Agenda Jurisprudence of Pharmacy

Courtney Campbell, LL.B., LL.M. courtneyc@ocpinfo.com

Health Professions Regulation Register & Protected Titles Code of Ethics Complaints/ Investigation Process Discipline Process Fitness to Practise Process Sexual Abuse Prevention

Who is regulated? Health Professions Regulation

Regulated Health Professions Act, 1991 Profession-specific legislation

Listing Regulated Professions

More Regulated Health Professions

Audiology and Speech-Language Pathology Chiropody Chiropractic Dental Hygiene Dental Technology Dentistry

Denturism Dietetics Massage Therapy Medical Laboratory Technology Medical Radiation Technology Medicine

Midwifery Nursing Occupational Therapy Opticianry Optometry Pharmacy Physiotherapy

Psychology Respiratory Therapy

Soon To Be Self-Regulating (with own College)

Now Part of OCP

Homeopathy Kinesiology Naturopathy Psychotherapy and Registered Mental Health Therapy Traditional Chinese Medicine

Pharmacy Technicians

Mandate of OCP

Implementation of Mandate

To

serve and protect the public interest

Setting entrance to practice requirements Developing standards of practice Assuring continuing quality in the practice of pharmacists, pharmacy technicians and pharmacies Enforcing the standards through investigation and discipline of members

The Register

The Register and Protected Titles

Legislation and by-laws mandate what information the College must keep about members, and what it is allowed to tell the public about members through the register (available on College website)
Current terms & conditions Findings of hearings stay on the public register indefinitely, with very few exceptions Findings of sexual abuse stays on the public register forever

Trend is toward transparency

information should be public unless there is a good reason for it NOT to be (e.g. residence phone numbers)

Protected Titles

pharmacist pharmaceutical chemist apothecary (the person; this is not a protected title for a store) druggist pharmacy technician

Code of Ethics

What is the Code of Ethics?

Why do members need to practice ethically?

A set of principles that form the basis of ethical conduct of members* Provides members with guidance as to how to exercise professional judgment
*Members are defined as pharmacists, registered pharmacy students, interns and pharmacy technicians.

To engender the trust of the public To maintain the reputation of the profession To deliver excellent care To protect the public interest To retain the ability to self govern

Principle One
The patients well-being is at the centre of the members professional and/or business practices.
Patient trusts member to act in patients interest Each member develops professional relationship with each patient (within scope) Patient is encouraged to participate in decisions about his/her health right to selfdetermination

Principle Two
The member exercises professional judgment in the best interest of the patient (consistent with scope of practice) to meet the patients needs.

Principle Three
Each member preserves the confidentiality of information about individual patients acquired in the course of his or her professional practice and does not divulge this information except where authorized by the patient or required by law, or to protect patient or another person from harm.

Confidentiality

Technician leaves computer screen accessible Husband requests copies of wifes records Physician calls to request patients drug history
professional judgment in emergency situations/ circle of care

Patient divulges information about child abuse Police ask questions about a patients medication Police present a warrant for narcotic records for a patient College requests patient records

Personal Health Information Protection Act, 2004

Circle of Care: Permitted Disclosure

applies to the collection, use and disclosure of personal health information by health information custodians as of November 1, 2004 contains specific rules on how health care practitioners may collect, use, retain, disclose and dispose of personal information See website of Information & Privacy Commissioner: www.ipc.on.ca

Circle of Care: Sharing Personal Health Information for Health-Care Purposes

Brochure created by Information & Privacy Commissioner Describes when health information custodians can assume a patients implied consent to collect, use or disclose personal health information

Complaints about privacy

Principle Four
Each member respects the autonomy, individuality and dignity of each patient and provides care with respect for human rights and without discrimination. No patient shall be deprived of access to pharmaceutical services because of the personal convictions or religious beliefs of a member. Where such circumstances occur, the member refers the patient to a pharmacist who can meet the patients needs.

A patient receives a vial with a label partially detached. She peels back the label and finds another label that lists a different patients name, medication and dosage.
what issues does this raise for the pharmacy, pharmacist and pharmacy technician?

March 2001 Council position

Objecting pharmacists have a responsibility to participate in a system designed to respect a patient's right to receive pharmacy products and services.

Other Principles

A pharmacist is permitted to decline providing certain pharmacy products or services if it appears to conflict with the pharmacist's view of morality or religious beliefs and if the pharmacist believes that his or her conscience will be harmed by providing the product or service. Objections should be conveyed to the pharmacy manager, not the patient. The individual pharmacist must insure an alternate source, to enable the patient to obtain the service or product that they need. Any alternate means must minimize inconvenience or suffering to the patient or patient's agent.

acting with honesty and integrity commitment to continuous competence improvement collaboration with the multidisciplinary health team enable other members to practise in accordance with high standards of professional practice

Screening Committee: ICRC Investigation Process

Inquiries, Complaints and Reports Committee
Receives and reviews official complaints Receives and reviews other information about member-specific issues, including reports for termination, incompetence, and incapacity As of June 4, 2009, this committee replaced the Complaints Committee and took over some functions of the Executive Committee

Complaints and non-complaint matters

ICRC

Complaint Investigations

What do people complain about?

dispensing errors rudeness unmet needs and concern for public welfare dispensing without authority labelling errors unauthorized reduction in quantity insurance fraud

Inquiries, Complaints and Reports Committee

is a panel of 3 to 5 members chosen from a larger Committee consists of some pharmacists, pharmacy technicians & some public (non-pharmacist) members conducts a paper review of results of investigation may direct further investigation decides on appropriate disposition

Must be about pharmacy practice

ICRC & Complaints

ICRC & Complaints

How does the College investigate a complaint?

Shares copy of complaint and documentation with the member or Designated Manager (if no member specified) Provides the member with their prior decisions history Gathers all relevant information Gives the member the right to respond in writing within 30 days Shares copy of members response with complainant Investigates within 150 days

#1 question asked by pharmacists when they

are notified that they have been complained about?

ICRC & Complaints

Is my name going to be published in the next edition of Pharmacy Connection?

ICRC & Complaints #2 question asked by pharmacists when they

are notified that they have been complained about?

ICRC & Complaints

Do I need a lawyer?

What can the ICRC do?

take no action issue advice, reminders, or written caution require members attendance for an oral caution require member to do a specified continuing education or remediation program invite member to undertake (promise) to do something refer to Discipline Committee with specified allegations of professional misconduct or for incompetence appoint another ICRC panel to inquire into the health of a member
this ICRC panel can refer to Fitness to Practise Committee

ICRC & Complaints: HPARB

ICRC & non-Complaint matters

For complaint matters, both the complainant and the member have the right to request a review by an independent board
HPARB (Health Professions Appeal and Review Board) Deals with requests for review from all health regulatory college ICRCs

Other than complaints, what do people inform the College about?

e.g. employer reports termination or suspension of a member because of misconduct, incompetence or incapacity e.g. member reports criminal charges against them

What does the ICRC do?

appoints an investigator if reasonable and probable grounds exist to think that the member has committed professional misconduct conducts health inquiries if appropriate

Discipline Committee Discipline Proceedings

The Discipline Committee

has approximately 25 members from which a panel is appointed panel usually consists of 3 pharmacists/pharmacy technicians and 2 public members hears matters referred by screening committees:
ICRC as of June 4, 2009 Accreditation Committee (about pharmacies) Formerly the Complaints and Executive Committees

Professional Misconduct

Professional Misconduct Regulation: Examples

Four types in the RHPA:

guilty of an offence relevant to suitability to practice
theft, fraud, forgery, other

guilty of professional misconduct in another jurisdiction or by another College guilty of sexually abusing a patient guilty of professional misconduct (as defined by Regulation 681/93 to the Pharmacy Act)

Contravening a term, condition or limitation Failing to maintain a standard of practice Abusing a patient (verbally or physically) Practicing while impaired Failing to keep records, or falsifying records Charging an excessive fee Contravening the DPRA or other law Soliciting business from potential patients

Restricting patients choice of pharmacist Influencing patient to change his/her will Allowing pharmacy to be used for unlawful purpose Refusing entry to inspector Offering gifts or inducements Engaging in conduct that would reasonably be regarded by members as disgraceful, dishonourable or unprofessional

Incompetence
If a members professional care of a patient displayed a lack of knowledge, skill or judgment for the welfare of the patient of a nature or to an extent that demonstrates that the member is unfit to continue to practise or that the member's practice should be restricted

Discipline Hearings

At a hearing, the Panel hears evidence and decides:

What happened? (facts) Is that professional misconduct? (law) If it is professional misconduct, what should happen? (appropriate penalty)

Discipline Hearings

Penalties
What kinds of penalties can the Discipline Committee order? For members:
reprimand (given in open hearing) suspension terms, conditions or limitations on Certificate of Registration fine payable to the province, up to $35,000 revocation of Certificate of Registration for sexual abuse, repayment of the victims fund

who is a party? panel has no prior knowledge or involvement open (most) vs. closed uncontested (most) vs. contested costs

Penalties

For Pharmacies:
Revocation of Certificate of Accreditation Suspension fine up to $100,000

Fitness to Practise Proceedings

Health Inquiries

Process of Inquiries

Incapacity means:
suffering from a physical or mental health problem so that a restriction of practice is appropriate to protect the public
e.g. substance use e.g. mental illness

If Registrar has reasonable grounds to believe that member is incapacitated

obtain health history and information ICRC may appoint a panel to conduct further inquiries (Health Inquiry Panel = HIP) HIP may order an assessment of member by an independent medical examiner HIP may refer to Fitness to Practise Committee

Issue may be raised by:

Mandatory report, self-report, other

Fitness to Practise Committee

Professionals Health Program

Health Inquiry Panel may refer the matter to the Fitness to Practise Committee for a hearing Hearing is confidential, closed to the public, and not punitive Fitness to Practise Committee decides whether member is incapacitated, and if so what appropriate restrictions to impose on members practice

On behalf of College, carries out monitoring of restrictions imposed by Fitness to Practise Committee Also available directly and anonymously to pharmacists, pharmacy technicians, pharmacy students, their co-workers and families Early intervention for stress and other difficulties which could lead to incapacities http://www.phpoma.org/

Patient Relations Program Sexual Abuse Prevention

RHPA requires each College to design measures to prevent and/or deal with sexual abuse of patients, including:
(a) Educational requirements for members (b) Guidelines for the conduct of members with their patients (c) Training for College staff (d) The provision of information to the public

RHPA: Definition of Sexual Abuse

Scenario
A pharmacist dispenses medication from time to time to a pharmacy technician working in the same pharmacy. The pharmacist and technician start dating.

Sexual abuse of a patient by a member means

(a) Sexual intercourse or other forms of physical sexual relations between the member and the patient; (b) Touching, of a sexual nature, of the patient by the member; or (c) Behaviour or remarks of a sexual nature by the member towards the patient Exception: sexual nature does not include touching, behaviour or remarks of a clinical nature appropriate to the service being provided. This exception is not very relevant to pharmacy practice.

What to do?

Mandatory Report of Sexual Abuse of a Patient (s. 85.1)

How to report Sexual Abuse

A member shall file a report to the College

if the member has reasonable grounds to believe obtained in the course of practicing the profession that another member of the same or a different College has sexually abused a patient.

Good faith reporter is protected against lawsuits Fine for failing to report: up to $25,000 for a first offence; up to $50,000 for a second or subsequent offence

In writing within 30 days (unless imminent risk to victim) To the Registrar of the members College Giving your name, name of member being reported on, and explanation of the alleged sexual abuse Give the name of the patient only if he/she has consented

Mandatory Penalties for finding of professional misconduct for sexual abuse of a patient

Sexual abuse vs. harassment

Reprimand Revoke if category (a) or (b) of definition of sexual abuse (i.e., sexual intercourse or touching)
Cannot apply for reinstatement for five years

May order that funding be provided to the patient/victim for therapy and counselling

Sexually harassing conduct towards a co-worker is not sexual abuse per RHPA BUT, it could still result in complaint of professional misconduct (to the College), sexual discrimination (to the Human Rights Tribunal), or a lawsuit (to court), etc. February 1995: The Ontario College of Pharmacists regards any act of abuse or harassment of a patient, customer, staff person and/or colleague, as unacceptable and such actions may constitute professional misconduct and/or criminal offence. Furthermore, ignoring harassment or abuse is equal to condoning the abuser's actions and further harming the victim. [emphasis added]

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Conclusion: Jurisprudence

The ethical application of the law Members must recognize that laws govern the way they practice, including:
Pharmacy Act Regulated Health Professions Act Personal Health Information Protection Act

For more information: www.ocpinfo.com

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