Eye on ethics: Whose prescription is it anyway?

February 11, 2008

Pharmacists must observe HIPAA regulations and also have a clear duty to warn patients.

Q: A worried man in his forties comes to your pharmacy and shows you the pill in his hand. He wants to know how it is used. You are quite sure that it's a birth control pill. A week later, a woman picks up a prescription for her boyfriend and asks you what the drug is for. The prescription is for genital herpes. How should you approach these questions?

In addition to observing HIPAA, pharmacists also have a clear duty to warn. The pharmacist (the expert) is required to warn the patient (the non-expert) about the hazards and appropriate use of medication. For example, pharmacists would agree that if the patient is not warned about potential drowsiness from pain medications, the pharmacist has failed in that duty. This responsibility also extends to information. When a pharmacist advises a patient about OTC or prescription drugs, a relationship is established. The patient trusts that the advice is both competent and confidential.

Be especially careful when:

If you have records of care (prescriptions) for a patient and someone else asks about that care, you must be certain that the patient has consented to share that information, if he or she is of legal age (standards vary by state).

If someone asks, "What is this drug for?" you may answer directly, but be careful if a relative or friend is asking the question. If the man at the counter tells you he's found a drug in his daughter's room, ask him to take the drug to his daughter and discuss it with her if she chooses. If you dispensed the prescription, you have a duty to the patient that must be honored; you may even need to consult a lawyer. Keep notes on any such exchange.

In an emergency, HIPAA allows healthcare providers to act expediently, to protect the patient. If a patient is in the midst of what you believe is a critical situation, you take a risk by revealing protected health information, but the patient's need for help overrides your risk. You may decide to recommend that the caller contact 911 or poison control, or take the patient to an ER. If you are contacted by emergency personnel, always phone back to verify the identity of the caller before discussing the patient's care.

Each state varies on the age of majority (full adult rights and responsibilities) and on parental notification regarding medical treatment, birth control, and so on. It would be sensible to formulate an ethical approach to these questions before the situation arises.

Disclaimer: This column highlights ethical situations that often occur in pharmacy practice. It is designed to stimulate discussion on how to deal with these situations and is not intended as legal advice. Pharmacists who need immediate assistance should consult their attorneys, employers, state boards of pharmacy, and state and federal laws.

THE AUTHOR has written a book, We Will Be Healed: Spiritual Renewal for Health Care Providers, recently published by ACTA Publications. She has practiced long-term care and community pharmacy in Oregon for more than a decade and has served on numerous professional and community boards.