A pharmacist with major depression said she was fearful for her job when she provided prescription medicines to her colleagues’ family and friends
The NSW Civil and Administrative Tribunal has found a pharmacist guilty of unsatisfactory professional conduct and professional misconduct, and said that had she been registered to practise at the time, it would have cancelled her registration with immediate effect.
In March 2013, the pharmacist, who had first gained her registration in 2009, began work at a Central Coast, NSW pharmacy in March 2013, as the pharmacist in charge.
She was one of two pharmacists in charge there, and usually worked five days a week as the sole pharmacist there.
After the Pharmaceutical Regulatory Unit visited and inspected the pharmacy in September 2018, it submitted a complaint to the Pharmacy Council of NSW.
The PRU had been tipped off by a staff member alleging the loss and possible diversion of large numbers of S8s, who accused the pharmacist of selling Endone privately.
The pharmacist had been fired after CCTV footage showed her removing stock from the pharmacy and she refused to explain why.
Photos taken from the footage showing her in August 2018, removing stock and putting it in a black bag, and unpacking stock from a cardboard box, putting it in her handbag.
An interim report by the PRU found that the woman was the only pharmacist present at the store on the relevant days between 17 February 2017 and 3 September 2018, when there was possible loss or diversion of 6,700 oxycodone 5mg tablets, 1,036 oxycodone 10mg tablets and 140 oxycodone 20mg tablets, as well as 200 alprazolam 0.5mg, 250 alprazolam 0.25mg, 300 alprazolam 1mg and 300 alprazolam 2mg tablets.
A Final Report listed oxycodone products not accounted for in the pharmacy as, “Mayne Oxycodone IR 5mg 20 – 5,000 tablets unaccounted for through invoices not being entered; Endone 5mg 20 – 4,260 tablets unaccounted for through invoices not being entered and an incorrect credit, 329 prescription entries with no copies of scripts; and Oxycodone Sandoz 10mg – 2,016 tablets unaccounted for through invoices not being entered and stock adjustments”.
It also noted, “Kalma 500mcg has 400 tablets that have invoices but have not been out through the DD register;” and “Kalma 250mcg has 250 tablets that have invoices but have not been put through the DD register”.
The Final Report noted “endless stock adjustments that have no clear reasons”.
The Final Report also concluded that she appeared to have failed to retain scripts for drugs of addiction separately; and seemed to have dispensed drugs of addictions based on non-compliant scripts.
She had also failed to perform the required periodical inventory of stock of drugs of addiction.
It was alleged that the pharmacist had supplied Valium and antibiotics to the friends and family of another pharmacist, her employer.
And the complaint also alleged that she had left her password to the electronic dangerous drugs register on a Post-It note near the dispensary computer keyboard.
One of the complaints against her was the allegation that she had an impairment which was likely to harm her ability to practise pharmacy – namely a diagnosis of major depression, for which she had been receiving “intensive” treatment – and of autism (in her case, previously referred to as Asperger’s Syndrome).
The pharmacist did not give evidence at the hearing, which relied on her January 2019 response to the HCCC about the complaints.
She said she was given little training and assistance in performing her duties, and believed that she was expected to provide pharmacy services without appropriate documentation; she also disputed that she had been employed as a pharmacist in charge.
“The demands of the business left her stretched in her capacity to fulfill all that was expected of her, causing her to fall behind in some of her responsibilities,” the Tribunal noted.
“She felt unsupported by the managers and staff within the pharmacy and conflict between staff members left her distressed.”
She did not renew her registration in November 2018 as she said she did not feel well enough to cope with working. However, she said she planned to do so at a future time when she was well enough.
She said that she had been employed at the pharmacy for just over five years and that her roster hours were changed from those stated in her employment contract: she was ordinarily required to work a minimum of 40 hours per week, contrary to her employment contract that provided for 26 hours per week and 31 hours per week for alternating weeks.
She said she felt pressured to provide owing medication and leave certificates to the pharmacy retail manager’s family members against her better judgement.
She said the other pharmacist, who worked as the pharmacist in charge two days a week, expected her to comply with the owner’s occasional requests, including providing and/or dispensing prescription medication for him, his family members and his associates when directed.
She said he expected her to supply medication without a script, with him telling her via phone the patient’s name and details of the medication.
She also said she had to regularly work while ill, and that it was her responsibility to find a locum if sick – but that the other pharmacist, who had been practising for 40 years, “did not tolerate locums working in the dispensary”.
As a result, sometimes she had worked 10 days straight.
Her holidays were used at a health retreat to try to manage her mental health issues, which she said were, “due in part to difficulty in dealing with ongoing and escalating stress and tension in the workplace”.
She was also expected to do some of the duties assigned to the retail manager’s daughter, she said.
“She understood it was a legal requirement to conduct a stock check of drugs of addiction each March and September,” the Tribunal heard.
“She attempted this task on several occasions when she was on duty in March and September, but had difficulty balancing the inventories and found missing entries, duplicate entries, and errors. On the occasions she conducted these checks it took her several days to complete the task. There were items that she could not successfully balance. She left notes for [the other pharmacist] to double check the items in question.”
When the register was changed in 2016 to an electronic system, she received no training on using it, she said, and said there was “little control” over who had access to it.
Earlier this month the other pharmacist’s record-keeping was the focus of his own hearing before the Tribunal.
At this hearing he said that he had assumed she was conducting appropriate checks and keeping on top of the eDD book once it was digitised.
He admitted he “should have been more vigilant” and was found guilty of professional misconduct and unprofessional conduct.
There was no suspicion that he had been involved with the diversion of the medicines.
The Tribunal found that the breaches of her obligations had been “extremely serious” and that she suffered from an impairment.
The Tribunal ordered that until such time as she is registered as a pharmacist again, she may not work in any role where she could possess, handle or control any S8 drugs.
It “strongly” recommended she use this time to undertake active steps to overcome her impairment.
It also ordered that she pay two-thirds of the Health Care Complaints Commission’s costs.
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