Reprimand over S8 dispensing


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A NSW pharmacist has been found guilty of unsatisfactory professional conduct related to 10 complaints about his dispensing of addictive drugs

The pharmacist was first investigated by the Pharmaceutical Services Unit (PSU) in 2014, after it received reports of large quantities of high-strength opioids being ordered by pharmacies on the mid-north coast of NSW.

One pharmacy in particular had a high rate of dispensing fentanyl and oxycodone to patients with a past or present Opioid Treatment Program history, of which the respondent was the pharmacist-in-charge.

Following the PSU investigation, the Health Care Complaints Commission (HCCC) referred a complaint to the NSW Civil and Administrative Tribunal, which conducted its hearing in December 2017.

In a decision handed down just before Easter last week, the Tribunal found the pharmacist had inappropriately dispensed drugs of addiction including fentanyl and oxycodone to 10 different patients between 2009 and 2015:

  • in dosages that exceeded a therapeutic dose;
  • in excessive quantities;
  • in circumstances where he ought to have been aware the patient may have been drug dependent;
  • in inappropriate combinations with other drugs such as diazepam, quetiapine, buprenorphine, alprazolam, and morphine; and
  • in circumstances in which he ought to have known the patient still had supply remaining.

Three expert witnesses who gave evidence at the hearing were critical of the respondent’s conduct, with one highly critical of the pharmacist’s overreliance on the clinical judgement of the prescribing doctor.

And according to the estimation of an expert witness, the pharmacist had dispensed one patient enough fentanyl to cover 360 days of normal usage within a six-month period.

The respondent himself gave evidence that he “genuinely believed” he was adhering to his legal obligations during the period 2009 to 2015, and highlighted that he had made regular contact with prescribing doctors.

He submitted that he now realised he was lacking a full understanding of the relevant guidelines governing the prescribing and dispensing of dangerous drugs.

He also submitted that there were mitigating circumstances in relation to some of the transactions, including that the patients presented as suffering chronic pain and not obviously “doctor shoppers”.

One expert witness stated that some patients “are very practised in the art of persuading health practitioners of their need for powerful analgesics”.

The Tribunal stated: “In our view, [the pharmacist’s] admitted conduct, while not motivated by bad intentions, was seriously incompetent over a significant period of time.

“Pharmacists, once registered, are placed in a position of trust and have responsibilities, among other things, for protecting the public from the misuse and abuse of drugs of addiction.”

“He appears to have been far too readily willing to suspend his own judgement and to subordinate it to that of prescribing doctors whom he never challenged in any serious way.”

However it accepted that he had attempted to query one doctor about a number of prescriptions he had issued.

In a separate case in 2017, the Tribunal found this doctor had prescribed drugs of addiction to 12 patients in a quantity in excess of recognised clinical standards, without conducting an appropriate clinical assessment.

It found his conduct amounted to professional misconduct but made no protective orders, as the doctor had voluntarily surrendered his registration and given a written undertaking not to resume medical practice.

While the Tribunal found the pharmacist’s conduct “was of a sufficiently serious nature to justify suspension of cancellation” of his registration, it decided that given the passage of time and remedial steps taken by the pharmacist, “no useful purpose would now be served in suspending or cancelling [the pharmacist’s] registration, notwithstanding the seriousness of the subject conduct”.

Both parties agreed that he should be reprimanded rather than have his registration suspended or cancelled.

It was found that the pharmacist had made conscientious efforts to improve his practice, and demonstrated his willingness to seek guidance and support from experienced practitioners.

He had organised to have his practice formally reviewed by two pharmacy practitioners, and was undertaking an ethics course offered by the PSA.

Altogether the pharmacist was found guilty of unsatisfactory professional conduct under the Health Practitioner Regulation National Law; that he had engaged in conduct significantly below the standard reasonably expected of a practitioner of an equivalent level of training; and that he had engaged in improper or unethical conduct relating to the practice of pharmacy.

Based on these findings, he was reprimanded and ordered to pay 60% of the HCCC’s costs.

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6 Comments

  1. justapharmacist
    05/04/2018

    Just wandering what happened to the prescriber himself who originally wrote these scripts and signed them ?

    • Sheshtyn Paola
      05/04/2018

      Hi justapharmacist, thanks for your question! In a separate case in 2017, the Tribunal found this doctor had prescribed drugs of addiction to 12 patients in a quantity in excess of recognised clinical standards, without conducting an appropriate clinical assessment.

      It found his conduct amounted to professional misconduct but made no protective orders, as the doctor had voluntarily surrendered his registration and given a written undertaking not to resume medical practice.

      The above has been added to the article.

      Kind regards,
      Sheshtyn Paola (author)

      • justapharmacist
        05/04/2018

        Thanks for you reply. Hopefully with every S8 incident both doctor and pharmacist treated fairly by the authorities according to everyone responsibility of prescribing and dispensing

    • The Cynic
      05/04/2018

      Without understanding all the details I find it difficult not to have sympathy for this colleague. If we can take anything from this story it is that we must not allow ourselves to be blindsided by the peculiar prescribing practices of some doctors. Rural Australia in particular had large numbers of chronic pain sufferers who are treated with opioids. It is easy to imagine becoming desensitized to seeing a large number of prescriptions for opioids. In a busy dispensary where every minute is divided three ways a pattern of overuse may not be as apparent to the pharmacist as it would be to the auditor going through the books.
      We should feel for our colleague who has admitted the shortfall in his knowledge and learn from it so that we not fall into the same trap.

      • justapharmacist
        05/04/2018

        Totally agree with you. But without the sympathy side as some may agree or disagree wit you. the article saying the pharmacist had dispensed one patient enough fentanyl to cover 360 days of normal usage within a six-month period. So to prescribe 360 days fentanyl is normal but to dispense them is a crime !!!!!!!!!!. recent months saw a lot of articles about catching a lot of drug dealers (AKA pharmacists) by the task force unit (AKA PSU). I am totally fine with that. What about the green piece of paper that we get and been issued by a GP?. Another interesting point, Gp’s consultation time with a single patient around 30 minuet but pharmacist interaction with a single patient is around 10 minutes (when it is quiet or not in a big yellow box shop) pharmacist gets a disciplinary action and Gp may or may not just get a phone call.

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