Professional misconduct – or not?

A pharmacist said he was unsure which of several forged scripts and non-compliant scripts for drugs of addiction he had dispensed, claiming staff were using his log-in details

The pharmacist appeared before the Civil and Administrative Tribunal NSW over conduct which took place at his Sydney pharmacy.

The first complaint against the pharmacist consisted of seven particulars and alternative formulations of each particular. The pharmacist admitted to each of these, and that his conduct amounted to unsatisfactory professional conduct – but did not admit that it amounted to professional misconduct.

The conduct took place between 31 March 2014 and 13 August 2014.

The pharmacist admitted that he had dispensed, or permitted to be dispensed, S8 medications without compliant prescriptions, including alprazolam, morphine and oxycodone.

Twenty of these scripts, made out to five different patients, were filled.

The pharmacist was the dispensing pharmacist for each of these scripts, though during the period of the complaint, he claimed his staff sometimes used his log-in details to access the pharmacy’s dispensing system.

He said that he was recorded as the dispensing pharmacist for the 20 scripts only as a result of this taking place, and cited an example where he was overseas yet was recorded as the dispensing pharmacist in the system.

However he was unable to identify which of the 20 scripts in question he might have dispensed, after admitting he “probably” filled at least some of them.

He admitted failing to discharge his obligations as the pharmacy’s proprietor, for failing to maintain an awareness of the manner in which the pharmacy’s dispensing practice was being conducted in accordance with the requirements.

He said that while in 2014 he hadn’t known the staff were using his log-in details, he should have done so and implemented measures to stop the practice.

The pharmacist also admitted dispensing, or permitting to be dispensed, clonazepam at shorter intervals than indicated in the prescription. This related to 10 scripts for five patients.

Again, he said he was unsure which of the scripts he had filled. He claimed that the non-compliance was due to his failure to check the patients’ prescribing history; and admitted that as the pharmacy’s owner, he should have known what was taking place.

Nine scripts for alprazolam did not identify the intervals of repeats as required.

Regarding this particular, the pharmacist said that “in 2014 he was unaware of a number of key statutory requirements governing the handling and dispensing of Schedule 8 drugs including the prohibition on dispensing such drugs where the prescription presented by the patient did not specify the intervals between repeats”.

Another 34 scripts, for alprazolam, morphine and oxycodone, were found to be forged; the pharmacist denied knowingly filling forged scripts, but there was dispute regarding whether the pharmacist “ought reasonably to have known” this.

Each of the scripts was defective in some way, and the Health Care Complaints Commission contended that this ought to have led the pharmacist to doubt their authenticity.

Some had information not written by hand as required; had particularly high doses described; had patients’ names misspelled; used incorrect or unknown medical abbreviations; and/or did not specify repeat intervals.

One was described as “fairly amateurish”.

The pharmacist admitted “that he should have known that the subject prescriptions did not comply with the relevant requirements of the PTGR but contends that the Commission has failed to establish that he ought reasonably to have known that the prescriptions were forged”.

The Tribunal decided that it was not satisfied that the pharmacist ought to have known one rather more expert script was forged, and said that it was not until their suspicions were confirmed by the purported prescribers that investigators concluded that each of the 34 prescriptions was forged.

The pharmacist admitted failing to check the authenticity of the 34 scripts, however, but only subject to the qualification that the staff were using his log-in details, so he did not know which of the scripts he had personally dispensed.

The pharmacist admitted failing to ensure that drug registers were kept for methadone and subutex in accordance with the requirements.

The Commission accepted that none of these particulars in isolation warranted suspension or cancellation of the pharmacist’s registration, they could do so when taken as a whole.

As to whether the conduct amounted to professional misconduct, the Tribunal noted that the Commission was not claiming dishonest conduct, but conduct “in the nature of reckless indifference to the professional obligations imposed on pharmacists and the dispensing requirements”.

The pharmacist said the conduct he admitted was “largely the result of his then lack of knowledge about aspects of the practice of pharmacy, his failure to adequately resource and manage the pharmacy, the difficulties he experienced throughout 2014 in obtaining competent and reliable staff and personal difficulties which resulted in him devoting insufficient time to the pharmacy,” the Tribunal noted.

He said that in 2014 he was preoccupied with caring for his gravely ill father, who was undergoing chemotherapy.

The Commission said the admitted conduct did not involve deliberate flouting of regulations or personal gain, it was “objectively serious”.

“Given that at the time [the pharmacist] had been practising for close to 14 years, his lack of knowledge of key requirements contained in the PTGR is troubling,” the Tribunal noted.

The pharmacist said that when the issues were brought to his attention, he made “concerted efforts” to improve his practice, becoming familiar with the regulations and undertaking a PSA ethics course.

The Tribunal found that the pharmacist’s conduct amounted to unsatisfactory professional conduct and professional conduct, and said it was appropriate for his registration to continue to be subject to conditions.

The Tribunal issued him with a reprimand, saying it was satisfied he was contrite and had taken steps to avoid doing the same things again.

However it noted he only worked three to five hours a week as a pharmacist and suggested he review his time commitment to practising the profession.

He must accept a mentor approved by the Pharmacy Council of NSW, submit to an audit appointed by the Council and a performance review, and pay the Commission’s court costs.

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