A pharmacist has been struck off the register for failing to question doctors over excessive prescribing, and dispensing dangerous combinations and amounts of drugs
A pharmacist proprietor from western Sydney, NSW, has been found guilty of professional misconduct and had his registration cancelled with a non-review period of two years.
The disciplinary orders were made regarding his dispensing behaviour in relation to 10 patients between 2015 and 2017.
He was found to have personally dispensed, or was responsible for the inappropriate dispensing of, Sudafed Nasal Decongestant, an S3 drug containing pseudoephedrine—around 324 tablets to Patient A and around 216 tablets to Patient B.
The Health Care Complaints Commission alleged, and the NSW Civil and Administrative Tribunal agreed, that the pharmacist failed to recognise the frequency of supply as a red flag and take appropriate steps such as counselling the patients, advising other pharmacy staff how to respond to further requests, referring the patients to a GP or drug and alcohol service, refusing to supply or contacting the Police.
He admitted that the supply of pseudoephedrine products by the pharmacy “on many occasions in the subject period was in excess of therapeutic thresholds.”
There were also issues with his records, with which showed that 53 of the 106 prescriptions for Patients A and B were recorded as being dispensed by a pharmacy assistant who had no pharmacy qualifications and was not authorised to dispense medication.
With respect to those instances, the proprietor was unable to say whether he was the pharmacist involved in the dispensing, or whether any consultation by this assistant had occurred with him or any other pharmacist dispensing pseudoephedrine to these patients.
The Tribunal also found that the pharmacist personally dispensed, or was responsible for the dispensing of S4D anabolic steroid Primoteston to Patient C, in circumstances where the suggested dose is one vial per month and the pharmacy was dispensing one vial per week.
The respondent said in evidence that he did not know that when he was dispensing four packets each of three syringes, he was dispensing what was normally one year of medication once a month.
Although he asked the prescribing GP why the medication was being prescribed and how often it should be used, he did not recall what was said to him nor did he write down any details of the conversation.
“Overall, the respondent did not call [the doctor] to question the amount of medication being prescribed,” said the Tribunal.
The same criticism was given with regards to Patient D, who had had been prescribed 925 tablets of temazepam 10mg.
The pharmacist proprietor had personally dispensed this medication on four occasions.
An expert witness, an experienced pharmacist by background, said that this amount of temazepam should have lasted the patient approximately 400 days having regard to the recommended directions by the prescribing doctor, yet they were supplied over a timeframe of 86 days.
Patient D was also supplied approximately 900 tablets of nitrazepam 5mg.
The expert witness said that this should have lasted the patient 500 days, but the supply was made over 85 days.
They told the Tribunal that the respondent should have recognised the potential that the patient was engaging in drug-seeking behaviour and should have questioned the prescribing doctor about the dispensing history, rather than merely confirming the quantity of prescribed drugs.
The pharmacist was found to have personally dispensed, or was responsible for the dispensing of benzodiazepines such as clonazepam, oxazepam and alprazolam to Patients E, F , G and I in combination with methadone, where the “potential for abuse and harmful interactions was well known”.
The dispensing records for Patient H showed that he was dispensed 1,600 tablets of Rivotril 2mg between July and November 2015, and the pharmacist personally dispensed this drug to the patient on five occasions, totalling 1,000 tablets.
This supply equated to 400 days’ supply based on the directions issued by the prescriber, despite directions to only take the drug for a period of 123 days.
The quantity indicates evidence of “drug misuse” and should have been discussed with the prescriber, said the expert witness.
Furthermore the pharmacist dispensed 500 tablets of clonazepam to Patient J over five occasions. Patient J was supplied with 1,000 tablets of clonazepam during the period 27 August 2015 to 29 October 2015, a period of 63 days, with directions to take 2 tablets twice daily. Accordingly, this supply should have lasted for 262 days.
The expert witness said this level of supply showed evidence of drug misuse which should have been discussed with the prescriber. It was his opinion that this conduct overall was significantly below the relevant standard.
Before the Tribunal, the pharmacist admitted that “as one of the proprietors of the pharmacy”, he did not adequately ensure the supply of products was always appropriate and that staff were cognisant of abuse of products.
The Tribunal found that in the aggregate, the misconduct of the respondent personally – and separately in his capacity as proprietor of the pharmacy – was such that it constitutes professional misconduct.
“The misconduct when taken as a whole is such that it is incompatible with the safe and appropriate dispensing of medication to the public…” said the Tribunal.
“It demonstrates a failure to operate the pharmacy with appropriate protocols and processes to protect the safety of the public, and a cavalier disregard for the importance of keeping and maintaining appropriate records.
“It is incompatible with the privilege of being entitled to practice as a pharmacist. On this basis cancellation of registration is justified,” it said.
“The respondent has not provided any proof that he has now established himself as a different practitioner. We can have no confidence that the respondent is unlikely to engage in similar misconduct in the future.”
The Tribunal ordered the cancellation of the pharmacist’s registration, with a non-review period of two years.
He was ordered to pay costs to the HCCC.