No conditions it could impose could mitigate the risk to the public posed by a NSW pharmacist if he repeated his misconduct, a Tribunal has decided
A pharmacist has been banned from practising or providing any pharmaceutical services for at least five years.
The pharmacist had appeared before the Civil and Administrative Tribunal NSW in December 2020 and been found guilty of both professional misconduct and unsatisfactory professional misconduct, after he dispensed what the Tribunal called “substantial” amounts of prescription opioids and anabolic steroids to multiple patients, and not for therapeutic purposes.
He had also failed to maintain proper and accurate records for methadone, failed to notify the NSW Ministry of Health of losses in methadone, and failing to undertake biannual stocktakes for methadone.
He also continued to use a methadone pump which on his account he did not believe was accurate, and put the safety of patients at risk by not receiving the correct dose.
The Tribunal has now made its decision regarding orders.
The pharmacist owned a western Sydney store which, according to wholesaler records, “purchased amongst the highest quantities of high strength Fentanyl patches and high strength Oxycodone tablets of any pharmacy in NSW”.
It was inspected by the PRU three times in 2017, and in March of that year the Pharmacy Council of NSW conducted Section 150 proceedings, imposing conditions on the pharmacist’s registration.
These included that he not practise the profession, which at the time of the 2021 decision he had not done since that March.
The conduct in question took place between January 2015 and March 2017. In December 2020, the Tribunal had heard that it included conduct relating to 38 patients, 25 of whom received drugs of addiction from the pharmacy.
These had been dispensed under forged scripts from three doctors.
The drugs in question included high strength Fentanyl patches and high strength Oxycodone tablets. The dispensing to these 25 patients also included benzodiazepines, such as Diazepam in high quantities and high strength Alprazolam in excessive quantities.
“The other 13 patients were dispensed prescribed restricted substances. The restricted substances included hormones and anabolic steroids which are known to be subject to abuse. The Complaint was proved in all but two of this cohort of patients.”
Many of the patients lived well outside the pharmacy’s catchment area.
In December 2020, the Tribunal had heard evidence about a person identified as 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 (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. All these were on private script.
Now, the Tribunal singled out the conduct relating to Patient Z for further scrutiny.
“Patient Z, a male, had been dispensed anabolic steroids, benzodiazepines, oestrogen suppression drugs ordinarily used for breast cancer, fertility drugs, human growth hormone and Tramadol for pain relief,” it said at the 2021 hearing.
“The prescriptions for these drugs were never located. The quantities were manifestly in excess of what would ordinarily be prescribed for an appropriate therapeutic purpose.
“We concluded that the combination of drugs dispensed to Patient Z, including in the quantities dispensed, suggested that the medication was being abused.”
It noted that the pharmacist had continued to fail to be “candid” about his role in dispensing medicines to Patient Z, or about his knowledge regarding the patient.
The Tribunal noted that there was “no exercise of judgement or ethics… to protect patients and the public from the risk of oversupplied or misappropriated opioids and restricted substances”.
The HCCC wanted the pharmacist’s registration cancelled, but the pharmacist said that he should be reprimanded and permitted to continue practising, with conditions.
He said that he had had demands on his personal and working life, including from a family-run business, and that he had lost oversight of his role as an owner pharmacist and “mistakes were made”.
“On behalf of [the pharmacist] reference was also made to a period of suspension during which [he] would complete 500 hours ‘as a supervised unregistered pharmacist’ prior to regaining his registration with conditions,” the Tribunal stated.
“In our view there are no conditions that could be imposed at this time on [his] registration as a pharmacist that would address the protection of the health and safety of the public.”
It said that it did not believe such conditions, or any other potentially available conditions, or a further period of suspension, “are capable of mitigating the risk” posed by the pharmacist to the public if there were to be a repetition of his past misconduct.
This was due to the severity of the misconduct, and the pharmacist’s “limited” insight and remorse.
Instead the conduct was “objectively so serious, as demonstrated by his multiple failures to act in a way consistent with the legislative provisions of the Poisons and Therapeutic Goods Regulation 2008 (PTGR), his failure to uphold the standards expected by his own profession and his inability to act in a way that is consistent with community expectations for pharmacists, that it must be denounced in the strongest of terms,” the Tribunal said.
It noted that he had attempted to divert attention from his own responsibilities throughout the regulatory process, saying, for example, that the PRU should have inspected his pharmacy earlier.
The Tribunal cancelled the pharmacist’s registration and ordered that he not apply to be registered again for at least five years.
He was also prohibited from providing any pharmaceutical services – including as a pharmacy assistant, dispensary assistant and/or compounding assistant – until such time as he is registered as a pharmacist again.
He was also told to pay the HCCC’s costs as agreed or assessed.