Patient received up to 57 prescription codeine tablets a day


codeine tabsules spill from orange pill bottle

A pharmacist has been fined $100,000 after her conviction for supplying “massive” quantities of prescription-only codeine to a patient

Appearing before the Sunshine Magistrates Court, Huyen Tran pleaded guilty to 10 charges representing 457 separate instances of contraventions of the Drugs, Poisons and Controlled Substances Act.

The behaviour took place between May 2015 and October 2018, and included the supply of S4 poisons – primarily codeine-containing analgesics – to a patient on 281 occasions, despite the fact that she had reason to believe the scripts presented by the patient had been fraudulently altered.

Ms Tran also supplied codeine-containing analgesics to a patient on nine occasions in excess of the instructions actually written on the scripts she was handed.

She also failed to notify the Department of Health and Human Services that she was being requested, directed or called upon to sell, supply or dispense the codeine-containing analgesics to a person in higher quantities than appeared to be reasonably necessary, or more frequently than appeared to be reasonably necessary. This failure to notify occurred 167 times.

In total, Ms Tran’s pharmacy supplied 52,368 codeine-containing analgesic tablets to the patient between 2015 and 2018, dispensed for fraudulently altered prescriptions.

During 2018, the average number of codeine-containing tablets dispensed to the patient reached 57 tablets a day, up from an average of 39 per day over the entire period.

The Department of Health and Human Services began an investigation into the matter in October 2018, after the patient was identified as the person who received the highest dose of codeine-containing analgesics in the entire state of Victoria – from Ms Tran’s pharmacy – between June and October 2018.

When asked about the dispensing during the investigation, Ms Tran replied that despite knowing that such an excessive paracetamol intake could result in liver damage, she did not contact the prescriber who was listed on the scripts, and did not notify the Department.

She told the investigators that she did not consider suspecting anything was wrong, because the patient was a regular customer and maintained relationships with staff at the pharmacy.

She said she could not clinically justify her treatment of the patient, and that she had just “blindly” followed the scripts she was given.

In sentencing Ms Tran, Magistrate Jennifer Grubissa told Ms Tran that she had found it “very difficult” to understand how somebody with Ms Tran’s professional background – requiring such a high level of professional responsibility – “would ever allow herself to be placed in this position, let alone be placed in this position time and time again in regard to the vast number of contraventions”.

The magistrate noted the potential for “very grave harm” associated with offences of this nature.

She imposed a fine of $100,000 and ordered Ms Tran to pay legal costs of $10,708.

“In relation to the matters before the court, Ms Tran, there does have to be a very plain way the court can affect general deterrence given the inherent seriousness of the offending behaviour and the potential for very grave harm in respect of offences of this nature,” Magistrate Grubissa noted.

“I do have an appreciation in regard to the fine I have settled upon, that that will impose a great burden upon you, but there must be a way the court can – immediately – show the rest of the community, particularly those that operate in your particular professional realm that these are offences they ought not to enter into under any circumstances whatsoever.

“They need to take their professional integrity very, very seriously to ensure offences of this nature simply do not occur in the first place.”

The Department urged pharmacists to ensure they are fully aware of their legal responsibilities.

This case highlights the importance of pharmacists complying with directions that are stipulated upon prescriptions and appropriately intervening when they have reason to believe the rate of prescribing is excessive and/or inappropriate, it said.

Victorian Minister for Health Jenny Mikakos also commented on the case.

“Pharmacists are among our most trusted medical professionals and most do incredible work – that’s why it’s so important we identify the rare cases where somebody is doing the wrong thing and putting the community at risk,” she said.

“The law is clear and it’s there to keep our community safe from the harm we know painkiller abuse can cause.”

A spokesperson for the Pharmacy Board said they can confirm Huyen Ngoc Tran was suspended on 12 March 2019.

“Our enquiries in relation to the matter are ongoing and we cannot comment further at this time,” they said.

Previous Tasmania moves on measles
Next A war of words

NOTICE: It can sometimes take awhile for comment submissions to go through, please be patient.

3 Comments

  1. chris
    13/09/2019

    Wow, a one hundred grand fine is a fair bit of coin for most people so whilst the stupidity on display here warrants no further comments, the business person in me hopes that she sold enough laxatives to cover that fine. Over a three year period, we would be talking about a shite load, pun intended of course of coloxyl with sennas, fleet enemas. Companion selling has to be encouraged in this tough economic climate. Patient instructions mandatory, ‘What do I do with this things this patient asks to which you reply, Oh just stick it where the sun don’t shine !. Not often the comeback line is ‘You mean i have to wait till sundown to stick it up my rrrrs !. Now the patient involved here actually has raised a conundrum. She was ingesting 57 Panadeine Fortes a day. Why is she not dead ? We were always taught that 48 will kill you, so this lady deserves a phone call from the Guiness Book of World Records for two reasons. Not dying on hundreds of occasions, and of course, the worlds best codeine pill popper. It’s a shame our professional (and I use that term lightly with her) colleague, well that’s loose too, let me call her the codeine chemist ( cc as in an email to her barrister), will not get a mention in the Guiness book for her years of involvement.

    Do you all agree with me here?

  2. Peter Allen
    13/09/2019

    In this case it took from 2015 until 2018 for the Drugs and Poisons Department data miners to recognise then prosecute the elephant-scale problem.
    AI is sufficiently Intelligent now, for wholesalers to generate and forward reports that flag outliers, differing vastly from norms.
    It took as long as three years.to bring this case to court, some would think not very competent in picking it up (if that is the case), not to mention the Golden Rule of Protecting the Public (the at-risk codeine paracetamol unfortunate patient.)

    Can we considering a new approach, by invoking Harm Minimisation in a new realm.

    Would it not be preferable to head off troublesome activities early. The Law would rather prevent a crime than prosecute it after the event.

    In pharmacy, iagine that a flag goes up; hypothetically ‘Pharmacy XYZ has suddenly increased their wholesale orders of Pan Fort by a factor of five.’
    Send around an official and likely discovers one of several reasons, almost all of which are better nipped in the bud.

    /Fraudently converted Rx by patient — easy to put a 1 in front of 20, overlooked by pharmacist.
    /Pharmacist notices it and proceeds anyway.
    /Staff pilfering, ‘Inside job’ (nobody suspects the inside job).
    /Pharmacist self-medicating, got into trouble with migraines.
    /Pharmacist diverting for profit.
    /Pharmacist blackmailed or threatened by bikie gang.

    Every one of these cases would be best picked up early.

    OR the powers that be collect information, which takes a lot of back room work.
    Eventually the case against the pharmacist is tied up with pink ribbon, and the law takes over. At least it looks good in the Annual Report of cases prosecuted.
    But I can only see that a pre-emptive investigation would produce a better outcome for all concerned.

  3. william hau kin so
    13/09/2019

    Not a lot of money really, only $2 per tablet.

Leave a reply