Personal boundaries must be respected – consent must be obtained

A recent hearing tribunal issued its written decision on the merit and orders about the conduct of a pharmacist who was found to have partially removed a patient’s clothing in a private setting to apply cream to her without obtaining her consent and without an authorized purpose. Also, the pharmacist was found to have provided the patient with a Schedule 1 medication without first properly prescribing and dispensing it. In doing so the hearing tribunal found that the pharmacist committed a serious boundary violation and misused his power and authority as a pharmacist, harming the integrity of the profession. The tribunal found that the pharmacist’s conduct was unprofessional and warranted serious sanctions.

The tribunal was also aware that the pharmacist was facing a parallel criminal matter stemming from the same conduct.

In this matter, the tribunal imposed significant penalties, even though there had been no previous history of unprofessional conduct on the part of the registrant and there was only a single occurrence of the offending conduct. The tribunal ordered

• a three-month suspension, with six weeks to begin within 30 days of the Hearing Tribunal’s decision and the remaining six weeks to be held in abeyance, subject to the successful completion of the other orders;
• the completion of an ethics course within nine month
• the registrant be responsible for 70 per cent of the investigation and hearing costs (to a maximum of $45,000); and
• that the following conditions be placed on the registrants practice permit:
  • the pharmacist shall not administer any medication to a patient except for administering a medication by injection, and
  • the pharmacist shall have a female chaperone in attendance during all times when he is in a private setting with a female patient.

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

The following are excerpts from the tribunal’s January 24, 2018, decision on the merits:

With respect to allegation #9 [placing the patient in a closed counseling room and then partially disrobing her and placing hands on her, followed by inappropriate touching and clothing removal without the informed and express consent of the patient], the Hearing Tribunal found that [the pharmacist’s] actions as outlined in allegation #6 [lowered the patient’s leggings and underwear below her buttocks and touching her hips and buttocks without proper notice to, and without obtaining consent, from the patient] and as described in allegation #9 occurred. These actions constituted a serious boundary violation in placing [the patient] in a closed counselling room and then partially disrobing her and placing his hands on her, followed by inappropriate touching and clothing removal without the informed and express consent of [the patient].

The Hearing Tribunal determined that [the pharmacist’s] conduct constituted a serious boundary violation that undermined the integrity of the profession.  

The Standards of Practice establish that pharmacists must act professionally, must establish and maintain appropriate relationships with their patients, and must obtain informed consent before administering a drug to a patient.

Pharmacists are expected to treat patients with dignity and respect.  Pharmacists have been granted a number of privileges and rights.  While they are entitled to administer drugs to patients, they must do so in a manner that is appropriate and respects a patient’s boundaries.  [The pharmacist] administered cream to the patient’s hips and buttocks without obtaining informed consent when there was no clinical reason requiring him to do so.  His actions in doing so clearly fell below the standard expected of members of the pharmacy profession, and clearly constitute unprofessional conduct.

Prior to issuing a prescription, it is the responsibility of the pharmacist with Additional Prescribing Authorization, to ensure when prescribing any Schedule 1 medication that an appropriate assessment is performed and the determination of that assessment is documented in its entirety.

The Hearing Tribunal finds that, conversely, Schedule 1 drugs cannot be prescribed (or administered) unless a prescription has been written.

Unlabeled medications should never be dispensed, even if the amount is small, since there is always a chance that a member of the public will use the medication for an unintended purpose. 

Pharmacists and Pharmacy Technicians – Review your Ethical Duties to our Profession and Yourself

1. Review, understand and comply with all aspects of the pharmacist-patient relationship and discuss your professional and fundamental ethical obligations with your colleagues. Principles 1 to 5 of the ACP Code of Ethics serve as an excellent guide to this discussion.
2. Review, and update as needed, your pharmacy’s patient counselling and medication administration policies and procedures. Consider offering and having present a patient chaperone, a second regulated pharmacy staff member or the patient’s agent when administering medication to a patient, especially for vulnerable individuals.
3. Always obtain the patient’s explicit and informed consent, and have an authorized purpose, BEFORE touching a patient as part of providing a pharmacy service; such as administering a medication.
4. Review and consistently comply with the prescribing and dispensing requirements found in the Standards of Practice for Pharmacists and Pharmacy Technicians. NEVER administer or provide a Schedule 1 medication to a patient without first complying with the applicable standards.