A recent hearing tribunal issued its written decisions on the merit and orders regarding the conduct of three pharmacists who acted as licensees at two pharmacies, both operated by the same owner and proprietor. The tribunal found that the pharmacists all received substantial personal benefits, in the form of “rebates” or “gifts” from generic pharmaceutical manufacturers, which they were not entitled to. The pharmacists did not report these benefits to their employer or to the Canadian Revenue Agency (CRA). Furthermore, these benefits were received in a perceivably clandestine manner, specifically pre-paid family vacations and substantial values of gift cards and pre-paid credit cards delivered to their homes.
The pharmacists’ assumption that the employer both knew of and accepted their receipt of these “gifts” was later found to be incorrect. Although the hearing tribunal found that the pharmacists did not appear to be actively concealing their conduct from their employer, they breached their ethical duties as pharmacists by not taking the initiative to report the rebates. Furthermore, the tribunal did not find evidence of any clinical risk to patients resulting from the pharmacist receiving substantial personal rebates. In failing to make a systematic record of the rebates and neglecting to report them to the CRA, these pharmacists harmed the integrity of the profession and eroded public trust.
Honesty and integrity are core values of the profession of pharmacy and these principles are set out in the ACP Code of Ethics. All members must conduct themselves within both the spirit and letter of it. The Hearing Tribunal finds that the conduct in this case is serious. It is a breach of the ACP Code of Ethics and it undermines the integrity of the profession. The lack of transparency with the investigated member’s employer and the failure to report the substantial personal benefits or keep any records does not comply with the spirit of the Code as it relates to honesty and integrity.
While the personal benefits received by [the pharmacists] did not compromise [their] professional independence or judgement in terms of patient care, there is a significant issue, in the eye of the public, of potential and perceived compromise of professional independence, judgment or integrity, especially with the substantial values involved, the perceivably clandestine manner of the rebates, and the fact that the [pharmacists] received these rebates on drug purchases that were paid by [their] employer.
All pharmacists are expected to conduct themselves honestly and with integrity. The lack of transparency and failure to report substantial personal benefits in this case undermines the integrity of the profession.
The tribunal also stated:
It must be mentioned that rebates in themselves are not illegal or unethical and previously, before being drastically reduced, were common and the normal part of commercial terms of pharmacy businesses. The distinction in this case is that rebates belonged to the owner of the pharmacy, not to [the pharmacists], but they were personally received and used by [the pharmacists] without reporting to [their] employer or to the Canada Revenue Agency as income.
Licensees, pharmacists, and pharmacy technicians – incorporate these lessons into your practice:
- Review and discuss your ethical obligations with your pharmacy owner/proprietor, co-workers, and other pharmacy colleagues.
- Review, understand, and comply with both the letter and the spirit of the Code of Ethics. Particular focus on Principle 10 is especially relevant in this matter.
- Don’t assume, especially when considering accepting substantial rebates or gifts from suppliers. Ensure that any rebates or gifts not only comply with: all your ethical responsibilities, the standards for practice, third party insurer agreements, your employer policies, and CRA requirements…
- …but that all rebates and gifts do not harm the integrity of the professions and would not be seen by the public as harming the integrity. When in doubt, ask.
- Be open and transparent in your business dealings as a pharmacist or a pharmacy technician. Openness and transparency are foundational to the trust the public instills upon pharmacy as a self-regulating profession.
Create and maintain proper records for your pharmacy, such as those for the receipt and disbursement of rebates.