New Zealand’s pharmacy regulator is reportedly “stunned” that a woman was able to use a single photocopied script to get tramadol from 21 pharmacies
Stuff reports that Ramona Deane developed a dependence on the medicine after she was prescribed tramadol, as well as codeine, after an operation to remove her gall bladder.
Ms Deane, a former top sports player who told reporter Tony Wall that she has never before had a substance abuse problem, soon discovered that for the medicines to have an effect she needed to take an increasingly large dose.
She said that she would take 10 tramadol tablets a day, and when her doctor stopped prescribing the medicine, she went to pharmacies to buy Nurofen Plus for the codeine.
A new prescriber—a dentist—gave her a script for antibiotics and 10 tramadol tablets.
Soon afterwards, she phoned the dental surgery to say the script was lost, and a new one was sent out to her – with no date or signature. The dental surgery did not comment on this.
“I just photocopied it numerous times—I didn’t forge any signatures—and just went to pharmacies,” she told Stuff.
New Zealand’s Pharmacy Council is “stunned” that she was able to use this script repeatedly to get tramadol: from 21 pharmacies and 37 pharmacists in Auckland and Waikato.
Pharmacists allegedly dispensed the script—which often remained without a date or signature—60 times.
Stuff reports that it’s believed one pharmacist dispensed on it eight times.
Ms Deane said that when going to pharmacies to fill the script, she would wear a bandanna and pretend that she had cancer. She would also let her children be loud and active in the shop to gain sympathy.
“I was a bit iffy because there was no signature. I thought ‘will they give it, will they not?’” she said.
“I go to a pharmacy, hand it over, they say ‘OK, five minutes’ and give me the tramadol.
“About 10 times I went [to that pharmacy] and they noticed something, so I’d go to the next one. I thought ‘nah, they won’t do it ‘cos there’s no signature’, but they did.”
She alleged that one pharmacist did ask her about the lack of signature, but still dispensed the medicine.
She was also challenged at a pharmacy which had already dispensed the medicines once, and on that occasion was not given the drugs; instead the pharmacist stamped the script and said she would not give it back. At this pharmacy, workers contacted police after this second attempt.
“The Pharmacy Council come down hard on pharmacists but they don’t realise this lady does a whole performance … she’s crying and [she says] she’s dying and all that,” said Melanie Baker, the pharmacist who refused the script.
A District Health Board staff member had also spotted unusual prescribing patterns and contacted police.
Ms Deane told Stuff that the ruse only came to light when she decided to address her substance abuse disorder and go into rehabilitation. She went to police, who told her that such dependence on prescription opioids was not uncommon.
She admitted to the fraud around the script, and was sentenced to 120 hours community work and 12 months of supervision.
Pharmacy Council chief executive Michael Paed said that as soon as the organisation became aware of the fraud, it created a professional conduct committee to investigate.
Four pharmacists were then referred to the Health Practitioners Disciplinary Tribunal, with the others asked participate in professional development and training. The Tribunal has not yet heard the cases of the four pharmacists referred to it.
“It did surprise us,” he said. “It’s the most significant fraudulent prescription we’ve seen in recent times. We were most definitely concerned about it.”
Regardless of Ms Deane’s performances in the shops, pharmacists needed to check whether scripts were legitimate.
“That’s what we’re concerned about—has the pharmacist done their job as expected?” he told Stuff.
The Pharmaceutical Society had also found the case “a bit of a surprise,” said Richard Townley, its chief executive, who said that fraudulent scrips were an increasing problem.
Mr Wall also reports that the case highlights frustration among pharmacists at the slow uptake of electronic prescribing by GPs.
Across the Tasman
PDL recently issued advice written by Meridian Lawyers’ Scott Ames on the subject of fraudulent scripts, which can be accessed here.
Mr Ames wrote that “generally, pharmacists have an obligation to notify the state health department and in some jurisdictions, the police if they reasonably believe a prescription has been forged or fraudulently altered”.
At the time he said that pharmacists should be alert to patients who seem to be in a hurry and unable to return later; or those who have presented at the pharmacy late in the evening or on the weekend, when it could be harder to confirm the script with the prescriber.
Pharmacists must also ascertain whether the date of a script is consistent with a patient’s urgency to fill it, he said.
He had warned at the time that people presenting fraudulent scripts could choose busy times in the pharmacy, or use a diversion to try to distract pharmacists, or pressure applied to encourage them to fill the script quickly—such as a crying baby or feigned illness.
Professional officer at PDL Gary West told the AJP that without commenting specifically on the Deane case, in Australia PDL would “always remind pharmacists that if there is some doubt as to the validity or indication of a prescription that they take steps to check with the prescriber”.
“There are limitations in some States regarding the full supply of a S8 medicine if the pharmacist is not able to validate the prescription at the time of presentation,” he advised.
“PDL would direct pharmacists to their State regulations with regard to this point.”
He said that if pharmacists have any concerns about scripts or whether any medicine is being used safely, they should discuss their concerns with the patient and prescriber.
Mr West also recently advised on handling these discussions, which can be difficult, with patients and prescribers, which can be accessed here.