A ‘fundamental failure of responsibility’

A pharmacist’s registration has been suspended after he provided medicines, including S8s, on scripts he knew were not valid – and a doctor’s registration has been cancelled over the matter

AHPRA and the Pharmacy Board have issued a statement about Andrew Nguyen, who appeared before the South Australian Civil and Administrative Tribunal for providing prescription medication to patients, while aware that the scripts had not been issued by a registered medical practitioner.

Mr Nguyen was the sole proprietor of a Salisbury North pharmacy located near a private medical practice, where Dr Bhagwant Singh was a registered medical practitioner.

The Tribunal heard that on “numerous occasions between January 2014 and December 2015, Mr Nguyen provided prescription medications to patients of the All Health Medical Centre on the basis of prescriptions which Mr Nguyen knew were not issued by a registered medical practitioner”.

Mr Nguyen, the Tribunal heard, believed that the recipients were Dr Singh’s patients, but that although Dr Singh had not seen the patient or issued the script, the doctor had authorised an employee at the practice to use his name and prescriber number to prepare scripts.

Mr Nguyen knew that this man was not a registered medical practitioner.

He also provided medication without prescriptions at all, on the basis that certain patients could be provided with regular medication without a prescription and the patient would then obtain a retrospective prescription.

On only one occasion was a retrospectively authorised script issued.

“Throughout the period, the respondent also dispensed medications, or permitted medications to be dispensed, on repeats where no retrospective approval had been received following the initial unsigned prescription,” the Tribunal noted.

Some of these medicines included controlled substances and some were for drugs of dependence. They included OxyContin and Endone.

One of the patients gave evidence that he had obtained an unsigned script for Somac from the medical centre’s employee, and presented it to “Andrew” at the pharmacy.

He returned on two later occasions, and had repeats dispensed.

All this took place without the patient having seen a registered medical practitioner at all, and without a script signed by one.

The tribunal said that by placing his trust in another person and the medical practitioner, Mr Nguyen was abdicating the responsibility of a pharmacist to care for the persons to whom the medications were dispensed. To do so was a fundamental failure of responsibility.

The Tribunal noted that the arrangements with Dr Singh and the employee had not been initiated by Mr Nguyen, and there had been no “concerted, sophisticated” plan to hid the conduct.

“The Tribunal accepts that Mr Nguyen considered that the patients all needed the medication he was dispensing,” it said.

“The Tribunal considers that the conduct involved a substantial departure from the standard reasonably expected of a pharmacist but does not demonstrate that Mr Nguyen would not, in future, perform the functions appropriately,” it said.

“A reprimand in strong terms is appropriate. A period of suspension is also appropriate, both to signal to Mr Nguyen and to the community the extent of Mr Nguyen’s departure from acceptable standards.”

The Tribunal said that a longer suspension period would normally be appropriate, but it recognised that Mr Nguyen had already substantially reduced his practise since the conduct, and had undertaken further study.

It suspended his registration for six months, but said that if the circumstances had been different, it would have been two years.

It also ordered that at the end of the suspension period, conditions be imposed on his registration.

As for Dr Singh, the Tribunal cancelled his registration, and he was disqualified for applying for registration for 18 months.

The Medical Board issued a statement about Dr Singh in which it noted that while he was on leave in 2014, the employee had accessed his records and generated scripts using his name and prescriber number, without the doctor’s knowledge.

However, when the doctor became aware of this, he did not report it.

Instead, when he was due to go on leave in 2015, he agreed that the employee could do so again, for “routine medications and some urgent medications”.

During the investigation into his conduct, Dr Singh indicated that he considered it would benefit his patients to have continuity of care during his absence in June 2015 but there was no registered practitioner to provide that care. In early 2015, Dr Sing was a sole practitioner.

The tribunal noted there was no evidence of Dr Singh attempting to arrange a locum or make arrangements with patients to ensure continuity of medication instead of the arrangement agreed to with the employee and the pharmacist.

While it had been argued that all three – the doctor, the pharmacist, and the employee – were culpable in the arrangement, the Tribunal decided that the doctor’s role was paramount.

“The pharmacist’s duties are onerous and contribute in a vital way to the integrity of the legal protections in place with respect to the administration of medication,” the Tribunal noted.

“As part of that regime, the pharmacist relies upon a general practitioner having made a professional assessment that the prescription is appropriate and necessary. That assessment is based on a consultation with the patient, which gives the general practitioner information to which the pharmacist does not have access.

“It was Dr Singh whose abdication of care for his patients gave rise to the greatest risk to the patients. It was Dr Singh who went on leave and made no proper arrangements for continuity of care for his patients.

“Without that abdication, the arrangement was not necessary. We consider that Dr Singh’s conduct is more serious than that of Mr Nguyen.”

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