COMMONWEALTH OF MASSACHUSETIS

SUFFOLK COUNTY   	BOARD OF REGISTRATION 
IN PHARMACY
___________________________                                            
					
In the Matter of			
Mark Steven Elfman, R.Ph.		
Pharmacist Registration No. 17929  	
______________________________

Docket No. PHA-2011-0250

CONSENT AGREEMENT

The Board of Registration in Pharmacy ("Board") and Mark Steven Elfman, R.Ph. ("Registrant"), a pharmacist registered by the Board (Pharmacist Registration No. 17929), do hereby stipulate and agree that the following information shall be entered into and become a permanent part of the file of the Registrant which is maintained by the Board:

1.	The parties enter into this Consent Agreement ("Agreement") to resolve that certain complaint pending against the Registrant as Docket No. PHA-2011-0250 (the "Complaint").

2.     The Complaint alleged that on or about February 22, 2011, while employed at Cape Cod  
        Home Infusion Services (Pharmacy Registration No. 3591), located at 111B County Road in 
        North Falmouth, Massachusetts, Registrant compounded and dispensed a 1300 m1
        intravenous solution containing Dextrose 7.7% and 1000 meq of sodium chloride rather than 
        Dextrose 10% and 77 meq of sodium chloride for a 2 ½ year old patient.

'
3.    Accordingly, Registrant freely agrees to the following:

a. 	That Registrant's conduct described in Paragraph 2 constitutes grounds for disciplinary action by the Board, pursuant to G.L. c. 112, §§ 42A and 61 and 247 CMR 9.01(1) and 10.03 (1)(a)(k);

b.	Registrant's Massachusetts Pharmacist Registration is hereby REPRIMANDED
by the Board for Registrant's conduct in this matter;

c.	      Within thirty (30) days of the Effective Date of the Agreement, Registrant shall   
            complete two (2) hours of continuing education (CE) related to medication error 
            prevention topics and submit the ORIGINAL CE certificates of completion to the 
            Board along with a copy of the Agreement;

d.	Within thirty (30) days of the Effective Date of the Agreement, Registrant shall file a Medication Error Report with the Institute for Safe Medication Practices (https://www.ismp.org/orderforms/reporterrortoiSMP.asp) and submit a copy of the report to the Board along with a copy of the Agreement;

e.	Within thirty (30) days of the Effective Date of the Agreement, Registrant shall complete a USP 797 course in sterile compounding; and
	
f.	Registrant shall return a signed copy of the Agreement to the Board within ten
(10) days of receipt.

4.	The Agreement and its contents shall become a part of the records maintained by the Board, and as such, are public records subject to disclosure to the public, other licensing boards, and the National Association of Boards of Pharmacy.

5.     The Board agrees that in return for Registrant's execution of this Agreement, and   
        compliance with the terms and conditions set forth in Paragraph 3, the Board will not 
        advance the prosecution of Registrant pursuant to the Complaint; any and all other rights of 
        the Board to take action within the scope of its authority are expressly reserved.

6.     Registrant understands and agrees that the failure to abide by the terms of the Agreement 
        shall nullify the representations contained in Paragraph 5 and permit the Board to initiate 
        formal adjudicatory action under the State Administrative Procedure Act (G.L. c. 30A) and 
        801 CMR 1.00 et. seq.

7.     Registrant understands and agrees that the decision to enter into the Agreement and to 
        accept the terms and conditions herein described is a final act and is not subject to 
        reconsideration or judicial review.

8.     Registrant states that Registrant has used legal counsel in connection with the decision to 
enter into this Agreement or, if Registrant did not, that an opportunity to do so was provided 
and that the decision to enter into this Agreement was freely made by Registrant.

9.    The Registrant understands that, by executing this Agreement, Registrant is waiving all 
       rights to a formal hearing at which time Registrant would possess the right to confront and
       cross-examine witnesses, to call witnesses, to present evidence, to testify on his own behalf,
       to contest the allegations, to present oral argument, to appeal to the court in the event of an
       adverse ruling, and all other rights set forth in the State Administrative Procedure Act, G.L.      
       30A, and the Standard Adjudicatory Rules of Practice and Procedure 801 CMR 1.01 et seq.

       							Mark Steven Elfman, R. Ph.
       							Date: 3/19/12

							
							Board of Registration in Pharmacy
							Michael J. Tocco, R. Ph.
							President
							Effective Date: 3/26/12

       Decision No. 2778