Providing professional services to family is only appropriate in exceptional circumstances

A recent Hearing Tribunal issued its written decisions on the merits and sanctions regarding a pharmacist who was also the pharmacy’s licensee during the period of the alleged unprofessional conduct. Central to the allegations were concerns that the pharmacist dispensed medications to his family members that were not for minor conditions, required in an emergency, or when another prescriber was not readily available. It was also alleged that the pharmacist had dispensed medications to his patients prior to obtaining the original prescriptions.

The Hearing Tribunal found that the pharmacist acted unethically and inappropriately when he dispensed medications to family members outside of the limited exceptions allowed in the Alberta College of Pharmacy’s (ACP) Code of Ethics. Also, the panel confirmed that a pharmacist must obtain the original prescription prior to dispensing a medication to their patient. A texted prescription photo sent by the patient, with the expectation of the original prescription being provided at a later date, is not sufficient to authorize a pharmacist to dispense a medication. In doing so, 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 a pharmacist and pharmacy licensee, his actions undermined the integrity of the profession, and warranted sanctions.

The Tribunal also noted that the pharmacist fully cooperated in the investigation and hearing process, took responsibility for—and admitted to—his conduct, had no prior findings of unprofessional conduct or misconduct, and there was no evidence of harm to patients.

In this matter, the Tribunal imposed educational and remedial sanctions. The Tribunal ordered the pharmacist to

• receive an unconditional pass of the Center for Personalized Education for Professionals (CPEP) Probe Course within six months of its decision,
• successfully pass ACP’s Ethics and Jurisprudence Exam within six months of its decision,
• not be a preceptor until he has completed the two above bulleted orders,
• provide a copy of its decision to any pharmacy employer or licensee of a pharmacy in which he applies to work, or works as a pharmacist, for a period of three years, and
• pay $5,000 towards the costs of the investigation and hearing.

Rationale for the Tribunal’s decision is reflected in the following statements from its January 22, 2024, decision:

The Hearing Tribunal felt the behaviour that was demonstrated by [the pharmacist] in Allegation 3 [pertaining to dispensing to family members] is fraught with considerable risk, especially with no supporting documentation for the decisions he made.

… … …

The Standards of Practice require pharmacists to obtain original prescriptions before dispensing medication. This is critical to allow a pharmacist to properly assess whether the prescription is current, authentic, complete, and appropriate.

… … …

The Hearing Tribunal found that [the pharmacist’s] approach was, at best, sloppy and illustrated the risk in providing pharmacy services to family members even in circumstances where an exemption under Principles 3(4) of the Code of Ethics may apply.

Incorporate these lessons into your practice

1. Review, consider, and understand your ethical responsibilities outlined in Principle 3, guideline 4 of the Code of Ethics. Providing treatments, such as prescribing, dispensing, or injecting, for yourself or family must only occur within the very limited exceptions outlined in the Code.
2. Recognize ACP’s definition of “emergency,” as stated in the Standards of Practice for Pharmacists and Pharmacy Technicians, is very narrow and limited. Patient convenience does not equate to an emergency circumstance.
3. 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 cannot provide them objective and appropriate care.
4. It is not acceptable to prepare a prescription in advance of obtaining an original prescription based on being provided an image to the pharmacy by text, email, or mobile app, or the patient reading a prescription over the phone or faxing a copy to the pharmacy. Based on such requests, regulated members are permitted to check their inventory to see if stock is available or confirm if a drug is covered by a third party payer; but the original prescription must be first obtained before a pharmacist can conduct an assessment or before a regulated member can create a patient record, enter information into Netcare, or dispense the medication. Refer to the ACP Link article: Transmission of prescriptions.
5. Ensure that all required pharmacy records are created, maintained, and can be retrieved in an efficient, systematic manner. 
6. Review the Pharmacy and Drug Act and the Standards for the Operation of Licensed Pharmacies with regard to your responsibilities when operating a pharmacy.
7. Complete Parts A and B of the ACP Licensee Education Program (LEP) to learn more about the duties and responsibilities of a licensee.