Squabble over scripts

Doctors are under intense scrutiny as their colleagues at the Medical Council of Jamaica and the Pharmaceutical Society of Jamaica try to remedy a ‘grey area’ in the Pharmacy Act that allows “unscrupulous” practitioners to stockpile and sell medication to patients, circumventing pharmacy outlets.

The Pharmaceutical Society claims the practice is putting the health of Jamaicans at serious risk and exploiting their financial vulnerabilities. Some cash-hungry practitioners reportedly sacrifice patient care for a fast buck. In some cases, doctors’ receptionists are allegedly filling the prescriptions at the doctors’ offices.

“It is just bringing down the practice of healthcare in the country,” bemoaned an embarrassed Dr Tyrone Smith, president of the Pharmaceutical Society, which represents professional pharmacists, as he listed a raft of legal and ethical concerns regarding the practice which is reportedly increasing, particularly in the Corporate Area and Westmoreland.

Section 18 of the Pharmacy Act (1975) dictates that: “No person shall compound, dispense, or store for sale any drug unless ... it is effected on premises registered as a pharmacy, and by a registered pharmacist or pharmacy student under the supervision of a registered pharmacist.”

Additionally, it states that: “No person shall carry on a business which includes the retailing of any poison (medication) unless such business is carried on in a registered pharmacy, or if he is an authorised seller... .”

However, Section 19 of the Act, outlines that: “Nothing in Section 18 shall apply to a drug which is supplied by a registered medical practitioner or by a registered nurse or midwife on the direction of a registered medical practitioner for the purpose of medical treatment.”

This is the grey area being exploited, Smith explained.

While doctors are allowed to store and administer limited amounts of medication for emergency, life-saving situations, outside of that the expectation is for a prescription to be written and the patient directed to registered pharmacies to have it filled.

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“What is happening is that doctors, in an effort to commercialise their business, are buying excess medication from the distributors, and are stocking their practices. After they have treated the patients, we find that after they have treated the patients, they are actually selling them the medication,” argued Smith, calling for amendments to the Act to plug this loophole.

“At the time, lawmakers set out a piece of legislation, but you don’t know that somebody was going to try and circumvent it ... Just as how we would have expected the doctor to buy what he needs for the urgent or immediate use; we did not foresee that the doctors would be going ahead now and stocking these everlasting amounts, selling the patients, and running the practice like it is a pharmacy.”

Or more like a backdoor ‘patty shop’, argued Dr Ernestine Watson, chairperson of the Pharmaceutical Council of Jamaica, the regulatory arm for registered pharmacists locally.

“When a law and the regulations of a law are written. It is based on the ethical standards of the law at the time it was written. Who would foresee that doctors would literally set up ‘patty shops’. That’s what they are doing. They want to make money, they are not interested in health service,” charged Watson, noting that, in Westmoreland, at least one pharmacy was forced to close due to its operators being unable to compete with doctors engaging in the practices around it.

The list of concerns is extensive, explained Smith and Watson last week – storage and dispensation practices at these offices are usually improper as some drugs, particularly the photo-sensitive ones, are usually dispensed in unsuitable envelopes or zip lock bags, they claimed. In other cases, patients have been sold expired medication, while in others, patients have been sold medication that they may not necessarily have needed based on the stage of their illnesses. These, however, are the medications that the doctors had in store. There are also concerns that patients are often given no direction on how to use medications, and that some doctors are shortening patient visits in order to fit more patients into allotted time slots to prescribe more drugs for sale at their front counters.

“If the doctors make an error, there is no way of stopping it, and when you practise as a pharmacist, every single day, we call a doctor at least three times for the day for errors,” charged Watson. “The dosage may be wrong. There may be a drug incompatibility, and you, as a pharmacist, know more of the medication that a patient takes than their doctors. Patients go to several doctors, and that patient may come to you with a medication that you know last week caused a severe allergic reaction. The patient is not going to tell the doctor that!”

Health Minister Dr Christopher Tufton told The Gleaner that he was hearing of the concerns for the first time, while Renee Badroe, president of the Jamaica Medical Doctors’ Association (JMDA), which represents the professionals, declined to comment on the issue last week. Instead, Badroe directed the newspaper to the Medical Association of Jamaica (MAJ), which represents the doctors’ employers.

Dr Leslie Meade, president of the MAJ, already aware of the issue, argued that there was nothing illegal nor unethical about the doctors’ conduct, explaining that in many instances, doctors engage in selling medication at their offices, especially in rural areas where access to pharmacies might be limited for patients.

“I don’t know of any widespread issues in terms of doctors dispensing medication from their practice. However, we are aware there may be some who are, and many times it is because of the lack of access to pharmacies in the areas in which they practise,” said Meade, noting that in some communities patients might have to travel great distances to a pharmacy.

“Where this may be happening, it is not a common practice, but it is not an illegal practice, and it is done to ensure that patients are able to access medication quickly, without having to travel great distances or having to find additional transportation costs. It is always in the best interest of the patients that my colleagues serve,” he charged, also rebuffing criticism regarding ethics.

Meade’s comment infuriated Watson.

“He can’t be serious, and the Medical Council does not agree with that. A doctor can supply medication for the course of treating his or her patients. That is as far as their authority goes. He cannot write a prescription and give it to his receptionist to fill. That is illegal, and I will challenge him on that.”

corey.robinson@gleanerjm.com