A General Pharmaceutical Council (GPhC) investigation regarding an epilepsy patient who died after he was unable to obtain his medication is now “open”, the regulator has announced.
In January, coroner Kevin McLoughlin found that David Crompton, aged 44, died when he was left without anti-epileptic medication Tegretol and instead “left a manuscript ‘IOU’” by his pharmacy.
In a response to McLoughlin sent last week (February 26), the pharmacy regulator said that it had inspected the “particular pharmacy” involved in the case.
Read more: Patient dies after pharmacy ‘unable to supply’ epilepsy meds for 10 days
While the inspection report is yet to be published, the GPhC said that its inspections found that “the pharmacy has robust processes in place to manage out-of-stock medicines, including for Tegretol”.
But the GPhC added that it has also “opened an investigation into the concerns raised” in the coroner’s report.
Read more: ‘Urgent review’ of epilepsy medicine shortages needed, say group of MPs
“The initial assessment of this case is complete and an investigation is open” with the GPhC’s fitness-to-practise (FtP) team, it said.
“The case has been allocated to a case officer who will consider the findings of the GPhC inspection and whether any further evidence is required,” it added.
“Once the investigation is complete, we will assess the evidence in line with our threshold criteria to determine whether further action against the individual pharmacist is required,” it said.
Emergency decisions standards?
In his report, McLoughlin stressed that “it is important that when anti-epileptic medication is prescribed by a GP that this is obtained and supplied promptly by the dispensing pharmacy”.
“Comment was made at the inquest to the effect that the pharmaceutical profession should have clear designated systems to deal with any shortages of supply encountered,” he said.
Read more: Student died after systemic failure to supply epilepsy drug
This could include “reference to hospital departments to ensure patients are not left without important medications”, he added.
In its response, the GPhC said that its “standards require pharmacy professionals to deliver patient-centred care, which includes making the care of the patient their first concern and using their judgement to make professional decisions”.
“This may include making decisions about providing medication in an emergency,” it added.
Shortage tragedies
Last week, some 45 MPs signed a letter calling on health secretary Wes Streeting to commission an “urgent review into the ongoing shortage of vital medications across the country”.
In January, another coroner found that a student died of sudden unexpected death in epilepsy (SUDEP) “likely contributed to by his lack of medication despite his efforts to obtain it over the course of two days”.
At the time, the coroner said that his pharmacy “should have sought to find a solution” when it “could not” supply him with the life-saving medication.
Read more: Pharmacist unable to prevent Costa allergy death due to EpiPen shortage
Meanwhile in August, a coroner found that a “national shortage” of EpiPens meant that a pharmacist could not prevent the death of 13-year-old Hannah Jacobs.
Jacobs was “incorrectly” served a “dairy hot chocolate at Costa Coffee Barking despite her mother informing staff of a dairy allergy” on her way to a dentist appointment.
