Irregular script wake-up call
Pharmacists are being reminded to exercise judgement when supplying large quantities of medicines with a potential for misuse after a doctor was struck off the register for irregular prescribing.
Johannes Wilson was found guilty by the Health Practitioners Disciplinary Tibunal of eight charges laid by the Medical Council’s Professional Conduct Committee. One charge was of obtaining large quantities of Sudomyl (a medicine containing the Class C controlled drug pseudoephedrine) and thereafter supplying it to individuals who were not patients and falsifying patient records to indicate Sudomyl had been supplied to patients who never received it.
Dr Wilson, who ran a men’s health clinic, a clinic associated with a gym, and a solo practice during the period to which the charges relate, obtained approximately 39,900 tablets of Sudomyl from late October 2007 to early December 2007 from Unichem on Broadway in Newmarket, Auckland, mainly using practitioner supply orders. Dr Wilson also obtained 760 Xanax tablets from the pharmacy between May 2007 and December 2007.
Unichem on Broadway pharmacist Jonathan MacDonald says Dr Wilson told him the Sudomyl tablets were required as part of a weight loss regimen for his patients. Mr MacDonald said he would be more cautious in the future, but says Dr Wilson was very convincing. Mr MacDonald told Pharmacy Today he wasn’t initially aware of the extent of the dispensing as there were several other pharmacists working at the pharmacy. However, when he realised the volumes of medicine going out to Dr Wilson, he contacted Medsafe.
“I guess if I had my time again I would have checked it out earlier.”
The experience was “pretty horrible,” he says. “We’re a lot more careful now about following up on what people tell us.”
Executive officer of the Pharmacy Defence Association Carolyn Hooper says the case is a reminder to pharmacists of their obligations under the Code of Ethics to question a prescriber about what they have written. Mrs Hooper says the quantity of Sudomyl ordered should have raised alarm bells sooner.
“Just because they are a doctor, you are not obliged to supply everything they write down. Pharmacists are professionals and they have responsibilities,” she says.
Under the Code of Ethics, the pharmacist must exercise professional judgement to prevent the supply of any medicine, complementary therapy, herbal remedy or other healthcare product likely to constitute a hazard to health or the supply of unnecessary or excessive quantities of these, particularly those which the pharmacist knows or should reasonably be expected to realise are likely to cause or have a potential for misuse, abuse or dependency.
She encourages pharmacists not to believe precribers’ “fanciful stories” and says, if something doesn’t look quite right, they should approach the doctor in the first instance, and then contact Medsafe or the Pharmacy Council. The latter carries literature on raising concerns with prescribers, she says.
Another charge Dr Wilson was found guilty of related to prescribing large quantities of Xanax, also a Class C controlled drug, to two patients in circumstances that departed from the usual prescribing practice of GPs.
Dr Wilson obtained 6720 tablets of Xanax, a benzodiazepine, from Aviemore Pharmacy in Manukau between May 2006 and November 2007 also using PSOs. He told a Medsafe investigator the Xanax was used to help two of his patients come off methamphetamine, but an expert witness, GP Adrian Gray, said this was highly unusual and the dosage of 30–50 tablets a day was vastly above the maximum recommended dosage and with serious risks.
A spokesperson from Aviemore Pharmacy told Pharmacy Today Dr Wilson had been very believable. However, the pharmacy took the appropriate steps to inform the authorities of the irregular prescribing, and cooperated fully with the Health Practitioners Disciplinary Tribunal, he said.
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Lesson from the past
In 2008 pharmacist Ian Graham May was found guilty of professional misconduct for dispensing more than 46,000 tablets of Sudomyl to Auckland GP Rhys Cullen.
Dr Cullen was struck off the register for excessive prescribing of the medicine.
Mr May, of Clevedon Rd Pharmacy, dispensed approximately 733 prescriptions each for 60 x 60mg tablets of Sudomyl – totalling 46,380 – between early October 2006 and late March 2007.
The Health Practitioners Disciplinary Tribunal found Mr May had failed to comply with the standards reasonably expected of a pharmacist when he knew or should reasonably be expected to realise the prescribed medicine in such quantities had the potential for misuse, abuse or dependency and was likely to constitute a hazard to health. Mr May’s registration was suspended for 12 months, and he was fined $5000 and ordered to pay 30% of proceedings costs.
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