July ⢠August 2003 - Ontario College of Pharmacists
July ⢠August 2003 - Ontario College of Pharmacists
July ⢠August 2003 - Ontario College of Pharmacists
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<strong>July</strong>/<strong>August</strong> <strong>2003</strong><br />
New Precursor Control Regulations<br />
created to address<br />
drug diversion in Canada
Council Members<br />
Council Members for Districts 1-17 are listed below<br />
according to District number. PM indicates a public<br />
member appointed by the Lieutenant-Governor-in-<br />
Council. DFP indicates the Dean <strong>of</strong> the Faculty <strong>of</strong><br />
Pharmacy, University <strong>of</strong> Toronto.<br />
1 Marie Ogilvie<br />
2 Vacant<br />
3 Oluremi Ojo<br />
4 Reza Farmand<br />
5 Larry Hallok<br />
6 Alexander Wong<br />
7 Leslie Braden<br />
8 Iris Krawchenko, Vice-President<br />
9 Larry Boggio<br />
10 Gerry Cook<br />
11 David Malian, President<br />
12 Sabih Uddin<br />
13 Donald Stringer<br />
14 Stephen Clement<br />
15 Gurjit Husson<br />
16 Albert Chaiet<br />
17 Shelley McKinney<br />
PM Russell Carrington<br />
PM Garry Dent<br />
PM Bob Drummond<br />
PM Dean French<br />
PM Tina Gabriel<br />
PM Steve Gupta<br />
PM Katherine Hollinsworth<br />
PM Mel Jones<br />
PM Stephen Mangos<br />
PM Linda Robbins<br />
PM Michael Schoales<br />
PM Christina Weylie<br />
DFP Wayne Hindmarsh<br />
Statutory Committees<br />
• Executive<br />
• Accreditation<br />
• Complaints<br />
• Discipline<br />
• Fitness to Practice<br />
• Patient Relations<br />
• Quality Assurance<br />
• Registration<br />
ONTARIO COLLEGE OF PHARMACISTS<br />
M I S S I O N S T A T E M E N T<br />
The mission <strong>of</strong> the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong> is to regulate the practice<br />
<strong>of</strong> pharmacy, through the participation <strong>of</strong> the public and the pr<strong>of</strong>ession, in<br />
accordance with standards <strong>of</strong> practice which ensure that pharmacists<br />
provide the public with quality pharmaceutical service and care.<br />
Some <strong>of</strong> you may be questioning if you<br />
really need to maintain your practice<br />
license given how you spend your time. If<br />
you are retired or working in a position<br />
removed from pharmacy practice with no<br />
intention <strong>of</strong> ever practicing again, but wish<br />
to stay connected with the pr<strong>of</strong>ession you<br />
contributed to for many years, you may be<br />
interested in the <strong>College</strong>’s<br />
Member Emeritus Roll.<br />
Standing Committees<br />
• Finance<br />
• Pr<strong>of</strong>essional Practice<br />
Special Committees<br />
• Communications<br />
• Standards <strong>of</strong> Practice<br />
Working Group<br />
• Structured Practical Training<br />
• Task Force on Primary<br />
Health Care Reform<br />
• Working Group on Certification<br />
Examination for Pharmacy Technicians<br />
• Working Group on Pharmacy Technicians<br />
Members who voluntarily resign from the<br />
OCP Register after serving 25 years or more<br />
as a registered pharmacist, in any<br />
jurisdiction, and are in good standing, are<br />
entitled to become a Member Emeritus.<br />
On the Member Emeritus Roll, you have no<br />
practice privileges, you pay no fees, but<br />
you will continue to receive Pharmacy<br />
Connection and other select member<br />
notifications from the <strong>College</strong>. You will also<br />
receive a certificate indicating your status<br />
as a Member Emeritus with the <strong>College</strong>.<br />
If you meet the criteria for<br />
emeritus membership,<br />
please send a letter to the<br />
<strong>College</strong> noting that you<br />
wish to resign your active<br />
practice license and indicate<br />
that you wish to become a<br />
Member Emeritus.
<strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong><br />
483 Huron Street<br />
Toronto, ON Canada M5R 2R4<br />
Telephone (416) 962-4861<br />
Facsimile (416) 847-8200<br />
www.ocpinfo.com<br />
David Malian, B.Sc.Phm., CAE<br />
President<br />
Deanna Williams, B.Sc.Phm.<br />
Registrar<br />
Della Croteau, B.S.P., M.C.Ed.<br />
Editor and<br />
Deputy Registrar/Director <strong>of</strong> Programs<br />
Layne Verbeek, B.A.<br />
Associate Editor<br />
contents<br />
President's Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4<br />
OCP Council Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6<br />
Precursors to Illicit Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10<br />
Precursors Control Regulations Chart . . . . . . . . . . . . . . . . . . . . . . . . . . . .14<br />
Q&A Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16<br />
<strong>2003</strong> Suspensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17<br />
Quebec <strong>Ontario</strong> Memorandum <strong>of</strong> Understanding . . . . . . . . . . . . . . . . . . .18<br />
International Pharmacy Graduate Program . . . . . . . . . . . . . . . . . . . . . . . .20<br />
Q&A SPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21<br />
Health Canada Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23<br />
Inspectors’ Corner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24<br />
Close Up on Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .28<br />
Coroner’s Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30<br />
Deciding on Discipline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32<br />
Pharmacy Practice Breakfast Series . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .36<br />
Focus On Error Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38<br />
Point <strong>of</strong> Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40<br />
Bulletin Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41<br />
CE Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42<br />
Agostino Porcellini<br />
Graphic Designer<br />
Suzanne McLoughlin<br />
Copy Editor<br />
Alice Wlosek<br />
Distribution<br />
ISSN 1198-354X<br />
© <strong>2003</strong> <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong><br />
Canada Post Agreement #40069798<br />
Undelivered copies should be returned<br />
to the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong>.<br />
Not to be reproduced in whole or in part<br />
without the permission <strong>of</strong> the Editor.<br />
Subscription Rates<br />
In Canada, $48 + GST for six issues/year.<br />
For international addresses, $60.<br />
Subscription rates do not apply to pharmacists,<br />
students, interns and certified pharmacy technicians<br />
registered with the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong>.<br />
Pharmacy Connection<br />
The objectives <strong>of</strong> Pharmacy Connection are<br />
to communicate information on <strong>College</strong><br />
activities and policies; encourage dialogue<br />
and to discuss issues <strong>of</strong> interest with pharmacists;<br />
and to promote the pharmacist’s role<br />
among our members, allied health pr<strong>of</strong>essions<br />
and the public.<br />
We publish six times a year, in January, March,<br />
May, <strong>July</strong>, September and November. We<br />
welcome original manuscripts (that promote<br />
the objectives <strong>of</strong> the journal) for consideration.<br />
The <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong><br />
reserves the right to modify contributions as<br />
appropriate. Please contact the Associate<br />
Editor for publishing requirements.<br />
We also invite you to share your comments,<br />
topics suggestions, or journal criticisms by<br />
letter to the Editor. Letters considered for<br />
reprinting must include the author’s name,<br />
address and telephone number. The opinions<br />
expressed in this publication do not necessarily<br />
represent the views or <strong>of</strong>ficial position<br />
<strong>of</strong> the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong>.
PRESIDENT’S<br />
MESSAGE<br />
Dave Malian<br />
President<br />
Ireceive many calls from members<br />
across the province asking about<br />
the <strong>College</strong>’s programs and services,<br />
the decisions that our Council<br />
makes, and most frequently, <strong>of</strong>fering<br />
advice about how the <strong>College</strong> should<br />
be run. Most <strong>of</strong> these calls are positive<br />
in nature; however some are more<br />
negative and critical <strong>of</strong> the <strong>College</strong>’s<br />
actions. This is especially true when a<br />
member calls in response to reports <strong>of</strong><br />
a pharmacist who has been the subject<br />
<strong>of</strong> a public complaint or a disciplinary<br />
hearing and decision.<br />
I welcome such dialogue as I<br />
believe it’s vital for our members to<br />
express their concerns on issues they<br />
see as directly affecting patient care<br />
and pharmacy practice in <strong>Ontario</strong>. The<br />
<strong>College</strong> is always receptive to new<br />
ideas and suggestions because it is our<br />
members who collectively determine<br />
how pharmacy practice is regulated<br />
and what programs and services will be<br />
needed to uphold the highest possible<br />
standards for our pr<strong>of</strong>ession.<br />
Yet how can this best be accomplished?<br />
And how can we ensure that<br />
the public is well protected and that<br />
members who come before the<br />
complaints or discipline process are<br />
given the appropriate resolution and/or<br />
decisions that will encourage self<br />
improvement and deter future<br />
misdeeds through our legislated regulatory<br />
role?<br />
Complaints and Discipline<br />
Philosophy<br />
The <strong>College</strong> recently held an informal<br />
session <strong>of</strong> the Executive, Complaints<br />
and Discipline committees to discuss<br />
these very important questions and to<br />
re-examine how we handle complaints<br />
and discipline to better meet the needs<br />
<strong>of</strong> today’s pharmacist while continuing<br />
to protect the public. The session went<br />
extremely well and it generated many<br />
new ideas that I believe will better<br />
serve both the public and our<br />
members. Overall, the group believes<br />
that the <strong>College</strong>’s approach to<br />
complaints and discipline must<br />
become more remedial than punitive<br />
to better protect the public. I<br />
encourage you to continue to express<br />
your views on this very important<br />
subject with your elected pharmacist<br />
Council member.<br />
Patient Praise<br />
I also periodically receive calls or letters<br />
from patients commending their pharmacist<br />
and highlighting the important<br />
role that their pharmacist plays in the<br />
management <strong>of</strong> their diseases.<br />
Recently, I got such a letter from a<br />
patient praising pharmacists at the<br />
White Cross Dispensary in Ottawa.<br />
The patient wrote, “Aside from<br />
their pr<strong>of</strong>essionalism, their warmth and<br />
compassion makes dealing with them<br />
an oasis in the relative desert <strong>of</strong> health<br />
care in <strong>Ontario</strong> <strong>of</strong> late. They demonstrate<br />
that the corner-store pharmacist<br />
is still available and caring.”<br />
It’s my pleasure to receive letters <strong>of</strong><br />
this kind because it’s an example <strong>of</strong> the<br />
type <strong>of</strong> pharmacist that practices in<br />
<strong>Ontario</strong>. I also know that letters <strong>of</strong> this<br />
sort could come from patients from any<br />
one <strong>of</strong> the 2768 <strong>Ontario</strong> pharmacies —<br />
as we all endeavour to put our patients’<br />
health and well being first.<br />
I congratulate both the pharmacists<br />
<strong>of</strong> White Cross Dispensary and all<br />
pharmacists in <strong>Ontario</strong> who practice<br />
our pr<strong>of</strong>ession with the highest standards<br />
<strong>of</strong> pharmaceutical care. The<br />
<strong>College</strong>’s role is to continue to license<br />
pharmacists who are knowledgeable,<br />
well trained and caring health care<br />
pr<strong>of</strong>essionals who can service the<br />
needs <strong>of</strong> all Ontarians. I am confident<br />
that the <strong>College</strong>’s mandate to regulate<br />
pharmacy in the best interests <strong>of</strong> the<br />
public is well served.<br />
4<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
Come out and vote in Districts 2, 6, 12 and 15<br />
As well, the following districts had acclamations:<br />
3: Oluremi Ojo, Toronto<br />
9: Larry Boggio, Port Colborne<br />
16: Albert Chaiet, Toronto<br />
An election ballot will be sent to the home addresses <strong>of</strong> all Part A and B<br />
pharmacists in districts 2, 6, 12 and 15.<br />
All ballots must be received at the <strong>College</strong> by <strong>August</strong> 6, <strong>2003</strong><br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 5
COUNCIL<br />
OCP COUNCIL REPORT<br />
JUNE <strong>2003</strong><br />
Strategic Plan<br />
Approved<br />
As reported in the March/April<br />
issue <strong>of</strong> Pharmacy Connection,<br />
Council held a strategic planning<br />
retreat in late March. At the<br />
session, Council agreed on five<br />
key strategic directions for<br />
<strong>College</strong>-focused activity over the<br />
next three to five years.<br />
The strategic directions were<br />
augmented by goals and rationale<br />
and then commended to the<br />
<strong>College</strong> management team to<br />
develop action plans with<br />
assigned responsibilities and<br />
timelines. The final report,<br />
Strategic Plan <strong>2003</strong>, was considered<br />
and approved by Council in<br />
June. As before, the plan will<br />
serve as the foundation for<br />
<strong>College</strong> decisions respecting its<br />
activities, resource allocation and<br />
budgeting for each year. The<br />
complete Strategic Plan <strong>2003</strong> is<br />
available on our website.<br />
The strategic directions are:<br />
1. Address the impact <strong>of</strong> technology<br />
on the <strong>College</strong>’s<br />
regulatory role<br />
2. Continue to communicate the<br />
value <strong>of</strong> pharmacists and the<br />
services they provide to the<br />
public, government and<br />
healthcare pr<strong>of</strong>essionals<br />
3. Explore and implement strategies<br />
to assist in the optimum<br />
supply <strong>of</strong> pharmacy human<br />
resources<br />
4. Consider an enhanced and<br />
expanded role for pharmacists<br />
5. Continue to effectively meet<br />
core mandate <strong>of</strong> self regulation,<br />
including exploring new<br />
approaches, in a fiscally<br />
responsible manner<br />
Council Member Reimbursement<br />
By-law<br />
Amended<br />
Council approved a recommendation<br />
from the Finance<br />
Committee to increase the<br />
expense allowance for elected<br />
members attending <strong>College</strong> business<br />
outside <strong>of</strong> their home<br />
district. The Finance Committee<br />
examined both the reimbursement<br />
model and the<br />
reimbursement amounts allowed<br />
under the by-law. Council agreed<br />
with the Committee’s recommendation<br />
that the <strong>College</strong> maintain<br />
the existing reimbursement<br />
model, namely: Council member<br />
contributions are essentially a<br />
volunteer service with no provision<br />
for income replacement.<br />
However, Council agreed that the<br />
allowance provided for expenses<br />
(that are reasonably incurred)<br />
should be increased as rates have<br />
not been adjusted for 15 years and<br />
accommodation costs in the<br />
Toronto area have significantly<br />
increased.<br />
OCP Pr<strong>of</strong>essorship in<br />
Pharmacy Practice<br />
Council approved a proposal<br />
presented by Dr. Wayne Hindmarsh,<br />
Dean, Leslie Dan Faculty<br />
<strong>of</strong> Pharmacy, to establish a<br />
Pr<strong>of</strong>essorship in Pharmacy Practice.<br />
The pr<strong>of</strong>essorship is an<br />
opportunity for the <strong>College</strong> to<br />
join the pr<strong>of</strong>ession in supporting<br />
the expansion and growth <strong>of</strong> the<br />
faculty while providing benefit to<br />
the <strong>College</strong> and its members<br />
through advancement in areas <strong>of</strong><br />
pharmacy practice study.<br />
Council was informed that,<br />
while the Faculty initially<br />
proposed <strong>College</strong>-funding for a<br />
room or other identifiable<br />
element <strong>of</strong> the new Faculty<br />
building, the Executive<br />
Committee considered this to be<br />
inconsistent with the <strong>College</strong>’s<br />
mandate but nonetheless wanted<br />
to show support to the Faculty (as<br />
has every other organization affiliated<br />
with pharmacy in <strong>Ontario</strong>).<br />
The OCP Pr<strong>of</strong>essorship in<br />
Pharmacy Practice will achieve<br />
6<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
COUNCIL<br />
this goal by helping the Faculty<br />
retain an outstanding scholar and<br />
educator who will research to<br />
advance pharmacy practice. The<br />
OCP Pr<strong>of</strong>essorship endowment<br />
requires a one-time contribution<br />
<strong>of</strong> $500,000, payable over five<br />
years. The endowment will be<br />
associated with, and bring benefit<br />
to, the <strong>College</strong> and its members<br />
in perpetuity.<br />
Member Emeritus<br />
Eligibility Expanded<br />
Council supported a change to<br />
the eligibility criteria for Member<br />
Emeritus status where members<br />
who have practiced continually in<br />
good standing in <strong>Ontario</strong> and/or<br />
other jurisdictions for at least 25<br />
years are now entitled to join this<br />
honorary roll. This adjustment<br />
was prompted by changes in the<br />
pr<strong>of</strong>ile <strong>of</strong> <strong>College</strong> registrants and<br />
recognizes the mobility <strong>of</strong><br />
members between jurisdictions.<br />
Guidelines for<br />
Reporting Incapacity<br />
Council has approved a set <strong>of</strong><br />
reporting guidelines, in response<br />
to many members’ questions<br />
about how to report colleagues<br />
who may be incapacitated*.<br />
These guidelines were developed<br />
as an attempt to provide guidance<br />
to members on their obligations<br />
as they relate to a colleague who<br />
is, or is suspected to be, incapacitated.<br />
These guidelines will be<br />
printed in a future edition <strong>of</strong><br />
Pharmacy Connection.<br />
In conjunction, Council also<br />
reviewed information about the<br />
<strong>Ontario</strong> Medical Association’s<br />
Physician Health Program which<br />
provides monitoring and followup<br />
to assist incapacitated<br />
members to return to their workplace.<br />
Council supported the<br />
need to formalize its approach in<br />
rehabilitating incapacitated<br />
members and, accordingly,<br />
<strong>College</strong> staff are studying this<br />
program and discussing a possible<br />
collaborative approach with the<br />
<strong>Ontario</strong> <strong>Pharmacists</strong>’Association.<br />
“‘Incapacitated’ means, in relation<br />
to a member, that the<br />
member is suffering from a<br />
physical or mental condition or<br />
disorder that makes it desirable<br />
in the interest <strong>of</strong> the public that<br />
the member no longer be<br />
permitted to practise or that the<br />
member's practice be<br />
restricted.” Section 1(1), Health<br />
Procedural Code, RHPA.<br />
Competency Pr<strong>of</strong>ile<br />
for the Proposed<br />
Registered Pharmacy<br />
Technician<br />
After two years <strong>of</strong> extensive<br />
development, consultation and<br />
feedback, Council approved the<br />
Competency Pr<strong>of</strong>ile for the<br />
proposed regulation <strong>of</strong> pharmacy<br />
technicians. This initiative<br />
focuses specifically on establishing<br />
a new class <strong>of</strong> registration<br />
with the <strong>College</strong> – the Registered<br />
Pharmacy Technician. Council<br />
set this priority in 1998 to create<br />
a class <strong>of</strong> support personnel with<br />
a defined level <strong>of</strong> responsibility<br />
and accountability that could<br />
assist pharmacists in meeting<br />
their standards <strong>of</strong> practice and<br />
focusing on patient care.<br />
The Competency Pr<strong>of</strong>ile<br />
serves as a framework to allow<br />
the <strong>College</strong> to proceed with the<br />
next stages in the process. The<br />
competencies are an essential<br />
basis to developing entry-to-practice<br />
requirements, standards <strong>of</strong><br />
practice, legislative changes, and<br />
eventually, continuing competency<br />
programs for technicians<br />
— all <strong>of</strong> which will be required<br />
by the provincial government to<br />
create a new class <strong>of</strong> registration.<br />
The complete competency<br />
pr<strong>of</strong>ile will be published in the<br />
September/October issue.<br />
Loyalty Points<br />
Council adopted a new policy<br />
position on loyalty programs. This<br />
policy, which takes effect on<br />
January 1, 2004, prohibits the<br />
awarding <strong>of</strong> loyalty/bonus points<br />
or air miles on any prescriptions,<br />
prescription services or pr<strong>of</strong>essional<br />
services related to<br />
pharmacy practice in <strong>Ontario</strong>.<br />
The <strong>College</strong> position is based<br />
on Section 29 <strong>of</strong> the Pr<strong>of</strong>essional<br />
OCP COUNCIL REPORT<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 7
COUNCIL<br />
OCP COUNCIL REPORT<br />
Misconduct Regulation, namely:<br />
“Offering or distributing, directly<br />
or indirectly, a gift, rebate, bonus<br />
or other inducement with respect<br />
to a prescription or prescription<br />
services.”<br />
The matter <strong>of</strong> loyalty programs<br />
has been before the <strong>College</strong> for<br />
several months, with a review<br />
being prompted both by external<br />
requests for review and internal<br />
concerns respecting ongoing<br />
enforcement challenges resulting<br />
from different interpretations <strong>of</strong><br />
the existing policy and causing<br />
confusion in the marketplace.<br />
It is Council’s position that<br />
<strong>of</strong>fering loyalty points, air miles<br />
or other incentives to induce<br />
patients to have prescriptions<br />
filled at more than one pharmacy<br />
is inconsistent with the current<br />
pharmaceutical care model that<br />
promotes high-quality care<br />
through long-term pharmacistpatient<br />
relationships. The<br />
<strong>College</strong> has long supported the<br />
view, shared by many health care<br />
pr<strong>of</strong>essions, that it is in the<br />
patient’s best interest to find (and<br />
stay with) one health care<br />
provider, and in our case, one<br />
pharmacy, that best meets the<br />
patient’s health care needs and is<br />
the custodian <strong>of</strong> all the patient’s<br />
health information.<br />
Council also acknowledges<br />
current trends to support an<br />
enhanced role for the pharmacist<br />
in primary care reform and<br />
payment for cognitive services,<br />
and considers this revised policy<br />
to be in keeping with these<br />
trends. The <strong>College</strong> has also<br />
expended significant resources<br />
on public communication initiatives<br />
to help shift the public’s<br />
perception <strong>of</strong> the pharmacist and<br />
it believes that this new policy is<br />
consistent with this objective. It<br />
is vital for the public to see pharmacists<br />
more as health care<br />
pr<strong>of</strong>essionals than retailers and<br />
that they view prescriptions more<br />
as important and serious entities<br />
necessary for their health than<br />
simple commodities or products.<br />
The new policy is:<br />
1. Bonus points, loyalty points or<br />
air miles may not be awarded<br />
on prescriptions, prescription<br />
services, or other pr<strong>of</strong>essional<br />
services related to the practice<br />
<strong>of</strong> pharmacy in <strong>Ontario</strong>.<br />
2. Points may not be redeemed, or<br />
used as legal tender, for the<br />
purchase <strong>of</strong> prescriptions.<br />
3. Prescriptions, prescription<br />
services, or other pr<strong>of</strong>essional<br />
pharmacy services may be paid<br />
by a major credit card that is<br />
linked to awards, loyalty points<br />
or air miles through special<br />
agreements with financial<br />
institutions, except where<br />
directly or indirectly, a special<br />
gift, bonus, or other<br />
inducement is <strong>of</strong>fered to a<br />
prescriptions, prescription<br />
services or other pr<strong>of</strong>essional<br />
pharmacy services.<br />
4. This policy does not affect the<br />
<strong>College</strong>’s current position<br />
respecting pharmacies and<br />
parking charges. Pharmacies<br />
that reimburse parking charges<br />
(for a client who is having a<br />
prescription filled) are not in<br />
violation <strong>of</strong> current regulations<br />
(pr<strong>of</strong>essional misconduct), as<br />
long as such reimbursement is<br />
not advertised.<br />
Council additionally, agreed<br />
that the current advertising regulation<br />
and related issues<br />
respecting prescription services,<br />
such as inducements, soliciting<br />
and waiving <strong>of</strong> co-payments,<br />
need to be reviewed.<br />
In an effort to inform pharmacists,<br />
designated managers<br />
and owners, a notice with this<br />
new policy was faxed to all pharmacies<br />
in June. As well, owners<br />
and directors <strong>of</strong> pharmacy chains<br />
are being invited to meet with the<br />
<strong>College</strong> for an information and<br />
question and answer session on<br />
the new policy.<br />
8<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
NOTICE<br />
Don’t Forget…..<br />
The next Pharmacy Technician<br />
Certification Examination will be<br />
held on Monday, October 20,<br />
<strong>2003</strong>.<br />
Once a pharmacy technician has<br />
been deemed eligible to sit the<br />
examination, the <strong>College</strong> will send<br />
the “Application to Write the<br />
Pharmacy Technician Certification<br />
Exam” package.<br />
Your application must be received at<br />
the <strong>College</strong>, with the appropriate fee<br />
<strong>of</strong> $233.26 (GST included) by no<br />
later than September 15, <strong>2003</strong>.<br />
Check our website www.ocpinfo.com<br />
for CE and other resources.<br />
For your information, the following<br />
are forthcoming:<br />
Aug. 24 – Oct. 5: Toronto<br />
Certification Review for Pharmacy<br />
Technicians – <strong>2003</strong><br />
Humber <strong>College</strong><br />
Sundays from 9 am to 4 pm<br />
Aug. 24, Sep. 7, 14, 21, Oct. 5<br />
tel: (416) 675-5000<br />
Oct. 24: Ottawa<br />
Pharmacy Technician Conference:<br />
Pharmacy - To Serve & Protect<br />
Ottawa Hospital, General Campus<br />
Kim Lamont<br />
tel: (613) 737-8899, x 72585<br />
fax: (613) 737-8891<br />
klamont@ottawahospital.on.ca<br />
Oct. 24-25: Listowel<br />
Technicians <strong>2003</strong> Current Topics<br />
for Pharmacy<br />
Listowel Memorial Hospital<br />
Chris Vanderspiegel<br />
tel: (519) 291-3125, x 231<br />
fax: (519) 291-5440<br />
chris.vanderspiegel@hphp.org<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 9
COVER STORY<br />
Precursor Control<br />
The prevalence <strong>of</strong> illicit synthetic drugs such<br />
as methamphetamine, ecstasy, P2P and<br />
other amphetamine-type stimulants has<br />
become increasingly widespread in Canada and<br />
beyond. As a result, governments around the<br />
world are working to reduce the diversion <strong>of</strong><br />
precursor chemicals, drugs and compounds that<br />
are used in illicit drug production.<br />
A number <strong>of</strong> countries, including the U.S.,<br />
have enacted legislation to help regulate the movement<br />
<strong>of</strong> precursors and to prevent diversion. While<br />
the U.S. has already placed strict restrictions on<br />
the use and sale <strong>of</strong> precursor drugs and chemicals,<br />
Canada has, as a result, become home to many<br />
clandestine labs as it did not have any regulations<br />
to restrict the sale or movement <strong>of</strong> precursors.<br />
You may have read April news reports about a<br />
10<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
COVER STORY<br />
Greg Ujiye, B.Sc.Phm.<br />
Manager, Pharmacy Practice Programs<br />
Regulation Now in Effect<br />
huge seizure and subsequent arrests across Canada, <strong>of</strong><br />
pseudo-ephedrine tablets destined for the U.S. for use in the<br />
illicit methamphetamine production.<br />
New Canadian Regulation<br />
Last year, the federal government created the Precursor<br />
Control Regulation under the Controlled Drugs and<br />
Substances Act (Regulation) to provide a regulatory framework<br />
that enables Canada to fulfill its international<br />
obligations and to address domestic concerns in monitoring<br />
and controlling access to precursors.<br />
Two classes <strong>of</strong> precursors, Class A and Class B, have<br />
been established. Class A precursors are essential components<br />
<strong>of</strong> illicit substances, such as methamphetamine,<br />
MDMA (ecstasy), cocaine, heroine, LSD, and PCP. Class<br />
B precursors are mostly solvents and reagents used in<br />
clandestine manufacturing processes. (See summary<br />
sheet for list <strong>of</strong> precursors and implementation schedule<br />
on page 14.)<br />
This regulatory framework will govern the international<br />
and domestic movement <strong>of</strong> precursor chemicals and will<br />
allow local and national law enforcement agencies, including<br />
Canada Customs and Revenue Agency, to identify and<br />
control illicit drug production and traffic.<br />
Implementation Dates<br />
A phased-in approach is being implemented: The licence and<br />
permit requirement for import/export <strong>of</strong> Class A precursors, as<br />
well as the licence requirement for their production, came<br />
into force on January 9, <strong>2003</strong>. Implementation controls over<br />
the domestic distribution <strong>of</strong> Class A precursors<br />
followed on <strong>July</strong> 7, <strong>2003</strong>, when the<br />
licence requirement to sell or provide came<br />
into force. Controls over Class B precursors<br />
will be effective on January 1, 2004.<br />
The intent <strong>of</strong> this Regulation is to reduce the diversion<br />
<strong>of</strong> precursor chemicals. It will also limit the ability <strong>of</strong> criminal<br />
organizations to legally purchase these chemicals as<br />
well as reduce the potential pressure on legitimate businesses<br />
from organized crime operators to sell these<br />
chemicals. At the same time, these controls will increase<br />
public safety and reduce the harm and risks to the environment<br />
that result from the clandestine laboratory operations<br />
that dump chemical wastes.<br />
Nonetheless, difficulties in upholding these regulations<br />
lie in the fact that most precursors have wide and legitimate<br />
uses in such common products as pharmaceuticals,<br />
fragrances, flavouring agents, petroleum products and<br />
paints. This Regulation enables Canada to address the need<br />
to monitor and control precursors, while at the same time<br />
remain sensitive and responsive to the approved uses <strong>of</strong><br />
these chemicals.<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 11
COVER STORY<br />
Impact on Pharmacies<br />
Pharmacies are classed as general retailers whose commerce<br />
is not “limited to chemicals or related equipment” and who<br />
provide or sell Class A precursors only in quantities equal to<br />
or less than the thresholds specified in the Schedule to the<br />
Regulation. Therefore, pharmacies are exempt under section<br />
5 from the licence requirements for selling/providing. (The<br />
Regulation has the greatest impact on importers, exporters,<br />
manufacturers, producers and distributors <strong>of</strong> the precursors<br />
found in Class A.)<br />
Exemption<br />
Pharmacies are considered retailers/end users and as such<br />
will be minimally affected by the new regulation. Furthermore,<br />
pharmacies that sell products to the public containing<br />
precursors which fall under the threshold as defined in the<br />
Schedule to the Regulation will not be required to have a<br />
licence under the Regulation. The regulations are not<br />
intended to impede the use <strong>of</strong> these products for legitimate<br />
purposes.<br />
For example, pseudoephedrine-containing products will<br />
be limited to 3g per package size. Package sizes <strong>of</strong> 60 tablets<br />
containing 60mg <strong>of</strong> pseudoephedrine HCL/ tab or 30 tablets<br />
containing 120mg <strong>of</strong> pseudoephedrine HCL/tab are considered<br />
under the threshold.<br />
Licence Required<br />
However, pharmacies will be required to have a licence if<br />
they sell oversized products with more than 3g pseudoephedrine<br />
per package. Furthermore, selling or<br />
transfering quantities <strong>of</strong> product to another pharmacy or<br />
retailer is considered wholesaling and will require a licence<br />
as the exemption under section 5 <strong>of</strong> the Regulation would<br />
not apply. (Please refer to threshold limitations in the Regulations<br />
Summary chart at end <strong>of</strong> this article.)<br />
End-Use Declarations<br />
Purchases <strong>of</strong> oversized products or quantities over the<br />
threshold will require an End-Use Declaration (EUD) to be<br />
signed:<br />
1. An End-Use Declaration will be provided by the distributor<br />
and must be signed by a person acquiring the Class<br />
A precursor — before the transaction takes place<br />
2. The declaration is valid until the end <strong>of</strong> the calendar year<br />
from the date <strong>of</strong> the first transaction<br />
We are currently aware <strong>of</strong> the following products that fall<br />
into this category: CoActifed Syrup2 L, Coactifed Expectorant,<br />
Covan®, Cotridin Syrup and Cotridin Expectorant;<br />
there may be others.<br />
The distribution <strong>of</strong> Class A precursors in Schedule F are<br />
exempted from the application <strong>of</strong> the Regulations. Such<br />
examples include Trinalin® and Cafergot®.<br />
End-Use Declarations Effective <strong>July</strong> 7,<br />
<strong>2003</strong><br />
As <strong>of</strong> <strong>July</strong> 7, <strong>2003</strong> pharmacists are required to sign EUDs<br />
when purchasing products over the threshold as defined in the<br />
Regulations from distributors. <strong>Pharmacists</strong> will also be<br />
required to prepare EUDs for selling over-limit quantities.<br />
However, there are transitional provisions for the<br />
package size stated in the schedule to the Regulation. For<br />
pharmacies and other retailers, the EUD requirement for<br />
selling over-limit quantities does not apply until October 9,<br />
<strong>2003</strong> for all ephedra, ephedrine and pseudoephedrine products<br />
produced and packaged before October 9, 2002.<br />
12<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
COVER STORY<br />
Information<br />
Office <strong>of</strong> Controlled Substances website:<br />
www.hc-sc.gc.ca/ocs-bsc<br />
(CDSA, guidance documents and application forms,<br />
up-to-date information and links)<br />
Pharmacies can sell any pseudoephedrine product manufactured<br />
before October 9, 2002 in any package size (100<br />
count pseudoephedrine HCL 60mg tabs) and still fulfill the<br />
exemption criteria under Section 5, until October 9, <strong>2003</strong>.<br />
Reporting Suspicious Transactions<br />
Licensed dealers are required to record all suspicious transactions<br />
and are encouraged to report these to Health<br />
Canada.<br />
Although this requirement is applicable only to licensed<br />
dealers, pharmacists are asked to practice due diligence<br />
and are encouraged to report any suspicious transactions<br />
that occur.<br />
Health Canada encourages everyone, licensed dealers and<br />
non-licensed dealers, to report all suspicious transactions to<br />
the RCMP National Chemical Diversion Program.<br />
Royal Canadian Mounted Police<br />
Federal Services, “0” Division<br />
130 Dufferin Avenue<br />
London, ON<br />
N6A 5R2<br />
Canada Gazette website:<br />
http://canadagazette.gc.ca/partII/tempPdf/<br />
g2-13621.pdf<br />
(Precursor Control Regulations)<br />
or<br />
Precursor Chemical Section<br />
Licences and Permits Division<br />
Office <strong>of</strong> Controlled Substances<br />
Drug Strategy and Controlled Substances<br />
Programme<br />
Healthy Environments and Consumer Safety Branch<br />
Health Canada<br />
A.L.3502A<br />
123 Slater Street, 2nd Floor<br />
Ottawa, ON K1A 1B9<br />
Telephone: (613) 946-1142<br />
Fax: (613) 941-5360<br />
Attn: Cpl. Brent Hill<br />
NCO I/C Chemical Diversion Program<br />
Tel: (905) 876-9848<br />
Cell: (905) 302-0369<br />
Fax: (519) 640-7255<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 13
HEALTH CANADA<br />
Advisories & Notices<br />
REGULATORY REQUIREMENTS<br />
under the Controlled Drugs and Substances Act (CDSA)<br />
PRECURSOR CONTROL REGULATIONS (PCR)<br />
Domestic<br />
JANUARY 9, <strong>2003</strong><br />
CLASS<br />
Acetic anhydride<br />
N-Acetylanthranilic acid and its salts<br />
Anthranilic acid and its salts<br />
Ephedrine, its salts and any plant<br />
containing ephedrine or any <strong>of</strong> its salts<br />
Ergometrine and its salts<br />
Ergotamine and its salts<br />
Isosafrole<br />
Lysergic acid and its salts<br />
A PRECURSORS<br />
3,4-Methylenedioxyphenyl-2-propanone<br />
Norephedrine (Phenylpropanolamine) and its salts<br />
1-Phenyl-2-propanone<br />
Phenylacetic acid and its salts<br />
Piperidine and its salts<br />
Piperonal<br />
Potassium permanganate<br />
Pseudoephedrine and its salts<br />
Safrole and any essential oil containing safrole<br />
Acetone<br />
Ethyl ether<br />
Hydrochloric acid<br />
CLASS<br />
B PRECURSORS<br />
Methyl ethyl ketone<br />
Sulphuric acid<br />
Toluene<br />
COMING INTO FORCE DATES<br />
CLASS<br />
January 9, <strong>2003</strong><br />
A PRECURSORS<br />
- a licence is required to import, export, produce, and package<br />
- a permit is required to import, export and transit/transhipment<br />
- only a licensed dealer may apply for an import or export permit<br />
<strong>July</strong> 7, <strong>2003</strong><br />
- a licence is required to sell/provide<br />
LICENCE<br />
REQUIREMENTS<br />
• a licence is required to import, export, produce, package or sell/provide<br />
• an end use declaration is required when selling Class A precursors to non-licensed dealers in<br />
quantities or package sizes greater than the threshold in the schedule to the Regulations 1<br />
• it may take up to 75 days for processing applications, due to the criminal record check<br />
requirement<br />
EXEMPTION FOR<br />
SELL/ PROVIDE<br />
(SECTION 5)<br />
The individual or business<br />
• only sells/provides goods on a retail basis(selling goods for the purpose <strong>of</strong> end-use and not<br />
re-sale);<br />
• sells/provides a selection <strong>of</strong> goods that is not limited to chemicals/chemicals and equipment<br />
used in the chemical industry for the production, processing or storage <strong>of</strong> chemicals;<br />
• and sells/provides a precursor in a quantity or package size, per transaction, that does not<br />
exceed the threshold in the schedule to the Regulations.<br />
NOTE: If the individual or business sells precursors over the quantity or package size specified in<br />
the Schedule, they will NOT meet the requirements for this exemption1.<br />
14<br />
1<br />
Transitional provisions in Section 92 - Any package size for any ephedra, ephedrine and pseudoephedrine products produced and packaged before<br />
October, 9, 2002 is deemed to conform with: paragraph 5(1)(c), exemption for sell/provide; and section 8, end use declaration, until October 9, <strong>2003</strong>.
CLASS<br />
A PRECURSORS<br />
INDIVIDUAL EXEMPTIONS<br />
Section 48, provides a process to exempt preparations and mixtures where the Class A precursor<br />
cannot be readily extracted or the product itself cannot be used in the production <strong>of</strong> a controlled<br />
substance<br />
GENERAL EXEMPTIONS<br />
COMING INTO FORCE DATE<br />
The following are exempted from the application <strong>of</strong> PCR:<br />
Fragrances or flavourings<br />
• containing no more than 20% total concentration <strong>of</strong> anthranilic acid, N-anthranilic acid,<br />
phenylacetic acid, piperonal or piperidine, AND is intended to be used in a food, drug cosmetic or<br />
household product;<br />
Formulated silicone products<br />
• containing 1% or less <strong>of</strong> acetic anhydride that is a sealant, adhesive, or coating; and<br />
Schedule F Drugs<br />
• domestic distribution (sell/provide) <strong>of</strong> drugs in dosage form that contain a Class A precursor<br />
listed in Schedule F to the Food and Drug Regulations.<br />
CLASS<br />
B PRECURSORS<br />
January 1, 2004 - a registration is required to import, export and produce for sale<br />
• a permit is required to export certain ClassB precursors to specific destinations<br />
• no permit is required to import Class B precursors<br />
• only a registered dealer may apply for an export permit<br />
REGISTRATION<br />
• it may take up to 75 days for processing applications, due to the criminal record check<br />
requirement<br />
• there are NO registration requirements for sell/provide<br />
SCHEDULE<br />
Class A Precursors Maximum Quantity Class A Precursors Maximum Quantity<br />
Acetic anhydride 1000 kg 3,4-Methylenedioxyphenyl-2-propanone 0<br />
N-Acetylanthranilic acid 1 kg Norephedrine (Phenylpropanolamine) 0<br />
Anthranilic acid 1 kg 1-Phenyl-2-propanone 0<br />
Ephedra 20 g/pkg Phenylacetic acid 1 kg<br />
Ephedrine 0.4 g/pkg Piperidine 0.5 kg<br />
Ergometrine 0 Piperonal 0.5 kg<br />
Ergotamine 0 Potassium permanganate 50 kg<br />
Isosafrole 0.5 kg Pseudoephedrine 3 g/pkg<br />
Lysergic acid 0 Safrole 0.25 kg<br />
INFORMATION RESOURCES<br />
The Precursor Control Regulations can be obtained from the Canada Gazette website:<br />
http://canadagazette.gc.ca/partII/tempPdf/g2-13621.pdf<br />
(under bookmarks SOR/DORS/2002-359 and 361)<br />
A series <strong>of</strong> guidance documents written as a companion to the Precursor Control Regulations to provide guidance on meeting the<br />
regulatory requirements under these Regulations, as well as application forms can be obtained from the Office <strong>of</strong> Controlled<br />
Substances website:<br />
http://www.hc-sc.gc.ca/ocs-bsc<br />
or by contacting the Office <strong>of</strong> Controlled Substances, Drug Strategy and Controlled Substances Programme, Health Canada, at:<br />
613-946-1142<br />
Copie en français disponible<br />
15
Q&A<br />
Q A&<br />
Q A<br />
Greg Ujiye, B.Sc.Phm.<br />
Manager, Pharmacy Practice Programs<br />
PRACTICE<br />
QHas the Drug and Pharmacies Regulation<br />
Act been changed to allow prescriptions<br />
from out <strong>of</strong> the province?<br />
This question refers to s. 158 <strong>of</strong> the DPRA which states:<br />
A pharmacist may dispense a drug pursuant to a written order<br />
signed by a physician or dentist licensed to practise in a<br />
province in Canada other than <strong>Ontario</strong>, if in the pr<strong>of</strong>essional<br />
judgment <strong>of</strong> the pharmacist the patient requires the drug<br />
immediately, but such order shall not be refilled.<br />
In the strict legal sense, only prescriptions that the<br />
pharmacist believes that a patient immediately needs (in<br />
their pr<strong>of</strong>essional judgement) can be filled.<br />
However, prescriptions written in other provinces have<br />
been an issue for <strong>Ontario</strong> pharmacists for some time —<br />
especially since <strong>Ontario</strong> patients <strong>of</strong>ten receive health services<br />
from a bordering province (Manitoba or Quebec). In<br />
these border community situations, pharmacists are<br />
expected to use their pr<strong>of</strong>essional judgment to verify the<br />
authenticity <strong>of</strong> a prescription order and to ensure optimal<br />
patient care. <strong>Pharmacists</strong> are also expected to make their<br />
decisions in the best interests <strong>of</strong> the patient.<br />
The issue <strong>of</strong> cross-border fills was first considered by<br />
Council in June 1999. At that time, Council “approved in<br />
principle”, that amendments be made to the DPRA to<br />
accept transfers from pharmacists from any province in<br />
Canada and to fill prescriptions written by prescribers across<br />
Canada. All other provinces permit this practice. These<br />
amendments have not been approved nor adopted by the<br />
<strong>Ontario</strong> Government.<br />
The situation is further confused as the proposed<br />
amendments to the DPRA allowing pharmacists to fill<br />
prescriptions from other Canadian prescribers was, along<br />
with the new Proprietary Misconduct Regulations, published<br />
in the <strong>July</strong>-<strong>August</strong> 2002 issue <strong>of</strong> Pharmacy Connection for<br />
member and stakeholder feedback and eventual re-submission<br />
to the government. Please bear in mind that these<br />
regulations remain as proposals that still require government<br />
approval and adoption.<br />
QI wish to subdivide my pharmacy to<br />
permit me to operate a “lock and leave”<br />
pharmacy. What must I do? Do I need to<br />
inform the <strong>College</strong>?<br />
In 1997, Council approved a recommendation from the<br />
Accreditation Committee to amend the DPRA regulations<br />
that require members to notify the <strong>College</strong> whenever they<br />
intend to operate a subdivided or “lock and leave” pharmacy.<br />
As such, the pharmacy must be constructed to separate the<br />
dispensary and non-prescription drug products (Schedules<br />
II and III) from general merchandise (unscheduled products).<br />
<strong>College</strong> inspectors have found instances where changes<br />
have been made to pharmacies without the <strong>College</strong> being<br />
notified. Simply ticking the “lock and leave” check box on<br />
your annual Certificate <strong>of</strong> Accreditation renewal does not<br />
constitute proper notification to the <strong>College</strong> that you intend<br />
to operate a “lock and leave”.<br />
Notifying the <strong>College</strong><br />
When you notify the <strong>College</strong> <strong>of</strong> your intent to implement a<br />
“lock and leave” operation, the <strong>College</strong> will:<br />
• Send you the requirements for operating a “lock and leave”<br />
pharmacy<br />
• Require your pharmacy’s designated manager or owner to<br />
sign and submit an updated floor plan<br />
16<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
Q&A<br />
• Ensure that all relevant documentation is included in the<br />
pharmacy’s file so it can be later reviewed by a <strong>College</strong><br />
inspector<br />
“Lock and Leave” Design<br />
The pharmacy must be constructed to ensure that the area<br />
can be locked and made inaccessible to the public when a<br />
pharmacist is not on the premises.<br />
• The barrier must be at least 2.44 metres (8 feet) hight and<br />
wide enough to render the area inaccessible (amended<br />
March 2001)<br />
• If the barrier does not extend to the floor, it cannot be more<br />
than 15 centimeters from the floor<br />
• All products must be at least one meter from the barrier if<br />
it is possible for a person to reach products either over the<br />
top, under the bottom, or through the barrier<br />
The barrier should be constructed so that front store staff<br />
can also access the back storage areas and staff facilities<br />
whenever the barrier is in place. Situations where such<br />
access can only be achieved by opening the barrier are in<br />
violation <strong>of</strong> the policy. In such situations the pharmacy is<br />
considered opened and unsupervised.<br />
No drugs in the Food and Drug Act, Controlled Drugs and<br />
Substances Act or National Schedules I, II, or III may be sold<br />
while the pharmacy is closed. As well, the pharmacy phone<br />
must not be answered during the absence <strong>of</strong> an on-duty pharmacist.<br />
Renovations<br />
Creating a “lock and leave” is considered a renovation. Any<br />
renovation where the physical structure <strong>of</strong> the pharmacy is<br />
changed must be reported to the <strong>College</strong>. These changes<br />
include moving or changing the size <strong>of</strong> the dispensary,<br />
moving or removing walls, or expanding or decreasing the<br />
size <strong>of</strong> the pharmacy. In these cases, the designated manager<br />
or owner must sign and submit an updated copy <strong>of</strong> the floor<br />
plan.<br />
All questions or notifications should be directed to Elaine<br />
Maloney at 416-962-4861 x 293 at the <strong>College</strong>.<br />
Suspensions<br />
<strong>2003</strong><br />
Pursuant to Section 24 <strong>of</strong> the Regulated Health Procedural<br />
Code, the Registrar has suspended the following members’<br />
Certificates <strong>of</strong> Registration for nonpayment <strong>of</strong> annual fees.<br />
As <strong>of</strong> June 13, <strong>2003</strong><br />
Deborah Lynne Appel<br />
Denise Nancy Baldwin<br />
Krista Anne Baragar<br />
Keith Bernard<br />
Emiko Michiko Bolton<br />
Larry Howard Broadfield<br />
Lori Lynn Brown<br />
Dante Pugay Buhain<br />
Ahmad Haiderali Ramji Charania<br />
Shu Ki (William) Chung<br />
Paul Morton Cutler<br />
Nigel Alistair Degruyther<br />
Job Steven Goulding<br />
Trudy Carly Huyghebaert<br />
Tariq Ijaz<br />
Woon-San Ip<br />
Ranbir Kaur (Randi) Kataria<br />
Michael Frederick Kemp<br />
Samuel Sadak Kolta<br />
Susan Kotlyar<br />
Kevin Peter Kowalchuk<br />
Linda Irene Kuber<br />
John Yuen Fai Lee<br />
Anna Fay Leong<br />
Aaron Troy Marchand<br />
Brendan Joseph McGinn<br />
Nazanin Mehin<br />
Shiu-Cheung Richard Ng<br />
Vinh Hung Nguyen<br />
Tanya Marie O'Brien<br />
Chiemezie Oti<br />
Eric Boakye Poku<br />
Lori Jean Power<br />
Sunita Rao<br />
Jane Elizabeth Royle<br />
Rosemary Sibanda<br />
Margaret Frances Smith<br />
Charlene Gabrielle Soulliere<br />
Peter John Walters<br />
James Stuart Watson<br />
Mary Katherine Wulff<br />
Lingling Xu<br />
Christelle Marie Zacharki<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 17
FEATURE<br />
Chris Schillemore, B.Sc.Phm.<br />
Manager, Registration Programs<br />
Historic<br />
Agreement<br />
signed by<br />
Quebec and <strong>Ontario</strong><br />
At a special ceremony in Montreal on<br />
May 7, <strong>2003</strong>, the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong><br />
<strong>Pharmacists</strong> and L’Ordre des<br />
pharmaciens du Quebec signed a<br />
Memorandum <strong>of</strong> Understanding<br />
(MOU) that will enhance pharmacist<br />
mobility between our provinces.<br />
The signing <strong>of</strong> this agreement allows pharmacists<br />
licensed in <strong>Ontario</strong> or Quebec, who graduated from a<br />
Canadian Council for Accreditation <strong>of</strong> Pharmacy<br />
Programs (CCAPP) accredited program, to move more easily<br />
between the two jurisdictions. However, due to the way<br />
Quebec’s legislation is framed, the Ordre can only accept<br />
pharmacists under the terms <strong>of</strong> the MOU who graduated<br />
from a CCAPP-accredited program with a minimum <strong>of</strong> 125<br />
credits and who graduated five or fewer years ago. (This<br />
agreement also facilitates recognition for Quebec students<br />
currently enrolled in the bachelor <strong>of</strong> pharmacy program at<br />
the University <strong>of</strong> Toronto as their educational credentials<br />
will be recognized by the Ordre under this agreement.)<br />
Structured Practical Training<br />
The primary intent <strong>of</strong> this agreement is for both regulators to<br />
mutually recognize each other’s structured practical training.<br />
The structured practical training requirement in Quebec is<br />
18<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
FEATURE<br />
currently 15 weeks versus 12 weeks in <strong>Ontario</strong>. Therefore,<br />
<strong>Ontario</strong> pharmacists moving to Quebec will be required to<br />
complete an additional three weeks <strong>of</strong> structured practical<br />
training while those coming to <strong>Ontario</strong> will not be required<br />
to complete any additional in-service training.<br />
Entry-to-Practice Requirements<br />
Each province maintains its requirements for entry-topractice<br />
as defined in the chart below.<br />
In addition, Quebec will be <strong>of</strong>fering its courses on legislation<br />
and the Quebec health care system on the Internet<br />
— so <strong>Ontario</strong> candidates will be able to complete these<br />
courses prior to relocating to Quebec. As these courses<br />
were only previously <strong>of</strong>fered once-per-year at the University<br />
<strong>of</strong> Montreal and Laval University, this accommodation will<br />
expedite licensure for Quebec-bound candidates.<br />
We are optimistic that the scope <strong>of</strong> this agreement will<br />
be expanded in the future as legislation changes are made,<br />
so that an even greater number <strong>of</strong> pharmacists will be able<br />
to move to Quebec or <strong>Ontario</strong>.<br />
With this agreement, <strong>Ontario</strong> now enjoys mobility<br />
enhancing agreements with all provinces — as it is also a<br />
signatory to the Mutual Recognition Agreement for Pharmacy<br />
in Canada, 2000 (MRA). The MRA outlines the<br />
conditions under which a pharmacist, who is licensed or<br />
registered in one Canadian jurisdiction, will have his/ her<br />
qualifications recognized by another Canadian jurisdiction.<br />
If you any questions about moving to another province,<br />
please contact the provincial regulatory authority in the<br />
jurisdiction to which you wish to move.<br />
Summary <strong>of</strong> Licensure Requirements for<br />
<strong>Ontario</strong> and Quebec -Licensed <strong>Pharmacists</strong>, May <strong>2003</strong><br />
<strong>Ontario</strong> Requirements for Licensure<br />
Have a valid licence with L’Ordre des<br />
Pharmaciens du Quebec<br />
Have obtained a bachelor degree from a<br />
CCAPP-accredited pharmacy program<br />
12-Week Structured Practical Training<br />
internship program<br />
Pro<strong>of</strong> <strong>of</strong> reasonable fluency in<br />
English/French<br />
Appropriate documentation (pro<strong>of</strong> <strong>of</strong><br />
identity, sworn affidavit, letter <strong>of</strong> good<br />
standing, etc.)<br />
Pro<strong>of</strong> <strong>of</strong> having passed the PEBC<br />
Qualifying Examination<br />
Pro<strong>of</strong> <strong>of</strong> having passed the<br />
Pharmaceutical Jurisprudence<br />
Examination<br />
Québec Requirements for Licensure<br />
Have a valid licence with the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong><br />
Have a Bachelor <strong>of</strong> Science in Pharmacy degree provided it was obtained less<br />
than five years prior to making application for a permit [licence] in Quebec as<br />
a pharmacist— provided that the program for which the degree was issued had<br />
at least 125 credits and is accredited by the CCAPP (“Equivalent Degree”)<br />
15-Week Structured Practical Training internship program. The Ordre will<br />
recognize and give a 12-week credit to candidates who complete the OCP’s<br />
Structured Practical Training internship program<br />
Submit pro<strong>of</strong> <strong>of</strong> fluency in French according to the requirements <strong>of</strong> the<br />
Charte de la langue francaise<br />
Appropriate documentation (pro<strong>of</strong> <strong>of</strong> identity, sworn affidavit,<br />
letter <strong>of</strong> good standing, etc.)<br />
Successfully complete a three-credit course on legislation and deontology at<br />
University <strong>of</strong> Montreal or Laval University or any equivalent course<br />
acknowledged by the Ordre<br />
Successfully complete a two-credit course on the Québec Health System at<br />
University <strong>of</strong> Montreal or Laval University or any equivalent course<br />
acknowledged by the Ordre<br />
Successfully complete a three-hour program on emergency<br />
contraception prescribing<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 19
IPG<br />
ENGLISH<br />
COMMUNICATION<br />
SUPPORT<br />
Christina Yurchuk B.A., M.Ed<br />
Janet Sio B.Sc.Phm., ESL Instructors<br />
International<br />
Pharmacy<br />
Graduate<br />
Program<br />
One <strong>of</strong> the biggest challenges for pharmacists<br />
who graduated outside Canada or the<br />
U.S., whose first language is not English, is to learn<br />
the language skills to communicate and counsel patients.<br />
Although all participants in the IPG program must meet<br />
the fluency requirements set by the <strong>Ontario</strong> <strong>College</strong> <strong>of</strong> <strong>Pharmacists</strong>,<br />
there remains a need to empower participants with<br />
the required pr<strong>of</strong>essional communication skills to effectively<br />
practice pharmaceutical care. This need was the impetus<br />
behind the creation <strong>of</strong> an important component in our<br />
program: the “English for Specific Purposes” (ESP) curricula.<br />
After conducting a language task analysis <strong>of</strong> practicing<br />
pharmacists, it was determined that the greatest language<br />
need for internationally trained pharmacists was counselling<br />
on prescriptions. This was translated into a course called<br />
“The Language <strong>of</strong> Patient Counselling”, that provides specific<br />
language practice (particularly in listening and speaking<br />
skills) that is required to conduct an effective patient interview.<br />
This course is woven into the IPG program and<br />
reinforces concepts taught in other courses (i.e. Communications<br />
Course) and provides the language supports necessary<br />
for the student to be able to conduct the Pr<strong>of</strong>essional Practice<br />
Labs, where participants are, in addition to dispensing, also<br />
assessed on their counselling skills.<br />
This new course was structured according to a<br />
communication model specific to the patient<br />
counselling interview. Through this course,<br />
participants learn to:<br />
• Establish rapport with the patient<br />
• Gather information to compile a patient<br />
pr<strong>of</strong>ile<br />
• Provide relevant information in an organized and<br />
effective way<br />
• Express empathy when appropriate<br />
• Conclude the interview in a pr<strong>of</strong>essional manner<br />
The language classes are divided into two parts: a) the<br />
practice phase (or pre-communicative phase); and b) the<br />
role-play phase with feedback (also known as a communicative<br />
phase).<br />
In the first phase participants have many listening and<br />
speaking opportunities to practice English in the context <strong>of</strong><br />
pharmacy practice: grammatical structures, appropriate use<br />
<strong>of</strong> terminology, socio-cultural context <strong>of</strong> language, logic,<br />
sequence <strong>of</strong> questions, etc. In the second phase, participants,<br />
in groups <strong>of</strong> three, have the opportunity to role-play portions<br />
<strong>of</strong>, and eventually, the complete counselling interview. Each<br />
student has the chance to be the patient, the pharmacist and<br />
the observer. (The observer’s role is to provide feedback to the<br />
pharmacist.)<br />
continued on page 22<br />
20<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
Q&A<br />
Q A&<br />
Q A<br />
Stephanie Edwards, B.Sc.Phm.<br />
SPT<br />
Diana Spizzirri, B.Sc.Phm.<br />
QDo pharmacy students need to be<br />
registered with the <strong>College</strong>?<br />
Students must be registered with the <strong>College</strong> to perform<br />
the “controlled acts” (e.g., dialoguing with patients, taking<br />
telephone prescriptions) while under the direct supervision<br />
<strong>of</strong> their preceptor or another pharmacist.<br />
This applies to both international pharmacy graduates<br />
doing SPT Studentship and to Canadian/U.S. students<br />
registered in non-credit studentship positions. (Note: There<br />
is no OCP studentship training requirement for students in<br />
accredited Canadian or U.S. faculties <strong>of</strong> pharmacy, as they<br />
receive experiential training through their existing curricula.)<br />
Furthermore, pharmacy students must identify themselves<br />
as “students” in any situation where they are<br />
performing the controlled acts. All OCP-registered pharmacy<br />
students are assigned an OCP student number and<br />
given an identification card that displays their status.<br />
Interns<br />
Interns must also be registered with the <strong>College</strong> to legally<br />
perform the controlled acts, first under supervision and<br />
then independently, once the preceptor agrees and a pharmacist<br />
remains present in the pharmacy. Preceptors are<br />
reminded that interns must receive notification from the<br />
<strong>College</strong> that their SPT Internship has been successfully<br />
completed. Furthermore, they cannot work alone until they<br />
are licensed.<br />
QIf the student must be supervised while<br />
performing the controlled acts, such as<br />
taking a verbal prescription by phone,<br />
how do you suggest this be done?<br />
This question is frequently raised at the preceptor workshops.<br />
The important thing is for you to give your student as<br />
much practice as possible in listening to, and transcribing,<br />
drug names and directions as well as noting people’s names<br />
over the telephone. You may allow the student to take “live”<br />
verbal prescriptions under direct supervision when you<br />
become comfortable with their ability.<br />
Some creative suggestions for providing students with<br />
opportunities to practice taking telephone prescriptions<br />
include:<br />
• Having a technician or pharmacist read prescriptions<br />
from hard copy files and then have the student review<br />
the written prescriptions to self-assess their accuracy<br />
• Asking a physician’s <strong>of</strong>fice to fax a copy <strong>of</strong> the<br />
prescription so the verbal order can be later verified<br />
• Having a physician assist by giving a verbal order to<br />
the student, and repeat and spell the details as<br />
necessary<br />
• Using a telephone system which allows two people to<br />
listen in on the line, have the student identify<br />
him/herself as a student before taking the prescription,<br />
while the pharmacist listens to verify the order.<br />
continued on page 22<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 21
Q&A<br />
QI have heard that all interns are required<br />
to forward their completed Activities to<br />
the <strong>College</strong>. Is this true?<br />
Yes, effective <strong>2003</strong>, all students and interns are required to<br />
submit their completed Activities to the <strong>College</strong> as part <strong>of</strong><br />
their structured training. They will be notified by SPT staff<br />
approximately one month into the rotation. We suggest that<br />
you submit your Activities three weeks prior to the end <strong>of</strong><br />
your rotation.<br />
Preceptors should discuss the Activities with the<br />
student/intern and review the final version before it is<br />
submitted. This will reduce re-submissions and expedite the<br />
overall licensing process.<br />
The <strong>College</strong> conducts in-house random reviews <strong>of</strong><br />
completed Activities to ensure the SPT program is fairly<br />
implemented across all SPT sites. Although we do not<br />
review every report in detail, we do look for evidence that<br />
preceptors have provided necessary feedback to their<br />
student/intern and that the final submissions are high<br />
quality. Please refer to the guidelines for completing the<br />
Activities in the SPT manual.<br />
QHave there been any changes in the<br />
assessment process <strong>of</strong> SPT programs?<br />
Please note that the assessment process for the SPT<br />
programs has changed slightly in <strong>2003</strong>. For Canadian/U.S.<br />
SPT Internship, one <strong>of</strong> the three monthly formal assessments<br />
has been replaced by a TOC or Target Objective<br />
Conference. The TOC is a brief, one-page assessment form<br />
to be completed by the student or intern along with their<br />
preceptor’s feedback that is added during the discussion<br />
with the student/intern. (Similar changes for international<br />
pharmacy graduates will be made in the near future.) These<br />
changes were made in response to preceptors who sought<br />
decreases to the workload and required paperwork.<br />
International Pharmacy<br />
Graduate Program<br />
All sessions are led by an ESL<br />
instructor and a pharmacist teaching<br />
assistant (TA). This co-facilitation<br />
provides participants with a unique<br />
learning opportunity. The pharmacist<br />
TA assists in what participants may say;<br />
addressing specific pharmacist-patient<br />
interactions such as counselling a specific<br />
dosage form. The ESL instructor assists in<br />
how they may say it; addressing specific linguistic<br />
issues such as grammar and phrasing. Moreover,<br />
because <strong>of</strong> the small group size (10-15 per group) there is an<br />
opportunity for each participant to receive tailored feedback on their language and counselling skills.<br />
Student response has been positive as they are reporting that the ESL course is giving them new confidence in<br />
conducting patient interviews.<br />
22<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
HEALTH CANADA<br />
Advisories & Notices<br />
DATE<br />
June 9 / 03<br />
June 6 / 03<br />
June 4 / 03<br />
May 28 / 03<br />
May 27 / 03<br />
May 23 / 03<br />
May 9 / 03<br />
May 8 / 03<br />
April 29 / 03<br />
April 28 / 03<br />
April 14 & 17 / 03<br />
April 10 / 03<br />
April 2 / 03<br />
April 1 / 03<br />
March 18 /03<br />
March 12 / 03<br />
March 5 &<br />
February 28 / 03<br />
February 28 / 03<br />
February 19 / 03<br />
February 17 / 03<br />
February 17 / 03<br />
February 13 / 03<br />
January 30 / 03<br />
TYPE<br />
Advisory – Health Canada reminds Canadians <strong>of</strong> the Dangers <strong>of</strong> Ephedra / ephedrine products<br />
Advisory – Health Canada is advising Canadians not to use Empowerplus. Also known as EM Power+ and EM<br />
Power sold by Truehope Nutritional Support Limited (also known as Synergy)<br />
Insulin Products in Canada – an update from Health Canada<br />
Important Safety Information on Estrogen Plus Progestin (PremplusTablets) – Wyeth Pharmaceuticals<br />
Warning – Health Canada warns the public not to use Hua Fo / VIGOR-MAX<br />
tablets, a Chinese herbal product that contains tadalafil. Inappropriate use <strong>of</strong> tadalafilcould cause severe<br />
adverse reactions<br />
Important Medical Devices Safety Advisory to users <strong>of</strong> Siemens Servo 300 / 300A Ventilators – Siemens<br />
Canada Limited<br />
Public Advisory – Bronchial Problems Associated with Rapamune® (sirolimus) – Wyeth Pharmaceuticals<br />
Advisory – Health Canada advises against the use <strong>of</strong> SEAVITE products containing iodine<br />
Advisory – Health Canada is advising Canadians to be wary <strong>of</strong> products with claims concerning the<br />
prevention or treatment <strong>of</strong> SARS<br />
Advisory – Health Canada is advising Canadians <strong>of</strong> a dangerous interaction between diathermy therapy and<br />
implanted metallic leads<br />
Important Safety Information & Public Advisory Regarding Permax ® (pergolide mesylate) and Cardiac<br />
Valvulopathy – Eli Lilly Canada Inc. and Draxis Health Inc.<br />
Important Safety Information & Public Advisory About DIANE ® - 35 and the Risk <strong>of</strong> Venous<br />
Thromboembolism – Berlex Canada Inc.<br />
Notice to Hospitals - Important Safety Information Regarding Diathermy Therepy – Health Canada<br />
Important Dosing Clarification for Fragmin® (dalteparin sodium injection) – Pharmacia Canada Inc.<br />
Advisory on Diethylstilbestrol (DES) and the Risk <strong>of</strong> Genital and Obstetrical Complications – Health Canada<br />
Important Safety Information Regarding Ethyol (Amifostine) and Severe Cutaneous Reactions – Health<br />
Canada<br />
New Safety Information Associated with the Use <strong>of</strong> Zol<strong>of</strong>t® (sertraline hydrochloride) in Patients taking<br />
Pimozide (Contraindication) – Pfizer Canada Inc.<br />
Advisory – Health Canada reports back to public on safety pr<strong>of</strong>ile <strong>of</strong> Meridia ® (sibutramine)<br />
Warning Regarding Rapamune® (sirolimus) and Bronchial Anastomotic Dehiscence including Fatal Cases –<br />
Wyeth Pharmaceuticals<br />
Notice to Hospitals – Cochlear Implant Recipients may be a Greater Risk for Meningitis – Information Update,<br />
Health Products and Food Branch<br />
Letter to Healthcare Pr<strong>of</strong>essionals Regarding Synagis® (pavlivizumab) – Abbott Laboratories Limited<br />
Advisory – Health Canada is advising Canadians about the safe use <strong>of</strong> products containing Acetaminophen<br />
New Contraindication Regarding Ergotamine and Dihydroergotamine – containing drugs: Risk <strong>of</strong> Cerebral<br />
and/or Peripheral Ischemia – Novartis Pharmaceuticals Canada Inc.<br />
For complete information and electronic mailing <strong>of</strong> the Health Canada Advisories / Warnings /Notices,<br />
subscribe online at: http://www.hc-sc.gc.ca/hpfb-dgpsa/tpd-dpt/<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 23
COLUMN<br />
INSPECTORS’ CORNER:<br />
INSPECTORS’ CORNER:<br />
THE INSPECTION PROCESS<br />
Rose Fitzgerald, B.Sc.Phm.<br />
“Inspection is not a game <strong>of</strong> "catch as catch can". Rather, as I noted,<br />
it is a process <strong>of</strong> verification for the purpose <strong>of</strong> creating confidence.<br />
It is not built upon the premise <strong>of</strong> trust. Rather, it is<br />
designed to lead to trust…”<br />
– Hans Blix, United Nations Weapons Inspector, January, <strong>2003</strong><br />
Each year, the <strong>College</strong>’s Pharmacy Practice<br />
Department receives many calls, and<br />
inspectors and staff are also approached<br />
by many pharmacists, all asking questions<br />
about the process and details <strong>of</strong> pharmacy<br />
site visits/inspections.<br />
While past articles have focused on the<br />
details <strong>of</strong> the inspections, this article<br />
provides an overview to provide you with<br />
a greater understanding <strong>of</strong> the inspection<br />
process; starting from the Prior<br />
Notice letter informing the designated<br />
manager <strong>of</strong> an upcoming inspection<br />
through to the possible outcomes <strong>of</strong><br />
that visit. Future articles will discuss<br />
specific aspects <strong>of</strong> the inspection<br />
process such as “action plans”.<br />
There are over 2700 accredited pharmacies<br />
in <strong>Ontario</strong>. Each pharmacy receives a<br />
routine inspection once every three years. The<br />
<strong>College</strong> employs four inspectors and one compliance<br />
<strong>of</strong>ficer who are responsible for all inspections<br />
24<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
COLUMN<br />
which include routine, re-inspections, new openings,<br />
acquisitions and relocations.<br />
Inspections should not be confused with investigations.<br />
Inspections fall under the jurisdiction <strong>of</strong> the Accreditation<br />
program area whereas investigations are the responsibility <strong>of</strong><br />
the Investigations and Resolutions Department. The Drug<br />
and Pharmacies Regulations Act (DPRA) provides the<br />
<strong>College</strong> with the authority to appoint inspectors and the<br />
authority to inspect pharmacies and examine records.<br />
The Inspection process for a pharmacy is similar to<br />
the Quality Assurance Program for pharmacists. It is a<br />
form <strong>of</strong> practice review. The inspections are primarily<br />
educational and conducted to assist members in<br />
complying with legislative requirements for maintaining a<br />
practice site that allows for the safe distribution <strong>of</strong> drugs<br />
and for pharmacists to maintain pr<strong>of</strong>essional and operational<br />
standards <strong>of</strong> practice. The <strong>College</strong> has also worked<br />
over the years to revise the inspection process so that it<br />
becomes a more positive experience by shifting the<br />
inspection focus from “checking the nuts and bolts” <strong>of</strong> a<br />
pharmacy to a broad review <strong>of</strong> how members practice in<br />
the pharmacy site.<br />
Unfortunately identifying deficiencies is viewed by<br />
some pharmacists as criticism or enforcement. While<br />
some pharmacists view the inspection as adversarial or<br />
negative, the underlying role <strong>of</strong> the inspector is to accurately<br />
and pr<strong>of</strong>essionally identify deficiencies in the<br />
pharmacy and/or in its members’ practice. These deficiencies<br />
are brought to the attention <strong>of</strong> the designated<br />
manager and/or the owner.<br />
The inspectors are also available to answer questions<br />
about pharmacy practice, clarify issues and to make recommendations.<br />
The <strong>College</strong> and its inspectors work to provide<br />
the most suitable and constructive way to achieve the ultimate<br />
goal <strong>of</strong> inspection, namely, to ensure that every<br />
pharmacy complies with the legislation and standards and<br />
that pharmacists meet the Standards <strong>of</strong> Practice.<br />
Routine Inspections<br />
Every accredited pharmacy receives, at no cost, one inspection<br />
and one follow-up re-inspection (if required).<br />
Cost Recovery<br />
In the past, pharmacies that did not achieve compliance<br />
were re-inspected until compliance was achieved or until<br />
the pharmacy was referred to the Accreditation Committee<br />
for review and a possible further referral to the Discipline<br />
Committee for resolution. This process led to many delays<br />
from initial visit to a final resolution, and in some cases, it<br />
resulted in four or five pharmacy visits over a period <strong>of</strong> years.<br />
It was also found that, in most cases, the same pharmacies<br />
were responsible for several re-inspections and a more expeditious<br />
process was needed.<br />
In 2002, the Accreditation Committee believed that it<br />
was unfair for the majority <strong>of</strong> compliant pharmacies to pay<br />
for the few non-compliant locations and recommended that<br />
cost recovery charges be imposed on non-compliant locations.<br />
Effective January <strong>2003</strong>, pharmacies that the<br />
Committee decides require an inspection beyond their original<br />
inspection and one re-inspection will now be required to<br />
pay $500 (plus GST) for all future visits. Costs can also be<br />
charged for inspections determined through an undertaking<br />
as a result <strong>of</strong> a Complaints hearing or can be ordered as part<br />
<strong>of</strong> a Discipline decision.<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 25
COLUMN<br />
INSPECTORS’ CORNER:<br />
INSPECTORS’ CORNER:<br />
By better preparing for an inspection, the designated<br />
manager / owner will have more time to discuss any inspection<br />
or practice-related issues with the inspector. Some<br />
designated managers/owners like to be present during an<br />
inspection. Although inspectors do not schedule appointments,<br />
a request for the inspection to be held on a specific<br />
day <strong>of</strong> the week can be arranged when the inspector’s<br />
schedule permits it.<br />
Pharmacy Site Visit / Inspection*<br />
Inspectors try to avoid interfering with a pharmacy’s daily<br />
routine and usually request the use <strong>of</strong> an <strong>of</strong>fice or an area<br />
close to the main dispensing area. Once the inspection is<br />
completed, the inspector will generate a report for the designated<br />
manager to discuss any deficiencies identified.<br />
The Inspection Process<br />
The Prior Notice Letter Begins the<br />
Inspection Process<br />
When three years has elapsed from the last inspection, a<br />
Prior Notice letter is sent to the designated manager/owner<br />
advising him/her that an inspection will take place within<br />
the next 3 months. This allows ample time for the pharmacy<br />
to prepare for the inspection by:<br />
- Reviewing the inspection checklist<br />
- Reviewing library requirements<br />
- Checking record keeping<br />
(*The Pharmacy Site Visit is discussed in detail in the<br />
January/February <strong>2003</strong> issue.)<br />
Action Plan*<br />
When deficiencies are identified, the inspector will<br />
request an action plan, with a deadline, from the designated<br />
manager/owner. Any questions concerning the<br />
action plan should be discussed at that time with the<br />
inspector. You can also call the inspector with any followup<br />
questions.<br />
Action plans are filed and recorded at the <strong>College</strong> and<br />
become part <strong>of</strong> the pharmacy’s inspection record. (While<br />
the pharmacy will be reminded if the action plan is not<br />
submitted on time, failure to submit an action plan may<br />
result in a referral to the Accreditation Committee.)<br />
The inspector reviews the action plans and can either<br />
accept or deem the plan incomplete. In some instances,<br />
when a number <strong>of</strong> deficiencies are identified or a particular<br />
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Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
COLUMN<br />
deficiency is extreme, the inspector may request a re-inspection<br />
<strong>of</strong> the pharmacy in addition to an action plan.<br />
*An article detailing the Action Plan will be published in a<br />
future edition.<br />
Pharmacy Re-inspection<br />
The goal <strong>of</strong> a re-inspection is to ensure that the pharmacy<br />
has achieved compliance. The re-inspection is handled<br />
much like a regular inspection with special attention being<br />
paid to the issues/deficiencies identified in the prior inspection.<br />
Re-inspections normally occur within one to six months<br />
(after the <strong>College</strong> receives the action plan) and are<br />
performed by the compliance <strong>of</strong>ficer. Re-inspections are not<br />
usually done by the original inspector so as to allow the<br />
pharmacy to be reviewed without bias.<br />
Pharmacies that fail to achieve compliance upon this reinspection<br />
are then referred to the Accreditation Committee<br />
for a decision. The designated manager will be asked to<br />
provide a detailed action plan for the compliance <strong>of</strong>ficer that<br />
is then forwarded to the Accreditation Committee, along<br />
with the pharmacy’s previous inspection history, for review<br />
and decision.<br />
Accreditation Committee<br />
The Accreditation Committee is a statutory committee<br />
under the Pharmacy Act comprising <strong>of</strong> pharmacist members<br />
<strong>of</strong> Council, non-Council pharmacist members and public<br />
members appointed to Council. One <strong>of</strong> the Committee’s<br />
duties is to address issues related to the Certificates <strong>of</strong><br />
Accreditation <strong>of</strong> pharmacies that have failed to achieve<br />
compliance.<br />
In reviewing the inspection reports and any information<br />
provided by a pharmacy, the Committee can make the<br />
following decisions:<br />
1. Conclude the matter<br />
2. Request another re-inspection with costs<br />
3. Refer the pharmacy to the Discipline Committee<br />
4. Refer the pharmacy to the Discipline Committee and<br />
request an Interim Suspension <strong>of</strong> the Certificate <strong>of</strong><br />
Accreditation<br />
5. Refer the owner/designated manager to the Executive<br />
Committee to recommend action<br />
Helping <strong>Pharmacists</strong> Achieve the<br />
Accreditation Standards<br />
For most pharmacies, the inspection process results in a<br />
successful report that the pharmacy has met the accreditation<br />
standards. Some pharmacies require multiple visits<br />
before compliance is achieved. Very few re-inspections<br />
result in a pharmacy being referred to the Accreditation<br />
Committee.<br />
The ultimate goal <strong>of</strong> the <strong>College</strong> is to provide advice and<br />
feedback to the designated manager and/or owner in order to<br />
achieve compliance for the pharmacy.<br />
If you have questions about a past or upcoming inspection,<br />
please feel free to contact your inspector. They will be<br />
pleased to assist you.<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 27
COMPLAINTS<br />
CLOSE<br />
UP ON COMPLAINTS<br />
Altering Third Party<br />
Payor Information<br />
Acting Outside the Scope <strong>of</strong> the Pharmacist’s Role<br />
Eva Markowski, Complaints Officer<br />
The <strong>College</strong> frequently receives complaints from<br />
third-party payors about situations in which<br />
pharmacists acted outside their pr<strong>of</strong>essional scope <strong>of</strong><br />
practice by altering coverage data to assist patients<br />
in the processing <strong>of</strong> a claim. This article examines<br />
such a complaint and the Complaints Committee<br />
investigation and disposition.<br />
Facts<br />
A man attended a pharmacy and<br />
presented a third-party insurer card for<br />
two prescriptions. Upon entering information<br />
into the computer the<br />
pharmacist saw that, while the patient<br />
was not covered, the patient’s spouse<br />
was insured under the policy number.<br />
The patient insisted that he was<br />
covered and the pharmacist attempted<br />
twice more to process the transaction.<br />
Both attempts failed. A fourth attempt<br />
succeeded but only after the pharmacist<br />
altered the patient’s pr<strong>of</strong>ile to<br />
indicate that he was the cardholder,<br />
rather than the spouse. The pharmacist<br />
then entered the cardholder’s date<br />
<strong>of</strong> birth.<br />
Although the patient received<br />
coverage under the plan, a few days<br />
later, the pharmacist’s alterations to the<br />
pr<strong>of</strong>ile resulted in these transactions<br />
being assigned to the cardholder, not<br />
the patient. Documentation substantiating<br />
the transaction was provided to<br />
the <strong>College</strong> by the third party insurer.<br />
28<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
COMPLAINTS<br />
Reasons<br />
The Complaints Committee reviewed<br />
the transaction records and determined<br />
that the member had violated<br />
his pharmacy’s standing protocol with<br />
the insurer by repeatedly submitting<br />
the patient’s prescription (despite the<br />
system’s failure to accept the transaction).<br />
The Committee appreciated the<br />
member’s willingness and intent to<br />
promptly fill the patient’s prescriptions;<br />
there were; however, there were<br />
more appropriate courses <strong>of</strong> action<br />
available to the pharmacist. The pharmacist<br />
could have:<br />
• Dispensed the medication as a<br />
cash purchase to the patient,<br />
knowing that the patient could<br />
be reimbursed once he proved<br />
that he was insured; or<br />
• Paused to phone the insurer to<br />
verify whether there was indeed<br />
a “glitch” in the system records<br />
that failed to note that the<br />
patient was covered<br />
The Committee did not consider<br />
this to be a situation where the pharmacist<br />
was exercising his<br />
“pr<strong>of</strong>essional judgment” to override<br />
the system because the member has<br />
no discretionary permission to alter<br />
third party records or billings.<br />
It was highly inappropriate for the<br />
member to alter a record to force a<br />
transaction that would override an<br />
adjudication system.<br />
And, while the member’s motive<br />
may have been to accommodate his<br />
patient, his actions led to intentional<br />
and repeated re-submissions despite<br />
the computer system indicating<br />
“claimant not covered”.<br />
Decision<br />
Although the Committee concluded<br />
that the member had acted inappropriately,<br />
it struggled to determine a<br />
suitable disposition. Indeed, is<br />
referral to the Discipline Committee<br />
the only appropriate remediation for<br />
the member’s behaviour?<br />
After much discussion, the<br />
Committee decided that referral to<br />
the Discipline Committee would be<br />
inappropriate and that the member’s<br />
breach <strong>of</strong> the Standards <strong>of</strong> Practice<br />
would be appropriately addressed<br />
with the issuance <strong>of</strong> a written<br />
caution, which read:<br />
“As a practising pharmacist, you<br />
must maintain the standards <strong>of</strong><br />
your pr<strong>of</strong>ession and remain in<br />
compliance with the relevant<br />
legislation. While the Committee<br />
appreciates that you may have<br />
been attempting to accommodate<br />
your patient, you are cautioned<br />
that you are expected to fulfill<br />
your obligations to your patient<br />
without violating protocol and the<br />
standards <strong>of</strong> your pr<strong>of</strong>ession, and<br />
are reminded here particularly <strong>of</strong><br />
Standard 6 which reads:<br />
‘The pharmacist applies knowledge,<br />
principles and skills <strong>of</strong><br />
management as they pertain to the<br />
site <strong>of</strong> pharmacy practice, with the<br />
goal <strong>of</strong> optimizing patient care and<br />
inter-pr<strong>of</strong>essional relations.’ ”<br />
The Committee was <strong>of</strong> the<br />
opinion that another such incident<br />
was unlikely to occur in this<br />
member’s practice given: this was a<br />
single incident involving a minor<br />
amount <strong>of</strong> money for a patient who<br />
became insured within 4 days <strong>of</strong> the<br />
transaction; the member had no<br />
intent to mislead, and he provided a<br />
forthright response to the<br />
Committee.<br />
Nonetheless, although this<br />
complaint did not reveal any evidence<br />
<strong>of</strong> fraud by the member or the pharmacy,<br />
the <strong>College</strong>’s investigation did<br />
confirm that the third-party insurer<br />
should not have been billed and that<br />
the member had violated his pharmacy’s<br />
agreement with the insurer.<br />
The Committee therefore determined<br />
that a written caution<br />
adequately addresses the public<br />
interest raised in this complaint. The<br />
caution will remain on the member’s<br />
record in the non-public portion <strong>of</strong><br />
the Register.<br />
WHAT IS A WRITTEN<br />
CAUTION?<br />
A written caution is <strong>of</strong>ten issued by<br />
the Complaints Committee as an<br />
appropriate remedial measure for<br />
serious matters where a referral to<br />
the Discipline Committee would not<br />
be appropriate. Although the member<br />
identified in a complaint is not<br />
required to appear before the<br />
Complaints Committee for his/her<br />
“caution”, the caution is included<br />
in the Committee’s written decision,<br />
thereby sent to the complainant as<br />
well as the member. It is also permanently<br />
placed on the member’s<br />
non-public portion <strong>of</strong> the Register.<br />
Although it is not considered punitive,<br />
the caution may be considered<br />
should the member appear before<br />
the Committee for a new complaint.<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 29
REPORT<br />
CORONER’S REPORT<br />
CORONER’S REPORT<br />
The <strong>College</strong> regularly receives reports from the <strong>Ontario</strong><br />
Coroner’s Office. Following is a summary <strong>of</strong> the findings <strong>of</strong> a<br />
recent case along with recommendations that have an impact<br />
on pharmacists and pharmacy practice.<br />
CASE<br />
KIMBERLY ANN ROGERS<br />
On <strong>August</strong> 9, 2001, Kimberly Ann<br />
Rogers, a 40 year-old woman who was<br />
eight months pregnant, was found<br />
dead in the apartment in which she<br />
was confined by terms <strong>of</strong> a sentence<br />
imposed for welfare fraud. Ms. Rogers<br />
had a history <strong>of</strong> depression with panic<br />
attacks, migraines and a disabling knee<br />
injury. As a result <strong>of</strong> her conviction, Ms<br />
Rogers had been temporarily ineligible<br />
for welfare benefits under the<br />
province’s “zero-tolerance” policy.<br />
There were many stresses in Ms<br />
Roger’s life including financial, legal,<br />
medical and occupational issues.<br />
While the coroner’s jury made<br />
several recommendations, the<br />
following summary only lists the relevant<br />
medical aspects <strong>of</strong> this case as<br />
information and education for pharmacists.<br />
A full report <strong>of</strong> the coroner’s jury<br />
can be obtained by contacting the<br />
Office <strong>of</strong> the Chief Coroner at 416-<br />
326-5010.<br />
Recommendation #5 to the<br />
Government <strong>of</strong> <strong>Ontario</strong>—<br />
Minister <strong>of</strong> Health and the<br />
<strong>College</strong> <strong>of</strong> Physicians and<br />
Surgeons<br />
“Physicians should be educated on the<br />
potential risks <strong>of</strong> tri-cyclic anti-depressants<br />
in the treatment <strong>of</strong> depression, and<br />
should be encouraged to use the safer<br />
class <strong>of</strong> anti-depressants such as SSRI’s<br />
as a first line drug therapy. Wherever<br />
appropriate, physicians should<br />
encourage patients to access supportive<br />
counselling services in the community.”<br />
Rationale: To encourage the use <strong>of</strong><br />
extreme caution in the prescribing <strong>of</strong><br />
medications, by encouraging the<br />
prescribing <strong>of</strong> a less dangerous or lethal<br />
drug.<br />
<strong>Pharmacists</strong> should also bear this<br />
information in mind and are encouraged<br />
to collaborate with physicians,<br />
patients and community services agencies<br />
to ensure optimal drug therapy.<br />
(The report also noted that this patient<br />
was pregnant and therapy was chosen<br />
with that consideration in mind.) Each<br />
refill <strong>of</strong> a prescription for antidepressants<br />
is an opportunity for the<br />
pharmacist to dialogue with the<br />
patient, to monitor any changes in drug<br />
therapy or the patient’s condition, and<br />
to determine whether the patient is<br />
accessing counselling services.<br />
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Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
REPORT<br />
Recommendation #9 to the<br />
Government <strong>of</strong> <strong>Ontario</strong>—<br />
Minister <strong>of</strong> Health and the<br />
<strong>College</strong> <strong>of</strong> Physicians and<br />
Surgeons<br />
“Consideration should be given to the<br />
creation <strong>of</strong> a computer access Internet<br />
program such as British Columbia’s<br />
PharmaNet system. For example by<br />
using a health card that would permit<br />
pharmacies to access a patient’s drug<br />
dispensing records from other pharmacies,<br />
as well as to alert other pharmacies<br />
<strong>of</strong> a patient’s past attempt to utter forged<br />
prescriptions. <strong>Pharmacists</strong> should be<br />
required to notify the prescribing physician<br />
<strong>of</strong> any attempts by the patient to<br />
alter the prescription.”<br />
Rationale: Evidences showed that<br />
several different pharmacies were used<br />
to fill prescriptions. This will give pharmacists<br />
a history <strong>of</strong> a patient’s<br />
prescriptions.<br />
Other coroner’s reports have<br />
recently made recommendations<br />
regarding a central data base <strong>of</strong> prescription<br />
and health information to aid<br />
pharmacists and other health pr<strong>of</strong>essionals<br />
in providing optimal care to<br />
patients. Until such time a system is in<br />
place which provides this information,<br />
while protecting patient privacy, pharmacists<br />
need to continue to enter into<br />
dialogue with their patients, gather as<br />
much information as possible, identify<br />
any potential problems, and intervene<br />
in the best interests <strong>of</strong> the patient.<br />
Recommendation to the<br />
Government <strong>of</strong> <strong>Ontario</strong>—<br />
Minister <strong>of</strong> Health and the<br />
<strong>College</strong> <strong>of</strong> Physicians and<br />
Surgeons<br />
“Physicians should be encouraged to<br />
write out prescriptions in both digits and<br />
longhand to prevent modification <strong>of</strong> the<br />
quantity by patients, e.g. “40, forty<br />
tablets”.<br />
Rationale: Evidence was introduced<br />
indicating possible quantity changes on<br />
the Physician’s prescription by the<br />
patient. This will prevent a patient from<br />
changing the numerically written<br />
number.<br />
Pr<strong>of</strong>essional practice staff from<br />
OCP and the <strong>College</strong> <strong>of</strong> Physicians<br />
and Surgeons meet on an ongoing basis<br />
to discuss matters <strong>of</strong> mutual concern,<br />
such as the clarity <strong>of</strong> prescriptions. The<br />
<strong>College</strong>’s Executive Committee also<br />
affirmed the recommendation that the<br />
prescribing physician should be notified<br />
<strong>of</strong> any attempts by the patient to<br />
alter the prescription.<br />
<strong>College</strong> inspectors also continue to<br />
point out problems regarding forged<br />
prescriptions as they visit pharmacies.<br />
A recent article in the<br />
November/December 2002 issue<br />
(pages 24-26) provides guidelines on<br />
how you can identify a forgery and<br />
what actions to take in the event <strong>of</strong> a<br />
forgery being received at your pharmacy.<br />
Recommendation to the<br />
Government <strong>of</strong> <strong>Ontario</strong>—<br />
Minister <strong>of</strong> Health<br />
“Health Canada and the publishers <strong>of</strong><br />
the Compendium <strong>of</strong> Pharmaceuticals<br />
and Specialties(CPS) should ensure<br />
that the information for both brand<br />
name drugs and generic drugs reflect the<br />
same information. For example, the<br />
current descriptive entries for Elavil®<br />
(brand name) and Amitriptyline<br />
(generic name), while the same pharmaceutical/medicine,<br />
are noticeably<br />
different with respect to dosage for outpatients.”<br />
Rationale: To provide doctors with<br />
accurate information in regards to<br />
dosage and side effects.<br />
Pharmacist need to stay current<br />
and be aware <strong>of</strong> dosage and side<br />
effect information. This recommendation<br />
has been forwarded to the<br />
CPhA as they publish the CPS. <strong>Pharmacists</strong><br />
should also maintain a variety<br />
<strong>of</strong> references in their pharmacy so<br />
that they can verify these types <strong>of</strong><br />
discrepancies as they <strong>of</strong>ten occur in<br />
daily practice. It is also a current<br />
requirement that all pharmacies have<br />
access to an OCP-approved drug<br />
information service. This and an upto-date<br />
reference library will greatly<br />
assist pharmacists in clarifying drug<br />
information and assisting physicians<br />
with patient care.<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 31
DISCIPLINE<br />
DECIDING ON<br />
DISCIPLINE<br />
CASE 1<br />
Failure to Maintain Records as Required<br />
Member: Hilton Silberg, Dundas<br />
Hearing Date: February 27, <strong>2003</strong><br />
Mr. Silberg was found to have:<br />
• Failed to keep records as required respecting<br />
his patients<br />
• Contravened, while engaged in the practice <strong>of</strong><br />
pharmacy, any federal or provincial law or<br />
municipal by-law with respect to the distribution,<br />
sale or dispensing <strong>of</strong> any drug or mixture<br />
<strong>of</strong> drugs<br />
The following Agreed Statement <strong>of</strong> Fact<br />
formed the basis <strong>of</strong> Mr. Silberg’s admission <strong>of</strong><br />
pr<strong>of</strong>essional misconduct.<br />
Facts<br />
The Complaints Committee referred two incidents<br />
to the Discipline Committee. In the first,<br />
Mr. Silberg dispensed 100 ASA Enteric 325mg<br />
tablets to a patient. The receipt for the transaction<br />
listed a doctor as the prescriber, but in fact,<br />
the prescription was not authorized until later<br />
when Mr. Silberg was able to contact a different<br />
doctor to confirm the prescription. Before the<br />
authorization was received, the medication was<br />
dispensed and charged to the <strong>Ontario</strong> Drug<br />
Benefit Plan. A written prescription is required in<br />
order to charge the ODB for the dispensed<br />
medication.<br />
In the second, Mr. Silberg’s pharmacy<br />
received a compound prescription for Sulfazine.<br />
Another pharmacist in his pharmacy prepared<br />
the Sulfazine to be dispensed to a patient.<br />
However, the medication was not dispensed<br />
from the pharmacy where it was prepared.<br />
Instead, the medication was delivered to a<br />
second pharmacy, not owned by Mr. Silberg, for<br />
dispensing to the patient. The second pharmacy<br />
relabeled the medication so that it was no longer<br />
apparent that the medication was compounded<br />
at one <strong>of</strong> Mr. Silberg’s pharmacies. Mr. Silberg<br />
did not have an Establishment License to fabricate,<br />
package/label, distribute, import or<br />
wholesale a drug as required by the Food and<br />
Drug Regulations in such circumstances. Mr.<br />
Silberg had no direct knowledge that the medication<br />
was being compounded at one <strong>of</strong> his<br />
pharmacies and then being transferred to a<br />
different pharmacy to be dispensed under that<br />
pharmacy’s label.<br />
Reasons<br />
The Committee noted that as designated<br />
manager, Mr. Silberg acknowledged his responsibility<br />
to the public and to the pr<strong>of</strong>ession for the<br />
breaches <strong>of</strong> the practice <strong>of</strong> the pharmacy.<br />
However, given that the breaches were largely<br />
technical in nature, the Committee considered it<br />
appropriate for Mr. Silberg to complete remediation<br />
that is not burdensome and can be<br />
completed through take-home assignments.<br />
Order<br />
1. A reprimand<br />
2. Mr. Silberg’s Certification <strong>of</strong> Registration shall<br />
be subject to specified terms, conditions and<br />
limitations, and in particular, that Mr. Silberg<br />
complete successfully, at his own expense<br />
within six months <strong>of</strong> the date <strong>of</strong> this order,<br />
remedial training in the form <strong>of</strong> take-home<br />
written assignments, from the Canadian<br />
Pharmacy Skills Program, namely: “Law<br />
Lesson 4 – Standards <strong>of</strong> Practice” and “Law<br />
Lesson 7 – Pr<strong>of</strong>essional Liability”<br />
32<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
DISCIPLINE<br />
DISCIPLINE<br />
CASE 2<br />
Failure to Take Appropriate Care When Dispensing<br />
Coumadin ® to a Patient; Failure to Obtain Requisite<br />
Authority to Dispense a Reduced <strong>of</strong> Quantity<br />
Member: Abdulkader Zalgaonker, Hespeler<br />
Hearing Date: February 27, <strong>2003</strong><br />
Mr. Zalgaonker was found to have:<br />
• Failed to maintain a standard <strong>of</strong> practice <strong>of</strong> the pr<strong>of</strong>ession<br />
• Contravened, while engaged in the practice <strong>of</strong> pharmacy,<br />
federal or provincial law or municipal by-law with respect<br />
to the distribution, sale or dispensing <strong>of</strong> a drug or mixture<br />
<strong>of</strong> drugs<br />
The following Agreed Statement <strong>of</strong> Fact formed the basis<br />
<strong>of</strong> Mr. Zalgaonker’s admission <strong>of</strong> pr<strong>of</strong>essional misconduct.<br />
Facts<br />
Mr. Zalgaonker is an owner, director, designated manager<br />
and dispensing pharmacist at his pharmacy.<br />
The patient was prescribed 250 Coumadin® 1mg<br />
tablets with directions to take two and one-half tablets<br />
once a day. Mr. Zalgaonker dispensed Coumadin® 5mg<br />
tablets in a container indicating that the contents were<br />
Coumadin® 1mg tablets. As a result, the patient<br />
consumed 12.5mgs <strong>of</strong> Coumadin® each day that she<br />
took the drug instead <strong>of</strong> the 2.5mgs that were<br />
prescribed. She suffered internal bleeding and was<br />
hospitalized for three days.<br />
In addition, the pharmacy records confirmed that the<br />
physician authorized three repeats <strong>of</strong> 250 Coumadin®. On<br />
some <strong>of</strong> these occasions, Mr. Zalgaonker reduced quantities<br />
without authority.<br />
Mr. Zalgaonker explained that the quantity <strong>of</strong> the<br />
prescription was reduced from 250 to 100 tablets to<br />
accommodate the limited personal budget <strong>of</strong> the patient<br />
and that he did not reduce the quantity for financial gain<br />
(which was marginal). Mr. Zalgaonker recognizes that the<br />
patient’s written authorization for the reduced quantities<br />
being dispensed would have been required in these<br />
circumstances.<br />
Reasons<br />
In accepting the Joint Submission on Penalty, the<br />
Committee considered that Mr. Zalgaonker has practised for<br />
20 years without any dispensing error complaints, and that<br />
since this incident Mr. Zalgaonker has developed new<br />
storage procedures for Coumadin® in the pharmacy by<br />
maintaining separately marked boxes for each strength and<br />
has revised his dispensing protocols to prevent future errors.<br />
The Committee also took into account that Mr.<br />
Zalgaonker was previously found guilty <strong>of</strong> pr<strong>of</strong>essional<br />
misconduct by the Discipline Committee in June, 1999 in<br />
connection with a conviction for income tax evasion by his<br />
pharmacy business for the years 1992, 1993, 1994 and<br />
1995, contrary to the Income Tax Act.<br />
Order<br />
1. A reprimand<br />
2. Specified terms, conditions and limitations on Mr.<br />
Zalgaonker’s Certification <strong>of</strong> Registration and in particular,<br />
that Mr. Zalgaonker complete successfully, at his<br />
own expense and within twelve months <strong>of</strong> the date <strong>of</strong> this<br />
order, the following:<br />
i) Courses <strong>of</strong>fered through the Canadian Pharmacy<br />
Skills Program: “Law Lesson 6 - Standards <strong>of</strong> Practice”<br />
and “Law Lesson 7 - Pr<strong>of</strong>essional Liability”<br />
ii) “Confronting Medication Errors” <strong>of</strong>fered by the<br />
<strong>Ontario</strong> <strong>Pharmacists</strong>’ Association, including<br />
“Module 1, Understanding the Issues and Dealing the<br />
Incidents” and “Module 2, Taking Action to Improve<br />
Patient Safety”<br />
3. A suspension for a period <strong>of</strong> two months; one month <strong>of</strong><br />
the suspension to be remitted on condition that Mr.<br />
Zalgaonker completes the remedial training workshops,<br />
courses and evaluations described in paragraph 2 above<br />
4. Costs to the <strong>College</strong> in the amount <strong>of</strong> $2,000<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 33
DISCIPLINE<br />
CASE 3<br />
Failure to Ensure That Appropriate Systems Were in<br />
Place to Assure Accurate Delivery <strong>of</strong> Medication to A<br />
Patient; Failure to Appropriately Dispose <strong>of</strong> Drugs<br />
Returned to Stock<br />
Member: Gerald Friesen, Thunder Bay<br />
Hearing Date: March 14, <strong>2003</strong><br />
Mr. Friesen was found to have:<br />
• Failed to maintain a standard <strong>of</strong> practice <strong>of</strong> the pr<strong>of</strong>ession<br />
• Returned to stock or again sold or dispensed a drug previously<br />
sold or dispensed and delivered<br />
• Engaged in conduct or performed an act relevant to the<br />
practise <strong>of</strong> pharmacy that, having regard to all the circumstances,<br />
would reasonably be regarded by members as<br />
disgraceful, dishonourable or unpr<strong>of</strong>essional<br />
The following Agreed Statement <strong>of</strong> Fact formed the<br />
basis <strong>of</strong> Mr. Friesen’s admission <strong>of</strong> pr<strong>of</strong>essional misconduct.<br />
Facts<br />
A pharmacist at Mr. Friesen’s pharmacy filled a prescription<br />
for 100mL Hydrocortisone suspension 1mg/mL (a<br />
compound prescribed for congenital adrenal hyperplasia)<br />
for a child patient. The prescription was then placed in a<br />
refrigerator for delivery the next day. The dispensing pharmacist<br />
also filled a prescription for Methadone for another<br />
client, which was stored in the same refrigerator as the<br />
Hydrocortisone compound.<br />
In error, the Methadone was packaged for delivery to<br />
the child instead <strong>of</strong> the Hydrocortisone compound. The<br />
child’s mother received the package, poured the medication<br />
into a teaspoon and was about to administer the medication<br />
to the child when she noticed by its content that it was not<br />
the correct medication. She then read its label which indicated<br />
that the medication was Methadone prepared for<br />
another patient. The mother notified the pharmacy<br />
regarding the packaging error. Mr. Friesen personally delivered<br />
the Hydrocortisone compound to the mother and<br />
retrieved the Methadone.<br />
Mr. Friesen returned to the pharmacy and placed the<br />
Methadone back in the refrigerator. He did not set the<br />
bottle aside or take other precautions to ensure that the<br />
Methadone was not re-dispensed to the wrong patient. The<br />
Methadone was relabelled to reflect the day’s date and was<br />
then dispensed to the patient it was intended for.<br />
Reasons<br />
The Committee believes the Joint Submission on Penalty<br />
was appropriate for the following reasons:<br />
• Mr. Friesen pleaded guilty and immediately accepted<br />
responsibility for the errors, saving the <strong>College</strong> undue<br />
cost and expense <strong>of</strong> investigation<br />
• In 34 years <strong>of</strong> practice in <strong>Ontario</strong>, this was Mr.<br />
Friesen’s first appearance before the Discipline<br />
Committee<br />
• The initial packaging error was made by an unknown<br />
pharmacy employee and Mr. Friesen, as the designated<br />
manager, accepted responsibility for the error<br />
• Mr. Friesen accepted full responsibility for returning<br />
to stock and re-dispensing the Methadone solution<br />
• Prior to the hearing, Mr. Friesen, on his own accord,<br />
attended and completed the Methadone Treatment<br />
Workshop provided by the Centre for Addiction and<br />
Mental Health. The workshop included seven hours <strong>of</strong><br />
instruction, including the fundamentals <strong>of</strong> methadone<br />
maintenance, counselling <strong>of</strong> methadone patients, pharmacy<br />
issues, urine drug screens and an overview <strong>of</strong><br />
substance use disorders<br />
• While there was potential for patient harm, none in<br />
fact occurred<br />
• Mr. Friesen has modified his practice by designating a<br />
separate refrigerator for storing methadone<br />
The panel notes that dispensing errors concerning<br />
methadone, as well as other narcotic and controlled<br />
substances, may lead to very serious consequences and<br />
urges the member to exercise extreme caution when<br />
dispensing these substances.<br />
34<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
DISCIPLINE<br />
DISCIPLINE<br />
Order<br />
1. A reprimand<br />
2. Specified terms, conditions and limitations on Mr.<br />
Friesen’s Certificate <strong>of</strong> Registration, and in particular,<br />
that he attend at and participate in the education<br />
program, “Confronting Medication Errors”, <strong>of</strong>fered by the<br />
<strong>Ontario</strong> <strong>Pharmacists</strong>’Association, including: “Module 1,<br />
Understanding the Issues and Dealing with Incidents” and<br />
“Module 2, Taking Action to Improve Patient Safety”<br />
3. One month’s suspension <strong>of</strong> Mr. Friesen’s Certificate <strong>of</strong><br />
Registration, the suspension to be remitted on condition<br />
that Mr. Friesen complete the remedial training exercise<br />
specified above<br />
4. Costs to the <strong>College</strong> in the amount <strong>of</strong> $2,500<br />
Charging an Excessive Fee<br />
CASE 4<br />
Member: Abe Kucyi, Toronto<br />
Hearing Date: April 24, <strong>2003</strong><br />
Mr. Kucyi was found to have:<br />
• Charged a fee that is excessive in relation to the service<br />
provided<br />
• Engaged in conduct or performed an act relevant to the<br />
practise <strong>of</strong> pharmacy that, having regard to all the circumstances,<br />
would reasonably be regarded by members as<br />
disgraceful, dishonourable or unpr<strong>of</strong>essional<br />
The following Agreed Statement <strong>of</strong> Fact formed the<br />
basis <strong>of</strong> Mr. Kucyi’s admission <strong>of</strong> pr<strong>of</strong>essional misconduct.<br />
The Facts<br />
Mr. Kucyi dispensed Lupron Depot Ampkits® (3.75 mg) to<br />
a patient on eight occasions and the total cost <strong>of</strong> each <strong>of</strong><br />
these transactions ranged between $431.84 and $461.09.<br />
Mr. Kucyi advised the <strong>College</strong> that for “about one<br />
year”, his pharmacy’s pricing policy was a dispensing fee <strong>of</strong><br />
$11.99 with a mark-up <strong>of</strong> 30 per cent, regardless <strong>of</strong> cost.<br />
Six <strong>of</strong> the eight dispensing fees charged to the<br />
complainant were $12.68, not $11.99. Moreover, for the<br />
seven transactions for which drug supplier invoices were<br />
produced for the <strong>College</strong> by Mr. Kucyi the “mark-ups”<br />
ranged from about 30 per cent to 47 per cent.<br />
Reasons<br />
In accepting the Joint Submission on Penalty, the<br />
committee considered the fact that Mr. Kucyi cooperated<br />
with the <strong>College</strong> and entered a plea <strong>of</strong> guilty, saving the<br />
time and expense <strong>of</strong> a lengthy hearing. The Committee also<br />
noted that Mr. Kucyi has a prior disciplinary record from<br />
<strong>August</strong> 26, 1999, which also involved overcharging for<br />
prescriptions.<br />
Order<br />
1. A reprimand<br />
2. One month’s suspension <strong>of</strong> Mr. Kucyi’s Certificate <strong>of</strong><br />
Registration<br />
3. Costs to the <strong>College</strong> in the amount <strong>of</strong> $6,000<br />
Insurance Fraud<br />
CASE 5<br />
Member: Harit Kumar Nathwani, Waterloo<br />
Hearing Date: April 24, <strong>2003</strong><br />
Mr. Nathwani was found to have:<br />
• Failed to maintain a standard <strong>of</strong> practice <strong>of</strong> the pr<strong>of</strong>ession<br />
• Failed to keep patient records as required<br />
• Falsified a record relating to his practice<br />
• Signed or issued in his pr<strong>of</strong>essional capacity, a document<br />
that he knew to contain a false or misleading statement<br />
• Submitted an account or charge for services that he knew<br />
was false or misleading<br />
• Breached the Drug and Pharmacies Regulation Act and<br />
continued on page 37<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 35
The Pharmacy Practice Department invites you to breakfast<br />
to meet with your <strong>College</strong> inspector and your peers.<br />
This is your opportunity to discuss <strong>College</strong> policies,<br />
pharmacy practice and general issues that affect your<br />
day-to-day practice in an informal atmosphere.<br />
<strong>2003</strong> Pharmacy Practice<br />
Breakfast Series<br />
As A Participant, You Choose the Topics for Discussion<br />
The meetings are structured to allow you to select topics <strong>of</strong> your choice in advance<br />
(Standards <strong>of</strong> Practice, inspection process, pr<strong>of</strong>essional judgment, etc.) Where possible<br />
other staff or invited guests from the Practice Area or <strong>College</strong> will attend.<br />
There will also be sufficient time for questions and answers. The inspectors will remain<br />
after the meeting to continue discussions with those who wish to stay.<br />
Let us Know if You Want a Meeting in Your Community<br />
Invitations will be mailed to all pharmacies in each selected area (within 30 minutes<br />
driving distance) 30-45 days prior to the meeting. Held at a local restaurant, each<br />
breakfast meeting will be limited to about 20 participants at no cost. As space is<br />
limited, firm commitments will be accepted on a first come, first served basis only.<br />
We will also ask one local pharmacist to act as a liaison between his/her local<br />
colleagues and the attending field inspector. A reminder will be sent by fax to the<br />
pharmacy one week prior to the meeting. Breakfastwill be served from 7:00 a.m. with<br />
the meeting portion running from 7:30 a.m. to 8:30 a.m.<br />
For more information, or to arrange a meeting in your area, please contact your<br />
OCP inspector or Barb Church at the <strong>College</strong> at (416) 962-4861 x. 236.<br />
We look forward to hearing from you!<br />
36<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
DISCIPLINE<br />
DISCIPLINE<br />
regulations there under<br />
• Engaged in conduct or performed an act relevant to the<br />
practice <strong>of</strong> pharmacy that, having regard to all the circumstances<br />
would reasonably be regarded by members as<br />
disgraceful, dishonorable or unpr<strong>of</strong>essional<br />
The following Agreed Statement <strong>of</strong> Fact formed the<br />
basis <strong>of</strong> Mr. Nathwani’s admission <strong>of</strong> pr<strong>of</strong>essional misconduct.<br />
Facts<br />
Mr. Nathwani was the owner, designated manager and<br />
dispensing pharmacist <strong>of</strong> Northfield Pharmacy. Through a<br />
series <strong>of</strong> random provider service audits, Green Shield<br />
discovered that claims were being submitted by Mr. Nathwani’s<br />
pharmacy, and paid by Green Shield, when no<br />
medication was actually provided to the patients. Green<br />
Shield provided subscriber confirmation letters from<br />
patients who denied receiving prescriptions related to<br />
claims made in their name by Northfield Pharmacy.<br />
The <strong>College</strong> contacted two <strong>of</strong> the eight patients in question<br />
who verified that they did not receive the medication as<br />
claimed by Northfield Pharmacy. The <strong>College</strong> also met with<br />
a physician who denied prescribing three prescriptions<br />
attributed to her by Northfield Pharmacy.<br />
Reasons<br />
The Committee considered the undisputed fact that Mr.<br />
Nathwani’s conduct was a deliberate attempt to defraud a<br />
third-party insurer and to create records to cover up the<br />
fraud. The misconduct occurred over a 10-month period <strong>of</strong><br />
time and involved 34 prescriptions, eight subscribers and a<br />
total <strong>of</strong> $1,438.83. Mr. Nathwani did not provide the<br />
Committee with any explanation for his conduct other than<br />
to express shame and regret.<br />
In concluding that the penalty is fair, reasonable and<br />
consistent, the Committee considered that Mr. Nathwani<br />
had no prior discipline record, as well as the fact<br />
that its penalty affirms the seriousness <strong>of</strong> Mr. Nathwani’s<br />
misconduct in a real and immediate sense. At the same<br />
time, the penalty provides Mr. Nathwani with an opportunity<br />
to rehabilitate while also providing necessary<br />
public protection.<br />
Order<br />
1. A reprimand<br />
2. Specified terms, conditions and limitations on Mr. Nathwani’s<br />
Certificate <strong>of</strong> Registration, and in particular, that<br />
Mr. Nathwani complete successfully, at his own expense,<br />
within 12 months <strong>of</strong> the date <strong>of</strong> this order, the OCP<br />
Jurisprudence Seminar as well as remedial training in<br />
the following courses and evaluations from the Canadian<br />
Pharmacy Skills Program: “Law Lesson 2 – The<br />
Regulation <strong>of</strong> Pharmacy Practice”, “Law Lesson 4 – Standards<br />
<strong>of</strong> Practice”, and “Law Lesson 7 – Pr<strong>of</strong>essional<br />
Liability”<br />
3. A six-month suspension <strong>of</strong> Mr. Nathwani’s Certificate<br />
<strong>of</strong> Registration<br />
4. Additional specified terms, conditions and limitations<br />
on Mr. Nathwani’s Certificate <strong>of</strong> Registration, and in<br />
particular that, for a period <strong>of</strong> one year following the<br />
completion <strong>of</strong> his suspension, (December 01, <strong>2003</strong> –<br />
November 30, 2004):<br />
i) Mr. Nathwani is prohibited from having any proprietary<br />
interest in a pharmacy, in any capacity<br />
ii) Mr. Nathwani cannot act as a designated manager<br />
in any pharmacy<br />
iii) Mr. Nathwani must inform all employers in a pharmacy<br />
setting <strong>of</strong> the full details <strong>of</strong> the decision <strong>of</strong> the<br />
Discipline Committee and ensure that they<br />
confirm their information with the <strong>College</strong> directly<br />
iv) Mr. Nathwani’s employment remuneration shall be<br />
based only on hourly or weekly rates and his<br />
employer(s) are to confirm this arrangement in<br />
writing with the <strong>College</strong><br />
5. Costs to the <strong>College</strong> in the amount <strong>of</strong> $3,000<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 37
COLUMN<br />
F O C U S<br />
O N<br />
Error Prevention<br />
Counselling Patients on Pre<br />
brand <strong>of</strong> the drug. The tablets were therefore labelled<br />
NovoPurol® 100mg. The following day, Mr. Smith<br />
continued to take his regular medication including Apo<br />
Allopurinol 100mg along with what he believed to be a new<br />
drug NovoPurol® 100mg.<br />
Ian Stewart, B.Sc.Phm.<br />
Though the pharmacist may dispense the right drug at<br />
the right dosage, patient education is critical in<br />
ensuring that the right patient takes the right dosage<br />
<strong>of</strong> the right drug at the right interval. As the following cases<br />
illustrate, lack <strong>of</strong> patient education may lead to drug administration<br />
errors.<br />
CASE 1<br />
Mr. Smith, a 70-year-old patient, regularly takes the<br />
following medications.<br />
Drug<br />
Apo Allopurinol 100mg<br />
Avapro® 150mg<br />
Apo Atenolol 50mg<br />
Dose<br />
Once daily<br />
Once daily<br />
Once daily<br />
Recently, Mr. Smith received a new three-month<br />
prescription <strong>of</strong> Allopurinol 100mg from his physician. On<br />
this occasion, the pharmacist dispensed the Novopharm<br />
A few days later, Mr. Smith requested a refill <strong>of</strong> his Apo<br />
Allopurinol 100mg tablets. On questioning the patient<br />
regarding the need for an early refill, the pharmacist learned<br />
<strong>of</strong> the misunderstanding and as a result, the doubling <strong>of</strong> the<br />
prescribed dosage <strong>of</strong> Allopurinol.<br />
Possible Contributing Factors:<br />
• The patient was unaware <strong>of</strong> the relationship between Apo<br />
Allopurinol and NovoPurol®<br />
• The patient did not question the physician or the pharmacist<br />
regarding his ‘new’ therapy<br />
• Appropriate counselling did not take place when NovoPurol®<br />
was dispensed<br />
Recommendations:<br />
• Always review the patient’s medication history prior to<br />
counselling<br />
• Educate your patients regarding the relationship between<br />
brand names and generic names — this is especially<br />
important when switching brands. In these instances,<br />
place a sticker or note on the prescription bag to remind<br />
the pharmacist/yourself <strong>of</strong> the need to counsel the patient<br />
• Encourage your patients to ask questions, especially when<br />
they notice something different about their prescription/medication<br />
38<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
COLUMN<br />
scription Renewals/Changes<br />
CASE 2<br />
Mr. Jones, a 60-year-old patient has been taking Novo<br />
Fen<strong>of</strong>ibrate Micro 200mg capsules prescribed by his family<br />
physician. In an effort to better control his cholesterol levels,<br />
Mr. Jones was then referred to a specialist. Following an<br />
assessment, a prescription was written for Lipidil Supra®<br />
160mg to be taken once daily.<br />
Assuming that Lipidil Supra® 160mg is a different drug<br />
to be added to his medication regimen, Mr. Jones decided to<br />
take both drugs together. However, his wife convinced him<br />
to first check with the pharmacist who confirmed that the<br />
Novo Fen<strong>of</strong>ibrate Micro should be discontinued.<br />
Possible Contributing Factors:<br />
• Neither the specialist nor the pharmacist provided any<br />
information regarding the discontinuation <strong>of</strong> Novo Fen<strong>of</strong>ibrate<br />
Micro<br />
• The patient was unaware that the generic name <strong>of</strong> both<br />
drugs is Fen<strong>of</strong>ibrate<br />
Recommendations:<br />
• Always review the patient’s medication history to identify<br />
potential drug related problems<br />
• Encourage your patients to also learn the generic names <strong>of</strong><br />
the drugs being taken<br />
Please note the <strong>College</strong>’s generic or “single entity” drug policy:<br />
Please ensure that your pharmacy’s dispensary s<strong>of</strong>tware is<br />
set to label these drugs according to this policy.<br />
Title: Generic Prescriptions<br />
Date <strong>of</strong> Council Report: January 1980<br />
a) The preferred method <strong>of</strong> labelling all prescriptions for single-entity<br />
drugs is that they be labelled using the<br />
non-proprietary (generic) name <strong>of</strong> the drug, plus the<br />
name <strong>of</strong> the manufacturer, and<br />
b) Particular care should be taken when labelling generically-written<br />
and 'product-selected prescriptions' — that<br />
is when the brand name is prescribed but the generic is<br />
dispensed. In these cases, the pharmacist should use<br />
the generic name, plus the name <strong>of</strong> the manufacturer,<br />
and not the trade name.<br />
Editor’s Note:<br />
Both <strong>of</strong> these errors may have been prevented with appropriate patient counselling. Some pharmacists believe that the standard is that they only<br />
counsel on a new prescription, and only on that prescription. These cases emphasize the need for pharmacists to evaluate the entire patient pr<strong>of</strong>ile<br />
whenever a medication is dispensed. Operational Component 1.2 <strong>of</strong> the Standards <strong>of</strong> Practice includes “The pharmacistreviews relevant information<br />
from the patient pr<strong>of</strong>ile with each new prescription, change <strong>of</strong> prescription, and repeat prescription.” Operational Component 1.3 outlines the role <strong>of</strong><br />
the pharmacist in evaluating drug therapy and identifying potential and actual drug-related problems.<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 39
Shoppers Drug Mart<br />
HARROW<br />
If you are interested in including<br />
the Point <strong>of</strong> Care symbol in your<br />
permanent pharmacy signage,<br />
please contact the Communications<br />
Department for an electronic copy<br />
<strong>of</strong> the artwork. You may also go<br />
online to www.ocpinfo.com and<br />
Main Drug Mart<br />
TORONTO<br />
select "Point <strong>of</strong> Care" to view the<br />
graphic usage standards.<br />
Comber Drug Store<br />
COMBER<br />
40<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
B U L L E T I N B O A R D<br />
Class 7T3 30th Reunion<br />
We will be returning to the Fern<br />
Resort in Orillia Sept 19-21, <strong>2003</strong>.<br />
For information please contact<br />
Tom/Liz Betts (905) 945-9078, Bill<br />
Dingwall (905) 475-1395, Vera<br />
Smith (705) 326-8290.<br />
Class <strong>of</strong> 7T8 25th Reunion<br />
Our 25th Pharmacy Reunion is planned for<br />
October 3-5, <strong>2003</strong> at Nottawasaga Inn Resort in<br />
Alliston. The American Plan rates for a 2-night stay<br />
(accommodation, meals, gratuities) are $136 per<br />
person/night-double occupancy and $189 per<br />
person/night-single occupancy (plus taxes).<br />
For information on the resort and all its amenities<br />
(golf, tennis, swimming, etc.) please visit<br />
www.NottawasagaResort.com<br />
Reserve your room with the Resort’s Group Reservations<br />
Department for the “U <strong>of</strong> T Faculty <strong>of</strong> Pharmacy<br />
Reunion” before Friday, <strong>July</strong> 4, <strong>2003</strong> at (416) 364-5068<br />
or (905) 939-2220 or (705) 435-5501 or 1-800-669-<br />
5501. The Saturday Evening Reunion Banquet-only is<br />
also available.<br />
Please express your interest by forwarding your<br />
email and home addresses with phone numbers to Doris<br />
Kalamut (Hallmann) 35 Anderson Avenue, Toronto,<br />
M5P 1H5 (416-485-2067) or dkalamut@rogers.com.<br />
Class <strong>of</strong> 9T8 5th Reunion<br />
The five-year class reunion will be held this fall at the<br />
Nottawasaga Inn, October 3-5 <strong>2003</strong>. There will be a<br />
variety <strong>of</strong> activities at the resort during the weekend and<br />
a banquet on Saturday evening. For more information<br />
contact Stacie Harley at stacie_harley@hotmail.com,<br />
(416) 413-9196 or Jessy Samuel at<br />
Jessy.Samuel@moh.gov.on.ca. Hope to see you there!<br />
Upcoming Practice Review Dates<br />
Practice Reviews will be held at the<br />
<strong>College</strong> on the weekends <strong>of</strong> September<br />
13-15, and November 29, 30,<br />
December 1, <strong>2003</strong>. <strong>Pharmacists</strong> considering<br />
undergoing the Practice Review in<br />
order to move from Part B to Part A <strong>of</strong> the<br />
Register can contact the <strong>College</strong> at 416-962-<br />
4861 for details.<br />
Welcome to the <strong>College</strong><br />
Shabniz Jaffer joined the <strong>College</strong> in March as Program<br />
Secretary, Continuing Competence Programs. Shabniz<br />
has extensive experience in various administrative roles.<br />
Most recently she was with the Bank <strong>of</strong> Montreal,<br />
working with two vice-presidents in the e-business division.<br />
Recent Marriages<br />
Congratulations to Maria Beck (now Maria Earley) who<br />
surprised us all when she eloped with her husband<br />
Darren and to Shelliann Sterling (now Shelliann Harris)<br />
who travelled to Jamaica, with her husband Leon, for<br />
her special day. The staff would like to wish Maria and<br />
Shelliann all the best in the years to come.<br />
Alumni Death<br />
John Hassard, B.Sc.Phm. passed away on May 31,<br />
<strong>2003</strong>, the evening he was going to receive his 50-year<br />
Alumni certificate. Hassard, who practiced in Tilbury,<br />
Cobourg and Toronto is survived by three sons and a<br />
sister.<br />
PRECEPTOR WORKSHOPS<br />
Preceptor Orientation Workshops:<br />
Wednesday, <strong>August</strong> 6<br />
Thursday, Sept 11 Preceptor Advanced Workshops:<br />
Tuesday, Oct 7<br />
Wednesday, Sept 17 (Intercultural<br />
Communication/IPG Program)<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong> 41
CE EVENTS<br />
Visit the <strong>College</strong>’s website: www.ocpinfo.com for a complete listing <strong>of</strong><br />
upcoming events and/or available resources. A number <strong>of</strong> the<br />
programs listed below are also suitable for pharmacy technicians.<br />
Sep. 11-13: Toronto<br />
CLEAR Conference<br />
The Council on Licensure<br />
Enforcement and Regulation<br />
(CLEAR)<br />
web: www.clearhq.org<br />
Sep. 12-14: Toronto<br />
HIV/AIDS Patient Care - Level 1<br />
Certificate Program<br />
<strong>Ontario</strong> <strong>Pharmacists</strong>’Association<br />
Vaughan Estates<br />
Karen Cameron<br />
tel (416) 441-0788, x 4235<br />
kcameron@ontpharmacists.on.ca<br />
web: www.opatoday.com<br />
Paula Ferreira<br />
tel (416) 785-2500, x 2363<br />
fax (416) 7785-4215<br />
e-mail: pferreira@baycrest.org<br />
Sep. 19-21: Alliston<br />
55th Annual General Meeting and<br />
Education Sessions<br />
Canadian Society <strong>of</strong> Hospital<br />
<strong>Pharmacists</strong> - <strong>Ontario</strong> Branch<br />
Nottawasaga Inn<br />
Patricia Fontana<br />
tel (905) 804-4927<br />
fax (905) 277-3556<br />
Oct. 17-19 and Nov. 7-9: Toronto<br />
Certified Geriatric Pharmacist Preparation<br />
Course, (Parts 1 & 2)<br />
<strong>Ontario</strong> <strong>Pharmacists</strong> Association<br />
the Institute for Learning<br />
Karen Cameron or Sandra Winkelbauer<br />
tel (416) 441-0788, x 4235<br />
fax (416) 441-0791<br />
kcameron@ontpharmacists.on.ca<br />
or swinkelbauer@opatoday.com<br />
web: www.opatoday.com<br />
Sep. 18: Newmarket<br />
Emerging Treatment Strategies in<br />
Mood and Anxiety Disorders<br />
York North <strong>Pharmacists</strong>’Association<br />
and Janssen-Ortho<br />
Janet Shore<br />
tel (905) 841-4423<br />
fax (905) 853-0571<br />
Sep. 18: Toronto<br />
Fall Educational Evening and 28th<br />
Annual General Meeting<br />
<strong>Ontario</strong> Respiratory Care Society<br />
Greater Toronto Region, 6th Floor<br />
Fell Pavilion, Room 103<br />
Toronto Western Hospital<br />
Sheila Gordon-Dillane<br />
tel (416) 864-9911, x 236<br />
fax (416) 864-9916<br />
e-mail: orcs@on.lung.ca<br />
Sep. 19: Toronto<br />
Medication Use in the Geriatric<br />
Population,<br />
Baycrest Centre for Geriatric Care,<br />
Joseph E. & Minnie Wagman Centre<br />
Upcoming Live CE Event<br />
Physician-Pharmacist Collaboration – To Optimize Patient Care<br />
The workshop format <strong>of</strong> this event provides learning interaction through the<br />
application <strong>of</strong> case studies related to cardiovascular health. When you<br />
attend, you can expect:<br />
• Small group <strong>of</strong> 15 to 18 participants to permit personalized learning<br />
• An equal number <strong>of</strong> physicians and pharmacists from the same community<br />
to promote strengthened pr<strong>of</strong>essional relationships for the long term<br />
The workshop is moderated by a physician-pharmacist team who will guide<br />
you through specially designed case studiesrelated to cardiovascular health.<br />
Learning Objectives<br />
On completion <strong>of</strong> the workshop, you will be able to:<br />
• Explain how closer physician-pharmacist collaboration improves<br />
patient care<br />
• Discuss the key components <strong>of</strong> effective physician-pharmacist<br />
communication<br />
• Use communication techniques to optimize communication between<br />
physicians and pharmacists<br />
• Use the knowledge acquired during the session to work out collaborative<br />
initiatives that could be used in a practice setting<br />
A Communimed program, this workshop will roll out in the Fall <strong>of</strong> <strong>2003</strong>.<br />
42<br />
Pharmacy Connection <strong>July</strong> • <strong>August</strong> <strong>2003</strong>
O C P M A N U A L - June <strong>2003</strong><br />
Each issue <strong>of</strong> Pharmacy Connection includes an up-to-date summary <strong>of</strong> all current OCP Manual items in the table shown. These items are available<br />
and can be printed <strong>of</strong>f from our website: www.ocpinfo.com. Individual copies, or complete sets <strong>of</strong> the legislation (with binder and tabs), can also<br />
be ordered from the <strong>College</strong>. The OCP Manual, sold with the OCP Policy Handbook (complete with index and copies <strong>of</strong> reference articles), is $85<br />
($90.95 with GST). Sold separately, the OCP Manual is $64.20 (GST included) and the OCP Policy Handbook is $32.10 (GST included).<br />
Drug and Pharmacies Regulation Act (DPRA) *<br />
Amended 2000<br />
Regulations to the DPRA:<br />
DPRA R.R.O. 1990, Regulation 545 – Child Resistant Packages<br />
DPRA R.R.O. 1990, Regulation 547 Amended to O.Reg. 548/93 – Dentistry<br />
DPRA <strong>Ontario</strong> Regulation 297/96 Amended to O.Reg. 180/99 – General<br />
DPRA R.R.O. 1990, Regulation 551 Amended to O.Reg. 179/99 – General<br />
DPRA R.R.O. 1990, Regulation 548 Amended to O.Reg. 705/93 – Medicine<br />
DPRA R.R.O. 1990, Regulation 550 Amended to O.Reg 550/93 – Optometry<br />
<strong>Ontario</strong> Drug Benefit Act (ODBA) & Regulations *<br />
Amended 2002<br />
Regulations to the ODBA:<br />
<strong>Ontario</strong> Regulation 201/96 Amended to O.Reg. 395/02 – General<br />
Food and Drugs Act (FDA) & Regulations ✝<br />
Updated Health Canada Version as <strong>of</strong> Dec. 19, 2001<br />
Amendment 1248-Iburpr<strong>of</strong>en-Jan. 31, 2002<br />
Drug Schedules **<br />
Summary <strong>of</strong> Laws Governing Prescription Drug Ordering, Records, Prescription<br />
Requirements and Refills - January 2001 OCP<br />
Canada’s National Drug Scheduling System – May 26, <strong>2003</strong> NAPRA (or later)<br />
Controlled Drugs and Substances Act (CDSA) ✝<br />
Updated NAPRA Version as <strong>of</strong> October 25, 2000<br />
Benzodiazepines & Other Targeted Substances Regulations-Can.Gazette June 21/00<br />
Precursor Control Regulations – Can.Gazette October 9/02<br />
Regulated Health Pr<strong>of</strong>essions Act (RHPA) *<br />
Amended 2002<br />
Regulations to the RHPA:<br />
<strong>Ontario</strong> Regulation 39/02 -Certificates <strong>of</strong> Authorization<br />
<strong>Ontario</strong> Regulation 107/96 – Controlled Acts<br />
<strong>Ontario</strong> Regulation 59/94 – Funding for Therapy or Counseling for Patients Sexually<br />
Abused by Members<br />
Pharmacy Act (PA) & Regulations *<br />
Amended 1998<br />
Regulations to the PA:<br />
<strong>Ontario</strong> Regulation 202/94 Amended to O.Reg. 548/99 – General<br />
<strong>Ontario</strong> Regulation 681/93 Amended to O.Reg. 122/97 – Pr<strong>of</strong>essional Misconduct<br />
Standards <strong>of</strong> Practice ▲<br />
New Standards <strong>of</strong> Practice, January 1, <strong>2003</strong> OCP<br />
Narcotic Control Regulations **<br />
Updated NAPRA Version as <strong>of</strong> October 25, 2000<br />
OCP By-Laws By-Law No. 1 – June <strong>2003</strong> ▲<br />
Schedule A - Code <strong>of</strong> Ethics, May 1996<br />
Schedule B - Conflict <strong>of</strong> Interest Guidelines for Members <strong>of</strong> Council and<br />
Committees - Oct 1994<br />
Schedule C - Member Fees - Jan 1, <strong>2003</strong><br />
Schedule D - Pharmacy Fees - Jan. 1, <strong>2003</strong><br />
Schedule E – Certificate <strong>of</strong> Authorization – Jan. <strong>2003</strong><br />
Reference ▲<br />
Handling Dispensing Errors, Pharmacy Connection Mar/Apr 1995<br />
Revenue Canada Customs and Excise Circular ED 207.1<br />
Revenue Canada Customs and Excise Circular ED 207.2<br />
District Excise Duty Offices - Oct. 10/96<br />
Guidelines for the <strong>Pharmacists</strong> on “The Role <strong>of</strong> the Pharmacy Technician”<br />
Drug Interchangeability and Dispensing Fee Act (DIDFA) & Regulations *<br />
Amended 1996<br />
<strong>Ontario</strong> Regulation Reg. 935 - General<br />
<strong>Ontario</strong> Regulation Reg. 936 – Notice to Patients<br />
Regulations to the DIDFA:<br />
Regulation 935 Amended to O.Reg. 394/02 – General<br />
Regulation 936 Amended to O.Reg. 205/96 – Notice to Patients<br />
*<br />
**<br />
Information available at Publications <strong>Ontario</strong> (416) 326-5300 or 1-800-668-9938<br />
Information available at www.napra.org<br />
✝ Information available at Federal Publications Inc. Ottawa: 1-888-4FEDPUB (1-888-433-3782)<br />
Toronto: Tel: (416) 860-1611 • Fax: (416) 860-1608 • e-mail: info@fedpubs.com<br />
▲ Information available at www.ocpinfo.com<br />
C O L L E G E<br />
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Volume 10, Number 4<br />
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