Patient given 13 testosterone injections a month


legal law case justice crime

A pharmacist has been reprimanded and her registration suspended for three months after she dispensed large amounts of anabolic steroids prescribed to one patient by two doctors

A Melbourne pharmacist and former owner has faced a hearing at the Victorian Civil and Administrative over excessive dispensing of testosterone products.

Concerns were raised about her supply of excessive quantities of injectable anabolic-androgenic steroids, Primoteston and Sustanon, to a single patient between 2012 and 2014, following a routine prescription monitoring inspection in late 2014 at the pharmacy she owned.

The pharmacist was found to have dispensed 472 testosterone 250mg injections on 48 separate occasions – an average 13 injections per month.

According to the Australian Register of Therapeutic Goods Product Information for Sustanon 250mg/mL and Primoteston 250mg/mL, the usual adult therapeutic dosage of these drugs of dependence is one intramuscular injection every three weeks and every two to three weeks respectively, the Tribunal noted.

Criminal charges were heard in the Magistrates’ Court against the pharmacist as well as two prescribing medical practitioners, who were found to have prescribed the same drugs of dependence at different times during the period of supply by the pharmacist.

The two GPs were prosecuted and found guilty.

Without conviction, each doctor was fined $6,000 and ordered to pay costs.

Meanwhile the pharmacist initially faced 14 charges in the Magistrate’s Court relating to breaches of the Drugs, Poisons and Controlled Substances Act 1981, and the Drugs, Poisons and Controlled Substances Regulations 2006—although 11 were withdrawn.

The Tribunal noted that this was reportedly to facilitate a plea of guilty to the three remaining charges.

These related to her failure to report – in breach of the law – that she had been called upon to dispense for person greater quantities of, or more frequently than appeared reasonable, a drug of dependence; and to failure to notify different prescribing doctors of the supply of the same drug of dependence in the previous eight weeks.

In 2017, she was found guilty of these three charges.

“Without conviction, the Magistrate imposed an aggregate sentence involving a $5,000 fine and payment of costs in the amount of $6,820,” the Tribunal noted.

An investigation by the Department of Health and Human Services concluded that the pharmacist appeared to have “failed to raise concerns or otherwise intervene to address the apparently excessive rate of testosterone injections being supplied to the patient until after the matter was identified by the DHHS”; failed to notify the DHHS about excessive prescribing; failed to notify the relevant medical practitioners about the concurrent prescribing; and chose not to seek approval from the prescribers to supply multiple repeats on the same day.

Disciplinary proceedings were then commenced by the Pharmacy Board.

After the sale of her pharmacy in early 2015, Board’s Immediate Action Committee received an undertaking from the pharmacist not to practice as a sole practitioner and not to access androgenic anabolic steroids except in the event of an emergency.

In 2017 she resumed work part-time at a community pharmacy owned by a pharmacist friend.

This friend, who is responsible for giving regular reports to AHPRA, gave a statement testifying that the pharmacist has been compliant with the conditions posed on her registration, and highlighting her professionalism.

Before the Tribunal, the pharmacist attributed her conduct to several circumstances including “a lack of knowledge of the reporting requirements in relation to dispensing anabolic steroids; her interpretation of the prescription direction on the Private Prescriptions presented by the patient; her assumption that the patient was under the care of an endocrinologist who had knowledge of his testosterone regime; a letter from a doctor that the patient had shown her; and reassurances she had received from the patient and subsequently from the first general practitioner to the effect that the increased dose she understood had been prescribed was intended”.

She said this led her to believe the dispensing had been appropriate.

However the Tribunal found the pharmacist guilty of three charges of professional misconduct.

She was reprimanded and her registration suspended for three months.

Conditions were placed on her registration, including that she undertake and successfully complete education about legal and ethical dispensing, as well as on the harmful effects of steroid misuse.

Its determinations addressed any risks to the public arising from the pharmacist’s “apparently deficient” understanding of her legal and ethical obligations, and of the risks and harm associated with steroid misuse, the Tribunal said.

They also “reflect to the pharmacy profession at large the seriousness with which those practising within it must regard the clinical and legal obligations when dispensing to patients who seek or require drugs of dependence,” it said.

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