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Pharmacist struck off after leaving technician in charge of pharmacy

Oluyomi Olugbenga Adenaike (2037153) had not faced fitness-to-practise proceedings before
Oluyomi Olugbenga Adenaike (2037153) had not faced fitness-to-practise proceedings before

A contractor who recorded a technician as the responsible pharmacist on three occasions and ran an online pharmacy with “multiple failures of governance” has been struck off.

Oluyomi Olugbenga Adenaike, registration number 2037153, left either a pharmacy technician or the pharmacy's director in charge of the premises on “at least five occasions”, the General Pharmaceutical Council’s (GPhC) fitness-to-practise committee concluded at a hearing on December 14, 2018.

The GPhC noted that Mr Adenaike – who had been a registered pharmacist for 28 years – was likely to have been impacted negatively by his wife leaving his online pharmacy business and that no previous fitness-to-practise findings had been made against him.

However, it stressed that Mr Adenaike – who did not attend the hearing – had “persistently exposed” patients to harm and showed “no evidence of insight, remorse or remediation”.

No responsible pharmacist

Mr Adenaike was the owner and superintendent pharmacist of Asset Chemist in Tilbury, Essex from February 2015 to February 2016, during which time a pharmacy technician was recorded as being the responsible pharmacist on three occasions and the pharmacy's director on two occasions, the GPhC heard.

The GPhC committee found “it was more likely than not that, on the five occasions…there had been no responsible pharmacist in charge of the business”, despite the registrant denying this.

Mr Adenaike had also failed to ensure that the responsible pharmacist notice was visible during an inspection in February 2016, the GPhC heard. The inspector reported that when she asked where the notice was, Mr Adenaike went to “the far corner behind the counter”, where the notice was “partially obscured by bagged-up medication”.

The regulator noted that Mr Adenaike accepted the notice had not been visible, but said it had been on show earlier that day.

“Repeated poor record keeping”

Mr Adenaike had also “failed to make…any adequate record in the responsible pharmacist log”, including not signing out on “at least 13 instances”, and signing out for the previous day when signing in for the current day in “at least nine instances”, the GPhC heard.

The GPhC said: “The committee was concerned by this repeated poor record keeping by the registrant. It persisted over a long period and cannot be said to be the result of occasional error.”

“A gross abrogation of duties”

The inspector also found Mr Adenaike “failed to secure” Oxycontin in the controlled drugs cabinet, when she saw two boxes of 5mg tablets on the side in the dispensary, the GPhC said. The cabinet's keys were left in the lock, she noted.

“He explained he had opened the controlled drugs register to make an entry and had then been distracted by a telephone call from the district nurse,” the GPhC said. “He apologised for this error and said he appreciated safe storage of controlled drugs is necessary for the protection of the public.”

The registrant said he would usually leave the keys with the pharmacy director – who was not a registered pharmacist – which was “wholly unacceptable and a gross abrogation of the responsible pharmacist’s duties”, the GPhC added.

Asset Chemist also dispensed certain drugs to patients in “excessive” quantities, including amoxicillin, alendronic acid and allopurinol, the GPhC noted.

Online pharmacy failures

The GPhC heard that in addition to his role at Asset Chemist, Mr Adenaike was registered manager and director of Essex-based online pharmacy MD Direct from May 2015 to December 2016.

An inspection by healthcare regulator the Care Quality Commission (CQC) – prompted by an article in the Independent newspaper – in December 2016, revealed that Mr Adenaike had “failed, adequately or at all, to ensure the services [he] provided to patients were safe”, the GPhC said.

The website did not adequately “confirm a patient’s medical history before a prescription was issued”, “verify a patient’s identity, including age”, or “receive and/or manage medical patient safety alerts”, the GPhC said.

Staff “working outside competence”

MD Direct processed its orders with “one or more non-clinical staff…working outside of the scope of their competence”, the GPhC heard. Administrative staff would “refuse an order before it got to the doctor”, with “no policy or process to provide guidance on how these decisions would be made”.

Staff did not have “an adequate understanding” of how to seek a patient’s consent to care and treatment, or how to assess a patient’s capacity to make a decision, the GPhC heard.

“Persistently exposed to risk of harm”

The GPhC acknowledged that the registrant had “made some admissions” to areas of concern raised during the investigation, such as not signing in and out as the responsible pharmacist and the controlled drug errors.

However, it concluded that Mr Adenaike’s “misconduct concerned aspects of…skills, knowledge, character and behaviour”, which “persisted over a long period of time and permeated across many aspects of service provision”.

It stressed that “patients were persistently exposed to the risk of harm”, and ruled to strike him from the register.

Read the full determination here.

What do you make of the GPhC's ruling?

Michael Achiampong, Community pharmacist

Although I cannot for one moment condone the struck-off [or should it be alt-control-deleted pharmacist's repeated acts of omission and comision, they have not helped themselves by not appearing at the hearing in person. 

Of course, the decision could be appealed with a damn good defence lawyer! However, there are many residual learning points for all of us remaining pharmacy registrants.

For example, ensuring that the Responsible Pharmacist Register is legibly signed on AND signed off on a daily basis can be a challenge. May I suggest that each RP entry also records a contact phone number/email address in case issues arise subsequently.

With the daunting prospect of unannounced GPhC visits [for which no GP surgery would stand for] the issue of the CD keys left in the lock will become a bone of contention. Long gone are the halcyon days when it was just one simple key for the CD cabinet. The reality now in practice is that there are multiple CD cabinents with a bunch of multiple keys for each cabinent -and often with double locks. I feel fortunate when there is some sort of colour coding system to help me efficiently identify whch key belongs to a particular cabinent. This issue is particularly relevant if you work in a dispensary with a very high volume of supervised clients who basically show-up at any time "they" seem to want.

 And the fact that we're getting increasing numbers of controlled drugs being prescribed by medical and non-medical prescribers, and CD's therefore being ordered and delivered from multiple suppliers thoughout the working day means that you're practically in and out of the CD cabinet(s) for a considerable amount of time.

A LOCUM, Community pharmacist

totally agree , CD items are a full time job in most pharmacies ,i'm sick of the daily abuse when i crush buprenophine or ask them to drink water after their methadone , but who cares , nobody , but a pharmacist put a foot wrong under extreme pressure,  then bring out the guillotine 

SydBashford Sold&Retired&DeRegistered, Community pharmacist

So who amongst us has never forgotten to sign out of the register at the end of the day?.... clearly a major, serious, incriminating pharmacy event!! REALLY !!!!

A B, Community pharmacist

His individual mistakes on their own were not major but if you read the full determination there sheer volume of times he didn't follow basic procedures makes the judgement correct in my view.

Also, his explanations were clearly made up e.g. the RP sign was visible earlier in the day but had been moved into a non-visible area later on for no reason. Complete rubbish

Interleukin -2, Community pharmacist

Ha hahahhahahahahahahahahahahahahahahahahahahahahaha!

Benie I, Locum pharmacist

This gentleman was simply unlucky. In a few years what he done in 2015 will be perfectly legal. More of a pioneer than a transgressor. I wish him every success in the future.

Interleukin -2, Community pharmacist

it shall be called remote supervision.......

A LOCUM, Community pharmacist

Agree with Gphc decision, always seems to be independants, our morning delivery drivers complain regularly , especially saturdays when there's no pharmacist to sign for CD's , it's always the 'big boys' or as i call them UNTOUCHABLES.

David Moore, Locum pharmacist

What is an unqualified Pharmacist?

James Waldron, Editorial

Hi David,

This is a reference to the pharmacy's director. However, in this specific context the GPhC instead describes the individual as "not at the time a qualified pharmacist".

For consistency's sake I've amended this reference in the article.


James Waldron, C+D Editor

David Moore, Locum pharmacist

Thanks James.

Only two and a half years to resolve. Wow this is progress indeed. 

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