Dispensing practices at a Sydney pharmacy were so bad that a Tribunal has said a report on them should be “compulsory reading for every pharmacist”
Part One of a report into multiple failures at a Sydney pharmacy owned by the GP next door.
A proprietor pharmacist and GP’s failure to oversee dispensing practices at his pharmacy is one of several complaints made and proven against him at a hearing conducted by the NSW Civil and Administrative Tribunal.
The practitioner, who was both a qualified GP and pharmacist, had previously had complaint proceedings brought against him as a medical practitioner; these proceedings were brought against him as a pharmacist.
The pharmacist had gained registration in 2002, and while completing his medical degree, worked at a western Sydney pharmacy in which he had a 50% share, becoming the sole owner in 2006, by which time he no longer worked there as a pharmacist.
In 2015 he was first registered as a medical practitioner, working from the medical centre next door, while he retained ownership of the adjacent pharmacy until 2017.
The Health Care Complaints Commission argued that this meant the pharmacist had a potential or existing conflict of interest – given his position as a GP next door to the pharmacy he owned – and alleged that he had failed to recognise and appropriately manage this conflict.
It alleged that he was aware that many of his patients would present scripts he had written next door.
It also alleged that the pharmacists he employed may have “felt constrained from scrutinising or questioning prescriptions written by the practitioner in fulfilment of their professional obligations because the practitioner was their employer and the practitioner failed to provide clarity and guidance to his employed pharmacists on this”.
The HCCC added that the practitioner had failed to discharge his obligations as the proprietor of the pharmacy, because he had not maintained an adequate awareness of the dispensing practice and failed to intervene when it had become necessary.
It said he had not established and adhered to systems and protocols for safe and legal S4D and S8 supply, nor protocols for supporting staff to raise concerns about unusual or unsafe prescribing or about prescriptions written by the practitioner himself.
The HCCC also alleged that he had failed to comply with guidelines on the responsibilities pharmacists have as proprietors.
In January 2017, the practitioner told the Pharmacy Council of NSW that he agreed to conditions being placed on his registration as a pharmacist, which included the surrender of his drug authority.
However while he was expected to do this on a date in January, it did not take place until mid-April.
The practitioner admitted to the behaviour described in many of the allegations, but not to all, including the complaint that he had engaged in improper or unethical conduct around being aware that patients would present scripts next door.
The Tribunal also heard about the complaints made against the practitioner as a GP, in which he admitted to inappropriately prescribing S8s for 13 patients and failed to keep appropriate and proper records.
In that instance he had admitted to being guilty of professional misconduct and in March 2020, he was reprimanded and had his registration as a medical practitioner suspended for six months.
The Medical Council of NSW had also conducted proceedings against the practitioner in which he was questioned about the perceived conflict of interest in conducting a medical practice next to a pharmacy he owned.
In assessing the allegations, the Tribunal noted that pharmacists are obliged to “take reasonable steps to ensure that the dispensing of the medicine in accordance with a prescription or order is consistent with the safety of the person named in that prescription or order”.
“In dispensing a prescription, a pharmacist has to exercise an independent judgement to ensure the medicine is safe and appropriate for the patient, as well as that it conforms to the prescriber’s requirements. If there is any doubt, the prescriber is to be contacted,” it observed.
The Tribunal noted that pharmacists employed in the practitioner’s pharmacy were bound by the guidelines in considering the filling of scripts issued by him to patients.
It considered evidence heard during the proceedings initiated by the Medical Council of NSW, in which the practitioner said that he was aware that many of the prescriptions issued by him to patients were filled at his pharmacy next door.
“He also conceded that if a pharmacist employed in his pharmacy had concerns about his prescribing practices, it would be difficult for his employee to either refuse to prescribe the medication or report him to the Pharmaceutical Investigation Unit,” it noted.
“He said that he did not think that an employee would report him, but that he had not realised that his employees could find themselves in the situation where they might feel that they could not talk to him about any concerns they had with his prescribing practices.”
At these proceedings the practitioner reportedly said, “I see now that because of the power imbalance this could have created difficulties for (the employees) and I am disappointed in myself for not realising this issue at the time”.
The Tribunal found this part of the allegations proven.
It also noted that evidence of an investigating pharmacist showed that the practitioner’s management of his pharmacy had “permitted extremely poor dispensing practices to go unnoticed and unchecked”.
This evidence painted a “most disturbing picture of the operations of the pharmacy whilst the respondent was a proprietor,” the Tribunal noted.
It added that the findings should be “compulsory reading for every pharmacist and aspiring pharmacist because they demonstrate the severity of the breaches by the respondent (and pharmacists engaged to work in the pharmacy)”.
AJP will look at this substandard dispensing history in Part Two.