A pharmacy was investigated after its wholesaler noticed it “purchased amongst the highest quantities of high strength Fentanyl patches and high strength oxycodone tablets of any pharmacy in NSW”
The Civil and Administrative Tribunal New South Wales has heard four complaints about the conduct of a pharmacist who owned a store in western Sydney – including details about the dispensing of enormous quantities of Schedule 8 drugs of addiction and Schedule 4B and D prescribed restricted substances to 38 patients.
Of these patients, 25 were dispensed drugs of addiction under prescriptions from three different doctors, whose prescription pads had been stolen.
These scripts were later shown to be fraudulent.
The remaining 13 patients in question were dispensed special prescribed restricted substances.
The pharmacist bought his store in July 2014, as the sole proprietor, and worked there alongside two full-time employee pharmacists as well as a locum.
Wholesaler records were provided to the NSW Ministry of Health Pharmaceutical Regulatory Unit (PRU), which noted the unusually high quantities of high strength Fentanyl and oxycodone purchased by the business, and decided to investigate.
After the PRU’s initial inspect of the pharmacy on 9 March 2017, its director, Bruce Battye, decided to take action to withdraw the owner’s authority to possess any S8 or S4D drugs, as well as several other restricted substances.
The owner was informed of this decision on March 17th, and on the 20th, the owner let the Pharmacy Council of NSW know about the decision to withdraw his authority.
The Council conducted a hearing, and imposed various conditions on the owner’s registration – including that he must not practise as a pharmacist. At the time of this new hearing, this condition remained in place.
The pharmacist sold his store on 20 December 2017.
The Tribunal heard particulars of four complaints made against the former pharmacy owner.
Forged scripts and frequent dispensing
The Tribunal heard a complaint concerning the inappropriate dispensing – or failure to ensure his pharmacists dispensed appropriately – of medicines to people identified as Patients A through Z, for S8s and S4B and S4D drugs.
It was also alleged that the owner inappropriately dispensed, or failed to ensure appropriate dispensing by employees, forged scripts for S8 drugs of addiction.
Forged scripts from three doctors were for Oxycodone 80mg, Fentanyl 100mcg and Alprazolam 2mg, all dispensed as non-PBS.
A total of 94 forged scripts from one doctor were dispensed at the pharmacy, for Patients A through Y, initialled by the owner.
This doctor, whose practice was some 20km away from the pharmacy and had closed in January 2017, said the script pad had been stolen, and that on review of his medical records he had never prescribed drugs of addiction to the patients in question. He also said he had never had a phone call from the pharmacy.
Five scripts (to Patients B, C, E, T and W) were from a second doctor, who said they were all forged and on stationery which had been stolen from his practice, more than 17km away from the pharmacy.
These were initialled by the owner and patient addresses were missing.
There were 15 forged scripts in the name of the third doctor, whose practice was more than 20km away from the store and who said she had never prescribed a drug of addiction to any of the 14 patients in question. These scripts were initialled by the owner, except in one case where the employee pharmacist’s initials appeared.
The patient histories for Patients A to Y show the patients received Oxycodone 80mg, Fentanyl (Durogesic) 100mcg and Alprazolam 2mg on Non-PBS prescriptions from multiple prescribers and at varying intervals, the Tribunal noted.
It heard a long list of particulars about these patients.
For example, Patient A, who also received S8s on forged scripts, had been dispensed S8 drugs from 10 other prescribers.
Patient B, whose address was in Queensland and who had been on the NSW Opioid Treatment Program until July 2016, also received forged scripts and, between February 2015 and December 2016, was dispensed Durogesic 100, Oxycodone Sandoz 80mg and Kalma 2mg from 15 prescribers on private prescriptions (other than on 21 February 2015 for Durogesic 100 and 11 July 2015 for Oxycodone Sandoz 80mg, when these two prescriptions were dispensed on the PBS using a concession card).
Many of these patients had addresses out of the pharmacy’s catchment area.
The owner said that the store “had lots of patients who came from out of the area,” the Tribunal noted.
“It was not unusual and it did not raise concerns for him.”
Regarding the number of different prescribers, he said that this was also not uncommon because sometimes a person’s regular doctor was unavailable.
The Tribunal also heard about Patient Z, who was given Proviron (1,000 tablets); Arimidex (300 tablets); Valium 5mg (1,000 tablets); and Primoteston Depot 250mg/1ml syringes (60 syringes) all on one day in October 2016.
This patient received the Primoteston five times in November 2016 alone, with 30 syringes (only 15 on one occasion).
He also received Tramal SR, Antenex, Nolvadex-D, Pregnyl 1500 iu Ampoules, Aromasin, Genotropin GoQuick Injection 12mg, and Clomid 50mg, between 6 October 2016 and 7 March 2017.
These were all on private script.
“The patient history indicates that significant sums of money were being spent in the name of Patient Z,” the Tribunal noted.
“For example, the three medications dispensed on 15 January 2017 Aromasin, Pregynl and Proviron cost a total of $5350 whilst the Genotropin dispensed on 16 February 2017 cost $3960.”
The pharmacy owner said at first that he did not know Patient Z and could not recall dispensing the scripts, but later said it was likely he did provide some of the medications.
“I can’t recall every time I was in the pharmacy and these medicines were dispensed, but I said it was more likely than not that I didn’t dispense some,” he said under cross-examination, saying he based this on “my dispensing habits”.
It was pointed out to the pharmacy owner that some of these medicines were prescribed in very large quantities – such as 1200 tablets (40 boxes of 30) of Nolvadex 20mg on 10 January 2017, and 600 tablets two days later.
“So someone must have known that there was going to be a prescription come in for Nolvadex 1200 tablets, do you agree?” he was asked.
The former pharmacy owner replied that he was “unsure”.
He said he had never seen a script for this quantity.
“So would someone have just made up this prescription by entering it in the system as there was no record of prescriptions for patient Z, so do you think someone has just made up a prescription with this quantity?” he was asked.
He said he did not believe so.
“At the point of sale system, patient Z’s prescriptions were taken out at no charge. Why was this?”
He said he was not sure, and when asked if Patient Z existed, he said he believed that he did.
Yet another complaint concerned people identified only as Patients A1 to L1, who were dispensed anabolic androgenic steroids and peptides.
The doctor who prescribed these had been asked to provide medical services to a company, but he only worked there six days, quitting after he realised that the biochemist there was a high-profile person who had been given a lifetime ban from the sports industry by the Australian Sports Anti-Doping Authority.
The doctor said he only prescribed for 23 patients, refused to prescribe for two, and had concerns when he realised patients were presenting to him having already been assessed and given a script form by the biochemist.
The Professional Standards Committee found that this doctor had engaged in unsatisfactory professional conduct in writing the scripts that he did.
All of the prescriptions were printed on printer-generated A4 pieces of paper and not on prescription pads or computer-generated prescriptions, and many did not contain prescription numbers.
In several cases repeats were not indicated, but were issued, and the scripts were dispensed as non-PBS despite not stating this.
The pharmacy was providing an opioid replacement therapy service, with around 40 patients who were taking methadone.
The first complaint related to the dispensing, stock checks and record-keeping for methadone.
On 7 November 2015, a pharmacist in the then owner’s employ recorded a loss of 869 millilitres of methadone in the store’s Drugs Register, but the owner failed to tell the NSW Ministry of Health. He also admitted that there had been no attempt to find out why the methadone went missing.
On 29 January 2017, the practitioner recorded a loss of 2,579 millilitres of methadone, and again did not tell the Ministry. He did, however, attempt to ascertain what was happening, and concluded that the methadone pump was the source of the discrepancy.
The Tribunal heard that accurate bi-annual stock checks for methadone were not undertaken in 2015 and 2016.
The pharmacist who had first raised the issue of the 869mL loss said that after he performed thIS stock check (AND especially in the light of a 149-millilitre methadone surplus at the January 2015 check) he became uncomfortable about doing the stock checks.
This was because he was concerned that the pump was not being fixed.
However, he was not sure whether he had told the owner he would no longer do the stocktake; the owner said he had not, and that this employee pharmacist was the one in charge of ordering and maintaining an accurate inventory of the drug.
When the PRU visited the pharmacy in March 2017, they found a 2L variance after checking the methadone register.
They also ordered the then owner to get a new pump, which reduced the variance to negligible.
The owner had claimed that he had been told by the PRU to keep using the faulty pump, however, until a solution was found… which he had done until he was suspended on 30 March.
The PRU officer in question was baffled by the owner’s claim that he thought the PRU would help him find a solution.
The complaint also contended that the owner failed to keep S4B scripts at the pharmacy separate to others.
Between 9 March 2017 and 19 April 2017, the owner also inappropriately removed his name and initials from the dispensing system at the pharmacy, the Tribunal heard.
He had said that the PRU had advised him to remove the initials, a claim denied by PRU officials.
The Tribunal said it found the former pharmacy owner to be an “unreliable witness” and “unable or unwilling” to face up to the gravity of the complaints against him.
“He was equally unable to accept the significance of his conduct both as the pharmacist responsible for dispensing individual prescriptions and as the owner responsible for the operations of the pharmacy.”
The Tribunal noted that, for example, 1500 Oxycodone tablets were received into the pharmacy through ordering and 1540 dispensed, mostly by the owner, between 8 December 2015 and 30 January 2016.
The Tribunal said it “beggars belief” that he was not aware of the significant amount of oxycodone passing through his pharmacy, or the potential for abuse or profitable diversion.
The Tribunal found almost every particular of the complaints against the former pharmacy owner to have been proved.
It found that his conduct amounted to unsatisfactory professional conduct, and that his conduct “encompassed significant and ongoing breaches of his obligations as both a proprietor and as a pharmacist”.
It also said it had no difficulty finding the complaint of professional misconduct to be proved.
Another hearing is set for 18 December, at which consideration of appropriate protective orders will be undertaken.