Professor Jim Smith. MISS NIMI BRUCE, counsel, of Capsticks, solicitors, appeared on behalf of the General Pharmaceutical Council.

Transcription

1 GENERAL PHARMACEUTICAL COUNCIL FITNESS TO PRACTISE COMMITTEE 129 Lambeth Road, London SE1 7BT Tuesday 9 September 2014 Chairman: Mr Michael Simon Committee Members: Committee Secretary: Mrs Jillian Alderwick Professor Jim Smith Mrs Georgia Jerome CASE OF: THAKRAR, UPESH (Registration Number: ) DETERMINATIONS MISS NIMI BRUCE, counsel, of Capsticks, solicitors, appeared on behalf of the General Pharmaceutical Council. MR THAKRAR did not appear and was not represented. Transcript of the shorthand notes of T A Reed & Co Ltd Tel No:

2 I N D E X Page DETERMINATION ON SERVICE AND PROCEEDING IN ABSENCE 1 DETERMINATION ON THE FACTS 2 DETERMINATION ON IMPAIRMENT 8 DETERMINATION ON SANCTION 11 DETERMINATION ON INTERIM MEASURES 16 PLEASE NOTE: Copies printed from may differ in formatting and/or page numbering from hard copies

3 (The Committee returned into open session at 2.00 p.m.) DETERMINATION ON SERVICE AND PROCEEDING IN ABSENCE THE CHAIRMAN: This is a principal hearing of an allegation of impaired fitness to practise by reason of misconduct brought against Mr Upesh Thakrar, a pharmacist first registered with the Royal Pharmaceutical Society of Great Britain on 23 July 1991 and currently registered with the General Pharmaceutical Council under registration number The Council is represented in this case by Miss Bruce, counsel, of Capsticks, solicitors. Mr Thakrar is neither present nor represented, but through legal representatives he has supplied us with written submissions and a statement. We were first addressed on service of the notice of hearing, which we were satisfied contained the correct details of this hearing and was sent more than the requisite 28 days before the hearing itself. It is clear that the notice and bundle were received by Mr Thakrar and/or his legal representatives. We are satisfied that in the circumstances the rules on service have been complied with. Having expressed ourselves as to service, Miss Bruce then made an application for the hearing to proceed in Mr Thakrar s absence. Miss Bruce submitted that paragraph 1 of Mr Thakrar s witness statement clearly indicated that he would not be attending the hearing and we were shown an from his legal representatives to the same effect. Miss Bruce submitted that Mr Thakrar had demonstrated that he had voluntarily decided not to come to this hearing for the reasons that he explained, and that he expected the hearing to proceed in his absence. The Committee readily appreciates the need to exercise the discretion to proceed in the absence of Mr Thakrar only with great care and caution. However, the nature and circumstances of his absence are set out in Mr Thakrar s own witness statement dated 5 September 2014, which says at paragraph 1: I should say at the outset that it is not my intention to attend the fitness to practise hearing listed on 8 September I hope that the Committee accept that this is not due to any lack of courtesy or respect for the Committee or my profession. 1

4 It seems to us, in light of this, that no adjournment is being sought and no useful purpose would be served by adjourning this hearing, as Mr Thakrar would be unlikely to attend any further hearing. Furthermore, the Council has a number of witnesses who are present and waiting to give evidence and the events with which the case is concerned date back to the period of 2010 to In the circumstances, we concluded that the public interest weighed heavily in favour or proceeding in Mr Thakrar s absence. DETERMINATION ON THE FACTS THE CHAIRMAN: The events with which we are concerned are all said to have taken place during the course of Mr Thakrar s practice as a pharmacist in two pharmacies known as Stockwell Pharmacy. The first is situated at 75 New Broadway, Ealing, West London ( NB ) and the second is situated at 124 Uxbridge Road, Ealing, West London ( UR ). The original allegation in full is: That being first registered as a pharmacist on 23 July 1991: 1. Whilst you were the owner and/or responsible pharmacist at Stockwell Pharmacy, 75 New Broadway, Ealing, you: (a) On a date in or around December 2010, supplied an unknown quantity of prescription only medicine, namely, Lorazepam tablets, to Ms A without a prescription; (b) On one or more dates between around 1 November 2010 and around 31 December 2011, supplied an unknown quantity of prescription only medicines, namely, Tramadol tablets, to Ms A without a prescription. 2. Whilst you were the owner and/or responsible pharmacist at Stockwell Pharmacy, 75 New Broadway, Ealing: 2

5 (a) On one or more dates between around June 2011 and around 31 December 2011, Mr X, a staff member, provided an unknown quantity of prescription only medicine, namely, Tramadol tablets, to Ms A, without a prescription; and (b) You: (i) (ii) Caused or permitted Mr X to supply Tramadol to Ms A without a prescription; or Failed to ensure appropriate controls were in place to prevent the unauthorised supply of prescription only medicine to Ms A, in that: (a) Mr X had not read and/or signed Standard Operating Procedures; (b) Mr X had not undertaken a pharmacy training course in the United Kingdom. 3. Whilst you were working as a locum pharmacist at Stockwell Pharmacy, 124 Uxbridge Road, West Ealing, you: (a) On a date in around November 2010, supplied an unknown quantity of prescription only medicine, namely, Lorazepam tablets to Ms B, without a prescription; (b) On or about 4 June 2011, caused or permitted a staff member to supply an unknown quantity of prescription only medicine, namely, Tramadol tablets, to Ms A, without a prescription. And that the particulars of misconduct alleged, individually or cumulatively, render your fitness to practise impaired by reason of misconduct. At the start of the hearing, Miss Bruce applied to amend paragraph 1(a) to read: On a date in or around December 2010, supplied Ms A with one box of Lorazepam 2.5mg, a prescription only medicine, without a prescription. 3

6 In Mr Thakrar s written submissions, this amendment was referred to as being agreed between the parties and we were satisfied that we should exercise our power to amend the allegation as suggested. At the conclusion of the oral evidence, Miss Bruce applied to amend the allegation by deleting paragraph 2(b)(ii)(b). Although this had not been raised with Mr Thakrar in advance and we did not know his stance on the application, we considered that such an amendment in the circumstances could only be to his advantage and we decided to exercise our powers of amendment by deleting that paragraph. Given the nature of much of Mrs A s evidence which touched on her health, we acceded to the application by Miss Bruce to hear Mrs A s evidence and that of her husband, Mr Y, in private session. We have been provided with a bundle of evidence from the Council, a witness statement and written submissions from Mr Thakrar, as well as a statement of case, chronology and dramatis personae from Miss Bruce. A number of additional documents, namely, witness statements from four members of staff from Stockwell Pharmacy, who did not come to give evidence, have been handed to us during the course of the proceedings at the request of Mr Thakrar s legal representatives. The Council s bundle contained a number of witness statements and exhibits. Some of the witness statements, including that of Ms Robson, the Council s Inspector, were redacted. Miss Bruce applied for one paragraph of Ms Robson s statement, namely, paragraph 37, which had been redacted, to be reinstated. The paragraph relates to a conversation between Ms Robson and Mr Tank, an employee at NB, about Standard Operating Procedures. Both Ms Robson and Mr Tank were due to give oral evidence and could each give their version of events for us to assess. Therefore we decided that the evidence was likely to be relevant and it would be fair to admit it. As to the oral evidence, on behalf of the Council we heard from: Mrs A; 4

7 Mr Y, the husband of Mrs A; Eilean Robson, the Council s Inspector; and Mr Tank, referred to as Mr X in the allegation and in some of the papers. For the sake of completeness, we note at this juncture that we did not hear directly from Ms B, the former friend of Mrs A, who is referred to in paragraph 3(a) of the allegation. Our task at this stage of the proceedings is to decide which, if any, of the particulars of the allegation have been proved by the Council. In this regard, it is proper that we set out some general points about the approach we have taken to this task. We have reminded ourselves that overarching all of our considerations it is the Council that brings this case and it is the Council that must prove it. Mr Thakrar does not have to prove anything. In deciding which facts, if any, should be found proved, we must apply the standard of proof applicable to civil proceedings, which is on the balance of probabilities. Case law has made clear that this is a single and unvarying standard. It means that a fact will be found proved if we consider it is more likely than not to have happened. We do not have to decide every point which has been raised. We need only reach conclusions about such matters as will enable us to say whether any of the paragraphs in the allegation have been proved. We must consider the evidence against and for Mr Thakrar on each paragraph or subparagraph individually. However, this does not mean that we should ignore any other evidence, whether of background circumstances or otherwise, as this may be evidence that assists us in reaching our conclusions. Moreover, it can sometimes be the case that our decision on the facts of one paragraph or subparagraph might assist us in coming to a conclusion on other paragraphs in the allegation. Miss Bruce invites us to make certain inferences from the evidence. We have reminded ourselves that drawing an inference is a process by which we find, from evidence which we regard as reliable, that we are driven to a further conclusion of fact. It almost goes without saying that we need to be careful to ensure that the evidence really does lead to the conclusion that we are advised to reach. Speculation or attempting to fit the evidence to a particular theory is not the same as drawing an inference from reliable evidence. 5

8 We have heard from a number of live witnesses in this case and we have to make an assessment in relation to their evidence, the extent to which we accept or reject it and the weight to attach to it. This task can usefully be split into two aspects: credibility, being the existence or absence of any ulterior motive or mala fides, which might lead one to be cautious about accepting a witness s evidence; and reliability, being the extent to which the evidence of a credible witness should be accepted and relied upon. This can often be assessed by reference to internal consistency and consistency with other oral and/or documentary evidence. It is within this context that we consider the evidence we have read and heard in reaching our conclusions. We listened carefully to the oral evidence. Mrs A impressed us as being clear, cogent and consistent. Neither she nor her husband had any ulterior motive in coming to give evidence, save to assist the Committee, and the broad premise of her evidence that Mr Thakrar sold her prescription only medication without a prescription on a number of occasions is acknowledged as being true by Mr Thakrar in his witness statement. Mrs A provided a very detailed statement to Ms Robson in January 2012, when matters would have been very fresh in her mind, and the nature of the events she was describing was such that it is no surprise to us that it should be so clearly recollected by her. As far as Mr Tank is concerned, he provided only a very brief statement in February 2012 and, as far as we are aware, was not asked to give any further thought to the matter, subject of this allegation, until he gave evidence to us this morning. It seemed to us that, whether through nerves or otherwise, his evidence was less cogent and, by extension, less reliable than that of Mrs A. In the circumstances, wherever there is a conflict of evidence as between Mrs A and Mr Tank, we prefer the evidence of Mrs A. Ms B was a friend of Mrs A with whom she has now lost all contact. It was Ms B who introduced Mrs A to Mr Thakrar and, in around November 2010, Mrs A was present in UR and observing whilst Ms B purchased a box of lorazepam tablets from Mr Thakrar for cash without a prescription. Thereafter, Mrs A told us that due to certain health issues, she went to NB in early November 2010 and asked Mr Thakrar if she could have a box of tramadol, which she knew was a strong painkiller. Mr Thakrar sold her a box of mg tramadol tablets for 10. 6

9 No record of the transaction was made. This was the first of many purchases made by Mrs A of tramadol. When she began purchasing tramadol, she was taking about six per day, but at times she was taking up to 16 per day, which we were told by Ms Robson would equate to approximately twice the maximum recommended dose. In December 2010, as a result of sleep disturbance, which Mrs A attributed to the effects of the tramadol, she bought a box of lorazepam from Mr Thakrar in NB. Mrs A noted that Mr Thakrar did not ask any questions at all, but just told her how much the tablets would cost. Mrs A gave evidence that from about June 2011 to December 2011, it was not always Mr Thakrar who sold her the tramadol. Other staff from the pharmacy did too. Specifically, having been shown photographs of a number of members of staff, Mrs A made a positive identification of Mr Tank as someone who sold her tramadol. Although Mr Tank denied this, we had no cause to doubt our very positive assessment of the reliability of Mrs A s evidence. Some of Mr Tank s answers seemed to us to be superficially simplistic. It is clear that Mr Thakrar, as responsible pharmacist, had direct accountability for the actions of staff members in relation to prescription only medicines. Mrs A also gave evidence about a specific occasion, namely, 4 June 2011, when she attended UR, which she knew was a pharmacy with which Mr Thakrar was connected. He was not present at the time, but a member of staff eventually managed to contact him by phone and Mrs A heard the conversation sufficiently well to believe that the staff member was speaking to Mr Thakrar and that, after checking Mrs A s name, Mr Thakrar gave the staff member permission to sell two boxes of tramadol 50mg tablets to Mrs A for 20. In his statement, Mr Thakrar writes: Whilst I do not accept that the statement of Ms A is entirely accurate, I do not seek to dispute that I supplied Lorazepam without a prescription on one occasion, as alleged, and that I supplied her with Tramadol without a prescription on a number of occasions. 7

10 Given the assessment of witnesses referred to above and Mr Thakrar s concession, we find paragraphs 1(a), as amended, 1(b), 2(a), 2(b)(i) and 3(b) proved. Mr Thakrar does not make any specific submission or comments about the sale of lorazepam to Ms B, but we are satisfied from Mrs A s direct evidence of the transaction that the Council has proved paragraph 3(a) as well. As to paragraph 2(b)(ii), this was pleaded as an alternative to 2(b)(i) and falls away with our finding the latter proved. That is our determination on the facts. (The Committee returned in open session at 3.50 p.m.) DETERMINATION ON IMPAIRMENT THE CHAIRMAN: Following the delivery of our determination the facts, we have now received submissions from the Council on the issue of misconduct and impairment. Miss Bruce made submissions strongly in support of a finding of current impairment with reference to case law and the relevant Standards of Conduct, Ethics and Performance, being the 2010 version. As to the Standards, Miss Bruce made specific reference to aspects of Standard 1: Make patients your first concern ; Standard 6: Be honest and trustworthy; and Standard 7: Take responsibility for your working practices. She submitted that the conduct found proved was of the most serious kind for a pharmacist. Miss Bruce argued that all three limbs of the public interest are engaged in this case, that is: public protection, the maintenance of public confidence in the profession and the declaration and upholding of proper standards of conduct and behaviour within the profession. She made particular reference to the case of Yeong v GMC [2009] EWHC (Admin) and CHRE v NMC and Grant [2011] EWHC 927 (Admin). She also emphasised the potentially negative impact on public confidence and the standards of the profession if we were not to make a finding of impairment in this case, given the breach of trust that we have found. 8

11 For his part, Mr Thakrar wrote in his statement: I fully recognise that the supply of prescription only medication without a prescription gives rise to a real risk that the medication will be misused. I cannot really explain why I did it, but to my great regret I think that having agreed to her request the first time, I just carried on. I just wish I had refused. The question of whether or not Mr Thakrar s fitness to practise is currently impaired is a matter for the Committee to consider by applying our judgment to the evidence before us in the context of our specific findings of fact. It is not a matter of proof. It is also a two-stage process when misconduct is alleged. We must first consider whether the findings of fact we have made against Mr Thakrar amount to misconduct and only if we so find do we go on to consider the question of current impairment. Not all conduct that is in breach of the Standards of Conduct, Ethics and Performance will necessarily amount to sufficiently serious conduct that it becomes misconduct. We take account of the dicta in the Court of Appeal decision in GMC v Meadow [2006] EWCA Civ 1390, which clearly sets out the need for conduct to fall seriously below the standards to be expected of a reasonable practitioner before it comes within the category of misconduct. We have also considered helpful the judgment of Mr Justice Collins in Nandi v GMC [2004] EWHC 2317 (Admin), in which he observed that seriousness in other contexts has been referred to as conduct which would be regarded as deplorable by fellow practitioners. It seems to us to be incontrovertible that other pharmacists would regard as deplorable Mr Thakrar s actions in selling prescription only medication directly to members of the public, that is, Mrs A and Ms B in this case, and we are satisfied that it amounts to misconduct, that is, a course of conduct falling seriously below that to be expected of a pharmacist. In this particular case, both Mrs A and Ms B were sold lorazepam, a Class C controlled drug, unauthorised supply and possession of which is a criminal offence carrying a potential prison sentence. Whether or not the specific details of Mrs A s symptoms as she described them are directly attributable to the tramadol or not, it is clear to us that the volume of purchases and the 9

12 number of tablets that she was taking daily suggests very strongly a level of dependence that was being fed by the continuation of the supplies from Mr Thakrar. We note from information supplied by the Council that the potential for dependence on tramadol has now been recognised by its inclusion in the list of Class C controlled drugs. Further, the conduct that we have found was undoubtedly in breach of wide-ranging provisions in the Standards, most notably Standards 1 and 7, and specifically Standard 6.6. As to the second stage of our consideration on current impairment, we begin, as we must, with the requirements of rule 5 of the General Pharmaceutical Council (Fitness to Practise and Disqualification Rules etc.) Order of Council 2010, which provides that: In relation to evidence about the conduct or behaviour of the registrant which might cast doubt on whether the requirements as to fitness to practise are met in relation to the registrant, the Committee must have regard to whether or not that conduct or behaviour (a) presents an actual or potential risk to patients or to the public; (b) has brought, or might bring, the profession of pharmacy into disrepute; (c) has breached one of the fundamental principles of the profession of pharmacy; or (d) shows that the integrity of the registrant can no longer be relied upon. This rule of course mirrors the relevant case law and in particular pronouncements by Mrs Justice Cox in the case of Grant as to the approach to be adopted by health regulators generally to the question of current impairment. In our view, Mr Thakrar s conduct put members of the public at unwarranted risk of harm, because he openly flouted all safeguards in respect of medicines whose attributes he must have known and the potential for dependence or worse he accepts. He made no efforts to counsel Mrs A into seeking appropriate help from her general practitioner and took advantage of her regular repeat custom over a period of approximately a year. Mr Thakrar s conduct undoubtedly brings the pharmacy profession into disrepute, constitutes substantial breaches of fundamental tenets of the profession and, although there is no charge of dishonesty in this case, nonetheless the conduct found calls seriously into question 10

13 Mr Thakrar s integrity as a pharmacy professional. We recognise that, despite his absence, Mr Thakrar has made clear his acceptance of the seriousness and unacceptability of his misconduct. As to remediation, we bear in mind the dicta in the case of Yeong v GMC that some conduct by a professional can be so egregious that attempts at remediation may be less persuasive than in cases involving deficient clinical competence. In this case, we have been provided with no evidence at all of any attempt at remediation and we are satisfied that the findings that we have made against Mr Thakrar are of a nature and degree that would make remediation a significant challenge. In the circumstances, save for Mr Thakrar s documented insight into the consequences to himself and the patients of his misconduct, there is limited information currently before us that would suggest that the public might not be put similarly at risk in the future from a repeat of the misconduct. As is often and legitimately said, pharmacists are the gatekeepers of medication. The public rightly expects the very highest levels of professionalism and integrity from those with ready access to medicines and drugs, even more so when those drugs are drugs of abuse or dangerous in other ways. The conduct in which Mr Thakrar engaged has the potential seriously to undermine public confidence in the pharmacy profession, such that a finding of current impairment must be made. Furthermore, that finding is also fully justified in our view in order to declare and uphold standards of conduct and behaviour within the pharmacy profession itself. Our judgment therefore is that Mr Thakrar s fitness to practise is currently impaired by reason of his misconduct. (The Committee returned in open session at 5.23 p.m.) DETERMINATION ON SANCTION 11

14 THE CHAIRMAN: We now move to consideration of sanction in this case. At the beginning of her submissions, Miss Bruce disclosed to us a previous finding of a Committee against Mr Thakrar. On 18 May 2010, Mr Thakrar was suspended for a period of three months for supplying a prescription only antibiotic cream to a patient without a prescription and then being dishonest in his explanation for his conduct. These events occurred in Miss Bruce pointed out that Mr Thakrar attended the hearing before the Committee in 2010 and the Committee was persuaded that the risk of repetition was low. In light of the previous finding, Miss Bruce contended for the Council that the only appropriate sanction in this case is one of removal. She submitted that Mr Thakrar s conduct as found proved by us in the current case would justify removal on its own, but that this was compounded by the previous finding. She submitted that the following aggravating features are present in this case: Abuse of trust; Taking advantage of a vulnerable person; Misconduct sustained or repeated over a long period of time; A previous finding of misconduct and impairment [I interpolate at this point that we would add of the same nature as the index finding ] Minimal or no steps to prevent actual harm; Actions premeditated; Abuse of position in the context of drug abuse; Blatant disregard for the Standards; Lack of insight; Misconduct committed by a person in charge of pharmacy premises; and Breaches of statutory requirements. Miss Bruce reminded us of Mr Thakrar s apology and his assertion of insight, which she indicated the Council did not accept as genuine. For the sake of completeness, we should quote again directly from Mr Thakrar s own statement. He writes: 12

15 I fully appreciate just how much I have let both myself and my profession down and I hope that my recognition and acceptance that I am likely to be removed from the Register of Pharmacists gives the Committee some degree of insight into how sorry I am about the whole state of affairs, which is my own responsibility. Finally I would simply like to apologise to Ms A and the Committee for my failings. We have not been provided with any other information from Mr Thakrar as to his personal circumstances or any testimonials or character references on his behalf. In addition to the usual considerations on sanction contained in the Indicative Sanctions Guidance, we must now also be mindful of the views of the Inner House of the Court of Session in the case of HK v General Pharmaceutical Council [2014] CSIH 61 delivered on 10 July 2014, (which, although being appealed that appeal is still to be heard) in which Lord Drummond Young opined that we should not consider ourselves restricted to contemplating a suspension order of only 12 months, but should consider the possibility of a longer suspension achieved through the imposition of an initial 12 months suspension, with an indication to the reviewing panel of how much longer we propose the suspension should last. The reviewing panel will then take this into account when deciding whether to extend the suspension in accordance with our indication or not. As in any determination on sanction, it is proper that we should set out some fundamentals about the approach we have taken in reaching our decision, which, in common with the impairment stage, involves the application of our independent professional judgment. We have of course had regard to the Council s Indicative Sanctions Guidance. As to our powers on sanction, we can take no action; give a warning; impose conditions for a period not exceeding three years; suspend Mr Thakrar s registration for a period not exceeding 12 months, with or without a review; suspend for 12 months with a review and a recommendation for extension of the suspension to a reviewing panel; or give a direction that Mr Thakrar s name be removed from the register. In the context of fitness to practise proceedings before a professional regulatory body, the purpose of sanction is three-fold: namely: 13

16 1. Protection of the public; 2. The maintenance of public confidence in the profession; and 3. The declaring and upholding of proper standards of conduct and behaviour within the profession. We have already determined that all three limbs of the public interest are fully engaged in this particular case. Although the object of regulatory proceedings is not to punish a registrant for their wrongdoing, the fact that a sanction will have a punitive effect does not make such a sanction inappropriate where its purpose is otherwise the protection of one or more limbs of the public interest. The Committee is also entitled to give greater weight to the public interest and to the need particularly to maintain public confidence in the profession and the regulatory process than to the consequences to Mr Thakrar of the imposition of any particular sanction, although of course proper consideration must be given to his interests in the necessary balancing exercise. In determining the appropriate sanction, we have to exercise our discretion. We have thus had regard to the principles of fairness, reasonableness and proportionality. We have taken account of the full range of sanctions available to us and we have ensured that the sanction imposed is proportionate and reasonable in all the circumstances of the case. The Indicative Sanctions Guidance suggests a matrix within which to view the application of the doctrine of proportionality, which is that it is to ensure that a sanction imposes no greater restriction on the registrant s ability to work in his or her chosen profession than is absolutely necessary to achieve the objective of protecting the public interest in all its guises. Thus, in order to ensure that proportionality is achieved, we have considered the sanctions in ascending order of severity. In reaching a determination on the appropriate sanction to impose, we must of course also consider the mitigating and aggravating features of the facts found proved. As to the aggravating features in this case, we agree entirely with Miss Bruce s identified list taken from the Indicative Sanctions Guidance. We have carefully considered the question of insight, but given the seriousness of the allegation with which we are concerned, particularly in light of the earlier finding against Mr Thakrar, we did not consider that his asserted insight 14

17 came close to being at an appropriate level. We cannot help but observe that the three months suspension imposed on Mr Thakrar by the previous Committee would have expired towards the end of September 2010 and yet he was already repeating his misconduct by early November the same year. Having been given the benefit of the doubt by the Committee in 2010, Mr Thakrar has demonstrated that the whole regulatory process had little or no positive impact on him or on his professional practice. We have already addressed the question of patient harm in our impairment determination. No consideration seems to have been given by Mr Thakrar to the level of potential harm that arose from his misconduct or that the specific drugs involved were capable of misuse and/or of causing addiction or dependency. His actions were premeditated, in the sense that he took a conscious decision to supply Mrs A with a constant supply of tramadol over a period of a year and appeared to have no qualms, on the evidence we heard, about adding lorazepam to this, having already previously supplied lorazepam to Ms B. There is no mention by Mr Thakrar of the criminality involved in Mrs A and Ms B possessing a Class C drug without due authority. The misconduct amounts to a blatant disregard for the Standards of Conduct, Ethics and Performance in place at the time and for the legislative framework governing the control and supply of medication. As to mitigating features, we have acknowledged the apology expressed in writing by Mr Thakrar the working day before the hearing. We approach sanction in ascending order of severity, although realistically it is clear to us that no action, a warning and conditions of practice would not protect the public and would be woefully inadequate to meet the high degree of public interest considerations that apply in this case. We have then given the most careful consideration to whether suspension would be a sufficient and proportionate sanction in this case, recognising, as we do, the serious impact that a suspension, whether of 12 months or longer, can have on a registrant. We have looked again at the Indicative Sanctions Guidance and taken full account of the allegations proved and the particular factual matrix in this case, as described in our earlier determinations. 15

18 There is an inescapable and fundamental aspect of this case that weighs heavily against the imposition of a period of suspension of whatever length and even of the sort contemplated in HK v General Pharmaceutical Council. The Council has contended more than once that the findings of fact we have made are of the utmost seriousness for a pharmacy professional. This is a contention which is wholly justifiable, because the abuse of trust necessarily entailed is serious enough, but the wanton disregard for the basic system for control of medicines, as well as for what harm they might do to others, strikes at the very heart of the caring and patientfocused ethos of the pharmacy profession. With that in mind, the misconduct of Mr Thakrar is justifiably categorised as fundamentally incompatible with continued registration and removal is both necessary and proportionate in order to protect the public. Moreover, the public and the profession would frankly be appalled, and rightly so, if serious misconduct of this sort were not met with the strongest possible response by the regulator. In those circumstances, we have concluded that public confidence in the profession, as well as the upholding of proper standards of conduct and behaviour within the profession, would be materially diminished if we were not to direct Mr Thakrar s removal from the register. Therefore that is the necessary and proportionate sanction that we impose. MISS BRUCE: Sir, would you hear me on an immediate order? THE CHAIRMAN: Yes, of course. MISS BRUCE: Sir, there is also an interim order in place that would need to be revoked, an interim order of suspension. THE CHAIRMAN: We so revoke. MISS BRUCE: Sir, in relation to an immediate order, you found that all three limbs of the public interest are engaged. You will be particularly concerned that patients may be put at risk if Mr Thakrar is able to practise during the 28-day appeal period and beyond if he appeals your decision. For those reasons, and bearing in mind the observations you have made at each and every stage of this hearing, may I ask you to impose interim measures for suspension? DETERMINATION ON INTERIM MEASURES 16

19 THE CHAIRMAN: Of course, as we must, we have given this some prior thought in light of our final sanction determination. Your submission has done nothing but reinforce the views that we had provisionally come to. It seems to us that to do anything other than to impose an interim measure of suspension at this stage would be wholly incompatible with the very specific and strong findings that we have made in relation to Mr Thakrar s misconduct. That is particularly so in light of the fact that this is a repeat offence, so to speak, and the fact that this is not a man of previous good character before this Committee. Miss Bruce, can I thank you very much indeed for your assistance? That ends the formal hearing. (The Committee adjourned at 5.40 p.m.) 17