Unregulated pharmacy team members must not be left alone

A recent Hearing Tribunal issued its written decision on the merit and orders regarding the conduct of a pharmacist who was a pharmacy owner and proprietor’s representative during the period of the alleged unprofessional conduct. Central to the allegations were concerns that the pharmacist created a system whereby the pharmacy was, at times, open to the public on Fridays without a pharmacist present and/or unregulated pharmacy staff were in the pharmacy performing pharmacy services and restricted activities without a pharmacist present. In carrying out her responsibilities as the de facto pharmacist in charge, the pharmacist failed to properly supervise the unregulated employees and permitted them to carry out restricted activities without a pharmacist present. These activities included

• preparing prescriptions,
• providing prepared prescriptions to patients,
• accessing and disclosing health information,
• creating and maintaining patient records, and
• securing drugs.

The Hearing Tribunal found that through the pharmacist’s actions, the potential for patient harm was created, the integrity of the profession was undermined, and the public’s trust in the profession was decreased. The Hearing Tribunal found the pharmacist’s conduct was unprofessional and, as a proprietor, she had engaged in misconduct.

The Hearing Tribunal also noted that the pharmacist accepted responsibility for her conduct, had no previous findings of unprofessional conduct, complied with the remediation efforts through subsequent ACP audits of the pharmacy, and fully cooperated with the investigation and hearing.

Even though the pharmacist admitted her responsibility for the allegations and acknowledged that she failed to exercise the professional and ethical conduct expected and required of an Alberta pharmacist and proprietor, the Tribunal ordered the following penalties:

• a practice permit suspension for a period of three months, with one month to be served between January 19, 2023, and February 18, 2023, and two months held in abeyance pending her completion of Part A of ACP’s Licensee Education Program (LEP);
• completion of Part A of the LEP by March 19, 2023;
• an order that should she fail to complete the LEP by March 19, 2023, she shall be prohibited from being an owner, proprietor, or licensee of a pharmacy until she completes Part A of the LEP;
• fines totaling of $6,000; and
• a payment of $10,000 towards the costs of the investigation and hearing.

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

[The pharmacist] demonstrated a lack of knowledge, skill, and judgment in the provision of professional services. Her conduct demonstrated a lack of judgment when she allowed the pharmacy to operate in breach of the requirements relating to pharmacies, by failing to employ the requisite number of staff with the training and qualifications to provide safe and effective pharmacy services. This was a lack of judgment because it could have put the public at risk due to the lack of appropriate supervision and pharmaceutical knowledge during the hours when a pharmacist was not present. In addition, there was a failure of supervision of the pharmacy’s unregulated employees, including the allowance of carrying out restricted activities, which demonstrated a clear lack of knowledge and/or judgment.

Owners, proprietors, and licensees – incorporate these lessons into your operation of pharmacies:

1. Unregulated pharmacy employees must not be allowed in the pharmacy, without a regulated pharmacy professional in attendance.
2. Don’t let your professional judgement to be impaired by commercial benefits.
3. Review the Pharmacy and Drug Act and the Standards for the Operation of Licensed Pharmacies (SOLP) with regard to your responsibilities when operating a pharmacy. Relevant sections and standards can be found in the Hearing Tribunal’s written decision.
4. Review the training and supervision requirements found in the SOLP and Standards of Practice for Pharmacists and Pharmacy Technicians. Ensure that unregulated employees are always properly supervised. Unregulated employees cannot perform restricted activities and must be supervised directly when supporting pharmacists and pharmacy technicians in providing restricted activities.
5. Review and consider your ethical responsibilities outlined in Principles 1, 7, and 10 of the Code of Ethics. Always hold the best interests of your patients to be your primary concern and take all appropriate steps to ensure the actions of your unregulated staff do not interfere with these requirements.
6. Complete Parts A and B of the ACP Licensee Education Program (LEP) to learn more about the duties and responsibilities of a licensee and proprietor.
7. Ensure that only authorized individuals can access the pharmacy information systems and drugs.