A Hearing Tribunal issued its written decision on the merits and sanctions regarding the conduct of a pharmacist who admitted to
- changing the dosage or dispensing of methadone prescriptions without advising the prescriber or seeking the prescriber’s authorization,
- creating or allowing the creation of false pharmacy and Netcare records,
- prescribing benzodiazepines without documentation, and
- extending methadone prescriptions inappropriately and without authorization.
In addition, the pharmacist, who was also the pharmacy owner and licensee, admitted to engaging in or permitting a practice where pharmacy staff did not report missed doses of methadone to patients’ prescribers and did not create required and fulsome methadone administration records.
The pharmacist’s actions were determined by the Hearing Tribunal to be acts of unprofessional conduct under the Health Professions Act.
In this matter, the Tribunal imposed significant penalties, even though the pharmacist admitted his conduct, the pharmacist took responsibility for his actions, he had demonstrated rehabilitative potential, there had been no previous history of unprofessional conduct, and there was no evidence of actual harm being done, even though the potential for harm existed. The Tribunal ordered the pharmacist
- Receive a reprimand.
- Successfully complete the Centre for Personalized Education for Professionals PROBE course on ethics and boundaries within six months. If not completed, his practice permit shall be suspended until such time as he receives an unconditional pass (Order 2).
- Successfully complete the College’s Practice Improvement Program (Order 3).
- Successfully complete the College’s Ethics and Jurisprudence Exam (Order 4).
- To have his Additional Prescribing Authorization (“APA”) suspended until such time as Orders 2, 3, and 4 are complete.
- To have his practice permit reflect his enrollment in the College’s Practice Improvement Program (PIP) until such time as the PIP Order is complete.
- To have his practice permit reflect a condition that he cannot be a licensee until such time as Orders 2, 3, and 4 are complete.
- For a period of five years, to provide a copy of the Hearing Tribunal’s decision to any pharmacy employer or licensee of a pharmacy in which he provides professional services.
- To be responsible for payment of $10,000 of the costs of the hearing.
Rationale for the Tribunal’s decision is reflected in its following statements:
The admitted conduct was not a single technical lapse. Across multiple patients, [the pharmacist] altered or continued controlled-substance therapy without the prescriber’s authorization or timely communication, permitted carries or split dosing contrary to prescribed directions, failed to ensure missed doses were reported, and prescribed or extended therapy without documenting the assessments required to support those decisions.
These actions bypassed safeguards that depend on individualized assessment, adherence to the prescriber’s directions, and timely collaboration with the patient’s other health professionals.
In the context of opioid agonist therapy, accurate dosing, witnessed ingestion, complete records, and coordinated care are important safeguards in place to protect a vulnerable patient subgroup. A pharmacist cannot substitute a routine pharmacy practice for the individualized professional assessment and team-based communication required in these higher risk clinical environments
.… … …
The breaches were substantive because the standards and code of ethics operate together as patient-safety safeguards. [The pharmacist] was providing care to OAT patients. It is recognized that this subgroup is at increased risk and the onus is on the pharmacist, not the patient, to ensure that they safeguard the well-being of each patient, especially those that are vulnerable.
Pharmacists and pharmacy technicians – incorporate these lessons when providing pharmacy services:
- Review, understand, and comply with your professional obligations and specific requirements outlined in ACP’s Code of Ethics, Standards of Practice for Pharmacists and Pharmacy Technicians, and Standards for the Operation of Licensed Pharmacies.
- Ensure that all opioid agonist therapy (OAT) services are always provided in complete compliance with ACP’s OAT Guidelines. Do not cut corners. Understand that the duties, responsibilities, and restrictions outlined in the OAT Guidelines exist for the protection of the patient, many of whom are vulnerable.
- Do not allow your personal circumstances to negatively affect your professional obligations.
- Review, discuss with your colleagues, understand, and consistently comply with ACP’s tenets of professionalism.