Providing care to an employee or co-worker can be complicated

A recent Hearing Tribunal issued its written decision on the merit and orders about the conduct of a pharmacist who was found to have disclosed a single patient’s health information in a manner that was neither private nor confidential, after the patient expressly asked that it not be disclosed. The patient was an employee of the pharmacist, and the health information was disclosed by the pharmacist in the presence of the patient and the patient’s co-worker. The unauthorized and unconsented disclosure occurred on a single occasion in the pharmacy. The Hearing Tribunal found that the pharmacist misused his authority as a health information custodian and pharmacist. Although the concerns flowed from a single incident, involving a single patient, the Hearing Tribunal found that the pharmacist’s conduct was unprofessional and warranted sanctions.

The requirement for registrants to properly collect, use, disclose, and safeguard patients’ health information is foundational to the relationship between pharmacy professionals and patients. When health information is disclosed for an unauthorized purpose, this relationship is eroded, as is the integrity of the profession.

Particular care and consideration should be given by pharmacy professionals in deciding how, or if, to enter into professional care relationships with employees and provide them with professional services. It is crucial that a pharmacy professional be objective when providing a service to a patient; this may be difficult to maintain if the patient is an employee or co-worker of the pharmacy professional providing the service.

Even though there had been no previous history of unprofessional conduct on the part of the pharmacist and the conduct arose from a single incident, the Tribunal ordered the following penalties:

• a reprimand;
• fines totalling $700;
• the completion of an ethics course, at the pharmacist’s own cost and within six months, with a corresponding order that should he not provide evidence of completion, that he be suspended until he unconditionally passes the course;
• an order that the pharmacist must disclose the Hearing Tribunal’s written decision to any pharmacy employer or licensee for a period of two years; and
• payment of 50 per cent of the costs of the investigation and hearing (50 per cent of $78,225).

Rationale for the Tribunal’s decision is reflected in its following statements:

• The Hearing Tribunal holds that a reasonable pharmacist would and ought to interpret a patient who says, “please don’t” to expressly mean “no” and to respect a competent patient’s wishes in this respect in accordance with Principle 2.5 of the Code of Ethics. In any case of ambiguity over consent, the onus is on the pharmacist, as the regulated healthcare professional in a position of trust, to clarify and ascertain consent.
• In the context of the evidence before the Hearing Tribunal, there is no justifiable reason why this [disclosing the patient’s health information in a setting with her coworker present] was not or could not have been done in a private and confidential setting, befitting the nature of personal health information. This is a clear contravention of Principle 4.6 of the Code of Ethics, requiring a pharmacist to protect a patient’s privacy during a consultation, which would extend to disclosure of such sensitive personal information as in this case, especially when not requested. 
• Pharmacists are entrusted by society and patients with access to personal health information.  This information is sacrosanct, and its collection, use, and disclosure is protected by statutory and regulatory duties. Beyond these prescribed duties, pharmacists are bound by a covenant of trust with patients and society for the great responsibility entrusted to them with access to patients’ personal health information. Breaking this trust brings disrepute to the profession and harms the ability for the profession to self-regulate.

Pharmacists and pharmacy technicians – review your ethical duties to your patients, your profession, and yourself

1. Review, understand, and comply with all aspects of your responsibilities when collecting, using, and disclosing personal health information, and the steps you should take to safeguard it. Excellent information about these responsibilities can be found on the ACP website in the Resource section. The publication Helping pharmacists and pharmacy technicians understand the Health Information Act may be particularly informative.
2. Understand that a foundational tenet in handling health information is to collect, use, and disclose the least amount of information necessary to accomplish the authorized task.
3. Visit the Office of the Information and Privacy Commissioner (OIPC) website. In addition to health information resources, this website also provides summaries of recent OIPC investigations and decisions involving health information.
4. Consider when and how it is appropriate to establish and maintain a professional relationship with a patient who is also an employee or co-worker. Pharmacy professionals need to maintain objectivity and a full adherence to the legislative framework when providing professional services to a patient. This objectivity and compliance may be more difficult to maintain if the patient is also an employee or co-worker of the pharmacy professional.
5. Discuss the proper disclosure of health information with your peers.
6. Review, and update as needed, your pharmacy’s health information policies and procedures.
7. Review and discuss with peers your fundamental ethical obligations. Principles 2, 4, and 10 of the Code of Ethics will provide you with valuable guidance in this respect.