Health Care Complaints Commission v Naamo [2021] NSWCATOD 109
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Civil and Administrative Tribunal
New South Wales
Medium Neutral Citation: Health Care Complaints Commission v Naamo [2021] NSWCATOD 109
Hearing dates: 26 July 2021
Date of orders: 5 August 2021
Decision date: 05 August 2021
Jurisdiction: Occupational Division
Before: The Hon F Marks, Principal Member
J Chen, Senior Member
A Aylott, Senior Member
J Sillince, General Member
Decision: (1) The respondent is reprimanded.
(2) Pursuant to s 149C(1)(b) the registration of the practitioner as a pharmacist is cancelled.
(3) Pursuant to s 149C(7) the respondent may not apply for review of Order (2) for a period of five years.
(4) The respondent is to pay the costs of the applicant in an amount assessed in default of agreement.
Catchwords: OCCUPATIONS — pharmacist – respondent found to have engaged in misconduct involving the dispensing, storage and dispersal of drugs of addiction and other restricted substances – respondent did not participate in proceedings – held conduct constituted professional misconduct – protective orders – reprimand imposed – registration cancelled – non-review period fixed of five years – costs order made
Legislation Cited: Health Practitioner Regulation National Law (NSW) ss 139B, 139E, 149A, 149C, 150
Poisons and Therapeutic Goods Regulation 2008 (NSW) cl 35, 39, 40, 41, 54, 67, 69, 76, 86(1)(f), 87(1), 80, 85, 89, 95, 112,113, 118, 124, 138, 177.
Cases Cited: Health Care Complaints Commission v Do [2014] NSWCA 307
Spicer v NSW Medical Council (unreported, CA No.3 of 1981, 19 February 1981)
Texts Cited: None
Category: Principal judgment
Parties: Health Care Complaints Commission (Applicant)
Sevan Naamo (Respondent)
Representation: Counsel:
D Fuller (Applicant)
Solicitors:
Health Care Complaints Commission (Applicant)
HWL Ebsworth (Respondent)
File Number(s): 2021/00025055
Publication restriction: Pursuant to section 64 of the Civil and Administrative Tribunal Act the publication of the names of the persons set out in Schedule 1 of the Amended Complaint and of any information which may tend to identify such persons is prohibited.
Reasons for decision
Background
1. These proceedings are constituted by an Amended Complaint whereby the applicant Health Care Complaints Commission complains that the respondent Sevan Naamo is guilty of unsatisfactory professional conduct and professional misconduct in his practice as a pharmacist as those terms are defined in the Health Practitioner Regulation National Law NSW (the National Law).
2. On 23 June 2021 solicitors acting for the respondent informed the Tribunal that he would not be filing any material in response to the Complaints then made against him and would not be participating in the hearing in relation to this matter. When the hearing of the proceedings commenced the applicant sought leave to amend the initiating process to correct a number of matters, primarily relating to the dates when certain events occurred. Notice of the amendments sought had been given to the respondent's solicitors, and no notification was received by the applicant from them indicating any objection to the proposed amendments. Having regard to the nature of these proposed amendments, leave to amend was granted accordingly.
3. The Amended Complaint is, relevantly, in the following terms:
The Health Care Complaints Commission of Level 12, 323 Castlereagh Street, Sydney NSW, having consulted with the Pharmacy Council of New South Wales in accordance with sections 39(2) and 90B(3) of the Health Care Complaints Act 1993 and section 145A of the Health Practitioner Regulation National Law (NSW) ("the National Law")
HEREBY COMPLAINS THAT
Mr Sevan Naamo ("the practitioner") of (address deleted) being a pharmacist registered under the National Law,
BACKGROUND TO ALL COMPLAINTS
The practitioner obtained a Bachelor of Medical Science in 2008 from the University of Technology Sydney. The practitioner obtained a Bachelor of Pharmacy in 2014 from the University of New England.
The practitioner was first registered to practise as a pharmacist on 17 November 2014. Upon registration, the practitioner commenced employment at Health Information Pharmacy in Castle Hill for a period of 2 years.
The practitioner was then employed as a pharmacist with Penna's Pharmacy Group from mid-2016 until April 2018. From 17 April 2018 onwards the practitioner commenced work at the Revesby Discount Drug Store ("Revesby Pharmacy") and Condell Park Discount Drug Store ("Condell Pharmacy").
The practitioner was the sole pharmacist and pharmacist in charge at the Revesby Pharmacy.
On 25 February 2019 the Pharmaceutical Regulatory Unit (PRU) inspected the Revesby Pharmacy. A further inspection was undertaken at the Revesby Pharmacy by the PRU on 17 April 2019. On 6 June 2019 the PRU completed their investigation report into the practitioner and his conduct at the Condell Pharmacy and Revesby Pharmacy.
COMPLAINT ONE
is guilty of unsatisfactory professional conduct under section 139B(1)(a) and/or (l) of the National Law in that the practitioner has:
i. engaged in conduct that demonstrates the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of pharmacy is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience; and/or
ii. engaged in improper or unethical conduct relating to the practice or purported practice of pharmacy.
PARTICULARS OF COMPLAINT ONE
REVESBY PHARMACY
1. Between May 2018 and August 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Endone 5mg tablets, on the dates and in the circumstances as set out in Schedule 2 to the Complaint on 23 occasions in circumstances where on each occasion:
a. a forged prescription written using a prescription pad from Medical Practitioner A was presented;
b. a quantity of 120 tablets was dispensed;
c. the dispensing was contrary to Clause 86(1)(f) of the Poisons and Therapeutic Goods Regulation 2008 ("PTGR");
d. the practitioner failed to verify the authenticity of the prescriptions contrary to Clause 87(1) of the PTGR;
2. Between May 2018 and August 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Endone 5mg tablets, on the dates and in the circumstances as set out in Schedule 2 to the Complaint on seven occasions in circumstances where on each occasion:
a. there was no corresponding original prescription duplicate contrary to Clause 89 of the PTGR;
b. the failure to keep the corresponding original prescription duplicate was contrary to Clause 89 of the PTGR;
c. a quantity of 120 tablets was dispensed.
3. Between August 2018 and September 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Oxycontin 40mg tablets, on the dates and in the circumstances as set out in Schedule 3 to the Complaint in circumstances where on each occasion:
a. a forged prescription written using a prescription pad from Medical Practitioner A was presented;
b. a quantity of 56 tablets was dispensed;
c. the dispensing was contrary to Clause 86(1)(f) of the PTGR;
d. the practitioner failed to verify the authenticity of the prescriptions contrary to Clause 87(1) of the PTGR.
4. On 18 October 2018, the practitioner inappropriately dispensed a Schedule 8 drug of
addiction, namely Oxycontin 40mg tablets, in the circumstances as set out in Schedule 3 to the Complaint on one occasion in circumstances where:
a. there was no corresponding original prescription duplicate contrary to Clause 89 of the PTGR;
b. a quantity of 56 tablets was dispensed;
c. the failure to keep the corresponding original prescription duplicate was contrary to Clause 89 of the PTGR.
5. On 3 January 2019, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Alprazolam 2mg tablets in circumstances where:
a. a forged prescription was presented;
b. a quantity of 50 tablets was dispensed;
c. the dispensing was contrary to Clause 86(1)(f) of the PTGR;
d. the practitioner failed to verify the authenticity of the prescription contrary to Clause 87(1) of the PTGR;
e. the prescription was not in compliance with Clause 80 of the PTGR because it did not contain written directions for use;
f. dispensing the drug was in breach of Clause 85 of the PTGR.
6. On 18 October 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Alprazolam 2mg tablets, in circumstances where:
a. there was no corresponding original prescription duplicate contrary to Clause 89 of the PTGR;
b. a quantity of 100 tablets was dispensed;
c. the failure to keep the corresponding original prescription duplicate was contrary to Clause 89 of the PTGR.
7. Around April 2018 the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Physeptone 10mg, in circumstances where:
a. the supply of the drug was not properly recorded in the Dangerous Drug register contrary to Clause 112 and Clause 113 of the PTGR, because it did not contain the correct reference number from the prescription dispensed;
b. the prescription was not in compliance with Clause 80 of the PTGR because:
i. it did not include adequate directions for use;
ii. the quantity was not expressed in both words and figures;
c. dispensing the drug was in breach of Clause 85 of the PTGR.
8. On 19 July 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 30mg tablets, in the circumstances as set out in Schedule 4 to the Complaint on three occasions in circumstances where on each occasion:
a. a forged prescription and five repeat prescriptions written using a prescription pad from Medical Practitioner A was presented;
b. a total quantity of 180 tablets was dispensed;
c. this was contrary to Clause 40(1)(e) of the PTGR;
d. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
9. On 30 November 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 30mg tablets, in the circumstances as set out in Schedule 4 to the Complaint in circumstances where on each occasion:
a. there was no corresponding original prescription duplicate;
b. a quantity of 180 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
10. Around August 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 30mg tablets, on the dates and in the circumstances as set out in Schedule 4 to the Complaint in circumstances where, on each occasion:
a. there was no corresponding original prescription duplicate;
b. a total quantity of 120 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
11. On 19 July 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 40mg tablets, in the circumstances as set out in Schedule 5 to the Complaint in circumstances where, on each occasion:
a. a forged prescription and five repeat prescriptions written using a prescription pad from Medical Practitioner A were presented;
b. a total quantity of 180 tablets was dispensed;
c. this was contrary to clause 40(1)(e) of the PTGR;
d. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
12. On 3 August 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 40mg tablets, in the circumstances as set out in Schedule 5 to the Complaint in circumstances where, on each occasion:
a. there was no corresponding original prescription duplicate;
b. a total quantity of 60 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
13. On 13 August 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 40mg tablets, in the circumstances as set out in Schedule 5 to the Complaint in circumstances where, on each occasion:
a. there was no corresponding original prescription duplicate;
b. a total quantity of 120 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
14. Between September 2018 and November 2018, the practitioner dispensed a Schedule 4D drug, namely Duromine 40mg tablets, on the dates and in the circumstances as set out in Schedule 5 to the Complaint in circumstances where:
a. on each occasion, there was no corresponding original prescription duplicate;
b. a total quantity of 90 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
15. On 22 November 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 40mg tablets, in the circumstances as set out in Schedule 5 to the Complaint in circumstances where:
a. there was no corresponding original prescription duplicate;
b. a quantity of 30 tablets was dispensed.
16. On 29 June 2018, the practitioner inappropriately dispensed a Schedule 4B drug, namely Primoteston 250mg/1ml depot syringe, in the circumstances as set out in Schedule 6 to the Complaint in circumstances where, on each occasion:
a. a forged prescription and three repeat prescriptions written using a prescription pad stolen from Medical Practitioner A were presented;
b. a total quantity of 12 syringes was dispensed;
c. this was contrary to clause 40(1)(e) of the PTGR;
d. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances;
e. the dispensing was contrary to Clause 41(2)(b) of the PTGR in that:
i. the practitioner did not endorse across the prescription the word, "CANCELLED";
ii. Primoteston 250mg/1ml is a special restricted substsance;
iii. the prescription did not clearly specify the intervals at which the substance may be supplied
CONDELL PARK PHARMACY
17. In January 2019, the practitioner inappropriately dispensed Schedule 8 drugs of addiction, namely Endone 5mg tablets and Oxycontin 40mg tablets, on the dates and in the circumstances as set out in Schedule 7 to the Complaint in circumstances where
a. a computer generated forged prescription was presented;
b. the dispensing was contrary to Clause 86(1)(f) of the PTGR;
c. the practitioner failed to verify the authenticity of the forged prescriptions contrary to Clause 87(1) of the PTGR.
COMPLAINT TWO
is guilty of unsatisfactory professional conduct under section 139B(1)(a) and/or (l) of the National Law in that the practitioner has:
i. engaged in conduct that demonstrates the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of pharmacy is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience; and/or
ii. engaged in improper or unethical conduct relating to the practice or purported practice of pharmacy.
PARTICULARS OF COMPLAINT TWO
REVESBY PHARMACY
1. Between 1 March 2018 and 1 February 2019, the practitioner failed to account for the following numbers of Schedule 8 and Schedule 4 drugs, in circumstances where it was his duty, as the Pharmacist in Charge, to ensure the drugs were accounted for:
a. Endone 5mg – 2760 tablets;
b. Oxycotin 40mg – 168 tablets;
c. Alprazolam 2mg – 450 tablets;
d. Targin 5/2.5mg – 28 tablets
e. Targin 15/7.5mg – 28 tablets
f. Duromine 30mg – 2640 tablets;
g. Duromine 40mg – 2400 tablets;
2. Between March and September 2018, the practitioner failed to undertake accurate stock checks for the Schedule 8 drugs at the Pharmacy contrary to Clause 118 of the PTGR.
3. Between May 2018 and February 2019, the practitioner failed to make entries in the drug register in relation to the receipt of Schedule 8 drugs of addiction on the day they were received, namely Endone 5mg tablets, Oxycontin 40mg tablets and Alprazolam 2mg tablets, on the dates and in the circumstances as set out in Schedule 8 to the Complaint, contrary to Clause 112 of the PTGR.
4. Between April 2018 and February 2019, the practitioner failed to make entries in the drug register in relation to the supply of Schedule 8 drugs of addiction on the day they were supplied, namely Endone 5mg tablets, Oxycontin 40mg tablets and Alprazolam 2mg tablets on the dates and in the circumstances as set out in Schedule 9 to the Complaint contrary to Clause 112 of the PTGR.
5. Between April 2018 and February 2019, the practitioner made five false entries into the drug register in relation to the dispensing of Schedule 8 drugs of addiction, namely Endone 5mg tablets and Oxycontin 40mg tablets, on the dates and in the circumstances as set out in Schedule 9 to the Complaint, contrary to Clause 177 of the PTGR.
6. Between April 2018 and February 2019, as the Pharmacist in Charge, the practitioner failed to account for the following Schedule 8 drugs in circumstances where he had not taken steps to notify the Director-General of the loss of these drugs contrary to Clause 124 of the PTGR:
a. 2760 tablets of Endone 5mg;
b. 168 tablets of OxyContin 40mg;
c. 250 tablets of Alprazolam 2mg;
d. 28 tablets of Targin 5/2.5mg;
e. 28 tablets of Targin 15/7.5mg.
7. Between April 2018 and February 2019, as the Pharmacist in Charge, the practitioner failed to account for the following Schedule 4 drugs in circumstances where he had not taken steps to notify the Director-General of the loss of these prescribed restricted substances contrary to Clause 67 of the PTGR:
a. 2640 tablets of Duromine 30mg
b. 2400 tablets of Duromine 40mg
8. On 4 January 2019, the practitioner engaged in the following inappropriate conduct whilst working at the Pharmacy:
a. the practitioner left the inside of the Pharmacy whilst the pharmacy safe was opened and unlocked contrary to Clause 76 (3)(a) of the PTGR;
b. the practitioner used an e-cigarette device whilst inside the pharmacy contrary to Clause 138(b) of the PTGR.
9. On 4 January and 11 January 2019, the practitioner inappropriately handed out two takeaway methadone bottles that were not labelled, contrary to Clause 69(3) of the PTGR.
10. On 4 January 2019, the practitioner inappropriately removed the following drugs from the Pharmacy in circumstances where there was no valid prescription for the drugs:
a. up to eight bottles of Alprazolam 2mg containing 50 tablets per bottle, for a total of 400 tablets;
b. up to twelves packs of Endone 5mg containing 20 tablets per pack for a total of 240 tablets.
11. On 4 January 2019, the practitioner inappropriately removed the following drugs from the Pharmacy in circumstances where there was no valid prescription for the drugs:
a. twelve packets of Duromine containing 30 tablets per pack for a total of 360 tablets;
b. one bottle of Loxicom 1.5mg/ml 100ml oral suspension.
12. On 11 January 2019, the practitioner inappropriately removed the following drugs from the Pharmacy, in circumstances where there was no valid prescription for the drugs:
a. up to eight packs of Endone 5mg containing 20 tablets per pack for a total of 160 tablets;
b. up to twelve packets of Duromine containing 30 tablets per pack for a total of 360 tablets.
COMPLAINT THREE
is guilty of professional misconduct under section 139E of the National Law in that the practitioner has:
i. engaged in unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration, or
ii. engaged in more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify the suspension or cancellation of the practitioner's registration
PARTICULARS OF COMPLAINT THREE
The particulars of Complaint One and Complaint Two are repeated and relied on both individually and cumulatively.
1. These proceedings arise out of complaints made to the Health Professional Councils Authority by the principals of the two pharmacies at which the respondent had been employed, which resulted in enquiries being conducted by the NSW Health Pharmaceutical Regulatory Unit (PRU). Following findings made by the PRU, the Pharmacy Council of NSW conducted proceedings under section 150 of the National Law in which the respondent participated and made written submissions. Following that hearing the Council suspended the respondent's registration as a pharmacist effective 26 February 2019. His registration remains suspended.
2. At the hearing of these proceedings the applicant tendered into evidence before us two bundles of documents extending over 1000 pages in length together with CCTV footage of observations of the respondent whilst working in the pharmacies, the subject of these proceedings. Included in this material are reports of Nerida Croker an experienced and well-qualified pharmacist who was retained by the applicant to provide expert evidence to assist the Tribunal. We shall refer to such portions of this material as is relevant.
3. As we have said, the respondent filed no evidence in the proceedings and anything which he has said in response to the Complaints and Particulars is confined to his participation in the section 150 proceedings to which we have earlier referred, and which has been provided to us by the applicant.
The factual background
1. The narration which follows is based on the documentary and other evidence filed by the applicant.
2. The respondent was first registered as a pharmacist on 17 November 2014. After working in several pharmacies for some years he commenced employment in about April 2018 working across two pharmacies, one at Revesby and the other at Condell Park. These pharmacies are owned by a corporate structure, of which Messrs E Abdallah and M Kaoutarani are principals. Whilst he was working at the Revesby pharmacy, the respondent was the sole pharmacist and pharmacist in charge.
3. On 4 February 2019 Mr Abdallah made complaints concerning the respondent to the Health Professional Councils Authority with respect to his employment at each of the pharmacies. He alleged, among other things, that forged prescriptions for Schedule 8 drugs of addiction had been found at both pharmacies, forged prescriptions for a Schedule 4D drug had been found at the Revesby pharmacy, that significant quantities of both types of drugs had been stolen from both pharmacies, and that Schedule 8 drug registers had not been properly kept at both pharmacies. The detailed report produced by the PRU has been made available to us. Many of its findings have found their way into the several Complaints and Particulars which are the subject of these proceedings, and we shall refer to these matters in greater detail later in these reasons.
4. We now proceed to deal with the Complaints and the Particulars thereof. In order to assist in an appreciation of the context in which these allegations are raised, we reproduce hereunder a convenient summary of the misconduct alleged against the respondent formulated by counsel for the applicant
Between April 2018 and February 2019, while he was working as the sole pharmacist and pharmacist in charge at the Revesby Discount Drug Store (Revesby Pharmacy) and as a pharmacist at the Condell Park Discount Drug Store (Condell Park Pharmacy), the Respondent:
(a) dispensed large quantities of drugs of addiction (Schedule 8 drugs), special restricted substances (Schedule 4B drugs) and prescribed restricted substances (Schedule 4D drugs) on forged prescriptions or without receiving or retaining a prescription that complied with the requirements in the Poisons and Therapeutic Goods Regulation 2008 (NSW) (PTGR);
(b) dispensed quantities of Schedule 8 and Schedule 4D drugs that did not accord with the recognised therapeutic standard of what was appropriate in the circumstances, contrary to the PTGR;
(c) oversaw the disappearance of thousands of units of Schedule 8 and Schedule 4D drugs, which have not been accounted for;
(d) failed to keep proper records of the receipt and supply of Schedule 8 drugs; and
(e) engaged in other inappropriate conduct, including removing Schedule 8 and Schedule 4D drugs from the Revesby Pharmacy without a prescription, handing out unlabelled bottles of methadone to customers, leaving the Pharmacy while the Schedule 8 drug safe was unlocked and open, and smoking an e-cigarette in the dispensing area of the Pharmacy.
1. The allegations made against the respondent are of a most serious nature. In keeping with the jurisprudence adopted by this Tribunal in matters of this kind we observe that although the applicant bears the onus of proving a matter on the ordinary civil basis, namely on the balance of probabilities, we must nevertheless apply an appropriate standard in considering these matters. It is commonly expressed as requiring that we be "comfortably satisfied" on the balance of probabilities that a factual matter has been proven. We shall adopt this as the requisite standard to be applied in these proceedings.
Complaint One
1. In this Complaint the applicant alleges that the respondent was guilty of unsatisfactory professional conduct as defined in the National Law. We shall return to a consideration of this definition in the context of these proceedings later in these reasons for decision. For present purposes we set out each of the Particulars of this Complaint, and deal with the relevant evidentiary material.
2. Particulars 1 to 16 deal with the conduct of the respondent whilst employed at Revesby and Particular 17 deals with his conduct at Condell Park. We deal with each Particular in turn:
1. Between May 2018 and August 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Endone 5mg tablets, on the dates and in the circumstances as set out in Schedule 2 to the Complaint on 23 occasions in circumstances where on each occasion:
a. a forged prescription written using a prescription pad from Medical Practitioner A was presented;
b. a quantity of 120 tablets was dispensed;
c. the dispensing was contrary to Clause 86(1)(f) of the Poisons and Therapeutic Goods Regulation 2008 ("PTGR");
d. the practitioner failed to verify the authenticity of the prescriptions contrary to Clause 87(1) of the PTGR;
1. Schedule 2, which we have not reproduced is comprised inter-alia of a list of 23 patients for whom quantities of 120 each of 5mg Endone tablets were dispensed between 4 May 2018 and 23 August 2018. In each case the prescriptions against which these drugs were dispensed was forged. The material in Schedule 2 is based upon the dispensing records of the pharmacy as retrieved by the PRU when conducting its investigation including copies of the prescriptions, as well as information obtained from the medical practitioner whose name appears as the prescriber, Dr N Patel that the signature on each of the prescriptions purporting to be his signature was a forgery.
2. In her expert report Ms Croker noted that Endone was a Schedule 8 drug of addiction. It was her opinion that the standard reasonably expected of a pharmacist of an equivalent level of training and experience of the respondent would be to ensure that any medication was only dispensed on receipt of a valid, legal prescription. This would require careful monitoring of the dispensing of this medication for possibly forged prescriptions because of a risk of misuse. She noted that the amounts dispensed under these prescriptions were large and exceeded the normal dose. Furthermore, the prescriptions were private prescriptions which did not qualify the patient for any government subsidy, and this of itself should have raised reasonable suspicion of possible misuse.
3. Clauses 86 (1) (f) and 87(1) of the PTGR are in the following terms:
86 Certain prescriptions not to be filled
(1) A pharmacist must not supply a drug of addiction on prescription—
…………………………………..
(f) if the prescription appears to have been forged or fraudulently obtained
87 Prescriptions require verification
(1) A pharmacist must not supply a drug of addiction on prescription unless he or she—
(a) is familiar with the handwriting of the person who issued the prescription, or
(b) knows the person for whom the drug is prescribed, or
(c) has verified that the person who is purported to have issued the prescription has actually issued the prescription.
1. When interviewed about these matters by delegates of the Pharmacy Council during the course of the section 150 proceedings the respondent informed them that he endeavoured to contact Dr Patel on one occasion to verify a prescription but was unable to speak to him and spoke to his secretary. She confirmed that the named person was a patient. The respondent said that he did not remember whether he asked any questions about the prescription, and he made no notes of the conversation. The respondent also informed the delegates that he was familiar with the patients who had presented the prescriptions. He said
they are all people that I was familiar with. Either they would have come in for, not in regards to medication so much, it wasn't a very busy pharmacy, but they would come into their normal over-the-counter medications and things like that. I don't believe many of them would have been brand-new people that I had never seen.
1. In her report Ms Croker concluded that
…….the fact that the prescriptions were generally for a private prescription quantity of 120 tablets should have been a flag that the prescriptions may not be valid. Most prescribers will prescribe a single box of 20 tablets to patients as these are potent pain relief medications and are generally encouraged to be used intermittently. The larger quantity is also not on the PBS which means patients must pay increased amounts and may also be a flag that the prescription is not legitimate.
1. We are not satisfied that the respondent complied with the provisions of this legislation. In circumstances where he has declined to provide any information to the applicant or to the Tribunal with respect to the matters which are the subject of these proceedings and based upon such information as is available to us, we are satisfied to the requisite standard that this Particular has been made out.
2. Between May 2018 and August 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Endone 5mg tablets, on the dates and in the circumstances as set out in Schedule 2 to the Complaint on seven occasions in circumstances where on each occasion:
a. there was no corresponding original prescription duplicate contrary to Clause 89 of the PTGR;
b. the failure to keep the corresponding original prescription duplicate was contrary to Clause 89 of the PTGR;
c. a quantity of 120 tablets was dispensed.
1. When the PRU conducted a search of the pharmacy records investigators were unable to locate the duplicate of the original of 7 prescriptions. These records are required to be kept by Clause 89 of the PTGR which is in the following terms:
89 Prescriptions and orders to be kept
(1) A pharmacist who supplies a drug of addiction on prescription, or by order under clause 97 or 103, must keep the prescription or order, whether or not the prescription or order authorises more than one supply of the drug.
1. In the absence of any explanation from the respondent that may cast doubt upon the conclusion that the original prescription duplicates were not kept we are satisfied to the requisite standard that this Particular has been made out.
3. Between August 2018 and September 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Oxycontin 40mg tablets, on the dates and in the circumstances as set out in Schedule 3 to the Complaint in circumstances where on each occasion:
a. a forged prescription written using a prescription pad from Medical Practitioner A was presented;
b. a quantity of 56 tablets was dispensed;
c. the dispensing was contrary to Clause 86(1)(f) of the PTGR;
d. the practitioner failed to verify the authenticity of the prescriptions contrary to Clause 87(1) of the PTGR.
1. Schedule 3 of the Complaint sets out the details of 4 prescriptions for 40 mg OxyContin tablets dispensed to 4 different patients by the respondent between 17 August 2018 and 14 September 2018. Dr N Patel who purportedly issued these prescriptions has confirmed that they are forgeries. Ms Croker repeated her comments with respect to the large quantities of this drug of addiction which were dispensed as applied to the dispensing of Endone. The same considerations apply to this Particular as applied to Particular 1 above. We are satisfied to the requisite standard that this Particular has been made out.
4. On 18 October 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Oxycontin 40mg tablets, in the circumstances as set out in Schedule 3 to the Complaint on one occasion in circumstances where:
a. there was no corresponding original prescription duplicate contrary to Clause 89 of the PTGR;
b. a quantity of 56 tablets was dispensed;
c. the failure to keep the corresponding original prescription duplicate was contrary to Clause 89 of the PTGR.
1. The same factual and evidentiary circumstances apply to the dispensing of this prescription to this patient as applied to Particular 2 above. On this basis we are satisfied to the requisite standard that this Particular has been made out.
5. On 3 January 2019, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Alprazolam 2mg tablets in circumstances where:
a. a forged prescription was presented;
b. a quantity of 50 tablets was dispensed;
c. the dispensing was contrary to Clause 86(1)(f) of the PTGR;
d. the practitioner failed to verify the authenticity of the prescription contrary to Clause 87(1) of the PTGR;
e. the prescription was not in compliance with Clause 80 of the PTGR because it did not contain written directions for use;
f. dispensing the drug was in breach of Clause 85 of the PTGR.
1. In addition to Clauses 86 (1)(f) and 87 (1) of the PTGR previously set out, this Particular also asserts breaches of Clauses 80 and 85 the relevant parts of which are in the following terms:
80 Form of prescription
(1) A person who issues a prescription for a drug of addiction must ensure that the prescription includes the following details—
(a) the date on which it is issued,
(b) the name and address of the patient or (if the treatment is for an animal) the species of animal and the name and address of the animal's owner,
(c) the name, strength and quantity (expressed in both words and figures) of the drug to be supplied,
(d) adequate directions for use,
(e) the maximum number of times the drug may be supplied on the prescription,
(f) the intervals at which the drug may be supplied on the prescription,
(g) if the prescription is issued at a hospital, the name and designation of the person by whom it is issued and the name, address and telephone number of the hospital,
(h) if the prescription is issued elsewhere than at a hospital, the name and designation of the person by whom it is issued and the address and telephone number of the premises at which it is issued,
(i) if the drug of addiction is a type A drug of addiction and the person holds an authority to issue the prescription under section 29 of the Act or Part 8 of this Regulation, the reference number of the authority.
(2) The details referred to in subclause (1)(a)–(f) must be made out—
(a) in the handwriting of the person by whom the prescription is issued, or
(b) in such other manner as may be approved for the time being by the Director-General,
and the prescription must be signed by the person by whom it is issued.
(3) The person by whom the prescription is issued must confirm any dose that could be regarded as being dangerous or unusual by underlining the part of the prescription that specifies the intended dose and by initialling the prescription in the margin.
(4) A person must not issue a prescription that includes—
(a) more than one preparation containing a drug of addiction, or
(b) both a preparation containing a drug of addiction and another preparation.
……………………………………………….
85 Pharmacists may supply drugs of addiction on prescription
(1) A pharmacist may supply a drug of addiction on prescription if the prescription is in the form required by Division 3.
(2) This clause does not prevent a pharmacist from supplying a drug of addiction on prescription merely because—
(a) the prescription fails to specify the maximum number of times the drug may be supplied, or
(b) the prescription fails to specify the intervals at which the drug may be supplied.
(3) A pharmacist must not supply a drug of addiction on a prescription referred to in subclause (2) if it appears to the pharmacist that the drug has previously been supplied on the prescription, regardless of how many times the prescription purports to authorise the supply of the drug.
1. A copy of this prescription is in evidence before us. There is evidence that the signature of Dr K Jain who purportedly issued the prescription is a forgery, and that she did not issue it. The prescription makes reference to the quantity and the drug but does not contain any other details, and in particular any details concerning directions for use. There is no evidence that the respondent attempted to make any contact with the prescribing doctor, and there is clear evidence that the prescription fails to comply with the provisions of Clause 80 and should not have been dispensed by reason of Clause 85. We are satisfied to the requisite standard that this Particular has been made out.
6. On 18 October 2018, the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Alprazolam 2mg tablets, in circumstances where:
a. there was no corresponding original prescription duplicate contrary to Clause 89 of the PTGR;
b. a quantity of 100 tablets was dispensed;
c. the failure to keep the corresponding original prescription duplicate was contrary to Clause 89 of the PTGR.
1. The evidence and the factual circumstances are of the same nature as referred to in connection with Particular 2 above. We are satisfied to the requisite standard that this Particular has been made out.
7. Around April 2018 the practitioner inappropriately dispensed a Schedule 8 drug of addiction, namely Physeptone 10mg, in circumstances where:
a. the supply of the drug was not properly recorded in the Dangerous Drug register contrary to Clause 112 and Clause 113 of the PTGR, because it did not contain the correct reference number from the prescription dispensed;
b. the prescription was not in compliance with Clause 80 of the PTGR because:
i. it did not include adequate directions for use;
ii. the quantity was not expressed in both words and figures;
c. dispensing the drug was in breach of Clause 85 of the PTGR.
1. The dispensing records and the Dangerous Drugs register obtained by the PRU investigators confirm the allegations contained in paragraph a above. In addition, a copy of the prescription which is in evidence confirms that it did not contain the information referred to in paragraph b above. We are satisfied to the requisite standard that this Particular has been made out.
8. On 19 July 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 30mg tablets, in the circumstances as set out in Schedule 4 to the Complaint on three occasions in circumstances where on each occasion:
a. a forged prescription and five repeat prescriptions written using a prescription pad from Medical Practitioner A was presented;
b. a total quantity of 180 tablets was dispensed;
c. this was contrary to Clause 40(1)(e) of the PTGR;
d. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
1. Copies of the prescriptions indicate that they were purportedly written by Dr Patel, who has confirmed that they are forgeries. This is in breach of Clause 40 (1) (e) which is in the following terms:
40 Certain prescriptions not to be filled
(1) A pharmacist must not supply a restricted substance on prescription—
………………………………………………………..
(e) if the prescription appears to have been forged or fraudulently obtained,
1. In a supplementary report Ms Croker noted that the usual dose of Duromine 30 mg is one capsule daily, so that 30 capsules would be sufficient for one month. However, the respondent dispensed a total of 180 tablets to each patient. Ms Croker noted that the Australian Medicines Handbook states that short-term treatment is recommended for this drug which may be up to 3 months. On this basis she said that the recognised therapeutic standard would be to dispense one box of medication at a time. It follows that the respondent was in breach of Clause 54, as alleged. This Clause is in the following terms:
54 Quantity and purpose of supply to be appropriate
An authorised practitioner or pharmacist must not supply any restricted substance in a quantity, or for a purpose, that does not accord with the recognised therapeutic standard of what is appropriate in the circumstances.
1. It follows that we are satisfied to the requisite standard that this Particular has been made out.
9. On 30 November 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 30mg tablets, in the circumstances as set out in Schedule 4 to the Complaint in circumstances where on each occasion:
a. there was no corresponding original prescription duplicate;
b. a quantity of 180 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
1. The available evidence is based on the investigations and findings of the PRU investigators, including dispensing records and the records of prescriptions issued. These confirm that there was no original prescription duplicate. We repeat our conclusions with respect to the recognised therapeutic standard which applies to this drug set out in connection with Particular 8 above. It follows that we are satisfied to the requisite standard that this Particular has been made out.
10. Around August 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 30mg tablets, on the dates and in the circumstances as set out in Schedule 4 to the Complaint in circumstances where, on each occasion:
a. there was no corresponding original prescription duplicate;
b. a total quantity of 120 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
11. On 19 July 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 40mg tablets, in the circumstances as set out in Schedule 5 to the Complaint in circumstances where, on each occasion:
a. a forged prescription and five repeat prescriptions written using a prescription pad from Medical Practitioner A were presented;
b. a total quantity of 180 tablets was dispensed;
c. this was contrary to clause 40(1)(e) of the PTGR;
d. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
12. On 3 August 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 40mg tablets, in the circumstances as set out in Schedule 5 to the Complaint in circumstances where, on each occasion:
a. there was no corresponding original prescription duplicate;
b. a total quantity of 60 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
13. On 13 August 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 40mg tablets, in the circumstances as set out in Schedule 5 to the Complaint in circumstances where, on each occasion:
a. there was no corresponding original prescription duplicate;
b. a total quantity of 120 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
14. Between September 2018 and November 2018, the practitioner dispensed a Schedule 4D drug, namely Duromine 40mg tablets, on the dates and in the circumstances as set out in Schedule 5 to the Complaint in circumstances where:
a. on each occasion, there was no corresponding original prescription duplicate;
b. a total quantity of 90 tablets was dispensed;
c. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances.
d. the dispensing was contrary to Clause 39 (1) of the PTGR in that there was no prescription available to satisfy any part of Clause 35 of the PTGR
15. On 22 November 2018, the practitioner inappropriately dispensed a Schedule 4D drug, namely Duromine 40mg tablets, in the circumstances as set out in Schedule 5 to the Complaint in circumstances where:
a. there was no corresponding original prescription duplicate;
b. a quantity of 30 tablets was dispensed.
1. Having regard to our conclusions with respect to Particulars 8 and 9 above, it is convenient that we deal with Particulars 10 to 15 together. The underlying evidence is the same and from the same sources, and the evidence concerning the appropriate therapeutic standards is the same. By reference to the available evidence, and without specifying each and every detail thereof, we are satisfied that these Particulars have been made out.
16. On 29 June 2018, the practitioner inappropriately dispensed a Schedule 4B drug, namely Primoteston 250mg/1ml depot syringe, in the circumstances as set out in Schedule 6 to the Complaint in circumstances where, on each occasion:
a. a forged prescription and three repeat prescriptions written using a prescription pad stolen from Medical Practitioner A were presented;
b. a total quantity of 12 syringes was dispensed;
c. this was contrary to clause 40(1)(e) of the PTGR;
d. the dispensing was contrary to Clause 54 of the PTGR in that it was in a quantity that does not accord with a recognised therapeutic standard of what was appropriate in the circumstances;
e. the dispensing was contrary to Clause 41(2)(b) of the PTGR in that:
i. the practitioner did not endorse across the prescription the word, "CANCELLED";
ii. Primoteston 250mg/1ml is a special restricted substsance;
iii. the prescription did not clearly specify the intervals at which the substance may be supplied
1. The dispensing records reveal that on 29 June 2018 the respondent dispensed to Patients VV, WW and XX 4 syringes each of Primoteston 250mg/1mL. In total, the respondent dispensed 12 syringes on that day to each of these three patients. Dr Patel confirmed that his signatures on the prescriptions were forgeries.
2. As is alleged in this Particular, the prescriptions did not specify the intervals at which the substance was to be supplied. There is no endorsement on the prescriptions of the word "CANCELLED" as required by Clause 41 of the PTGR which is in the following terms:
41 Prescriptions to be endorsed
(1) A pharmacist who supplies a restricted substance on prescription must (on each occasion the substance is supplied) endorse the following particulars (in ink) on the prescription—
(a) the date on which the substance was supplied,
(b) the address of the place at which the substance was supplied,
(c) the prescription reference number.
Maximum penalty—15 penalty units.
(2) A person who supplies a substance on prescription must endorse (in ink) across the prescription the word "CANCELLED"—
(a) if the maximum number of times the prescription is to be dispensed is not clearly specified, or
(b) if (in the case of a prescription for a special restricted substance) the intervals at which the substance may be supplied are not clearly specified, or
(c) if the prescription has reached the last occasion on which it can be supplied according to the maximum number of times specified on it.
1. In a supplementary report Ms Croker noted that the usual therapeutic dose of Primoteston is one syringe every 2 to 3 weeks. Accordingly, a supply of 12 syringes would be sufficient for 24 to 36 weeks. Ms Croker noted that generally
the syringes are dispensed singly at the time the GP is going to administer them (by our intramuscular injection which are not usually done by the patients themselves and require someone to administer). Dispensing quantities greater than one syringe at a time does not meet the recognised therapeutic standard.
1. It follows that we are satisfied to the requisite standard that this Particular has been made out.
CONDELL PARK PHARMACY
17. In January 2019, the practitioner inappropriately dispensed Schedule 8 drugs of addiction, namely Endone 5mg tablets and Oxycontin 40mg tablets, on the dates and in the circumstances as set out in Schedule 7 to the Complaint in circumstances where
a. a computer generated forged prescription was presented;
b. the dispensing was contrary to Clause 86(1)(f) of the PTGR;
c. the practitioner failed to verify the authenticity of the forged prescriptions contrary to Clause 87(1) of the PTGR.
1. Information obtained by investigators of the PRU and provided by Dr Haddad who is identified as the prescriber confirms that the signatures of the prescribing medical practitioners on all 9 prescriptions were forgeries. There is no indication in the records of the pharmacy that the respondent made any attempt to satisfy himself about the authenticity of the prescriptions. We have previously set out the provisions of Clauses 86(1)(f) and 87 (1) of the PTGR. We are satisfied to the requisite standard that this Particular has been made out.
Complaint Two
Revesby Pharmacy
1. Between 1 March 2018 and 1 February 2019, the practitioner failed to account for the following numbers of Schedule 8 and Schedule 4 drugs, in circumstances where it was his duty, as the Pharmacist in Charge, to ensure the drugs were accounted for:
a. Endone 5mg – 2760 tablets;
b. Oxycotin 40mg – 168 tablets;
c. Alprazolam 2mg – 450 tablets;
d. Targin 5/2.5mg – 28 tablets
e. Targin 15/7.5mg – 28 tablets
f. Duromine 30mg – 2640 tablets;
g. Duromine 40mg – 2400 tablets;
1. The evidence to sustain these allegations is derived from information obtained by investigators from the PRU. This evidence consists of the quantities of those drugs supplied to the pharmacy as contained in the records of wholesalers, records of the quantities dispensed by the pharmacy, and the opening and closing balances of those drugs as recorded in the relevant Dangerous Drugs registers. Perusal of these records substantiates the allegations contained in this Particular.
2. During the course of the section 150 proceedings the respondent said by way of explanation that he frequently received stock intended for other pharmacies owned by the same proprietors and was required by them to transfer this stock to those pharmacies. He said that he sometimes drove the stock after work in his own vehicle to take it to the other pharmacies or to the homes of the proprietors. The proprietors in written statements denied that such arrangements existed, especially involving drugs of the kind described in this Particular.
3. In her report Ms Croker referred to the assertions made by the respondent concerning the transfer of medication between pharmacies. She said:
Under regulation 95 of the Poisons and Therapeutic Goods Regulation, there are clear rules regarding supply of S 8 medications. This can only be done on receipt of a written order by the authorised person. Even if S 8 transfers could be allowed between pharmacies, it would require clear documentation such as an order and duplicate signed receipts to be kept for up to 2 years. There was no documentation of any request for transfer or any signed receipt etc.
1. We are satisfied to the requisite standard that this Particular has been made out.
2. Between March and September 2018, the practitioner failed to undertake accurate stock checks for the Schedule 8 drugs at the Pharmacy contrary to Clause 118 of the PTGR.
1. Clause 118 is in the following terms:
118 Periodical inventory of stock of drugs of addiction
(1) The person responsible for maintaining a drug register at any place—
(a) must, during the prescribed periods, make an accurate inventory of all drugs of addiction at that place, and
(b) must endorse the relevant drug register, immediately under the last entry for each drug of addiction, with the quantity of each drug of addiction actually held and the date on which the inventory was made, and
(c) must sign each entry.
(2) The prescribed periods for the purposes of subclause (1)(a) are—
(a) March and September each year, or
(b) if the Director-General determines some other periods, either generally or in specified circumstances, the periods so determined.
(3) A person who assumes control for a period of one month or more over any place at which drugs of addiction are held must, immediately on assuming control, make an inventory and endorse the drug register as if the inventory were an inventory made under this clause.
1. Investigations carried out on behalf of the PRU failed to locate any stock count carried out by or on behalf of the respondent between March and September 2018 in contravention of Clause 118. We are satisfied to the requisite standard that this Particular has been made out.
3. Between May 2018 and February 2019, the practitioner failed to make entries in the drug register in relation to the receipt of Schedule 8 drugs of addiction on the day they were received, namely Endone 5mg tablets, Oxycontin 40mg tablets and Alprazolam 2mg tablets, on the dates and in the circumstances as set out in Schedule 8 to the Complaint, contrary to Clause 112 of the PTGR.
4. Between April 2018 and February 2019, the practitioner failed to make entries in the drug register in relation to the supply of Schedule 8 drugs of addiction on the day they were supplied, namely Endone 5mg tablets, Oxycontin 40mg tablets and Alprazolam 2mg tablets on the dates and in the circumstances as set out in Schedule 9 to the Complaint contrary to Clause 112 of the PTGR.
1. It is convenient to deal with both of these Particulars together. They both involve an alleged breach of Clause 112 which is in the following terms:
112 Entries in drug registers
(1) On the day on which a person manufactures, receives, supplies, administers or uses a drug of addiction at any place, the person must enter in the drug register for that place such of the following details as are relevant to the transaction—
(a) the quantity of the drug manufactured, received, supplied, administered or used,
(b) the name and address of the person to, from, or by, whom the drug was manufactured, received, supplied, administered or used,
(c) in the case of a drug that has been administered to an animal or supplied for the treatment of an animal, the species of animal and the name and address of the animal's owner,
(d) in the case of a drug that is supplied or administered on prescription—
(i) the prescription reference number, and
(ii) the name of the authorised practitioner by whom the prescription was issued,
(e) in the case of a drug that has been administered to a patient, the name of the authorised practitioner (other than a veterinary practitioner) by whom, or under whose direct personal supervision, the drug was administered,
(f) in the case of a drug that has been administered to an animal, the name of the veterinary practitioner by whom, or under whose direct personal supervision, the drug was administered,
(g) in the case of a drug that has been administered by a person authorised to do so by an authority under Part 8, details of the circumstances requiring administration of the drug,
(h) in the case of a drug that has been used by a person who is in charge of a laboratory, or is an analyst, the purpose for which the drug was used,
(i) the quantity of drugs of addiction of that kind held at that place after the transaction takes place,
(j) any other details approved by the Director-General.
(2) Each entry in a drug register must be dated and signed by the person by whom it is made.
………………………………..
1. Records obtained during the PRU investigation showed that on a number of occasions the respondent signed receipts for Schedule 8 drugs but did not record the receipt in the Dangerous Drugs register on the same day and dispensed Schedule 8 drugs but did not record them in the same register on the same day.
2. We are satisfied to the requisite standard that these Particulars have been made out.
5. Between April 2018 and February 2019, the practitioner made five false entries into the drug register in relation to the dispensing of Schedule 8 drugs of addiction, namely Endone 5mg tablets and Oxycontin 40mg tablets, on the dates and in the circumstances as set out in Schedule 9 to the Complaint, contrary to Clause 177 of the PTGR.
1. Clause 177 is in the following terms:
177 False or misleading entries in records and registers
(1) A person who is required by this Regulation to keep any record or register must not make any entry in the record or register that the person knows to be false or misleading in a material particular.
(2) A person must not make any alterations, obliterations or cancellations in a record or register required by this Regulation, but may correct any mistake in any entry by making a marginal note or footnote and by initialling and dating it.
1. Schedule 9 to the Complaint contains details of the supply of Schedule 8 drugs by the respondent. It is derived from information gathered during the course of the PRU investigation. That information discloses that false entries were made in the Dangerous Drugs register on five occasions being 17 October 2018, 30 July 2018 (twice) and 27 August, 2018 (twice). We are satisfied to the requisite standard that this Particular has been made out.
6. Between April 2018 and February 2019, as the Pharmacist in Charge, the practitioner failed to account for the following Schedule 8 drugs in circumstances where he had not taken steps to notify the Director-General of the loss of these drugs contrary to Clause 124 of the PTGR:
a. 2760 tablets of Endone 5mg;
b. 168 tablets of OxyContin 40mg;
c. 250 tablets of Alprazolam 2mg;
d. 28 tablets of Targin 5/2.5mg;
e. 28 tablets of Targin 15/7.5mg.
1. This Particular refers back to Particular 1 of Complaint Two above. In circumstances where there was a loss because of an inability to account for these drugs, this is a matter which should have been notified as required by Clause 124 which is in the following terms:
124 Loss or theft of drugs of addiction
A person who is authorised to be in possession of drugs of addiction must immediately notify the Director-General if the person loses a drug of addiction or if a drug of addiction is stolen from the person.
1. We are satisfied to the requisite standard that this Particular has been made out.
7. Between April 2018 and February 2019, as the Pharmacist in Charge, the practitioner failed to account for the following Schedule 4 drugs in circumstances where he had not taken steps to notify the Director-General of the loss of these prescribed restricted substances contrary to Clause 67 of the PTGR:
a. 2640 tablets of Duromine 30mg
b. 2400 tablets of Duromine 40mg
1. This Particular also refers back to Particular 1 of Complaint Two above. In circumstances where there was a loss because of an inability to account for these drugs, this is a matter which should have been notified as required by Clause 67 which is in the following terms:
67 Loss or theft of prescribed restricted substances
(1) A person must immediately notify the Director-General if the person loses a prescribed restricted substance or if a prescribed restricted substance is stolen from the person.
(2) This clause does not apply to the loss of any substance by, or the theft of any substance from, a person who has been supplied with the substance by, or on the prescription of, an authorised practitioner.
1. We are satisfied to the requisite standard that this Particular has been made out.
8. On 4 January 2019, the practitioner engaged in the following inappropriate conduct whilst working at the Pharmacy:
a. the practitioner left the inside of the Pharmacy whilst the pharmacy safe was opened and unlocked contrary to Clause 76 (3)(a) of the PTGR
1. The PRU investigators obtained CCTV footage from cameras installed in the pharmacy. This discloses that on 4 January 2019 whilst he was the only pharmacist in the pharmacy, the respondent left the premises through the front door clearly leaving a safe open. The respondent identified this safe as being the pharmacy drug safe during the course of the section 150 proceedings.
2. Clause 76 is in the following terms
76 Storage in pharmacies
(1) The pharmacist for the time being in charge of a pharmacy must keep any drug of addiction stored apart from other substances or goods (other than cash or documents) in a separate safe.
(2) Unless otherwise approved for the time being by the Director-General, such a safe must comply with the following requirements—
(a) it must be made of black mild steel plate at least 9 millimetres thick with continuous welding along all edges,
(b) it must be fitted with a door made of mild steel plate at least 9 millimetres thick, the door being flush fitting with a clearance around the door of not more than 1.5 millimetres,
(c) it must have a fixed locking bar, welded to the inside face of the door near the hinged edge, that engages in a rebate in the safe body when the door is closed,
(d) it must be fitted with a five lever key lock (or a locking mechanism providing at least equivalent security) securely fixed to the rear face of the door,
(e) if mounted on a brick or concrete wall or floor, it must be attached to the wall or floor by means of suitably sized expanding bolts through holes 9 millimetres in diameter drilled in the rear or bottom of the safe,
(f) if mounted on a timber framed wall or floor, it must be attached to the wall or floor frame by means of suitably sized coach screws through holes 9 millimetres in diameter drilled in the rear or bottom of the safe,
(g) if mounted on any other kind of wall or floor, it must be attached to the wall or floor in a manner approved for the time being by the Director-General.
(3) The pharmacist must ensure that—
(a) the safe is kept securely locked when not in immediate use, and
(b) any key or other device by means of which the safe may be unlocked—
(i) is kept on the person of a pharmacist whenever it is on the same premises as the safe, and is removed from the premises whenever there is no pharmacist at those premises, or
(ii) is kept in a separately locked safe to which only a pharmacist has access, and
(c) any code or combination that is required to unlock the safe is not divulged to any unauthorised person.
b. the practitioner used an e-cigarette device whilst inside the pharmacy contrary to Clause 138(b) of the PTGR.
1. The same CCTV clearly shows the respondent smoking an e-cigarette whilst in the dispensing area of the pharmacy. Clause 138(b) provides that
138 Certain behaviour prohibited
A person who is involved in the preparation or handling of exposed substances, or who is in a place that is used for preparing or handling exposed substances, must not—
(b) use, smoke or chew tobacco or any other similar substance in the vicinity of,
any surface used for the purpose of preparing or handling exposed substances.
1. We are satisfied to the requisite standard that this Particular has been made out.
9. On 4 January and 11 January 2019, the practitioner inappropriately handed out two takeaway methadone bottles that were not labelled, contrary to Clause 69(3) of the PTGR.
1. CCTV footage taken on 4 and 11 January 2019 shows the respondent supplying bottles which are used to dispense takeaway doses of methadone to patients which are unlabelled. Clause 69 (3) provides that:
69 Packaging and labelling generally
(3) A pharmacist who supplies any quantity of a drug of addiction on prescription must ensure that the drug is supplied in a package that is labelled in accordance with the requirements of Appendix A instead of in accordance with the requirements of subclause (1).
(Appendix A not reproduced, as there were no labels).
1. We are satisfied to the requisite standard that this Particular has been made out.
10. On 4 January 2019, the practitioner inappropriately removed the following drugs from the Pharmacy in circumstances where there was no valid prescription for the drugs:
a. up to eight bottles of Alprazolam 2mg containing 50 tablets per bottle, for a total of 400 tablets;
b. up to twelves packs of Endone 5mg containing 20 tablets per pack for a total of 240 tablets.
11. On 4 January 2019, the practitioner inappropriately removed the following drugs from the Pharmacy in circumstances where there was no valid prescription for the drugs:
a. twelve packets of Duromine containing 30 tablets per pack for a total of 360 tablets;
b. one bottle of Loxicom 1.5mg/ml 100ml oral suspension.
12. On 11 January 2019, the practitioner inappropriately removed the following drugs from the Pharmacy, in circumstances where there was no valid prescription for the drugs:
a. up to eight packs of Endone 5mg containing 20 tablets per pack for a total of 160 tablets;
b. up to twelve packets of Duromine containing 30 tablets per pack for a total of 360 tablets.
1. It is convenient to deal with Particulars 10, 11 and 12 together because they involve the same course of conduct albeit on different dates and involving different drugs of addiction. These Particulars are based upon observations which are seen when viewing the CCTV footage taken in the pharmacy on 4 January 2019 and 11 January 2019 and comparing those observations with invoices and receipts. When all of this information is considered, it establishes that certain items which are capable of being identified are removed from packages delivered to the pharmacy and placed in black bags which in turn are taken away from the pharmacy by the respondent. We add for completeness that there are no pharmacy records of these drugs having been dispensed by the respondent, nor are there any records of any prescriptions held to corroborate their dispensing.
2. We are satisfied to the requisite standard that this Particular has been made out.
General observations of Ms Croker
1. We have previously referred to opinions expressed by Ms Croker concerning certain aspects of the respondent's conduct with respect to a number of the Particulars in each of Complaints One and Two. Before considering whether and to what extent the respondent has engaged in the misconduct alleged against him, we set out by way of summary some of the observations of Ms Croker.
1. With respect to those instances where the respondent was dealing with drugs which may be at risk of misuse, and especially Schedules 8 and 4D medication, these should be "carefully monitored for possibly forged prescriptions. It would be expected that the practitioner remain up-to-date about any possible patterns of forgery or presentation of prescriptions in the area…..and take necessary measures to crosscheck prescriptions and ensure they are valid and legal.
2. The large quantities of these medications, and the fact that they are restricted medications with potential for misuse or abuse lead Ms Croker to be "strongly critical" of the respondent's conduct. There is no evidence that he made appropriate attempts to contact medical practitioners issuing these prescriptions nor that he was appropriately familiar with the patients.
3. The respondent habitually dispensed quantities of this medication which were inappropriate and exceeded known therapeutic values. This is particularly so when dispensing multiple quantities of Duromine on the same day and for the same patient. This was an unusual pattern of dispensing which should have raised serious concerns to the respondent about the validity of the prescriptions. She had similar concerns with respect to the dispensing of Primoteston.
4. The respondent should have been aware that the issue of private scripts was an indication of potential misuse.
5. There are a number of instances where the prescriptions dispensed did not meet legal requirements including writing clear directions for use or hand written quantities in both words and numbers. All of these prescriptions should have been verified by contacting the prescriber and insisting that a new prescription should have been issued with the correct notations.
6. The dispensing of large quantities of medication without a corresponding prescription was significantly below the standard expected of a pharmacist of an equivalent level of training or experience as the respondent.
7. The respondent failed to ensure that the drug register was kept up-to-date on days that he was working as pharmacist in charge, he failed to ensure that proper records were kept and failed to ensure that all medication was accounted for.
8. The respondent's conduct as revealed on the CCTV recordings was inappropriate and fell significantly below the standard expected of him.
1. We accept the expert evidence of Ms Croker.
Complaint Three. Is the respondent guilty of professional conduct as alleged?
1. The applicant asserts that by reason of all of the matters contained in Complaints One and Two the respondent is guilty of unsatisfactory professional conduct. In Complaint Three the applicant asserts that by reason of the same matters the respondent is guilty of the more serious misconduct, namely professional misconduct. Because we have determined that the respondent is guilty of the more serious professional misconduct we commence by considering what is constituted by this statutory term and why we consider that he is so guilty.
2. Professional misconduct is defined in section 139 E of the National Law in the following terms:
139E Meaning of "professional misconduct" [NSW]
For the purposes of this Law, professional misconduct of a registered health practitioner means—
(a) unsatisfactory professional conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration; or
(b) more than One instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration.
1. This definition in turn refers to the definition of unsatisfactory professional conduct which is found in section 139B of the National Law. We reproduce hereunder that part of that definition which is relevant to our consideration of these proceedings:
139B Meaning of "unsatisfactory professional conduct" of registered health practitioner generally [NSW]
(1) Unsatisfactory professional conduct of a registered health practitioner includes each of the following—
(a) Conduct significantly below reasonable standard
Conduct that demonstrates the knowledge, skill or judgment possessed, or care exercised, by the practitioner in the practice of the practitioner's profession is significantly below the standard reasonably expected of a practitioner of an equivalent level of training or experience.
...
(l) Other improper or unethical conduct
Any other improper or unethical conduct relating to the practice or purported practice of the practitioner's profession.
1. It follows that it is a precondition to finding that the respondent is guilty of professional misconduct that he be found to be guilty of unsatisfactory professional conduct. If so, it is then necessary to find that that conduct is sufficiently serious or of a sufficiently serious nature, depending on whether paragraphs (a) or (b) are engaged to justify suspension or cancellation of registration, whether or not any order to that effect is ultimately made.
2. Our first task is to determine whether the respondent is guilty of unsatisfactory professional conduct. It is clear from the expert opinion of Ms Croker, which we accept, that the conduct of the respondent constitutes unsatisfactory professional conduct. The conduct of the respondent which is the subject of each of the Particulars of Complaint One has been assessed by her as being significantly below the standard reasonably expected of a pharmacist of an equivalent level of training and experience of that of the respondent for the reasons which we have earlier discussed.
3. It is axiomatic that the nature and extent of the respondent's conduct even in summary form constitutes unsatisfactory professional conduct:
1. large quantities of drugs of addiction and prescribed restricted substances disappeared from the pharmacy without any underlying documentation or other evidence as to where they went, the circumstances in which they were disposed of and which cannot be accounted for. If these drugs were dispersed in the general community without close medical supervision, they would create a significant risk to the health and safety of the public
2. he dispensed large quantities of drugs of addiction and prescribed restricted substances against prescriptions which were forged or which he should have ascertained were forged without making any or adequate enquiries as to their authenticity
3. he dispensed large quantities of drugs of addiction and prescribed restricted substances without receiving or retaining a prescription which complied with the requirements of the Poisons and Therapeutic Goods Regulation 2008 (NSW)
4. he dispensed large quantities of drugs of addiction and prescribed substances in circumstances where they did not accord with recognised therapeutic standards
5. he failed to keep proper records of the receipt and supply of the drugs referred to above
6. he participated in the removal of the drugs referred to above from the Revesby Pharmacy without a prescription or other authority to do so
7. he engaged in other inappropriate conduct including handing out unlabelled bottles of methadone to customers, leaving the pharmacy while the drug safe was unlocked and smoking an e-cigarette in the dispensing area of the pharmacy.
1. Each of these matters reflects upon the knowledge, skill and judgement of the respondent in his practice as a pharmacist, and especially as the pharmacist in control of and the sole pharmacist in the pharmacy. We are comfortably satisfied that in the aggregate all of these matters constitute unsatisfactory professional conduct, and we so find.
2. It is now necessary to determine whether the respondent is guilty of professional misconduct as asserted by the applicant. By reason of the definition contained in section 139E which we have set out above, it is necessary to determine whether the unsatisfactory professional conduct is of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration or there is "more than one instance of unsatisfactory professional conduct that, when the instances are considered together, amount to conduct of a sufficiently serious nature to justify suspension or cancellation of the practitioner's registration."
3. This directs attention to a consideration of those circumstances which would justify suspension or cancellation of registration. This involves the exercise of a value judgement having regard to all of the relevant factual circumstances and must be undertaken in the context of the statutory regime which applies to these proceedings.
4. It is well-established that the jurisdiction of this Tribunal is primarily protective in nature. In exercising this jurisdiction there are a number of matters to which we must have regard. They have been succinctly referred to in the judgement of Meagher JA in the New South Wales Court of Appeal in Health Care Complaints Commission v Do [2014] NSWCA 307 (Basten and Emmett JJA agreeing). At [35] and following his Honour said:
35. The objective of protecting the health and safety of the public is not confined to protecting the patients or potential patients of a particular practitioner from the continuing risk of his or her malpractice or incompetence. It includes protecting the public from the similar misconduct or incompetence of other practitioners and upholding public confidence in the standards of the profession. That objective is achieved by setting and maintaining those standards and, where appropriate, by cancelling the registration of practitioners who are not competent or otherwise not fit to practise, including those who have been guilty of serious misconduct. Denouncing such misconduct operates both as a deterrent to the individual concerned, as well as to the general body of practitioners. It also maintains public confidence by signalling that those whose conduct does not meet the required standards will not be permitted to practise.
36. In Law Society of New South Wales v Foreman (1994) 34 NSWLR 408 Mahoney JA described (at 441) the scope of the objective of protecting the public interest in the context of disciplinary proceedings against a solicitor as follows:
"The protection of the public has been described as, for example, the primary purpose or primary object of such proceedings: ... In the relevant sense, the protection of the public is in my opinion not confined to the protection of the public against further default by the solicitor in question. It extends also to the protection of the public against similar defaults by other solicitors and has, in this sense, the purpose of publicly marking the seriousness of what the instant solicitor has done.
But, in my opinion, it would be wrong to confine the objects of disciplinary proceedings and the purposes to be achieved by the orders made in them strictly to matters of this kind. Those purposes and objectives have traditionally been seen as having a wider operation. In the end, the question to be determined is whether the solicitor is a fit and proper person to be a solicitor of the Court and the orders to be made are to be directed to ensuring that, to the extent she is not, her practice is restricted."
37. In Herron v McGregor (1986) 6 NSWLR 246 McHugh JA referred more briefly to the same consideration (at 258):
"It is, of course, of fundamental importance to bear in mind the public interest in disciplining doctors who are guilty of professional misconduct. In many cases the protection of the public and the maintenance of professional standards requires that the names of doctors be removed from the register. However, it is present fitness to practise which is the principal and ultimate issue of public interest."
1. For present purposes we note that in determining whether the conduct of the respondent may be characterised as professional misconduct justifying cancellation or suspension of registration, such a characterisation is not necessarily determinative of any consequential appropriate protective orders. Our current task is to determine whether or not the conduct is such that cancellation or suspension is warranted. In determining this matter we have regard to the protection of the public, the maintenance of public confidence in the integrity of the profession, and the deterrent effect both on the respondent and on other members of the pharmacy profession.
2. As has been endorsed often by this Tribunal, a medical practitioner who prescribes and handles drugs of addiction recklessly and contrary to the law engages in conduct which constitutes professional misconduct. In Spicer v NSW Medical Council (unreported, CA No.3 of 1981, 19 February 1981), Hope JA (Reynolds and Hutley JJA agreeing) said:
In my opinion it is clear beyond argument that the proper handling and prescribing of drugs by medical practitioners are of the greatest importance to the community. If a medical practitioner handles or carries out that very great responsibility in a way that is reckless and which shows a disregard to the law it cannot be said that he is fitted at such a time to be a medical practitioner. In my opinion the view expressed by the Tribunal has implicit in it that not merely was he presently unfitted to treat those addicted or habituated to drugs but that that unfitness in itself demonstrated his present unfitness to be a medical practitioner
1. There is no reason why these comments made in Spicer should not apply equally in the case of pharmacists who are also given the privilege of supplying restricted drugs to the public, including drugs of addiction in response to a prescription issued properly and appropriately, and subject to the duty of care which is inherent in the exercise of their profession. Indeed, pharmacists have been described in this Tribunal as being representative of the "gateway" to access to these drugs by the public. As such there are very good policy reasons why the responsibility of pharmacists extends beyond the filling of prescriptions. As will have been seen from our discussion of the various provisions of the PTGR, pharmacists are required by law to make an assessment of the authenticity of a prescription for these drugs, the appropriateness of those drugs for use by patients especially having regard to the quantity and frequency of their use, and the period over which the drugs are to be used. There are also extensive requirements to ensure that these drugs are secured and that appropriate records are kept to ensure that the receipt and dispersal of these drugs are recorded by pharmacists.
2. We assess the conduct of the respondent as we have described it as constituting a flagrant breach of his legal, professional and ethical obligations as a practising pharmacist. His conduct is clearly incompatible with the practice of his profession at a standard which can reasonably be expected by the public. This renders him unfit to practise as a pharmacist and justifies the cancellation of his registration.
3. It follows that we find that the respondent is guilty of professional misconduct.
Protective orders
1. It is then necessary to determine what protective orders should be made in consequence of our finding that the respondent is guilty of professional misconduct. The primary available orders are described in section 149C of the National Law which reads in part:
149C Tribunal may suspend or cancel registration in certain cases [NSW]
The Tribunal may suspend a registered health practitioner's registration for a specified period or cancel the registered health practitioner's registration if the Tribunal is satisfied—
……………………………………………………..
(b) the practitioner is guilty of professional misconduct; or
………………………………………………………………………
d) the practitioner is not a suitable person for registration in the practitioner's profession.
……………………………………………
(7) An order may also provide that an application for review of the order under Division 8 may not be made until after a specified time.
1. The determination of what protective orders should appropriately be made involves a consideration of the factors identified in [72] to [76] above. Those factors must be considered in the context of the nature and extent of the respondent's misconduct as we have described it.
2. In determining what are appropriate protective orders we take into account all of these matters. We also take into account that during the course of the section 150 hearing, which is the only source of any information that we have concerning the respondent's response to what occurred he expressed limited insight into his misconduct, limited understanding of the legal requirements which applied to his practice as a pharmacist and no contrition or remorse for the potential harm to his patients which was caused by his misconduct. We also take into account that there is no evidence before us about whatever caused the respondent to engage in this extensive and pervasive conduct.
3. Having regard to all of these matters we conclude that an appropriate protective order is one that involves the cancellation of the respondent's registration. Such an order will not only perform its protective function but also serve as a deterrent to the respondent and to other pharmacists in the event that they might be tempted to engage in a practice marked by inappropriate dealing with drugs of addiction and other restricted substances combined with the other shortcomings in the respondent's practice which we have identified. Such an order will also assist in upholding the integrity of the profession in the eyes of the public.
4. We are also empowered to fix a minimum period under Division 8 of Part 8 of the National Law before the respondent is entitled to seek a review of this order and again make an application for registration as a pharmacist. As we have said, there is no information before us which would enable us to begin to consider why the respondent embarked upon the course of action which he did, which is entirely inconsistent with the proper and appropriate practice of the profession of a pharmacist.
5. The applicant suggested that a period of three years would be appropriate, to allow the respondent an opportunity of demonstrating recency of practice. We disagree. If the respondent were inclined to again apply for registration as a pharmacist, the protection of the public dictates that he should only be entitled to do so when he is able to demonstrate that he is fit to make that application. In making this observation we take into account that it would still be necessary for the respondent to satisfy registration requirements. Nevertheless, we are of the opinion that a period of five years is appropriate to be fixed in all the circumstances. This will enable the respondent to undertake whatever processes are necessary to ensure that he is unlikely to ever re-engage in conduct of this kind in the future. Without knowing what caused him to do so, it seems to us that it is preferable to approach this matter with some caution. A period of five years will enable the respondent to engage in whatever rehabilitative process is appropriate and will give him an opportunity to undertake courses and other action designed to assist in his return to safe practice as a pharmacist.
6. The applicant asked that we also make an order reprimanding the respondent, which we are entitled to do under section 149A of the National Law:
149A General powers to caution, reprimand, counsel etc [NSW]
(1) The Tribunal may do any one or more of the following in relation to the registered health practitioner—
(a) caution or reprimand the practitioner;
……………………………………………………………………….
1. The applicant informed us that it sought the imposition of a reprimand as a means of establishing a formal rebuke and an expression of disapproval of the conduct of the respondent. A reprimand would remain on the National Register if the respondent were to be reregistered unless the Pharmacy Board decided that it should be removed.
2. We would be concerned that in general terms if this respondent were to be reregistered as a pharmacist that the fact that his registration had previously been cancelled because of the heinous misconduct which has caused us to do so would prima facie not appear on the respondent's new registration unless there was some particular reason for not doing so. We ask the applicant to convey these concerns to the Pharmacy Board of Australia.
3. We shall comply with the applicant's request and impose a reprimand accordingly.
Costs
1. The applicant sought a costs order in its favour. The question of costs is governed by clause 13, Schedule 5D of the National Law, which renders this as a costs jurisdiction. There is no conduct of the applicant which would disentitle it to a costs order, and we shall make such an order accordingly.
Orders
1. Consequent upon the finding of professional misconduct which we have made we make the following orders
1. The respondent is reprimanded.
2. Pursuant to s 149C(1)(b) the registration of the practitioner as a pharmacist is cancelled.
3. Pursuant to s 149C(7) the respondent may not apply for review of Order (2) for a period of five years.
4. The respondent is to pay the costs of the applicant in an amount assessed in default of agreement.
**********
I hereby certify that this is a true and accurate record of the reasons for decision of the New South Wales Civil and Administrative Tribunal.
Registrar
I hereby certify that this is a true and accurate record of the reasons for decision of the Civil and Administrative Tribunal of New South Wales.
Registrar
DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated.
Decision last updated: 06 August 2021
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