Pharmacist Suspended for Unsafe and Unlawful Prescribing, Including Medication for Animals

The General Pharmaceutical Council (GPhC) Fitness to Practise Committee investigated a pharmacist following serious concerns about unsafe prescribing practices and the unlawful issue of prescriptions for animals.

Between June and July 2019, the pharmacist:

1. Issued prescriptions for animals despite not being a veterinary prescriber.
2. Failed to verify patient suitability before issuing medications.
3. Prescribed high-risk medications in large quantities without proper oversight.
4. Worked within an unsafe online prescribing model, where prescriptions were generated based on minimal or no clinical assessment.
5. Did not ensure adequate patient follow-up or monitoring.

The GPhC’s investigation was triggered following concerns about online prescribing and the high volume of prescriptions issued by the pharmacist in a short period.

Findings:

The Fitness to Practise Committee found that the pharmacist’s conduct amounted to serious professional misconduct, considering:

1. Unlawful Prescribing of Medications for Animals:
   • The pharmacist issued veterinary prescriptions without the required authority, in direct violation of prescribing regulations.
   • Veterinary medications must only be prescribed by a registered vet, and the pharmacist failed to check legal requirements before prescribing.
2. Failure to Conduct Proper Clinical Assessments:
   • He issued thousands of prescriptions per month without conducting proper checks.
   • Many prescriptions were essentially copies of overseas prescriptions, with no independent clinical assessment.
3. Prescribing Outside His Competency:
   • The pharmacist prescribed highly specialized medications, including mental health drugs, epilepsy medications, and cancer treatments, despite lacking expertise in these areas.
   • He relied too much on the clinical judgment of overseas prescribers, failing to take full responsibility for the prescriptions he issued.
4. Failure to Monitor Patients and Identify Red Flags:
   • There was no evidence that the pharmacist ensured patients were monitored after receiving medication.
   • In cases where long-term monitoring was required, such as with antidepressants, opioids, and immunosuppressants, he failed to check whether patients had necessary follow-ups.
5. Prescribing Excessive Quantities of High-Risk Drugs:
   • He prescribed large amounts of opioids, Z-drugs, and other controlled substances without sufficient justification.
   • The quantities far exceeded standard recommendations, creating a serious risk of abuse, dependence, or overdose.
6. Failure to Recognize and Address Risks:
   • The pharmacist was aware of concerns regarding online prescribing but continued issuing prescriptions in unsafe circumstances.
   • Instead of raising concerns or stopping unsafe practices, he continued issuing prescriptions to meet commercial demand.

The committee noted:

“A pharmacist independent prescriber is expected to exercise their professional judgment and uphold patient safety. The registrant’s actions demonstrated a complete failure to do so.”

GPhC Determination on Impairment:

The GPhC ruled that the pharmacist’s fitness to practise was impaired, citing:

• Significant risk to patient safety due to inappropriate prescribing.
• Public confidence in the profession being severely undermined.
• Failure to demonstrate full remediation or understanding of the seriousness of his actions.

The committee found that the pharmacist lacked sufficient insight into the gravity of his misconduct, stating:

“The Registrant failed to ensure the safe supply of medicines, demonstrated a lack of competence in prescribing, and did not take responsibility for his own practice.”

Given the high volume of unsafe prescriptions issued, the committee concluded that a clear regulatory response was necessary.

Sanction:

The committee imposed a 4-month suspension, considering:

• Aggravating Factors:
  • Prescribing without proper legal authority.
  • Failure to ensure patient safety before issuing prescriptions.
  • Issuing excessive quantities of high-risk medications.
  • Operating within an unsafe online prescribing model.
• Mitigating Factors:
  • The pharmacist admitted the allegations early and expressed some remorse.
  • He ceased prescribing in this manner and took part in further training.
  • His current employer provided positive testimonials about his conduct in a different setting.

However, the committee ruled that:

“The gravity of the pharmacist’s misconduct, particularly in relation to patient safety, requires a proportionate response to uphold public confidence in the profession.”

A review hearing will be required before reinstatement, ensuring that the pharmacist has fully reflected on the case and can demonstrate safe practice.

Key Learning Points for Pharmacy Professionals:

This case highlights critical lessons regarding safe prescribing, professional responsibility, and regulatory compliance.

1. Pharmacists Must Not Prescribe for Animals Without Proper Authority:
   • Veterinary medicines must only be prescribed by registered vets.
   • Pharmacists must ensure they understand the legal framework before issuing prescriptions.
2. Online Prescribing Requires Robust Safety Measures:
   • Prescribers must ensure that clinical checks and patient assessments are thorough.
   • Issuing prescriptions based on overseas medical records without verification is unsafe and unprofessional.
3. Pharmacists Are Accountable for Every Prescription They Issue:
   • Even if working within a structured prescribing system, pharmacists remain personally responsible for ensuring safety and appropriateness.
   • Relying on third-party organizations to conduct checks does not absolve responsibility.
4. High-Risk Medications Require Careful Monitoring:
   • Prescribing opioids, Z-drugs, and immunosuppressants requires stringent oversight.
   • Failure to ensure appropriate patient monitoring can result in serious harm or regulatory action.
5. Regulatory Bodies Take Unsafe Prescribing Seriously:
   • The GPhC imposed a substantial suspension to reinforce the importance of professional accountability.
   • Pharmacists must prioritize patient safety over commercial or operational pressures.