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.

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