A Birmingham pharmacist has been struck off after the GPhC’s fitness to practise committee found he had dispensed controlled drugs to himself by recording them as private prescriptions in his own patient medication record (PMR). 

Thomas Cave, who had worked as the responsible pharmacist at a branch of Jhoots Pharmacy on Raddlebarn Road in Birmingham, was also found to have dispensed incorrect measures of methadone to patients and to have failed to endorse one or more FP10MDAs with the amount of methadone dispensed. 

A remote FtP hearing that began in April and concluded on Thursday October 31 established that Mr Cave – whose legal counsel described him as “young and junior in his career” – had on at least 23 occasions in 2021 dispensed prescription medicines including Schedule A controlled drugs to himself without a valid prescription. 

These included tramadol capsules, morphine sulfate oral solution, co-codamol caplets and ramipril capsules. 

In May 2022, while Mr Cave was on annual leave, a locum pharmacist raised concerns around the accuracy of a number of entries in the controlled drug register, as well as a lack of annotations on methadone prescriptions.

After suspending Mr Cave the company launched an internal investigation, during which it unearthed evidence that a number of entries on Mr Cave’s PMR file were marked as private prescriptions and that “many hundreds of entries” that should have appeared in the CD register were not, the FtP committee heard. 

“A search of the pharmacy as part of the internal investigation found no private prescriptions for any patient during the periods in question,” said the committee in its report on the hearing, adding: “The scale of the incorrect and or missed entries in the CD register… were in the order of 700 over a period of several months.” 

Mr Cave, who was also arrested and interviewed by local police, resigned from his position while the investigation was ongoing. 

Other concerns came to light during the investigation, “in particular that methadone scripts were not being properly annotated… In addition to missing annotations, incorrect doses of methadone had been given to patients on a number of occasions”.

Commenting on his entry of several hundred items as private prescriptions on his own PMR, Mr Cave claimed he was trying to work around the company’s “long and time-consuming” processes, which he said emphasised the need to source drugs at the cheapest available price. 

“I resorted to using my PMA [sic] to quickly and efficiently order stock that was specifically required for the pharmacy, mainly to fulfil specific patient requests for a particular brand, as I found this a much quicker and more efficient way to order stock, compared to the usual method, which I had been shown when I started at the pharmacy,” he said in a written statement; he did not agree to provide an oral statement at the hearing. 

His account was disputed by Jhoots superintendent Dilsha Kiran Shah – herself the recipient of a warning from the regulator earlier this year – who outlined the ordering methods sanctioned by head office and denied that Mr Cave had been instructed to place orders in the way that he claimed.

The FtP committee acknowledged that there was no evidence of onward supply of the medicines in questions but found it preferred Ms Shah’s “reliable” account and said there was a fundamental lack of logic in Mr Cave’s claims, as he could have entered the items onto patients’ own PMRs rather than his own. 

According to the report: “Having found proved that the Registrant had placed a number of items onto his PMR on 2 September 2021 and paid for them, and deleted items from his PMR on 12 August 2021 but yet had paid for those, the Committee concluded that on the balance of probabilities the Registrant had dispensed to himself all the other remaining items entered onto his PMR as ‘private prescriptions’.”

The FtP committee was also gravely concerned by his “failure to give out the correct doses of methadone,” which it said placed vulnerable patients “at significant risk of actual harm”. 

In light of what it described as his dishonest behaviour, the committee concluded that the “appropriate and proportionate outcome” to the case was to remove Mr Cave’s name from the register, with an interim suspension imposed on him during the 28-day appeal period.