GENERAL PHARMACEUTICAL COUNCIL FITNESS TO PRACTISE COMMITTEE PRINCIPAL REVIEW HEARING 25 Canada Square, London E14 5LQ Friday 12 April 2019 Chairman: Mrs Sarah Hamilton Committee Members: Mrs Clare Curran

Mrs Victoria Smith Committee Secretary: Ms Zarina Ndemumana CASE OF: PATEL, Dineshbhai Naginbhai Registration Number 2028689

------------------------------------- MS ATEEQA RAJWANI, Solicitor Advocate, appeared on behalf of the General Pharmaceutical Council. MR GRAHAM EDWARDS, of EPLS, appeared via telephone link on behalf of Mr Patel, who was present. -------------------------------------

Transcript from the Shorthand Notes of T A Reed (Wiltshire) Ltd Tel No: 01793 764614

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I N D E X

Page Determination on Review 1 PLEASE NOTE: Copies printed from email may differ in formatting and/or page numbering from hard copies

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(The determination was handed down)

DETERMINATION

1. This is a Principal Review Hearing in respect of Mr Dineshbhai Patel (“the

Registrant”), who was first registered with the Royal Pharmaceutical

Society on 18 July 1983 and subsequently transferred to the General

Pharmaceutical Council (“the Council”) under registration number

2028689. At the Principal Hearing on 10-12 January 2018 a Suspension

Order was imposed on the Registrant for a period of 12 months. The

Suspension Order was reviewed on 10 January 2019 when the Committee

imposed a further period of suspension for four months, and ordered that

there be a review of that order one month before the expiry. We are here

today to undertake that review.

2. Today the Council is represented by Ms Rajwani. The Registrant is in

attendance and gave evidence under oath. He is represented by

Mr Edwards who attended by telephone. We have received and read

a bundle of documents submitted by the Council running to 331 pages,

and its statement of case and skeleton argument. The bundle included

testimonials from the Registrant and various CPD entries, training

documents and certificates. This morning we received an updated bundle

from the Registrant, containing a witness statement and two testimonials.

We heard oral submissions from Ms Rajwani and Mr Edwards.

3. The Particulars of Allegation which the Registrant admitted and which

were found proved by the Principal Hearing Committee were as follows:

“You were first registered as a Pharmacist on 18 July 1983;

1. On dates between 1 October 2013 and 30 April 2014, you

a. Sold;

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b. Supplied

Prescription only medication otherwise than in accordance

with a prescription from an appropriate practitioner, in that

the purported prescriptions did not contain

i. An ‘advanced electronic signature’;

ii. The address of the relevant healthcare

professional;

2. In or around 2013 you entered into a verbal agreement with

Danske XXXXXXXXXX (Redacted) to;

a. Receive Danish prescriptions for malaria medication at the

email addresses of

nucrosspharmacy. XXXXXXXXXX (Redacted) ;

malaria@ XXXXXXXXXX (Redacted) ;

b. Provide malaria medication to patients in Denmark from

a registered UK pharmacy;

3. On dates between 1 October 2013 and 30 April 2014 you;

a. Sold;

b. Supplied;

Prescription only medication other than from a registered

pharmacy, but from your home address;

4. Your conduct as described at paragraph 3 was dishonest in that;

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i. You intended to mislead Danske XXXXXXXXXX (Redacted)

into believing that the medication was sold and supplied

from a UK registered pharmacy;

ii. You intended to mislead patients in Denmark into believing

that the medication was sold and supplied from a UK

registered pharmacy.”

4. The Committee also found that the facts proved amounted to misconduct,

and further that the Registrant’s fitness to practise was impaired by reason

of that misconduct.

BACKGROUND

5. The Registrant was a long-term locum pharmacist at NuCross Pharmacy,

Hermitage Road, Hitchin, Hertfordshire (“the Pharmacy”). He was

arrested by the police on 2 December 2014 as a result of a matter raised

by the Pharmacy’s owner, Mr Mistry, which was not the subject matter of

the allegation before the Committee at the Principal Hearing. Whilst the

Registrant was being interviewed by the police under caution, a search

was carried out at his work address, his vehicle and at his home address.

The police seized a number of items including a pharmacy computer,

prescription stickers, post office receipts, prescriptions, accounts and 115

boxes of a drug called Doxycycline.

6. The police contacted Susan Melvin (“SM”), an inspector at the Council, and

they carried out a joint investigation. Initially the police were investigating

in relation to Mr Mistry’s allegation, but confirmed that there was

insufficient evidence to support this and that investigation ceased.

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7. However, the items seized led to a separate investigation, as SM advised

the police that distributing prescription drugs from a home address was

illegal. As a result of this investigation the Registrant was charged with

the following offence:

“Between 1st day of October 2013 and 13th day of April 2014, you sold or

supplied prescription only medicines otherwise than in accordance with

a legally held prescription given by an appropriate practitioner in that the

prescription did not contain

An advanced electronic signature, and

The address of the relevant healthcare professional.”

8. On 13 September 2016 the Registrant pleaded guilty to this charge at

Cambridge Crown Court.

9. At the Principal Hearing the Council relied on the evidence of DC Dixon

whose statement was dated 4 January 2017. The Registrant did not

challenge this evidence and DC Dixon was not required to attend the

hearing to give oral evidence. The statement of DC Dixon referred to two

interviews with the Registrant, on 2 December 2014 and 23 January 2015.

During the second interview the Registrant stated that the Doxycycline

tablets were anti-malaria tablets which he had possessed for about a year.

He explained that a travel clinic called Health Station in Hitchin would send

him prescriptions for the medication by email. He would then generate

a prescription label, attach it to the medication and send it on to the

patient in Denmark. He would receive £3.00 per box of medication. He

obtained the medication from a colleague and had possessed it for about

a year. However, the Registrant stated that there had been a drop-off in

demand in early 2014 and therefore he was left with a quantity of these

drugs at his home.

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10. During the police interview the Registrant accepted that this process was

not5 legitimate, and that he should have had a licence in order to send

out medication from his home address. The told the police that he carried

out this process as a side business whilst working as a pharmacist for

NuCross Pharmacy in Hitchin, and made a few thousand pounds.

11. SM also signed two statements for the Principal Hearing, dated 17 April

2015 and 10 August 2015. She explained in those statements that

prescription only medicines (“POMs”) can only be sold or supplied under

the conditions of a patient group directive (“PGD”) by a person lawfully

conducting a retail pharmacy business, from registered premises, as an

emergency supply or against a legally valid prescription, which must be

signed in ink or with an “advanced electronic signature”. Anti-malarial

drugs such as Doxycycline and Malarone tablets are classed as POMs.

12. SM was shown by the police copies of email printouts found at the

Registrant’s home address. The emails which had been exhibited to

DC Dixon’s statement were from an email address vaccinational@dvs.dk to

Hitchin NuCross Pharmacy containing prescriptions for the drugs Vbradox,

Doxycycline and Horisto (all anti-malarial tablets). SM exhibited to her

statement an email from the same address to the Pharmacy, but this time

for Malarone, which she explained is also medicine to prevent malaria

infection. The prescribing doctor was listed as Cheleage Thomas Birk

Kristiansen, who was registered as a doctor with the Danish Health and

Medicine Authority on 1 July 2000.

13. SM stated that although the prescription was from a doctor it was not

valid as it was not signed, either in ink or electronically with an advanced

electronic signature, and it did not contain the address of the prescribing

doctor. These are both requirements under Regulations 218 and 219 of

The Human Medicines Regulations 2012. SM went on to explain in her

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statement that as the prescriptions were not legal it followed that the

drugs which were sent to the patients were therefore not supplied legally.

14. In addition, the labels which were attached to the emails showed the

supplied as NuCross Chemist, 8/9 Hermitage Road, Hitchin, Hertfordshire

SG5 1BS. However, as the Registrant was not supplying this medication

on behalf of the Pharmacy, the address was incorrect. He was, in fact,

supplying them from his home, which he was not permitted to do. There

was no record of the supplies in the Pharmacy’s POM register.

15. The police also found paper copies of accounts, detailing the date, the

name of the patient, the drug supplied, and the amounts charged for the

drug and postage and packaging. These spreadsheets confirmed that the

Registrant had supplied medication between 3 October 2013 and

2 February 2014, and the total of all invoices was £23,880.50.

16. SM gave evidence under oath. The Committee at the Principal Hearing

had looked at the unredacted copies of the email prescriptions, which

contained the Danish doctor’s name and an Authorization ID number. SM

agreed that this was the equivalent of an English doctor’s GMC number,

showing that he was a registered professional.

17. Section 219(5) of the Human Medicines Regulations 2012 states that:

“advanced electronic signature” means an electronic signature that is—

Uniquely linked to the person (“P”) giving the prescription;

Capable of identifying P;

Creating using means that P can maintain under P’s sole control; and

Linked to the data to which it relates in such a manner that any

subsequent change of data is detectable.”

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18. In answer to questions from the Committee, SM stated that although the

prescriptions appeared to have a doctor’s name and registration number,

they did not come from a secure site or system. She stated that in her

opinion anyone could have sent the email purporting to be the doctor and

so category (c) was not satisfied. In addition, as far as SM was aware, in

the UK all email prescriptions come through the “NHS Spine” which is

a secure system. She had not seen any evidence to suggest that the EEA

healthcare professional in Denmark had been using a similar system to

send prescriptions to UK pharmacies and therefore believed that the

prescription was not secure, was capable of passing through unsecure

systems, and did not have a proper audit trail. Accordingly, this meant

that category (d) was also not satisfied.

19. The Council also called Mr Harald Madsen (“HM”) as a witness. He gave

evidence via telephone as he was in Denmark. He had made a statement

dated 23 May 2017 for the purpose of these proceedings. At the time of

the Principal Hearing he was the Chief Financial Officer for XMedicus,

which is a software company. Prior to holding this position he was the

Chief Financial Officer for European Lifecare Group A/S, which is the

parent company of the English subsidiary European Vaccination Group UK,

which in turn is the parent company of Vaccination UK, which was

previously called The Health Station Ltd, based in Hitchin, Hertfordshire.

20. HM gave evidence that in or around 2013 he was a representative for

Danske XXXXXXXXXX (Redacted), which translates into Danish Doctors

Vaccination Service. This was a subsidiary company of European LifeCare

Group A/S. He entered into a verbal agreement with the Registrant,

whom he assumed was a representative of NuCross Pharmacy, mostly

because they met at the Pharmacy. They agreed that the Registrant

would dispense anti-malarial medication and send it to Danish patients in

accordance with prescriptions which had been approved and “signed off”

by Danish doctors in Denmark.

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21. HM no longer had access to the actual emails he sent to the Registrant,

but did have some replies showing the Registrant’s email address to be

XXXXXXXXXX (Redacted). In March 2014 he received an email asking his

company to change the Registrant’s email address to XXXXXXXXXX

(Redacted), and he assumed that he followed this request.

22. HM stated that he believed that the anti-malarial medication was prepared

at and sent out from the Pharmacy address, or within another pharmacy

from the same chain. He accepted that he never discussed with the

Registrant where the medication was being prepared; his main concern

was that the Danish patients received the correct medication in a timely

manner. The patients were aware that their medication was coming from

the UK, as they had to choose this option and prepay for the UK service

prior to the medication being dispensed.

23. HM explained that there was a shortage of anti-malarial medication in

Denmark, and it was also cheaper to source it from the UK, saving

patients 20-25% of the cost in Denmark. He stated that, to his

knowledge, the agreement was lawful under EU rules, as any EU citizen

can have their prescription dispensed in any pharmacy within the EU.

24. HM told the Committee that he would receive a bill from the Registrant

approximately once a month, and paid him for the medication and his

professional services. He assumed that the invoice included a profit

element for the Registrant. HM did not ever have a conversation with the

Registrant as to where the medication was being dispensed, but he just

assumed that it would have been from one of NuCross’s licensed

premises.

25. HM stated that any relevant patient history including any allergies would

not be contained within the prescription, and the Registrant would not

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have received any other information from the prescribing doctor in

Denmark. The prescriptions were written in Danish. He recalled that

several patients brought medication back to the clinic in Denmark asking

for refunds for various reasons, so HM saw the boxes in which the

medication had been supplied. He was able to confirm that the

medication was supplied in its original packaging. There was also a label

attached explaining how the medication should be used. As far as HM

was aware, the Registrant does not speak Danish.

26. The Registrant also gave evidence under oath at the Principal Hearing. He

would receive a prescription by email, print off the label, attach it to the

required medication and post it to the patient in Denmark. He stated to

the police that the patient would pay the clinic direct (he would not know

the amount) and he would then charge the clinic a fee for dispensing the

item.

27. The Registrant admitted during his police interview that what he was

doing was not legitimate because he did not have a licence to supply the

medication from his home. He also told the police that he had brought

the medication from two colleagues, and paid about £2 or £3 for each

box. He stated that he would add postage and packaging costs, which

would be around £1. He would also add on a small handling fee, so would

charge the Health Station around £5. He explained that he did this as

a side business in order to make money to pay for a new clutch on his car.

He thought that in total he made a profit of a couple of thousand pounds.

28. In his oral evidence the Registrant said that he became interested in

malaria 15 years ago when he lost his uncle through malaria in India. He

knew the previous owner of the Health Station, as he used to come into

the Pharmacy. When it was sold to HM’s company the Registrant was

introduced to the new owner. He started advising the Health Station

regarding various pharmaceutical issues. In 2013 HM had come to see

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him at the Pharmacy and told him that he was having difficulties obtaining

anti-malarial medication in Denmark, where the price was much higher.

The Registrant said that he asked the owner of NuCross pharmacy if he

would dispense anti-malarial medication “at cost” to the Danish patients,

but the owner declined. The Registrant therefore decided that “due to the

urgency” he would start dispensing the medication from his home address.

He does not speak Danish, and all of the leaflets which came with the

medication and the labels which he attached were in English. He would

email HM every time he dispensed a medication to check whether the

patient could read English and would be able to understand the

instructions. According to the Registrant, over the seven month period he

was working with the Health Station he earned a couple of thousand

pounds. If, as he stated, he was earning about £2 profit per prescription

he would have dealt with thousands of prescriptions during that period.

The Committee did not consider it likely that the Registrant would have

been sending HM emails on that scale.

29. The Registrant admitted to the Committee that what he told the police

during his interviews (i.e. that he had brought the anti-malarial medication

from two colleagues) was “different to what actually happened”. Instead

he obtained it from a friend who was a registered pharmacist who lived in

Harrow and ran a wholesale business. This friend would give the

medication to the Registrant, who would then receive the email

prescription, check it, dispense the item, package it and then go to the

Post Office to send it to Denmark by special delivery. The postage would

cost about £1.00.

30. The Registrant told the police that he would invoice the Health Station and

they would pay him for the cost of the medication. In light of this

evidence, which was inconsistent with what he had said in the police

interviews, the Committee asked the Council to contact HM to enquire as

to where he still had copies of any of those invoices, and whether he

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received invoices from any other person in relation to these prescriptions.

HM confirmed by email that he no longer worked for the company, and

therefore could not access these documents. However, he stated that

there were “no other agreements with any other supplier and therefore no

other invoices received for any other supplier”.

31. The Registrant gave several different explanations as to why he stopped

doing business with the Health Station: that the demand dried up as the

medication became more available and cheaper in Denmark; that he had

decided to find his own business premises but once demand dropped he

did not proceed with this plan; and finally that he knew it was wrong. The

Committee found that it was likely that had demand not dried up and

business had continued to flourish, the Registrant would have carried on

supplying the medication, despite knowing that what he was doing was

illegal. The process of obtaining a licence for business premises or

working from other pharmacies would have taken some time, and it was

likely that the Registrant would have continued supplying from home

during that period. This demonstrated to the Committee a lack of insight.

32. The Registrant maintained that no parents were ever put at risk by his

conduct and that it was entirely safe to supply them with the medication.

He stated that he had learned from his mistake, that he was sorry and

that he would never do anything like this again. He spoke about the

difficult time his family had gone through as a result of the police

interviews and the Fitness to Practise proceedings.

33. The Committee did not accept that the Registrant did not seek to make

any profit out of the business arrangement, stating that it was highly

implausible that the Registrant was prepared to take the risk of supplying

medication unlawfully for such scant rewards. His account of receiving the

medication from a friend was not credible and did not accord with HM’s

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evidence that he paid the Registrant for the cost of the medication, the

postage and packaging and an element of profit.

34. Even making allowances for the fact that the Registrant was not

represented at the Principal Hearing, the Committee found that he was not

forthcoming in his answers but that he was guarded with his responses.

The Committee was left with the impression that he was not telling the

whole story, and at times his evidence was inconsistent with previous

accounts.

35. During the Principal Hearing the Registrant was reminded that he was

entitled to submit testimonials and character references. He brought

along four references on the second day of the hearing, but the

Committee noted that there was no reference from the Registrant’s

employer for whom he has been working since 2014, despite the

Committee indicating that this would be helpful.

36. The Committee found all the facts proved, including the charge of

dishonesty. It also found that the actions taken by the Registrant went

against his training, and he knew that what he did was unlawful. The

Committee had no hesitation in finding that they amounted to misconduct.

37. With regards to impairment, the Committee decided that the Registrant’s

actions at the time did have the potential to put patients at risk. The

Registrant does not speak Danish, and so asked HM to translate for him if

he required any text on the prescription to be translated into English. All

of the information sent to the patients was in English, and the Committee

found that it is unlikely that the Registrant checked in each case whether

the patient could read English. However, taking into account the fact that

the Registrant had been working as a pharmacist since 2014 without any

concerns, and reading the testimonial from his current colleague, the

Committee decided that there was no ongoing risk to patients or the

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public. The Committee found that the Registrant’s actions brought the

profession of pharmacy into disrepute. There was a positive intention to

mislead the Health Station and the patients. The Registrant accepted that

the labels on the medication probably had the name NuCross on them,

and the Committee was aware that the Registrant was using email

addresses containing the Pharmacy’s name. As far as integrity was

concerned, the Committee commented:

“The Committee does not consider that the business model which the

Registrant described to us (i.e. making a very small amount of profit from

the postage and packaging) is plausible. This was a pharmacist who had

run his own pharmacy business in the past, and had a vast amount of

experience in the retail sector. He was working full time as a Pharmacy

Manager at NuCross, and had given up running his own business in order

to spend more time with his family. The Committee does not consider it

likely that he would have spent so much time and effort for such little

reward. It found the contradictory accounts to the police and to the

Committee concerning as this goes to the issue of integrity”.

38. As far as insight was concerned, the Committee stated:

“Although the Registrant has shown some insight by admitting the

allegation and apologising for his wrongdoing, the Committee is not

satisfied that he appreciated the severity of what he had done, or the

importance of coming to this hearing and being entirely open and honest.

The Committee does not accept that the Registrant has remediated fully,

and finds that there remains a risk that he could act dishonestly again in

the future”.

39. When considering the appropriate sanction, the Committee identified the

following aggravating features:

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• The misconduct amounted to illegal activity

• The case included a finding of dishonesty

• This was not an isolated incident - the misconduct took place over

seven months

• The Registrant made a financial gain as a result of the misconduct,

and this was his primary motivation

• The Registrant gave inconsistent evidence to the Committee

• The Registrant misled the patients into believing that their

medication came from a licensed pharmacy

• The Registrant had shown limited insight.

40. The following were said to be mitigating factors:

• The Registrant provided positive character references, which

demonstrated that he cared for his patients and was well thought

of in the community as a pharmacist

• There was no actual harm to patients arising out of the misconduct

• The Registrant had had a lengthy career as a pharmacist, and he

had practised since 2014 without incident, which the Committee

viewed as some evidence of remediation

• The Registrant had not had any previous fitness to practise findings

against him

• The Committee gave the Registrant credit for engaging with the

proceedings, admitting the allegation and attending to give

evidence in person

• The Registrant has shown remorse.

41. As far as sanction was concerned, the Committee decided to impose

a sanction of suspension for 12 months. It was concerned that the

misconduct had occurred four years previously and the Registrant had

shown little evidence of remediation or insight since that time. The

Committee stated that it may well be that the Registrant would be unable

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to develop full insight, but he should be allowed the opportunity. It

ordered a review towards the end of the period of suspension, and

suggested that the reviewing committee may be assisted by the following:

• An updated statement from the Registrant reflecting upon these

findings and the impact his dishonesty and lack of integrity have

had on the profession

• Evidence of remediation and insight into his failings

• A statement from his employer for his employment between 2014

and today. It may well assist the Registrant if the employer

attended the hearing to give oral evidence

• Evidence that the Registrant had kept his professional knowledge

up to date, in line with the new Professional Development

requirements

• Evidence of any work, paid or unpaid, which the Registrant had

undertaken and references from those employers.

FIRST REVIEW HEARING

42. The first Principal Hearing Review took place on 10 January 2019. The

Registrant attended the hearing and was unrepresented. On the morning

of the hearing, the Committee received a bundle of documents that the

Registrant sought to rely on. The Registrant’s bundle included his witness

statement, which exhibited documents that he sought to use as evidence

of his volunteer work, attendance at pharmaceutical events, completed

return to practice and CPD courses and 4 testimonials.

43. The Committee was informed by an email from Mr Graham Edwards that

he assisted the Registrant in the preparation of his bundle, provided

advice about the hearing and was available on the phone before or during

the hearing. The Committee confirmed that the Registrant could call

Mr Edwards during the hearing if he wished to do so.

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44. The Committee summarised the Registrant’s oral evidence as follows:

“He also thought about how hard it was to demonstrate that he had

reflected on his dishonesty and the finding of his lack of integrity. He

described how he was ‘a doer’ rather than someone only inclined to write

or think but he was unsure what he could do. He described how he had

been the victim of aggravated burglary in February 2018 which led him

into conversation with a victims’ adviser who he has asked what he could

do about the position he found himself in. The advice was given that he

could try to give back to the community”.

45. The Committee noted that there were no particular concerns about the

Registrant’s clinical knowledge and skills, although it was to his credit that

he had undertaken CPD, a return to practice course and for showing

commitment to the profession by seeking work in a pharmacy setting.

The Committee also gave the Registrant credit for his voluntary work at

a hospice and local temple as a means for him to “give back to the

community”.

46. The Committee accepted that the Registrant was remorseful for his

actions, but had concerns about his level of insight and noted continuing

discrepancies in the Registrant’s evidence. The Committee commented

that the Registrant maintaining that there was no financial motivation to

his conduct undermined his claim to fully understand his wrongdoing and

was indicative of a lack of full insight.

47. The Committee was also concerned by what appeared to be the

Registrant’s focus on the impact of the findings and the sanction on

himself and his family, and that his evidence “showed little meaningful

insight into the impact of his misconduct on others”. The Registrant had

not provided evidence that he has considered the impact on the owner of

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NuCross Pharmacy, the Danish firm that had been supplied the medication

or patients who had been supplied through unlicensed means. It stated:

“These various issues were raised with the Registrant during his evidence

and, once raised, the Registrant repeated back the points made about the

impact on others. On being led and prompted by questions from the

Panel, the Registrant spoke about how the owner of NuCross had told him

that he felt let down, that he felt the Registrant had gone behind his back

and abused his trust. However, in his evidence to the Panel the Registrant

did not then either adopt that for himself what the owner had said or offer

a better understanding of the impact on others”.

48. The Committee concluded that due to the Registrant’s limited insight there

remained concerns about the risk of repetition and that “unless he fully

understands the nature, seriousness and consequences of his actions, any

concerns he may have about the effects on himself may not be enough to

inhibit him in the future”.

49. The Committee found that the Registrant’s fitness to practise remained

impaired due to the Registrant’s limited insight, the risk of repetition, the

possibility of putting the public at risk of harm, the adverse impact on

public confidence in the profession and upholding proper standards. The

Committee directed that the Registrant should be suspended for a further

period of 4 months, with a review to take place one month before expiry:

“to allow the Registrant further time to reflect on his misconduct and to

better understand the nature and seriousness of his misconduct other than

by focusing on the impact it has had on him. In reaching this conclusion

the Panel does not wish to conclude he is selfish or self-centred, simply

that he has not yet got to the point of appreciating the wider impact of his

misconduct”.

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50. The Committee suggested that the committee at the subsequent review

hearing was likely to be assisted by evidence of the following from the

Registrant:

“a A further reflective statement demonstrating in depth his insight

and understanding of how he came to misconduct himself, the

impact this had on others, and how he proposes avoiding any

repetition;

b. It is a matter for the Registrant, but, if he discusses this matter

with a peer mentor to assist him in developing his insight and

understanding, a statement from any such mentor reporting on

progress observed. The GPhC’s guidance in the revalidation

framework provides guidance on reflective accounts and peer

discussions which may be of assistance;

c. Evidence of any further CPD undertaken;

d. Any further testimonials that he wishes to produce; and

e. Evidence of any continuing work, paid or unpaid, that he has

undertaken”.

EVIDENCE AND SUBMISSIONS AT THIS HEARING

51. In advance of today’s hearing the Registrant had provided a one-page

document setting out what he had been doing since January 2019. He

had also provided further CPD entries and certificates of online courses

undertaken during his second period of suspension. We have seen

a statement from Ceegay Verley, Monitoring and Concerns Officer at the

Council, dated 18 March 2019, confirming that there is no evidence to

suggest that the Registrant has not complied with his suspension.

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52. On the morning of the hearing the Registrant provided a further written

reflection in which he stated that he was ashamed and embarrassed for

his earlier misconduct. His statement made repeated references to his

self-confidence. The Registrant also provided a brief report from his

mentor, Mr Gerard Lim, who is the Superintendent Pharmacist at

St Nicholas Pharmacy. Mr Lim stated that the Registrant “has tried to

amend his ways and shown to be sincere in his remorse and wanting to do

right by his profession”. Mr Lim has told the Registrant that his

misconduct has “created unnecessary problems”. The Registrant accepts

that this caused friction and tension between himself and colleagues.

53. The Registrant gave oral evidence at the hearing. He had pre-prepared

notes which he referred to throughout his evidence. For the first time he

accepted that his misconduct was motivated by financial gain. He said

that at the previous hearings he has been considering the impact on his

family when he should have been focusing on the public. Mr Edwards

took the Registrant to his statement, where he had repeatedly referred to

“mistakes” which he had made. When asked whether he stood by this

description, the Registrant said that he should have referred to his

misconduct as “errors”. He conceded that his behaviour had been “out of

order”.

54. When asked about the risk of repetition, the Registrant said that this

would not happen again, as he has now, with Mr Lim’s guidance, looked at

the standards of the profession and understands that he must not

jeopardise patient safety. He now appreciates that all medication must

come from a reputable source, against valid prescriptions, and must be

dispensed from valid premises. He spoke again about how the last nine

months working in the community pharmacy has restored his own

confidence.

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55. The Registrant gave evidence that a month ago he started an Open

University course called “Reflecting Forward and Reflecting Backward”.

Mr Lim had suggested it to him in order to help restore his confidence.

He has already learnt about admitting responsibility, learning to be clear

about mistakes he has made and how to build back up his reputation.

He said that his coursework has yet to be assessed, and accepted that

he had not provided any evidence in relation to this course.

56. The Registrant also spoke about an online course which he started about

a month ago, called the Mind Tools Club. This focuses on behaviour, and

going through the process of admitting your wrongdoing. Again, he

accepted that there was no documentary evidence regarding this course.

57. In cross-examination the Registrant said that he had been working

“behind the scenes” at a Community Pharmacy in Reading since June

2018. He assists with ordering and dispensing, and this has helped regain

his confidence.

58. When asked by Ms Rajwani about his understanding of “confidence in the

profession”, the Registrant said that this was about delivering and

improving the health and safety of the public. He said “by staying in the

profession I have shown a lot of confidence in my practice, and ensure

that the public are safeguarded”. He spoke about building rapport with

customers and receiving good feedback from colleagues.

59. In answer to a question from the Committee as to why the Registrant’s

misconduct had occurred, he said that he saw an opportunity to start

a business, and was investigating the possibility of opening a dispensing

hub in this country. When asked why he stopped, he gave two reasons:

that the Danish company had made promises about a hub which did not

happen, and, also, that he became uncomfortable about patient safety.

He therefore told the company that he wanted to put a stop to it.

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60. The Registrant tried to apologise to both the Health Station and NuCross

Pharmacy but was not able to do so as staff at both organisations had

moved on.

61. Having heard the Registrant’s evidence, Ms Rajwani accepted that he has

sought to keep his CPD up to date, has taken guidance from his mentor

and has worked in a community pharmacy setting. She acknowledged

that the Registrant appears to have chosen courses that could assist with

developing full insight into the impact of his conduct on others and the

profession more broadly. However, as the Registrant has not provided

any independent evidence of these, we will need to decide what weight

should be attached to them. The Council also noted that the CPD

certificates provided were all undertaken relatively recently, all being

dated 19 March 2019.

62. The Council submits that the Registrant has now accepted that he was

motivated by financial gain, has tried to apologise to the two UK

companies and has accepted responsibility for his actions. Ms Rajwani

submitted that whilst the Registrant has shown remorse, he appears to

struggle with how misconduct impacted on public confidence in the

profession, concentrating rather on his own self-confidence. It is a matter

for this Committee as to whether the Registrant has discharged the

persuasive burden so as to convince us that there no longer remains the

risk of repetition.

63. Mr Edwards submitted that his client now understands what he did was

wrong, but that his unblemished career between 1980 and 2014 shows

that he can be trusted to behave properly. The Registrant also worked

between 2014 and the Principal Hearing without further complaint.

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64. Mr Edwards submitted that the Registrant does not communicate well in

either his written or spoken English and that this does not mean that he is

being evasive in his evidence. Mr Edwards urged the Committee to find

that his client has addressed the concerns of the last reviewing committee

and that going forward there was no risk of repetition.

LEGISLATION

65. The Fitness to Practise Committee’s powers in relation to reviewing this

suspension are contained in Article 54(3)(a) of the Pharmacy Order, which

provides:

“(a) where the entry in the Register of the person concerned is

suspended, give a direction that—

(i) the entry be removed from the Register;

(ii) the suspension of the entry be extended for such further

period not exceeding 12 months as may be specified in the

direction, starting from the time when the period of

suspension would otherwise expire …

(v) On expiry or termination of the period of suspension

(including a period of suspension that was expressed to be

indefinite), the entry be conditional upon that person

complying, during such period, not exceeding 3 years as may

be specified in the direction as the Committee thinks fit to

impose for the protection of the public or otherwise in the

public interest or in the interests of the practitioner

concerned”.

66. In the case of Abrahaem v GMC [2008] EWHC 183 (Admin), Blake J said:

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“In practical terms there was a persuasive burden on the practitioner at

a review to demonstrate that he or she has fully acknowledged why past

professional performance was deficient, and through insight, application,

education, supervision or other achievement sufficiently addressed the

past impairment …”

67. Ms Rajwani referred us to the guidance set out by Silber J in the case of

Cohen v General Medical Council [2008] EWHC 581 (Admin), which states:

“It must be highly relevant in determining a doctor’s fitness to practise is

impaired that first his or her conduct that led to the charge is:

(a) easily remediable

(b) been remedied

(c) highly unlikely to be repeated?”

DECISION ON IMPAIRMENT

68. Today we must first decide whether the Registrant’s fitness to practise is

still impaired, pursuant to Article 54(3) of the Pharmacy Order. Only if

there is such a finding do we go on to consider the range of options open

to us in terms of sanction.

69. We have considered the case of Abrahaem v GMC referred to above, and

in particular Blake J’s comments regarding what the Registrant needs to

show to persuade us that he has full insight and has addressed the finding

of impairment at the previous hearing.

70. We are reminded that there is a “persuasive burden” on the Registrant to

demonstrate at a review that his fitness to practise is no longer impaired.

It appears to us that the misconduct is capable of being remedied, but we

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must look to the evidence before us today in order to make the

assessment as to whether the failings have actually been remedied.

71. We have considered the Registrant’s written reflection and taken into

account his oral evidence. We have decided that he has shown genuine

remorse and is sorry for his actions. He spoke repeatedly about his shame

and embarrassment, and we accept that these sentiments are genuine.

We are also satisfied that the Registrant has taken steps to keep his skills

and knowledge up to date during his suspension. He is working as an

assistant in a community pharmacy, which shows his ongoing commitment

to the profession.

72. We have also taken into account the testimonials from the Registrant’s

mentor, Mr Lim, who speaks positively about the Registrant. It would

have been helpful if we could have heard from Mr Lim in person as to

exactly what the Registrant has told him about the misconduct, and their

discussions around what impact this has had on others and the profession.

It may well be that the Registrant does have difficulty articulating himself,

in which case the views of someone else who knows him well might have

been of assistance.

73. Based on the Registrant’s appearance before us today, there does seem to

have been some development in his level of insight since the last review

hearing in January 2019. He has admitted for the first time today that he

was motivated financially, and has also accepted that he should not have

prioritised the impact the misconduct has had on himself and his family.

74. However, we still have reservations regarding the Registrant’s

understanding of the impact his actions had on the public and the

reputation of the profession. He repeatedly used the phrase “standards of

the profession” during his evidence, but was not able to demonstrate that

he has now fully considered the impact his actions had on the pharmacy

25

or the Danish customers. He was not able to tell us what the risks were to

the patients who were sent the medication, or how they would have

viewed his actions if they knew the truth. We note that the Registrant has

very recently signed up to undertake online courses, and we hope that he

will utilise these tools in order to develop this insight.

75. For today, we are not satisfied that there would not be a repetition of the

previous failing if the Registrant were permitted to return to unrestricted

practice. He has not discharged the burden of persuading us that he fully

understands the impact his actions had on others, or the profession. Too

much of his evidence today concentrated on his own self-confidence. That

was not the concern of the last committee, nor is it ours. We therefore

find that his fitness to practise remains impaired.

DECISION ON SANCTION

76. Having found that the Registrant is still impaired, we then went on to

consider the appropriate sanction, in ascending order. We consider that

Conditions of Practice would be not workable in this case as the main

concern was that there was an ongoing risk of repetition of dishonesty.

77. We therefore moved on to consider whether a further period of

suspension was appropriate, or whether we had come to the conclusion

that the Registrant is unlikely to ever develop full insight and that the

ultimate sanction of strike-off should be imposed. We acknowledge that

the Registrant is moving along his journey and that his insight is gradually

developing. He appears to have taken note of some of the findings of the

last reviewing Committee. We are prepared to provide him with a further

opportunity to continue to develop his insight and would encourage him to

take advantage of the online tools to explore the areas where further work

is still required, and his mentoring relationship with Mr Lim. We consider

26

that strike-off would be a disproportionate response, taking into account

the Registrant’s developing insight.

78. We therefore order a further period of suspension. This order will remain

in place for four months from the expiry of the current order. There will

be a review before the expiry of the order. The reviewing committee may

be assisted by the following:

a. Evidence of further and amplified reflections by the Registrant,

demonstrating his understanding of the impact his misconduct had

on the patients in Denmark, his employer, the Health Station, and

on public confidence in the profession.

b. Documentary evidence that he has continued with his online

courses (even if this is simply by way of screenshots).

c. It may also be of assistance to the next committee to hear evidence

from the Registrant’s mentor and his current employer.

79. This ends our determination.

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