July • August 2003 - Ontario College of Pharmacists

COMPLAINTS
Reasons
The Complaints Committee reviewed
the transaction records and determined
that the member had violated
his pharmacy’s standing protocol with
the insurer by repeatedly submitting
the patient’s prescription (despite the
system’s failure to accept the transaction).
The Committee appreciated the
member’s willingness and intent to
promptly fill the patient’s prescriptions;
there were; however, there were
more appropriate courses of action
available to the pharmacist. The pharmacist
could have:
• Dispensed the medication as a
cash purchase to the patient,
knowing that the patient could
be reimbursed once he proved
that he was insured; or
• Paused to phone the insurer to
verify whether there was indeed
a “glitch” in the system records
that failed to note that the
patient was covered
The Committee did not consider
this to be a situation where the pharmacist
was exercising his
“professional judgment” to override
the system because the member has
no discretionary permission to alter
third party records or billings.
It was highly inappropriate for the
member to alter a record to force a
transaction that would override an
adjudication system.
And, while the member’s motive
may have been to accommodate his
patient, his actions led to intentional
and repeated re-submissions despite
the computer system indicating
“claimant not covered”.
Decision
Although the Committee concluded
that the member had acted inappropriately,
it struggled to determine a
suitable disposition. Indeed, is
referral to the Discipline Committee
the only appropriate remediation for
the member’s behaviour?
After much discussion, the
Committee decided that referral to
the Discipline Committee would be
inappropriate and that the member’s
breach of the Standards of Practice
would be appropriately addressed
with the issuance of a written
caution, which read:
“As a practising pharmacist, you
must maintain the standards of
your profession and remain in
compliance with the relevant
legislation. While the Committee
appreciates that you may have
been attempting to accommodate
your patient, you are cautioned
that you are expected to fulfill
your obligations to your patient
without violating protocol and the
standards of your profession, and
are reminded here particularly of
Standard 6 which reads:
‘The pharmacist applies knowledge,
principles and skills of
management as they pertain to the
site of pharmacy practice, with the
goal of optimizing patient care and
inter-professional relations.’ ”
The Committee was of the
opinion that another such incident
was unlikely to occur in this
member’s practice given: this was a
single incident involving a minor
amount of money for a patient who
became insured within 4 days of the
transaction; the member had no
intent to mislead, and he provided a
forthright response to the
Committee.
Nonetheless, although this
complaint did not reveal any evidence
of fraud by the member or the pharmacy,
the College’s investigation did
confirm that the third-party insurer
should not have been billed and that
the member had violated his pharmacy’s
agreement with the insurer.
The Committee therefore determined
that a written caution
adequately addresses the public
interest raised in this complaint. The
caution will remain on the member’s
record in the non-public portion of
the Register.
WHAT IS A WRITTEN
CAUTION?
A written caution is often issued by
the Complaints Committee as an
appropriate remedial measure for
serious matters where a referral to
the Discipline Committee would not
be appropriate. Although the member
identified in a complaint is not
required to appear before the
Complaints Committee for his/her
“caution”, the caution is included
in the Committee’s written decision,
thereby sent to the complainant as
well as the member. It is also permanently
placed on the member’s
non-public portion of the Register.
Although it is not considered punitive,
the caution may be considered
should the member appear before
the Committee for a new complaint.
Pharmacy Connection July • August 2003 29