‘Script owing’ culture leads to diverted oxycodone

A pharmacist’s “perceived lack of security” in his employment influenced his failure to adequately supervise a technician

The South Australian pharmacist has been reprimanded and conditions imposed on his registration after he faced a tribunal over professional misconduct.

The complaint against him concerned the steps to dispense oxycodone, failing to secure oxycodone, the lack of timely record keeping and the lack of supervision regarding dispensing the drug.

Among the pharmacy’s clients were the residents of an aged care facility, including one Ms H, who was routinely prescribed oxycodone among other drugs, the complaint alleged.

Between October 2014 and May 2015, the pharmacist – in accordance with monthly prescriptions – wholly dispensed the oxycodone by supplying it from the pharmacy safe to a pharmacy technician, Ms M, for packing in Webster packs.

He was to ensure a record was made in the pharmacy’s system, and ultimately, dispensed the oxycodone and other prescription medicines to the customer.

“Over the relevant period, in the absence of prescriptions issued by a treating medical practitioner, the respondent on multiple occasions over the relevant period took steps to dispense such medication (but such medication was not ultimately dispensed by him from the pharmacy) by: providing oxycodone from the pharmacy safe to Ms M on the basis it was to be packed into Webster packs; ensuring that a record was made in the pharmacy prescription system; [and] ultimately entering such dispensing in the drug of dependence register of the pharmacy,” the complaint read.

However the complaint alleged that on those occasions he failed to limit his provision of oxycodone to Ms M for packing by reference to the patient’s prescribing history and other information.

Once the amount of oxycodone provided to Ms M had substantially exceeded the patient’s monthly requirements, the respondent then failed to refuse to provide oxycodone to her for packing without a prescription, the Tribunal noted.

He also failed to ensure that Ms M packed the oxycodone by making adequate checks of her activities; failed to take adequate steps to ensure the prescribing practitioner had been spoken to and did not refuse to provide Ms M with further oxycodone notwithstanding that failure.

He further failed to ensure that, once packed into Webster packs, the oxycodone was returned to the pharmacy safe; and having provided the oxycodone to Ms M, did not always make timely entries in the drug of dependence register such that there was an accurate and consolidated record of stock at all times.

The Tribunal noted that the dispensing conduct in question was “serious in that it occurred without a prescription on multiple occasions each month, where the cumulative effect of the dispensing without a prescription should have caused inquiry”.

“Further, it occurred without checking with the prescribing doctor in advance, or following up immediately thereafter with the doctor in relation to the issue of prescriptions. As a result it permitted the actual diversion of oxycodone within the pharmacy.

“The relevant dispensing conduct involved failures across a range of pharmacy practice including not checking prescribing history and other information; taking steps to dispense without a prescription; failing to take precautions as regards the control of drugs of dependence; failure to take responsibility as a pharmacist to supervise a technician and to follow-up on securing drugs and failure to make timely entries in the drug of dependence register.

“As a result of the latter there was a loss of accounting control of the quantity of oxycodone in the pharmacy that gave rise to the potential inability to manage stocks.”

The complaint alleged that the pharmacist’s behaviour was negligent, not dishonest or disgraceful.

The respondent contended that when he started work at the pharmacy in October 2014, he was not particularly experienced, having only been first registered in 2010.

“He found himself in a pharmacy which by his observations had a certain practice or culture,” the Tribunal noted.

“Due to his perceived lack of security in his employment he failed to take responsibility for the situation.”

A pharmacist who worked with the respondent in the same pharmacy made a statement to AHPRA that “the pharmacy had the practice of dispensing Schedule 8 medicines on an owing basis”.

“It was something that happened at the pharmacy of which the respondent was aware.

“The dispensing on a script owing basis was confined to the packing of Webster packs. At the time the respondent considered that if the medication remained in the pharmacy it was okay [as] it was Webster packs were not being secured in the safe after packing.

“An audit revealed that large amounts of oxycodone had gone missing.”

Following the notification the respondent lost his job and has struggled to obtain full-time employment since.

He has undertaken a significant amount of relevant education since, at his own initiative and cost.

He sought to avoid a reprimand, particularly given he was considering registering in Singapore – not possible following a reprimand.

The Tribunal accepted that the pharmacist has gained “clear insight” into his behaviour and the dispensing requirements of S8 drugs, but issued a reprimand and imposed certain conditions on the pharmacist’s registration.

These included that he may only practise only in place(s) of practice approved by the Board/AHPRA (indicating one pharmacy); that he must be directly supervised by a nominated pharmacist when handling any S8s; must not supervise another pharmacist; and must be mentored by another registered pharmacist in relation to certain topics, such as managing personal work priorities and professional development.

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