An experienced pharmacist who went against her concerns and dispensed a hardcore chemotherapy drug to a patient who died days later has been found guilty of professional misconduct.
Melbourne pharmacist Jennifer Barca inappropriately dispensed an unsafe dose of methotrexate to Ian Gilbert, 77, despite raising concerns with his doctor the dose prescribed was too high.
In its ruling, the Victorian Civil and Administrative Tribunal agreed with the Pharmacy Board of Australia she should not have dispensed it.
“She dispensed a drug that in her professional view was unsafe and possibly lethal, and unfortunately it turned out to be so,” VCAT said in its finding.
Mr Gilbert was prescribed the drug for his skin condition psoriasis by Stephen Lim in January 2015.
He died 15 days later from complications of methotrexate toxicity.
When Dr Lim looked up the dosage of methotrexate for psoriasis, he did not read the prescribing reference that it should only be prescribed by a specialist, VCAT heard, nor did he order any blood tests beforehand or tell Mr Gilbert of any side effects.
Ms Barca recognised the daily dose appeared incorrect, given the drug is usually taken once a week, not daily.
She called Dr Lim to clarify, telling him she was extremely concerned, as the daily dose was possibly lethal.
Dr Lim confirmed the dose as prescribed and said it was only to be taken for five days, with Mr Gilbert to have a review appointment days later.
However, Mr Barca remained concerned and considered changing the instructions for the drug, but didn’t.
She told Mr Gilbert’s daughters of her concerns and to ensure he attended his review appointment with Dr Lim before dispensing the drug according to the prescription.
She also filled out a clinical intervention form noting the dose.
In her 2018 finding, Coroner Rosemary Carlin noted Ms Barca “clearly felt conflicted”.
“However, in reality her choice was clear. Since (she) was not satisfied that the prescribed dose of methotrexate was safe, she should not have dispensed it,” she wrote.
Coroner Carlin also said doctors and pharmacists should trust and respect each other, while retaining their independence.
“In dismissing her concerns, it appears Dr Lim did not afford Ms Barca the respect she deserved. In dispensing the methotrexate despite her concerns, it appears Ms Barca afforded Dr Lim too much respect, or at least lost sight of her role as an independent safeguard against inappropriate prescribing,” she said.
Ms Barca accepted responsibility for her conduct and was deeply remorseful. She argued a professional misconduct finding was punitive.
The sole practitioner with an unblemished record felt unsupported to challenge Dr Lim’s view, telling VCAT she failed to assert herself when expressing her concerns to him.
But VCAT found her guilty of professional misconduct, saying she could have done more research or not dispense the drugs at all, given there was no urgency for what was a non-life threatening skin disorder.
“She dispensed what she knew to be the incorrect dose, she abrogated all responsibility to Dr Lim, in breach of her professional responsibilities,” the VCAT members said.
As well as reprimanding her, they ordered she undertake more training.
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