a further supply of 210ml and directed that the prescription endorsement should be amended.

The committee was further informed that on 4 June 2004, a Society inspector had visited the pharmacy at about 9am and found it was open for business without the presence of a pharmacist. She noted that the CD cabinet key was in the lock, that a pot containing 153 temazepam 20mg tablets was on an open shelf, and that on the dispensary bench was a 500ml bottle containing 145ml of methadone mixture, labelled to indicate that it contained 406ml dispensed for a specific patient but marked “not collected using as stock” and marked with an indication that 406ml had been dispensed.

Anil Khanna had arrived at the pharmacy at about 9.30am and had used the same bottle to dispense methadone for patients other than the person named on the label, explaining that the patient concerned had failed to collect her supply. However, the inspector found a register entry and a prescription endorsement indicating that the supply had been made.

Police interview

During a police interview, Mr Khanna had said that he had been in the pharmacy earlier that morning to prepare CD prescriptions for dispensing later in the day but had left in a hurry at about 8.30am to sort out a problem at another branch.

The committee was also advised that on or about 20 June 2004 Anil Khanna had removed the methadone register from the pharmacy, contrary to regulations, and it had never been returned. He claimed that a staff member had inadvertently put the register in a bag of paperwork that he was to take home. The bag had been stolen from his van when it had been parked overnight.

Giving the committee’s determination, the chairman, John Burrow, said that, apart from infringements of the law, the events complained about indicated poor procedures at the pharmacy and a breach of professional standards. In the opinion of the committee, the misconduct was so serious that it rendered both brothers unfit to be on the Register.

In determining the appropriate sanction, the committee noted that the brothers had a long and unhappy record, which included two convictions, two reprimands, an admonishment and six warning letters. In 1989 they were admonished by the Society’s Statutory Committee for misconduct in substituting a different medicine for the product prescribed (PJ, 9 December 1989, p747). In 1993 the committee reprimanded them after they had been convicted of permitting the supply of a medicines not on a general sale list when no pharmacist was present (PJ, 29 January 1994, p154). In 1999 they were again reprimanded for similar convictions and for a series of dispensing errors (PJ, 15 January 2000, p90). In addition, they had received written warnings from the Society about advertising (twice in 1985), the supply of a medicine not of the nature requested (1986), printed labels (1988), labels that breached the Medicines Act 1968 (1993) and a dispensing error by Sunil Khanna (2001).

The case included a number of features that aggravated the seriousness of the misconduct, said the chairman. They included a potential risk to patients, a breach of confidentiality in the loss of the CD register and other documents from the company van and a failure to take heed of earlier written advice from the Society and its inspectors.

Mitigating factors included the brothers’ admission of misconduct, the fact that they had been short-staffed at the time of the incidents, a number of good references and testimonials, evidence that the pharmacy was now clean and modern, and material indicating that the Khannas were fully engaged in local community groups and organisations.

The committee also noted that the pharmacy’s somewhat piecemeal written instructions had been brought together in one 200-page standard operating procedure document, and that regular inspections of the pharmacy by the police and the primary care trust since 2004 had not produced any complaint. Nor had there been complaints from GPs, patients or the public.

However, because of the number of earlier transgressions, the seriousness of the misconduct and the clear breaches of warnings, the committee concluded that nothing less than removal would suffice.

The brothers were advised that they had three months in which to exercise their right of appeal. Their names were removed from the Register on 30 November 2007.