Probing the hand that Doles Out

Armed with a doctor’s prescription we go to a pharmacy to buy drugs. But do we for one moment stop and think, is this a registered pharmacy and are the pharmacists qualified to dispense drugs?

Kumudini Hettiarachchi, Dhananjani Silva, Tahnee Hopman and Namali Premawardhana report, Pic by Sanka Vidanagama

What is the expectation of a mother or a father of a sick child who submits a prescription from a doctor to a pharmacy in any part of the country? Dispensation of the prescribed drugs by a qualified pharmacist.

But what of the ground situation not even in a village off the beaten track but in several areas quite close to the capital? Drugs being dispensed by so-called pharmacists who are unqualified or hardly qualified, without the direction of a Registered Pharmacist, without whom no pharmacy can seek to do business.

Of 40 pharmacies visited by The Sunday Times, in a major investigation carried out early last week, half or 20 did not have the Registered Pharmacist present at that time. However, people employed in those pharmacies were dispensing drugs.

In seven pharmacies sans the Registered Pharmacist there were no qualified employees to handle the dispensation of drugs while in the others although employees claimed they had undergone a course, they were unable to produce any documentation to back up their claim.

To aggravate matters, when the Registration Certificate of the pharmacy and the Registration Certificate of the pharmacist were requested, numerous were the excuses including “we are too busy”. Six pharmacies came out with outright refusals while five pharmacies which said they were awaiting renewal of their registrations produced old Registration Certificates.

The law is very clear, The Sunday Times understands, from the Sri Lanka Medical Council (SLMC) which issues registrations not only to all qualified doctors but also all qualified pharmacists.

Pointing to a large tome where all the names of the Registered Pharmacists are meticulously recorded since the Sri Lanka Medical Ordinance came into being, SLMC Registrar Dr. N.J. Nonis says there are two types of pharmacists – internal and external.

Under the ‘internal’ category, the Health Ministry recruits trainees, who undergo a training period and then sit the Pharmacists’ Examination. After they pass the exam they are issued a Certificate of Proficiency with which they seek registration from the SLMC. The details are entered into the big book and they are allocated numbers and issued Registration Certificates. These are the ‘internal’ pharmacists who are thereafter employed within the state hospitals, The Sunday Times learns.

The other category of ‘external’ pharmacists follows a different route but also end up with a number and Registration Certificate issued by the SLMC. “People who have the right qualifications can register as ‘apprentice’ pharmacists to work under a Registered Pharmacist,” says Dr. Nonis explaining that each Registered Pharmacist can have only a maximum of six ‘apprentices’.

These apprentice pharmacists have to work two years under the Registered Pharmacist, after which they sit the Pharmacists’ Examination, pass that, get a Certificate of Efficiency and then gain their registration, it is learnt.

The basic qualifications required to become an apprentice pharmacist are three Advanced Level passes with chemistry as a compulsory subject in the Science stream (with the other subjects being physics, pure mathematics, biology or agriculture) and a credit pass in English at the Ordinary Level examination.

The Pharmacists’ Examination is conducted by the Ceylon Medical College Council which has the Director-General of Health presiding at its meetings and about 10-12 members comprising professors from the medical field as well as nominees of the Health Minister.

The others who can seek registration as pharmacists are those who have a Degree in Pharmacy (B.Sc.) from a Sri Lankan university and any AMP (Assistant Medical Practitioner) or Estate Apothecary after many years of experience and a service letter of eligibility from the Health Ministry.

If a person has qualified as a pharmacist, outside Sri Lanka, then the Ceylon Medical College Council evaluates his/her qualifications and training, after which he/she has to sit a special examination before being issued a registration number.“No medical practitioner can get registered as a pharmacist,” says Dr. Nonis, because you cannot be doctor and pharmacist at the same time.

When The Sunday Times met Dr. Nonis last Tuesday, the SLMC Pharmacists’ Register had 6,422 Registered Pharmacists while 19,256 apprentice pharmacists had been issued preliminary documentation.

All these registrations were from 1929. Some may have died and others may have gone abroad while some of the apprentices would have gained full registration, it is understood.

The Director of the Medical Technology and Supplies Division (the drug regulatory authority), Dr. Dhammika Jayalath says many checks are carried out before registration is issued.

“Firstly, whoever hopes to open a pharmacy should get a business registration from the local body (Pradeshiya Sabha, Urban Council or Municipal Council) and come along with that to finalize the registration process,” she says adding that the potential pharmacy owner would also have to sign an agreement with a Registered Pharmacist as no pharmacy is allowed to operate without a Registered Pharmacist.

“Then food and drug inspectors in the area visit the premises to check out whether it is suitable to operate a pharmacy,” says Dr. Jayalath, adding that thereafter the Regional Director of Health Service (RDHS) of the area will be informed who in turn has to send a recommendation to the drug authority. “Finally, the pharmacist and the owner are called for an interview at the drug authority where the background of the pharmacist is assessed before the pharmacy registration is issued.”

Once the registration is complete, it is mandatory that the pharmacy displays in a prominent place, the Registration Certificate bearing all details, The Sunday Times learns, with the public having the liberty and the right to scrutinise it.

“It is both the right and the responsibility of the public to check whether they are being served at a Registered Pharmacy by a Registered Pharmacist,” she stresses.

Each year pharmacies need to renew their registrations, says Dr. Jayalath, adding that not only food and drug inspectors but flying squads keep checks on pharmacies.

The law is in place and the mechanisms to ensure the law is implemented are in place. But the patients still seem to be at the mercy of unqualified people who stand behind pharmacy counters without the supervision of Registered Pharmacists.

What most patients wonder is whether the “cure” being doled out by these so-called pharmacists could become deadlier than the illness.

Complaints with regard to any pharmacy or drug may be lodged with the Medical Technology and Supplies Division, urges Director Dr. Dhammika Jayalath. The public may make such complaints on phone: 011-2676498.

Meanwhile, complaints against Registered Pharmacists are entertained by the SLMC. Explaining that the SLMC has no authority over unregistered people dispensing drugs, Dr. N.J. Nonis said that any problem with a Registered Pharmacist such as dispensation of the wrong drug may be sent to the SLMC.

Here are three instances among numerous others how reputed registered pharmacies have given the wrong drugs. “My father recently submitted a prescription written very clearly for methylphenidate to a pharmacy run by a chain in the heart of Colombo. After much searching and delay, the ‘pharmacist’ produced a drug, the price of which was way below the amount usually paid by us,” said a youth.

On suspicion, his father asked the ‘pharmacist’ what the drug was for, to be told that it was for a skin rash. But his father knew that the prescription written by a Consultant Psychiatrist was not for a skin condition but for Attention Deficit Hyperactivity Disorder.

Perturbed, the youth’s father called for the senior person, showed him the prescription and also the drugs. “Sorry, we don’t have this drug. The other pharmacist has mixed up the medication,” came the answer.

In a different area, an elderly woman suffering from Parkinson’s disease took her prescription to a leading supermarket, purchased the medication and filed the prescription carefully. Having taken the first set of tablets, she continued to buy the drug based on the name printed on the foil of the tablets she had bought. Soon she developed a craving for sweet food, which was unusual in her case.

Her son then compared the name on the foil to that on the prescription, to find to his horror that the names did not tally. When confronted, the pharmacist’s reply had been that the drug that had been issued earlier was not for Parkinson’s but to control diabetes.

The scariest of all, which The Sunday Times learns, is of a four-year-old girl for whom the drug Bricanil was prescribed as treatment for wheezing. Her mother submitted the prescription to a registered pharmacy, where the drug was dispensed with the dosage being given as 11/2 tablets twice a day.

Dutifully, in keeping with the instructions of the pharmacist, the mother gave the little girl three doses of one and a half tablets each. The result was that the child began to tremble and quiver.

On checking the prescription and the dosage once again, the mother found that the pharmacist had mistaken the ‘L’ in Bricanil for 1 and written a dosage way above that given to a child. The usual dosage is half a tablet.