Who Will Bear Legal and Professional Responsibility for the Actions of Pharmacist Prescribers

The psychiatric consultation department at Massachusetts General Hospital (MGH) sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. Such consultations require the integration of medical and psychiatric knowledge. During their three weekly rounds, Dr. Stern and other members of the Psychiatric Counselling Service discuss the diagnosis and treatment of the conditions they face. These discussions resulted in roundtable reports that will prove useful to clinicians practicing at the intersection of medicine and psychiatry. Thus, the position of a pharmacist in the interpretation of prescriptions is almost identical to that of the physician who dispensed the prescription even if the pharmacist did not examine the patient or check his medical record. Therefore, pharmacists filling a prescription for a controlled substance must proceed with caution and use their professional judgment to determine whether a prescription for a controlled substance has been dispensed for legitimate medical purposes as part of their normal professional practice. Take the time to discuss the risks and benefits of treatment with the patient. During this discussion, the practitioner should have a mental “checklist” indicating whether their patient demonstrates their ability to participate in the process and understand the nature of their decisions. These skills include the ability to understand treatment options, reflect on available policy options, understand the impact of treatment on the situation in question, and express a consistent decision in this regard. One should be open and cautious about the possible side effects of medications and the course of action the patient should take if these side effects occur. When it comes to building alliances, this mutual discussion of realistic expectations and pitfalls can strengthen the patient`s understanding and commitment to treatment, while minimizing surprises and misunderstandings.14 In terms of risk management, adequate informed consent shifts some of the responsibility for adverse outcomes to the patient who has been warned of the risks of treatment. While a treatment relationship is a prerequisite to a professional liability claim, the term is interpreted broadly because a physician may have direct responsibility for a patient under treatment or indirect liability through joint practice or a supervisory relationship with another physician.

A physician who supervises other providers is often held legally liable for the substandard practices of those under his or her supervision.3 There are 2 legal bases for this liability; One is based on tort law with the claim of negligent professional supervision, and the other is based on agency law, which claims it is superior or “asks the master to answer on behalf of the servant.” Regulatory responsibility may be proportional to the degree of oversight and control that the supervisory authority exercises over the clinician to be supervised;4 This is especially important for physicians who supervise multiple prescribers in managed care organizations. The responsibility of the agency, or the responsibility of those who are considered representatives of a physician, is generally determined hierarchically, regardless of the professional competence of the supervisor. Why is it important for me, as a practicing pharmacist, to understand such a responsibility? `A prescription for efficacy of a controlled substance must be issued for a legitimate medical purpose by a physician acting in the normal course of his or her professional practice. Responsibility for proper prescribing and dispensing of controlled substances rests with the prescribing physician, but a corresponding responsibility rests with the pharmacist filling the prescription. An order purporting to be an order that was not issued as part of normal occupational treatment or legitimate and authorized research is not an order within the meaning and purpose of section 309 of the Act (21 U.S.C. 829) and the person knowingly making such an alleged order and the person issuing it are subject to penalties for contraventions of the Controlled Substances Act.┬áIn the vignette presented here, the final question would be whether the plaintiffs suffered compensable damage. In this case, if the patient has suffered a significant bodily or psychological injury, the responsibility may lie with the prescribing physician. In many States, the responsibility of the prescribing physician does not stop at the harm caused to the patient and may extend to all undesirable consequences of the accident, whether for the patient or for third parties.

These damages may include compensation for physical and emotional harm, medical bills, statutory bills, and lost wages. Unless intervening factors are responsible for the consequences for third parties, the chain of liability may well extend to others affected by the accident.2 For example, in Coombes v. Florio,2 a family physician was held responsible for failing to warn a patient about the dangers of medication side effects and for failing to warn him not to drive. Liability extends to persons who were likely endangered by the physician`s omission.2 Only a person authorized or otherwise authorized under this section may practise a pharmacy or use the title “pharmacist” or a derivative product.