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22 Jan 2021
A pharmacist who dispensed medication in an unsafe dosage has been reprimanded by a tribunal and ordered to do more education.
In January 2015, pharmacist Jennifer Barca dispensed an unsafe dose of methotrexate to a patient who subsequently died from complications of methotrexate toxicity.
A general practitioner (GP) had prescribed the patient methotrexate tablets (Methoblastin), among other medications, to help treat a flareup of psoriasis, an uncomfortable but non-threatening skin condition.
A dispensing technician had made up the prescription and given it to Ms Barca to authorise. She immediately recognised that the daily dosing of methotrexate appeared to be incorrect, telling the patient’s daughters that it was usually taken once a week and not daily.
Ms Barca spoke by telephone to the prescribing GP, expressed her concern about the dosage prescribed and described it as possibly lethal. In response, the GP confirmed the dosage as prescribed, explaining he had checked it in the Monthly Index of Medical Specialties. He said the dosage was to be taken for five days only and that the patient had a review appointment a few days later.
While she remained concerned about the dosage and expressed that to the patient’s daughters, Ms Barca dispensed the methotrexate to the patient in accordance with the prescription. She gave the daughters a consumer brochure about Methoblastin tablets and told them to ensure the patient attended his follow-up appointment.
Ms Barca completed a ‘clinical intervention’ form in compliance with the Pharmaceutical Society of Australia’s Standard guidelines for pharmacists performing clinical intervention.
The Victorian Civil Administrative Tribunal (the tribunal) agreed with the Pharmacy Board of Australia’s submission that Ms Barca’s conduct amounted to professional misconduct.
The tribunal found that when Ms Barca confirmed the dose of methotrexate, she dispensed what she knew to be an incorrect and possibly lethal dose, relinquishing all responsibility to the prescribing GP.
By doing so, Ms Barca breached her professional duties of being a safeguard between prescribers and patients and refusing to dispense when faced with a situation that cannot bring about a safe outcome for the patient.
‘Ms Barca disregarded her professional role as someone with expert knowledge of medications and as a safeguard against incorrect prescribing. She could have refused to dispense or asked (the patient’s) daughters to come back later after she had undertaken further research as there was no urgency in the dispensing of the medication which was for a non-life-threatening skin disorder.'
The tribunal also stated that the GP could not direct Ms Barca’s professional conduct, which in this case was to dispense a medication she viewed as unsafe. It said that, as an independent professional, Ms Barca did not have to convince the GP that he was wrong in order not to dispense.
The tribunal ordered that Ms Barca:
The tribunal considered the mentoring conditions appropriate to give Ms Barca an opportunity in a supportive environment to reflect on what went wrong and where she could have acted differently.
The tribunal’s decision is available on the AustLII website.