Boundary Violations by Pharmacists--Crossing the Line by having Personal Relationships--Great Reminder by Dale J. Atkinson in Article Entitled Pharmacist Fills More than Just Prescriptions

Legal Briefs: Pharmacist Fills More than Just Prescriptions

August 28, 2013 1:00 pm Topics: Pharmacists

By Dale J. Atkinson 

Originally published in the August 2013 NABP Newsletter 

Many licensed professionals are subject to codes of ethics and other standards of practice that limit and, in some cases, prohibit personal relationships with patients/clients. Indeed, such boundary violations are far too common in many of the mental health professions whereby a personal relationship ripens out of the professional relationship. In most cases, a specified period of time must expire between the termination of the professional relationship and the beginning of the personal one. Under some circumstances, such as a clinical relationship, a personal relationship may be forever prohibited. Of course, violations of boundary parameters subject licensees to administrative prosecution and ultimately to adverse actions against licenses.

Similarly, pharmacists have a unique relationship with patients, including access to confidential and sensitive information. Pharmacists are placed in a position of trust regarding medical conditions and treatments thereof. While apparently not commonplace in the sphere of pharmacy practice as illustrated by the lack of published case law, boundary violations are certainly a possibility.

The full article, which reviews a case involving a pharmacist using patient information to pursue a personal relationship, is available in the August 2013 NABP Newsletter (PDF; pages 148-149).

Idaho Board of Pharmacy Recent Board Discipline

R.P., DO: CS registration revoked pursuant to Board of Medicine order.
K.N., PA: CS registration restricted pursuant to Board of Medicine order.
L.L., MD: CS registration revoked pursuant to DEA registration lapse. J.A., PA: CS registration revoked pursuant to Board of Medicine order. L.H., PharmD: License and CS registration revoked for diversion. J.M., Pharmacy Technician: Registration revoked for diversion. C.M., Pharmacy Technician: Registration revoked for felony
burglary convictions.
L.M., RPh: License and registration restricted for five more years
for not following an order of the Board, for Pharmacy Recovery
Network noncompliance.
L.W., RPh: Fined $5,000 and completion of three additional CPE
hours for illegally accepting the return of prescription drugs for
a period of five years.
R.L., PharmD: $500 fine and an additional six CPE hours for
failing to follow the instructions of a person writing, making, or ordering a prescription. 

quoted from Idaho Board of Pharmacy September 2013 Newsletter

Idaho Board of Pharmacy 2014 Proposed Rules

2014 Proposed Rules
The Board has held four negotiated rulemaking sessions in 2013, mostly focused on compounding rules in the wake of the New Eng- land Compounding Center tragedy and post-2013 changes to non- resident drug outlet law. Other rulemaking topics include secured delivery rooms and limiting Board-approved continuing pharmacy education (CPE) programs. The Board is very thankful for the im- mense amount of public input that has helped form these proposed rules, which are posted on the Board’s Web site. Upon printing of the proposed rules in the October Idaho Administrative Bulletin on October 2, 2013, a 21-day comment period will commence. On the 21st day, October 23, 2013, the Board will meet at the Idaho State Capitol to hear final verbal comments at an open public meeting. Written comments may be submitted to the Board at any time during the 21-day comment period. The Board will consider all comments on October 24, 2013, post the resulting pending rules on its Web site, print the pending rules in the January Idaho Administrative Bulletin, and request approval by the 2014 Idaho Legislature.
quoted from Idaho Board of Pharmacy September 2013 Newsletter 

Idaho Board of Pharmacy--Pharmacy Provision of Prescription Blanks

The Idaho State Board of Pharmacy has reviewed and consid- ered the provision of pre-printed, hard copy prescription drug order blanks containing compounding formulas, by a pharmacy to a prescriber, and has concluded it is legal. However, considering the best interest and safety of the public, the Board has concluded that the provision of hard copy prescription blanks containing pharmacy-specific information, such as pharmacy name or address, is prohibited. In reaching this conclusion, the Board considered the following law:
504. UNLAWFUL ADVERTISING.
01. Unlawful Advertising or Inducements. A licensee or registrant may not promote or induce, directly or indirectly, the provision of professional services or products through the dissemination of a public communication that contains a false, misleading, or deceptive statement or claim.
The Board’s decision is based upon the determination that the inclusion of pharmacy-specific information on such a prescription blank creates too great of a risk of being “misleading” or “decep- tive,” as the patient would likely be led to believe that his or her prescription drug order may only be dispensed by that specific pharmacy.
The Board also cautions pharmacies that engage in such provision of blanks containing controlled substances (CS), that blanks for CS are required to be on non-copyable paper as per Section 37-2725, Idaho Code, and that they may be deemed by Drug Enforcement Administration (DEA) to have been illegally prepared for the pre- scriber’s signature by someone other than the prescriber’s agent. 

quoted from Idaho Board of Pharmacy September 2013 Newsletter

Iowa Board of Pharmacy Update on Epilepsy Medications

A committee of the Board met with representatives of the Iowa Epilepsy Treatment & Education Task Force on June 12, 2013. The discussion focused on the proper handling of prescriptions for brand-name products, generic products, and branded generic products. The advantage of having the patient’s diagnosis on the prescription was also discussed. All parties agreed on the following course of action: (1) clarify, in Board rules, the difference between generics and branded generics vis-à-vis Iowa’s law for drug product selection; (2) clarify the proper method for dispensing products from morethan one company in a single prescription due to a drug short- age or other extenuating circumstance (ie, mixing two different generic products in the same prescription vial); and (3) educate pharmacists on the need to notify prescribers whenever a change is made in the dispensing of a patient’s epilepsy medi- cations. The Board will publish proposed changes in rules as soon as they are available and will continue to work with the members of the Epilepsy Task Force to resolve dispensing is- sues and ensure patient safety. A recent study in the Journal of the American Medical Association Internal Medicine has concluded that “changes in pill color significantly increase the odds of nonpersistence; this may have important clinical implications. Our study supports a reconsideration of current regulatory policy that permits wide variation in the appearance of bioequivalent drugs.”

Source: “Variations in Pill Appearance of Antiepileptic Drugs and the Risk of Nonadherence,” JAMA Intern Med. 2013; 173(3): 202- 208. Background: “Generic prescription drugs are bioequivalent
to brand-name versions but may not have consistent color or shape, which can cause confusion and lead to interruptions in medication use. This study sought to determine whether switching among different-appearing antiepileptic drugs (AEDs) is associated with increased rates of medication nonpersistence, which can have serious medical, financial and social consequences.

quoted from the Iowa Board of Pharmacy September 2013 Newsletter