Home' Australian Pharmacist : Australian Pharmacist September 2012 Contents 746 Australian Pharmacist September 2012 I ©Pharmaceutical Society of Australia Ltd.
Between a rock and a hard
place -- Andrew's predicament
By Dr Betty Chaar
Dr Betty Chaar is a Lecturer in Pharmacy
Practice and Professional Ethics at the Faculty
of Pharmacy, The University of Sydney.
Soon after registering, Andrew took
a job at a small suburban shopping
strip pharmacy. The owner was often
present, but left Andrew in charge
for extended periods.
Andrew discovered that pharmacy
sta and technicians regularly supplied
customers with S3 products, sometimes
in multiple packs, without referring them
to the owner or himself. He tried to get
them to refer all such requests to him,
at least when he was left in charge, but
they refused and complained to the
owner. The owner directed Andrew to
allow the practice to continue, saying he
would take responsibility.
Andrew also observed that some
customers regularly obtained
benzodiazepine tablets without
supplying a prescription. When this
happened, the owner made no attempt to
contact the 'prescriber' to obtain approval
for the supply, explaining that their
doctors were 'OK' with what is happening.
Over several months Andrew never
observed the owner taking action to
obtain prescriptions from the doctors,
nor to his knowledge, had such
prescriptions been received.
Andrew had refused to follow this
practice, but told the customers to wait
until the owner was present to get what
they wanted. The owner did not ask
Andrew to follow what he did in this
regard. Eventually Andrew sought advice
about what he should do.
Unfortunately this is a real scenario,
submitted by a young pharmacist seeking
advice. It presents some serious problems
First, there is the issue of S3 medicines
handed out by pharmacy assistants; then
the contention of 'responsibility', and
nally the supply of benzodiazepines
without prescriptions! This pharmacy is a
catastrophe waiting to happen.
Let us take a closer look at these issues.
Supply of S3 medicines
When medicines are down-scheduled
from S4 to S3, the onus of caring for
patient safety and appropriate supply lies
squarely on the pharmacist's shoulders.
Regulations clearly require the handling
of S3 medicines by pharmacists only. It is
a privilege pharmacists must value, as
S3 scheduled medicines provide a clear
delineation of purpose for pharmacists.
No other professional has this privilege.
It is also an obligation -- one the
pharmacist must never delegate or evade.
Legal requirements aside, the Code of
Ethics for Pharmacists clearly explains
pharmacists' ethical obligations,
P3-Obligation 1: A pharmacist must
demonstrate accepted standards of
professional and personal behaviour.
Andrew allowing pharmacy sta to
supply S3 medicines on his watch
is unacceptable, no matter what
reassurances he is o ered.
This is an important concept, with many
implications, both legal and ethical. You
become a professional by taking upon
yourself 'professional responsibility',
which cannot be delegated. And you
earn it the hard way: by passing exams,
working the long internship hours,
and the immense e ort made to gain
registration. Why would you jeopardise
The Code of Ethics emphasises
professional accountability, as follows:
P7: A pharmacist is responsible for the
professional decisions and contributions he
or she makes in professional practice.
The Code further elaborates: A pharmacist
must not override the professional
autonomy of pharmacists in his or her
employ unless consumer safety may be
So, reassurance from this proprietor is
disingenuous. Andrew needs to insist on
his responsibility. There is no protection
or any plausible excuse for delegation of
Supply of benzodiazepines without
prescriptions is a crime. Each state
and territory has legislation and clear
instructions about this category of
medicines. A plethora of restrictions
apply, and yet this proprietor de es them
In so doing he clearly demonstrates 'a lack
of adequate knowledge, skill, judgement
and care in the practice of pharmacy'
and has 'engaged in unethical conduct
relating to the practice of pharmacy', both
well established tests of professional
The proprietor's behaviour is particularly
reckless, because he knew, or ought to
have known, that the customers had
not consulted medical practitioners
for the bona de purpose of obtaining
prescriptions. We do not know whether
such supplies were in 'quantities not in
accordance with recognised therapeutic
standards', but it is clear that such
behaviour cannot be construed to be in
the interests of patients or the interests of
society in general; in fact, it demonstrates
lack of insight into the harm that can be
incurred or repercussions for patients.
From a professional ethics perspective,
the Code states:
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