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Charles and the fraudulent
By Dr Betty Chaar
Charles manages a small pharmacy on Sundays which suits him, as it is a
relatively quiet shift and the extra work allows him to save for an overseas trip.
However, once a month, the owner comes into the pharmacy to go through the
repeat prescriptions held on file. She selects 20 or 30 that are close to expiry
and processes them, saying that the patients are unlikely to use them, so they
could be claimed quite safely.
Recently, she asked Charles to assist in
this, by processing the repeats and signing
receipts them, to save her coming in.
Charles expressed concern, but the owner
justified it as the only way she can afford to
open the pharmacy on Sundays, and if he
does not help, she will have to stop trading
on Sundays and Charles will lose his job. In
any case, the owner said she will take the
blame if she is ever caught.
Some scenarios are so deplorable they
appear almost fictitious. This one included.
The troubling issue is that there have
been real cases similar to this scenario. The
challenge is not only to highlight what is
wrong or unethical -- it is to advise these
predominantly young pharmacists about
how to resolve the situation.
On the face of it, this scenario is about
the illegality of processing prescriptions
without the knowledge or consent of the
patient. The owner is taking advantage of
vulnerable patients who have entrusted
her with their prescriptions for her own
gain, then fraudulently claiming subsidy
of the items from the government. It
would not be the first time we hear of
pharmacists engaging in this kind of
activity, as evidenced by several court cases
on the public record, all of which end up
in substantial penalties and all manners of
legal sanctions. It is clearly illegal and we
could stop there.
However, there is also an underlying issue of
unethical behaviour worthy of mention. The
employer, using the imbalance of power
in her favour, engages in coercion, denies
the employee professional autonomy and
claims to 'take the blame' if caught. Not to
mention the appalling role modelling.
How many principles in the Pharmacists
Code of Ethics has this employer breached?
Here are a few:
Firstly, in relation to her patients, the
employer breaches Principle 2 which states:
'A pharmacist pays due respect for the
autonomy and rights of consumers
and encourages consumers to actively
participate in decision-making.'
By processing 'left over' repeats in her trust,
the owner is denying consumers'/patients'
right to ownership of their prescriptions. It
is underhanded manipulation of that trust.
Furthermore, the employer deliberately
and consistently practices in defiance of
Principle 3, which states:
'A pharmacist upholds the reputation and
public trust of the profession.
A pharmacist will not abuse the trust and
respect of individuals and society'
The employer's behaviour is undoubtedly
an abuse of trust and clearly contradicts
pharmacists' social mandate to act in the
patient's best interests.
Dr Betty Chaar is a Lecturer in Pharmacy
Practice and Professional Ethics at the
Faculty of Pharmacy, The University of
Reinforcing this notion and particularly
relevant to this case, is Principle 8, which
'A pharmacist conducts the business of
pharmacy in an ethical and professional
A pharmacist will ensure business practices
are conducted primarily in the best interest
of the consumer, paying due respect to
colleagues, while upholding the reputation
of the profession.'
Principle 5, which explains the obligations
of the pharmacist towards training and role
modelling, is also relevant to the case at
'A pharmacist demonstrates a commitment
to the development and enhancement of
Obligation 5.2 Encourage and support
the ongoing development of staff and
...and must act as a role model and actively
engage in teaching and mentoring'
As for Charles, Principle 7 is applicable:
'A pharmacist agrees to practise only under
conditions which uphold the professional
independence, judgement and integrity of
themselves or others.'
He must also be aware that the employer
simply cannot take full blame for his
fraudulent signing and processing, even
if she ordered this. Professionals cannot
delegate professional responsibility. It is
imperative that this is clearly understood.
How trustworthy is this employer anyway?
So, what do we say to Charles? Well, there
is no doubt that this young man is heading
for trouble. Unfortunately that trip he is
planning will have to stay on hold. Nothing
is worth being dragged into the illegal,
professionally destructive, pathway the
owner is leading him along. He must leave,
report to authorities and look for another
Sunday position. In that order and without a
Questions and comments about issues
raised in Ethical Dilemmas are welcomed.
Send comments to australian.pharmacist@
psa.org.au. The Pharmacists Code of Ethics
is available online at www.psa.org.au/
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