Cork pharmacist suspended after dispensing returned syringes to another patient

Pharmaceutical Society of Ireland recommended a four-week suspension for pharmacist after he was found guilty of professional misconduct and poor professional performance, which was ratified by High Court

The pharmacist, who also removed a patient’s label from the syringes before placing them on a dispensary shelf for picking, apologised and expressed remorse for his actions. Picture: PA

A Cork pharmacist who created “considerable” potential for harm after partially used syringes returned by one customer were dispensed to another patient has been suspended from practising.

The High Court has ratified the recommended sanction of the Pharmaceutical Society of Ireland (PSI) of a four-week suspension for James Casey after he was found guilty of professional misconduct and poor professional performance over the incident at a pharmacy in Cork on August 30, 2021, where he was a supervising pharmacist.

Mr Casey made admissions he had taken a box containing partially-used, pre-filled syringes of Innohep 4500iu solution — a medication used to prevent blood clots — which had been returned to the pharmacy from the returns area and failed to check the seal on them had not been broken.

The pharmacist, who also removed a patient’s label from the syringes before placing them on a dispensary shelf for picking, apologised and expressed remorse for his actions.

A fitness-to-practise inquiry held by the PSI’s professional conduct committee heard another patient had to undergo a needle stick injury test after using one of the syringes.

Counsel for the PSI, Hugh McDowell BL, told the inquiry Mr Casey had failed to comply with the pharmacy’s standard operating procedures in relation to disposal of sharps and medicines.

The PSI claimed he was guilty of professional misconduct by acting in a manner which breached the code of conduct for Pharmacists.

Mr McDowell said Mr Casey was also guilty of poor professional performance by failing to meet the standards of competence that might reasonably be expected of a registered pharmacist.

However, Mr Casey said it was his belief at all times the syringes were uncollected stock as opposed to return stock, although he accepted he should never have made that assumption.

The inquiry heard he had misguided good intentions, as Innohep medicine was in short supply from its manufacturer and suppliers at the time.

Mr Casey said he genuinely believed the Innohep box was one which had not been dispensed previously.

He accepted his behaviour amounted to professional misconduct by being in breach of the code of conduct for pharmacists relating to patient safety and the safe supply of medicines.

He made no admissions his conduct amounted to poor professional performance or that it was infamous or disgraceful.

The inquiry heard evidence the syringes had been placed in the pharmacy’s returns area after a patient had brought them back on August 27, 2021.

When tidying up three days later, Mr Casey saw some Innohep 4500 on the returns bin and removed it.

He removed the label and then placed the syringes on a shelf from where they were subsequently re-dispensed to another patient.

Mr Casey’s solicitor, Maria Dillon, claimed the pharmacist had been personally blindsided by the situation involving the syringes.

She said he was keenly aware of the importance of Innohep due to a profound and tragic familial loss and there had also been a known shortage of the drug at the time.

The inquiry chairperson, Susan Ahern, said the committee could not condone the pharmacist’s actions, notwithstanding they accepted it was his genuine belief.

Ms Ahern noted the evidence of an expert witness that syringes once removed from a pharmacy are categorised as clinical waste and retrieving them from a returns area was “unequivocally serious".

She said Mr Casey’s failure to follow procedures reflected “a substantial lapse in professional judgment” and posed a clear risk to patient safety.

“Safe disposal of returned medication, particularly injectable products, is a core competency,” said Ms Ahern.

Mr McDowell told the inquiry the PSI believed the appropriate sanction was a short suspension to mark the seriousness of the wrongdoing and to uphold public confidence in the safe supply of medicines by pharmacists.

He also recommended a set of conditions be attached to the pharmacist’s registration, including the engagement by Mr Casey of an independent and external mentor for a period of six months.

Ms Dillon asked the committee to be as lenient as possible and noted the pharmacist had since taken remedial steps to address risk and governance issues in the pharmacy, while the toll and effect of the incident on him had been “considerable".

She claimed it would be unfair and very punitive to impose the sanction suggested by Mr McDowell and noted the pharmacist posed no risk to the public.

Ms Ahern acknowledged the pharmacist had an unblemished record before and since the incident in question and had also demonstrated insight.

She said the committee had recommended a four-week suspension on the basis the potential for harm in the case was “considerable”, although there was no evidence of actual harm to any individual.

However, Ms Ahern said the incident had caused extensive worry to the patient, to whom the medicine was subsequently re-dispensed, as they needed tests to ensure there were no adverse outcomes.

The committee ruled against imposing any conditions on the pharmacist’s registration.