The Society: Statutory Committee
The Pharmaceutical Journal
Reprimand given to pharmacist who dispensed outdated medicine A Hampshire pharmacist who dispensed out-of-date non-proprietary aciclovir on a prescription calling for Zovirax, and whose shelves contained dispensed medicines returned from patients and inadequately labelled items, has been reprimanded by the Statutory Committee [more]
A Hampshire pharmacist who dispensed out-of-date non-proprietary aciclovir on a prescription calling for Zovirax, and whose shelves contained dispensed medicines returned from patients and inadequately labelled items, has been reprimanded by the Statutory Committee
At its meeting on 19 June 2001, the committee inquired into the case of Colin Moody, proprietor of a pharmacy at 25 Rowner Road, Rowner, Gosport, Hampshire. A complaint had been received from the Council of the Royal Pharmaceutical Society alleging that on 21 October 1999 Mr Moody had dispensed date-expired aciclovir 200mg tablets against a prescription for Zovirax tablets. It was also alleged that on his dispensary shelves was a quantity of inadequately or incorrectly labelled stock and a number of medicines returned from patients.
Geoff Hudson, of Penningtons (solicitors) appeared in order to place the facts of the case before the committee.
Kenneth Aylett, of counsel, instructed by Charles Russell (solicitors), represented Mr Moody, who was present at the hearing.
The committee heard that the matter had come to light after the Society received a complaint from a patient who had had a prescription for Zovirax dispensed by Mr Moody on 21 October 1999. She had discovered that the tablets, which were in a Zovirax box, were in fact aciclovir and bore an expiry date of July 1999.
When the aciclovir tablets were returned to Mr Moody's pharmacy, he had apologised and replaced them with Zovirax tablets; it was noted that the Zovirax tablets bore the same batch number as the box in which the outdated aciclovir had been dispensed.
When one of the Society's inspectors visited the pharmacy following the complaint, he found a skillet containing aciclovir 400mg tablets which appeared to have been dispensed from the Royal South Hampshire hospital and returned by a patient for disposal. There were also a number of items of stock that were date-expired or inadequately labelled; two part full bottles of reconstituted antibiotic mixtures, flucloxacillin and amoxycillin, bore no indication as to when they had been reconstituted.
The inspector had warned Mr Moody on two previous routine visits about the presence of out-of-date and unlabelled stock on the dispensary shelves.
Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said it had not been satisfactorily explained how the outdated aciclovir tablets had been supplied against the prescription for Zovirax. Some suggestion had been made that the error might first have occurred while the tablets were with the wholesaler or even the manufacturer. The committee was not persuaded that this was the real likelihood.
Undoubtedly, there had been a serious error in dispensing, with date-expired tablets being handed over, and Mr Moody had to take the responsibility for that. While the committee made no conclusion as to whether the tablets had been deliberately substituted within the original packaging, at the very least, the problem had arisen because the arrangements in his dispensary allowed a wide potential for error.
As to the allegations of inadequate or incorrect labelling, the committee found that they had been proved. Mr Moody had also accepted that the returned skillet of aciclovir 400mg tablets dispensed at the Royal South Hampshire hospital should not have been on the dispensary shelf.
Those matters, taken together, amounted to conduct such as to render Mr Moody unfit to be on the register, said the chairman. However, in view of the delay before the case had been heard, which was felt to be unacceptable, the committee ordered that Mr Moody should be reprimanded.
A north London pharmacist who had supplied Viagra without being in possession of a valid prescription has been reprimanded by the Statutory Committee. The committee took no action against the company that owned the pharmacy and its superintendent pharmacist.
At its meeting on 20 June 2001, the committee inquired into the case of Mr Girish Balvantrai Desai, of 90 Gordon Avenue, Stanmore, Middlesex, Miss Anne Rosalinde Krestin, of 13 Manor Hall Avenue, Hendon, London, and Lemongold Ltd. The committee heard that the company operates a pharmacy trading as Landy's Chemist at 1191 Finchley Road, London NW11. Mr Desai is the managing director of the company and the regular pharmacist in charge of the premises; Miss Krestin is the superintendent pharmacist and works there two or three mornings a week.
A complaint had been received from the Council of the Royal Pharmaceutical Society that Mr Desai and Miss Krestin had failed to ensure that supplies of Viagra to a named patient had been made only against valid prescriptions, and failed to make accurate records of Viagra supplied. It was also alleged that no records had been kept of wholesale dealings with another pharmacy whereby stock was obtained of various medicines, repayment being made by supplying other medicines, including Viagra, to the same value.
David Bradly, of counsel, instructed by Penningtons (solicitors), appeared in order to place the facts of the case before the committee.
David Reissner, of counsel, instructed by Charles Russell (solicitors) represented Mr Desai and Lemongold Ltd. Philip Gaisford, of counsel, instructed by Butcher Burns (solicitors) appeared on behalf of Miss Krestin. Mr Desai and Miss Krestin were both present at the hearing.
The committee heard that on 10 August 1999, as part of an ongoing investigation into supplies of Viagra from the pharmacy, one of the Society's inspectors visited the premises to establish stock levels of Viagra and to make an audit of quantities received and supplied. She took possession of a single private prescription, for a named patient. It was dated 2 May 1999 and called for 16 Viagra tablets 50mg. Subsequent examination of the patient medication records showed that the patient had received Viagra tablets on five separate occasions, to a total of 80. The only valid prescription for those supplies, however, was that dated 2 May.
When the inspector returned to the pharmacy on 23 September, Mr Desai produced three prescriptions for the patient which had been issued by the doctor following a telephone call from Mr Desai made after the inspector's first visit. They were each for 30 Viagra tablets 50mg, and dated, respectively, 3 February 1999, 8 April 1999 and 10 July 1999 a total of 90, although 80 had been supplied. Mr Desai said he had given the Viagra supplies to the patient's doctor, who would call at the pharmacy and pick them up in the early evening while walking his dog.
Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said it was admitted that on four occasions Mr Desai had supplied Viagra without having a valid prescription. It was not clear why he had not required the doctor to provide a prescription at the time he handed over the Viagra to him.
Further, it was a legal requirement that supplies of prescription-only medicines such as Viagra should be entered in the prescription register on the day of supply or the following day. This had not been done, nor could it, because at the relevant time there were no prescriptions in existence. Also, there were instances where prescriptions had been entered in the register in their entirety, as if they had been supplied as such, although in many cases they had been supplied in instalments.
Finally, there was the matter of the pharmacy dealing by wholesale with another pharmacy. While it seemed a fairly common practice for small amounts of stock to be borrowed between pharmacies, the chairman said, this seemed to be an exceptional arrangement. No records of the supplies, which included Viagra, had been made in the prescriptions register nor any documents retained to account for the stock supplied.
Mr Desai had not at first appeared to recognise that this was in breach of the regulations but those transactions between pharmacies were indeed in breach of the law.
It seemed to the committee that on the occasions described Mr Desai had dealt with the law in a somewhat cavalier fashion. One of the first lessons that any pharmacist learnt during his training was that he should not supply prescription-only medicines without a valid prescription. It had been incumbent upon Mr Desai to have obtained a prescription when he gave the Viagra to the patient's doctor.
The committee ruled that Mr Desai's conduct had been damaging and ordered that he should be reprimanded.
As far as Miss Krestin was concerned, the chairman observed that she had had no part to play in anything complained of. She had been on holiday at the time of the inspector's first visit and had not been told what transpired. She had also had no knowledge of the wholesale transactions between pharmacies.
Furthermore, Mr Desai had acknowledged that, if Miss Krestin had been at his shoulder when he supplied Viagra without a valid prescription, she would not have allowed him to do it.
However, it was part of her responsibility as a superintendent pharmacist to check the private prescription register and ensure that entries were made in it on the day of supply or the day after. The committee was not confident that this was always being done at the pharmacy. The chairman advised Miss Krestin to be very careful to ensure the accuracy of the register in future. And, he added, she should be more assertive; it would be desirable for her to set out her systems more formally than she had done in the past.
No further action would be taken against Miss Krestin or Lemongold Ltd.
A Brecon pharmacist who had allowed the sale of medicines in his absence, had made an error in dispensing a prescription for an infant and whose record keeping and medicines storage had been inadequate in a number of respects has been reprimanded by the Statutory Committee.
At its meeting on 16 July 2001, the committee inquired into the case of John Edward Powell, of 14 King Street, Brynmawr, Gwent. A complaint had been received from the Council of the Royal Pharmaceutical Society making a number of allegations against Mr Powell. These included: the supply of a prescription-only medicine without a prescription; errors in entries in the poisons register; errors and omissions in the prescription book; the keeping of out-of-date stock; the incorrect storage of medicines; poor physical condition of a cellar storage area; methadone not stored in compliance with the safe custody requirements and entered in the Controlled Drugs register as having been already supplied; and dispensing an incompletely filled out prescription for a Controlled Drug. Mr Powell was also alleged to have labelled orciprenaline syrup dispensed for an 11-month old infant with the dose "two 5ml spoonfuls three times a day" when the prescriber had specified "one 5ml spoonful, three times a day". There were also allegations of supplying prescription-only medicines not under the supervision of a pharmacist and failure to remove restricted titles from a pharmacy when it started trading as a non-pharmacy outlet.
Geoff Hudson, of Penningtons (solicitors) appeared in order to place the facts of the case before the committee.
Mr Powell was present and was represented by David Aaronberg, of counsel, instructed by Hugh James Ford Simey (solicitors).
The committee heard that Mr Powell had been the proprietor of a pharmacy at 20 High Street, Brecon, until 10 April 2000, on which date he had opened another pharmacy at Ty Henry Vaughan, Bridge Street, Llanfaes, Brecon. The first pharmacy had subsequently been deregistered. The second pharmacy had since been sold by the receiver following Mr Powell's bankruptcy.
Giving the committee's decision, the chairman (Lord Fraser of Carmyllie, QC) said that on 21 February 2000 one of the Society's inspectors had visited the High Street pharmacy at about 9.25am and purchased 12 Solpadeine tablets from an assistant. Mr Powell was not present at the time and arrived at about 9.45am. The inspector found a number of prescriptions in the pharmacy, one of which, for Canesten HC cream, had been dispensed in Mr Powell's absence.
The inspector next visited the pharmacy on 29 March and made a detailed examination. He found a number of deficiencies, including the supply of temazepam in advance of a doctor's prescription. As a Controlled Drug, temazepam should not have been supplied, even on an emergency basis, without a prescription.
An entry in the poisons register for the supply of strychnine had a pencilled marginal note indicating a part supply to follow rather than stating the actual amount supplied; there were other inadequacies in entries for strychnine sales.
The chairman noted that poisons irregularities had been pointed out to Mr Powell on previous occasions. Repetition of the failure to keep records accurately was more important than the actual failures set out, the committee felt.
The private prescription book also had inadequate entries. Similar matters had been raised with Mr Powell by the Society's inspectors as far back as 1996.
The Controlled Drugs cabinet had contained three packages of Controlled Drugs that were out of date. Again, disposal of date expired stock had been discussed with Mr Powell on previous occasions.
Also on previous occasions the correct storage of medicines had been raised; on the same visit, the inspector had found in the dispensary stock a strip of 14 Modisal XL tablets in a box of 28 Isotard 60 XL tablets. That would not have been a particularly serious matter had it not been that, again, the inspector had discussed with Mr Powell the correct storage of blister packs.
In the circumstances of Mr Powell's imminent move from the High Street premises, the matter of shortcomings in their physical standard was of lesser consideration, said the chairman.
Turning to the second set of premises, the inspector visited them on 4 May 2000 for a post-opening visit. When he arrived at about 12.15pm there was no pharmacist present. It had been explained that Mr Powell was in another part of the premises, which were sited within a medical practice's building. The inspector had noted four bottles of methadone mixture on the dispensary shelves that were not being stored in accordance with the safe custody requirements and were not under the direct personal supervision of a pharmacist. While that was correct, said the chairman, the fact was that Mr Powell was in the building and had not left the methadone, which had been awaiting collection by those for whom it had been prescribed, for any protracted period.
The most disturbing incident was the dispensing of orciprenaline syrup for a baby patient with a label for twice the dose prescribed. There was some evidence of the apparent effect this had had on the infant and, as Mr Powell himself had recognised, it was clearly a real dispensing error on his part.
Taking into account his undertaking not to own a pharmacy again or to act as a superintendent pharmacist without first notifying the Society, and the unfortunate circumstances of his bankruptcy and the sale of his premises by the receiver, the committee decided that Mr Powell should be reprimanded.
Citation: The Pharmaceutical Journal URI: 20006127
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