Discipline Decisions (August 2023)

• Failed to successfully complete the ProBE Program on Ethics for Healthcare Professionals with an unconditional pass, at his expense, by the date required in an order of a panel of the Discipline Committee of the Ontario College of Pharmacists dated September 24, 2018 (the “Order”) and as extended by the Registrar of the Ontario College of Pharmacists, in accordance with the Order.

In particular, the Panel found that he:

• Contravened a term, condition or limitation imposed on his certificate of registration;

• Failed to maintain a standard of practice of the profession;
• Failed to comply with an order of a panel of the Discipline Committee of the Ontario College of Pharmacists;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;

2. Directing the Registrar to suspend the Registrant’s Certificate of Registration for a period of three (3) months. The suspension shall start April 27, 2023 and without interruption until July 26, 2023, inclusive;

3. Directing the Registrar to impose specified terms, conditions or limitations on the Registrant’s Certificate of Registration as follows:

a. The Registrant shall successfully complete, at his own expense and within twenty-four (24) months of the date of this Order: a course with Dr. Erika Abner or another ethics consultant acceptable to the College (the “Consultant”), to address the professional misconduct arising from this matter, to be designed by the Consultant. The following terms shall apply to the course:

i. The number of sessions shall be at the discretion of the Consultant, but shall be no fewer than three;

ii. The manner of attendance at the session(s) (e.g., in person, via videoconference etc.) is a matter to be discussed in advance between the Registrant and the Consultant, but shall ultimately be at the discretion of the Consultant;

iii. The Registrant shall, in advance of the course, provide to the Consultant a copy of the 2018 Decision and Reasons; the three (3) essays completed as part of the ProBE Program (that the Registrant completed as ordered in the 2018 decision) and either:

1. a copy of the Agreed Statement of Facts and this the Joint Submission on Order; or

2. the Panel’s Decisions and Reasons (if available) of this matter as well as the Decisions and Reasons from the 2018 matter; and

iv. The Registrant shall require the consultant to report the results of successful completion of the course to the College no later than twenty-four (24) months from the date of this Order.

b. The Registrant shall remain in Part B of the College’s register until successful completion of the ethics course set out in paragraph 3(a), above.

c. For a period of two (2) years from the date of this Order the Registrant shall be prohibited from acting as a Designated Manger in any pharmacy. This term, condition or limitation is in addition to, and applies irrespective of, any other Order made by this Committee or any other Committee of the College.

d. For a period of two (2) years commencing on the date on which the Registrant returns to Part A of the College’s register:

i. the Registrant shall be required to notify the College in writing the name(s), address(es), and telephone number(s) of all employer(s) within 14 days of commencing employment in a pharmacy;

ii. the Registrant shall only work for an employer who confirms to the College in writing within fourteen (14) days of the Registrant commencing employment that they have been provided with a copy of:

1. the Notice of Hearing in this matter; 2. this Order; and 3. the panel’s reasons for decision in this matter, when available.

In its reprimand, the Panel expressed its expectation that when a registrant indicates to the College that they will comply with an Order of the Discipline Committee, they must do so. In this case, the Registrant failed in this regard. He engaged in conduct that is both dishonourable and unprofessional, and failed to abide by the standards of the profession that are expected of you.

The Panel indicated its hope that the Registrant will take this time to learn from his mistakes and change his ways, and that he does not appear again before a Panel of the Discipline Committee.

Referral #1

The Panel found that the Registrant, while engaged in the practice of pharmacy as dispensing pharmacist, Designated Manager, shareholder and/or director at Clairhurst Medical Pharmacy and/or CC Pharmacy, both in Toronto, Ontario, from about January 1, 2016 to May 23, 2019, committed professional misconduct in that he submitted false claims for one or more of certain identified drugs and other products when a different product was actually dispensed to patients.

In particular, the Panel found that the Registrant:

• Failed to maintain the standards of practice of the profession;
• Signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement;
• Submitted an account or charge for services or products that he knew or ought to have known was false or misleading;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional.

Referral #2

The Panel found that the Registrant, while engaged in the practice of pharmacy as dispensing pharmacist, Designated Manager, shareholder and/or director at Clairhurst Medical Pharmacy and/or CC Pharmacy, both in Toronto, Ontario, from about January 9, 2018 to May 29, 2019, committed professional misconduct in that he dispensed and/or billed for certain identified prescription products in absence of a valid prescription.

In particular, the Panel found that the Registrant:

• Failed to maintain the standards of practice of the profession;
• Signed or issued, in his professional capacity, a document that he knew or ought to have known contained a false or misleading statement;
• Submitted an account or charge for services or products that he knew or ought to have known was false or misleading;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional.

Referral #3

The Panel found that the Registrant, while engaged in the practice of pharmacy as dispensing pharmacist, Designated Manager, shareholder and/or director at Clairhurst Medical Pharmacy and/or CC Pharmacy, both in Toronto, Ontario, from about December 11, 2019 to about May 5, 2020, committed professional misconduct in that he caused prescriptions to be processed and billed through Main Drug Mart in Thornhill under the auspices of a central fill agreement.

In particular, the Panel found that the Registrant:

• Failed to maintain the standards of practice of the profession;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members of the profession as unprofessional.

The Panel imposed an Order, which as follows:

1. A reprimand;

2. Directing the Registrar to suspend the Registrant’s Certificate of Registration for a period of 4 months with 1 month to be remitted on the condition that the Registrant completes the remedial program specified in paragraph 3(a) within 12 months of the date of this Order. The suspension shall commence on May 9, 2023, and shall continue until August 8, 2023, inclusive. If the remitted portion of the suspension is required to be served by the Registrant because he fails to complete the remedial requirement specified in paragraph 3, that portion of the suspension shall commence on May 10, 2024, and shall continue until June 9, 2024, inclusive. If the time for completing the remedial steps in paragraph 3 is extended by the Registrar, the date on which the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly;

3. That the Registrar is directed to impose specified terms, conditions or limitations on the Registrant’s certificate of registration, and in particular:

a. That the Registrant shall successfully complete, at his own expense and within 12 months of the date of this Order:

i. a course with Gail E. Siskind Consulting Services, or another professional ethics consultant chosen by the College, to be designed by the consultant, for the purpose of addressing the professional and ethical obligations raised by the facts and findings of professional misconduct in this case (the “Siskind Course”). The following terms shall apply to the Siskind Course:

(i) the number of sessions shall be at the discretion of the consultant, but shall be a minimum of two (2) meetings and a maximum of three (3) meetings;

(ii) the manner of attendance at the session(s) (e.g. in person, via video conference, etc.) is a matter to be discussed in advance between the Registrant and the consultant, but shall ultimately be at the discretion of the consultant;

(iii) the Registrant shall provide to the consultant the following documents, in advance of the Siskind Course, to facilitate the design of the Siskind Course:

1. the Notice of Hearing; 2. the Agreed Statement of Facts; 3. this Joint Submission on Order; and 4. the Panel’s Decision and Reasons, if and when available;

(iv) successful completion of the course will include completion of an essay, acceptable to the Registrar, addressing the issues raised in this matter; and

(v) the consultant shall agree to confirm to the College once the Registrant has completed the Siskind Course to the satisfaction of the consultant.

b. That the Registrant shall be prohibited from acting as a Designated Manager in any pharmacy for a period of 12 months, which period shall be reduced to six months if the Registrant successfully completes the College’s Designated e-Learning Module within six months of the date of this Order.

c. That if and when the Registrant resumes the role of Designated Manager at any pharmacy, the Registrant’s practice shall be subject to Compliance Audit Reviews (CARs) by the College for a period of 24 months following the Registrant’s resumption of the role of Designated Manager. The following terms apply to the CARs:

i. the College will be entitled to conduct any CAR for a period of 24 months from the date on which the Registrant is appointed as a Designed Manager (“CARs Period”);

ii. if the Registrant ceases to act as a Designated Manager at any time within the 24 months specified in subparagraph i above, such that the College is unable to conduct any CARs, then the CARs Period shall be paused and shall resume on the date on which the Registrant resumes the role of Designated Manager, and in such circumstances:

(i) the Registrant shall notify the College, in writing, if he no longer acts as Designated Manager at any point(s) during any times that the CARs Period remains active; and

(ii) if the CARs Period is paused at any time(s), the Registrant shall notify the College, in writing, when he resumes the role of Designated Manager, at which point the CARs Period shall resume and shall continue until a total period of 24 months has been achieved;

iii. the CARs will be conducted by means of attendances by a representative of the College at any pharmacy for which the Registrant serves as Designated Manager, at such times as the College may determine;

iv. during any CAR, the College representative will be entitled to review and examine the Registrant’s practice;

v. the CARs are in addition to any routine inspections conducted by the College pursuant to the Drug and Pharmacies Regulation Act, R.S.O. 1990, c. H.4., s. 148, and are not a substitute for such inspections;

vi. the Registrant shall fully cooperate with the College representative during the CARs; and

vii. the Registrant shall pay to the College in respect of such CAR the amount of $1,000.00 per CAR, immediately after each CAR is completed, with the total amount to be paid by the Registrant not to exceed $3,000, regardless of the number of CARs and/or attendances conducted by the College;

4. Costs to the College in the amount of $10,000.00.

In its reprimand, the Panel noted that the Registrant is a pharmacist and a member of the profession of pharmacy, which is a highly regarded profession within the healthcare system and community at large. Integrity and trust are foundational principles for those who practice this profession.

The Panel observed that the Registrant failed in his role as a pharmacist and a Designated Manager. As a Designated Manager, sole Director, and a shareholder of two pharmacies, the Registrant should have known better. The public expects a high level of professionalism, attention to detail, and adherence to standards when they receive care from a pharmacist. The Registrant’s misconduct could lead the public to lose confidence in the profession.

The Panel pointed out that practicing pharmacy is a privilege, not a right. It is granted to those who possess the knowledge, skill, and judgement to practice safely, ethically, and professionally, which the Registrant has not done.

The Panel noted that the Registrant must change his ways, remediate his practice, and learn from this shameful experience.

• Failed to maintain a standard of practice of the profession;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;

2. Directing the Registrar to suspend the Registrant’s certificate of registration for a period of three months. The suspension shall commence on May 17, 2023 and shall continue without interruption until August 17, 2023, inclusive;

3. Directing the Registrar to impose specified terms, conditions or limitations on the Registrant’s certificate of registration, including:

a. The Registrant must successfully complete, within 12 months of the date of the Order, the College’s Code of Ethics e-Learning Modules, and provide confirmation of such completion to the Manager, Conduct Operations at the College;

b. The Registrant must successfully complete, within 12 months of the date of the Order, a course with a professional ethics consultant retained by the Registrant at her own expense and approved by the College (the “Consultant”), to be designed by the Consultant with the purpose of reviewing the professional and ethical obligations applicable in the circumstances of this proceeding (the “Course”), and provide evidence satisfactory to the College that the Registrant has completed the Course, within 12 months of the date of the Order. The following terms will apply to the Course:

i. for the purpose of designing the Course, the Registrant will provide to the Consultant the following documents related to this proceeding:

1. Notice of Hearing;

2. Agreed Statement of Facts;

3. Joint Submission as to Order; and

4. Decision and Reasons of the Discipline Committee, should they become available before the Course is completed.

ii. the number of sessions shall be at the discretion of the Consultant, but shall be a minimum of three (3) sessions;

iii. the manner of attendance at the sessions (e.g. in person, via video conference, etc.) is a matter to be discussed in advance between the Registrant and the Consultant but shall ultimately be at the discretion of the Consultant;

iv. successful completion of the Course will include completion of an essay, acceptable to the College, addressing the ethical issues arising in this matter and/or any other topics suggested by the Consultant;

v. the essay shall be at least 1000 words in length. The Registrant shall be responsible for the cost of review of the essay by the Consultant who will report to the College whether the essay is acceptable. At the direction of the Consultant, the Registrant may be required to amend the essay until it is completed to the Consultant’s satisfaction;

vi. The Registrant will request a report from the Consultant confirming that the Registrant has completed the Course to the satisfaction of the Consultant, and the Registrant will provide a copy of the report and her essay to the Manager, Conduct Operations at the College, within 12 months of the date of the Order.

4. Costs to the College in the amount of $35,000.

In its reprimand, the Panel noted that the Registrant placed business interests above the interests of her patients. She breached the Ontario College of Pharmacists Code of Ethics in that she compromised her professional integrity to further business interests, to the detriment of the patient and the public. Specifically, she failed to ensure that her primary focus at all times was the well-being of her patients, and she interfered with the patient’s right to choose a pharmacy and/or pharmacy professional.

The Panel observed that the practice of Pharmacy is a privilege that carries with it significant obligations to the public, the profession, and oneself. The Registrant’s actions demonstrated a failure to uphold all of these.

The Panel expressed its trust that the Registrant now realizes the importance of this responsibility as a member of the College, and that she will benefit from the College’s Code of Ethics e-learning modules as well as a professional ethics course. The Panel relayed its expectation that she will return to the profession with the honour and integrity required by the public and the profession, and that she will not appear in front of this Discipline Committee again.

• Failed to maintain a standard of practice of the profession;
• Charged (or permitted, consented to or approved, expressly or by implication, charges of) a fee or amount that was excessive in relation to the service or product provided;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;

2. That the Registrar is directed to impose specified terms, conditions or limitations on the Registrant’s Certificate of Registration, and in particular:

a. that the Registrant complete successfully, with an unconditional pass, at his own expense, within 12 months of the date of this Order, the ProBE course and any related evaluations offered by the Centre for Personalized Education for Professionals, or provide evidence satisfactory to the College that he has completed this course and any related evaluations within the 12 months prior to the date of this Order; and,

b. that the Registrant shall be prohibited from acting as a Designated Manager in any pharmacy until the date the College is notified that the Member has successfully completed the course and evaluation set out in paragraph 2(a), above.

3. That the Registrar suspend the Registrant’s Certificate of Registration for a period of four (4) months, with one (1) month of the suspension to be remitted on condition that the Registrant complete the remedial training as specified in paragraph 2(a). The suspension shall commence on June 1, 2023, and shall continue until August 31, 2023, inclusive. If the remitted portion of the suspension is required to be served by the Registrant because he fails to complete the remedial requirement specified in paragraph 2(a), that portion of the suspension shall commence on June 1, 2024, and shall continue until June 30, 2024, inclusive. If the time for completing the remedial steps in paragraph 2(a), above, is extended by the Registrar, the date on which the remitted portion of the suspension shall commence, if required, shall be adjusted accordingly.

4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that the Registrant submitted claims to a third-party payor with markups that were excessive and unreasonable. He benefitted financially from this conduct, and as such he violated the ethical code of the College, which makes it clear that pharmacists must not compromise their professional integrity in order to further business interests and promote financial gain to the detriment of the patient and public interest.

The Panel observed that pharmacists are expected to conduct themselves, like all other health professionals, in a manner that maintains the public’s confidence in the healthcare system. Practicing pharmacy is a privilege granted to those who possess the knowledge, skill, and judgment to practice safely, ethically, and professionally, which the Registrant failed to do.

The Panel pointed out that the Registrant has taken a positive step to begin to remediate his practice. The Panel indicated that he must learn from this shameful experience and commit to not appearing before this Discipline Committee again.

• Returned (or permitted, consented to, or approved, expressly or by implication, the returning of) drugs to stock without cancelling the prescription or refunding the claim;
• Dispensed (or permitted, consented to, or approved, expressly or by implication, the dispensing of) prescriptions without accurately recording the details of dispensing, including, but not limited to, the date of dispensing and the prescription number;
• Directed (or permitted, consented to, or approved, expressly or by implication) an unregulated staff member to perform some, or all, of the process of clinical/therapeutic verification of prescriptions; and/or
• Provided his login credentials to an unregulated staff member.

In particular, the Panel found that Mr. Palumbo:

• Failed to maintain a standard of practice of the profession;
• Failed to provide an appropriate level of supervision to a person he was professionally obligated to supervise;
• Failed to keep records as required respecting his patients and/or his practice;
• Engaged in conduct or performed an act relevant to the practice of pharmacy that, having regard to all the circumstances, would reasonably be regarded by members as dishonourable and unprofessional.

The Panel imposed an Order, as follows:

1. A reprimand;

2. Directing the Registrar to suspend Mr. Palumbo’s certificate of registration for a period of 10 months commencing on the date Mr. Palumbo obtains an active certificate of registration;

3. Directing the Registrar to impose specified terms, conditions, or limitations on Mr. Palumbo’s certificate of registration, including:

a. Mr. Palumbo must successfully complete at his own expense and within 12 months before obtaining an active certificate of registration:

i. the ProBE Program on professional / problem-based ethics for health care professionals offered by the Centre for Personalized Education for Professionals, with an unconditional pass; and

ii. the Ontario College of Pharmacists’ Online Designated Manager e-learning module;

b. For a period of 3 years from the date Mr. Palumbo obtains an active certificate of registration, he shall be prohibited from:

i. having any proprietary interest in a pharmacy of any kind and/or receiving remuneration for his work as a pharmacist other than remuneration on an hourly or weekly basis; and

ii. acting as a Designated Manager in any pharmacy.

4. Costs to the College in the amount of $10,000.

In its reprimand, the Panel noted that the practice of pharmacy is a privilege that carries with it significant obligations to the public, the profession, and oneself. Mr. Palumbo has eroded public trust in the profession by engaging in misconduct.

The Panel observed that Mr. Palumbo failed to maintain the standards of practice of the profession, returned drugs to stock without cancelling the prescription or refunding the claim, and dispensed prescriptions without accurately recording dispensing details. He permitted an unregulated staff member to perform clinical or therapeutic verification of prescriptions and failed to keep records that he was required to keep respecting his practice.

The Panel expressed its expectation that, if and when Mr. Palumbo returns to active practice, he will always ensure that he complies with the standards and requirements of the profession. The Panel relayed its trust that the remediation that has been ordered will ensure that, in the future, he will practice in an ethical and professional manner, and that he will learn from this experience and will never appear again before this Discipline Committee.