Licensees must ensure compliance with standards and third-party agreements

A recent Hearing Tribunal issued its written decisions on the merits and orders regarding a pharmacist who was a pharmacy’s owner, proprietor, and licensee during the substantive period of the alleged unprofessional conduct. Central to the allegations considered were concerns that the pharmacist submitted prescription claims to a third-party insurer without being able to provide required records and inappropriately prescribed drugs for himself and his immediate family members.

The Hearing Tribunal found that the pharmacist acted unethically and inappropriately when he prescribed drugs to himself and his family that were not for minor conditions, required in an emergency, or when another prescriber was not readily available. The Tribunal also found the pharmacist failed to provide audited, supporting supplier invoices to the third-party insurer. As a result, the Hearing Tribunal found the pharmacist’s conduct was unprofessional and, as a licensee, he had engaged in misconduct. The Hearing Tribunal found that he failed to demonstrate the ethical conduct and professional judgement required of an Alberta pharmacist and pharmacy licensee, his actions undermined the integrity of the profession, and warranted serious sanctions.

The Tribunal also noted that the pharmacist did not participate in the hearing process and had a previous finding of unprofessional conduct. The committee observed that he did reimburse the third-party insurer the full recoverable amount based on the audit ($13,006.74).

In this matter, the Tribunal imposed the following significant penalties:

• a practice permit suspension for a period of six months;
• fines totalling $20,000;
• revocation of additional prescribing authority;
• prohibition from being an owner, proprietor, or licensee of a pharmacy for a period of five years;
• prior to consideration for reinstatement, the pharmacist must unconditionally pass an ethics course adjudicated by the Centre for Personalized Education for Professionals;
• upon reinstatement to the clinical pharmacist register, the pharmacist must
  • practise under indirect supervision for a minimum of six months, and
  • provide a copy of the written decisions in this matter and his previous Hearing Tribunal matter to any pharmacy employer or licensee of a pharmacy in which he applies to work or works as a pharmacist for five years; and
• a requirement to pay the full cost of the investigation and hearing, totalling $33,500.

The pharmacist voluntarily cancelled his practice permit as of August 15, 2021.

Rationale for the Tribunal’s decision is reflected in its following statements from its October 5, 2022, decision on merits:

As a pharmacy owner and the licensee of a pharmacy, [the pharmacist] was obliged to ensure that the records kept in his Pharmacy were kept in accordance with the Standards for the Operation of Licensed Pharmacies and that he complied with the agreement he had entered into with [the third-party insurer]. 

He should have known that the clinical risk of providing care to family members outweigh the challenges of seeking care from other unbiased care providers. In breaching those responsibilities, [the pharmacist]showed disregard to the foundational standards of professionalism.

Incorporate these lessons into your practice:

1. Review the Pharmacy and Drug Act, the Pharmacy and Drug Regulation, and the Standards for the Operation of Licensed Pharmacies with regard to your responsibilities when operating a pharmacy.
2. Complete Parts A and B of the ACP Licensee Education Program (LEP) to learn more about the duties and responsibilities of a licensee.
3. Review and discuss your obligations and the professional requirements of the pharmacy with your pharmacy’s owner and pharmacy staff to ensure that the pharmacy has the resources needed to meet these obligations.
4. Keep current with the contractual requirements pertinent to your pharmacy’s third-party insurer agreements. Don’t guess when submitting claims for drugs, healthcare products, and pharmacy services.
5. Take responsibility in preparing for, and participating in, third-party insurer audits. Have sufficient staff available to properly respond to the audit requirements in a complete and timely manner.
6. Review and consider your ethical responsibilities outlined in Principles 1, 3, and 10 of the Code of Ethics. Always approach your, and your pharmacy’s, contractual obligations ethically, professionally, and with integrity.
7. Ensure that all required pharmacy records are maintained in an authorized location and can be retrieved in an efficient, systematic manner.
8. Don’t let convenience and expediency outweigh the need to provide your patients with objective and appropriate care. Refer your patients to other healthcare providers when you can not provide them objective and appropriate care.
9. Understand the very limited circumstances in which emergency authorization may allow a pharmacist to prescribe for self and immediate family. The Standards of Practice for Pharmacists and Pharmacy Technicians define an emergency as: “a circumstance where a patient urgently requires a professional service that includes a restricted activity for the purposes of preventing imminent mortality or morbidity.”