Preventing Sexual Abuse: Providing Pharmacy Services to Spouses Can Be Considered Professional Misconduct

Pharmacists and pharmacy technicians must be committed to protecting patients from sexual abuse of any kind. As part of this obligation, it is important for registrants to know that defining who is a patient for the purposes of sexual abuse is guided by legislation and that no legislative exemption currently exists for the spouses, including common law spouses, or other intimate relationship partners of registrants.

This means that a registrant who provides pharmacy services (including dispensing, vaccinations and prescribing for minor ailments) to their spouse could potentially face a finding of professional misconduct and disciplinary action, with a significant risk of revocation of their certificate of registration should the matter be referred to the Discipline Committee. There are few scenarios where providing pharmacy services to a spouse would not be considered sexual abuse.

Registrants Hold a Position of Power

Within the registrant-patient relationship, registrants hold a position of power. Patients rely on pharmacy professionals to protect their well-being, personal health information and access to critical medication.

Treating a spouse, or any family member, gives rise to an inherent conflict of interest, and could potentially compromise a registrant’s ability to be objective and unbiased in their professional judgment. Additionally, the patient may not feel comfortable disclosing personal or health information that may have an impact on treatment.

Because of the power imbalance that exists between registrants and their patients, any sexual or romantic relationship a registrant has with a patient is considered an act of professional misconduct and possible sexual abuse, regardless of whether the relationship is consensual.

Ultimately, registrants have an obligation to maintain the professional integrity of the professional-patient relationship.

Who is Considered a Patient for the Purposes of Sexual Abuse?

Under the Regulated Health Professions Act, 1991, (RHPA) sexual abuse of a patient by a registrant means sexual intercourse or other forms of physical sexual relations with the patient; touching, of a sexual nature, of the patient; or behaviour or remarks of a sexual nature towards the patient.

For the purposes of sexual abuse, the RHPA states that an individual is considered a patient where there is a direct interaction between the individual and the health professional and any of the following conditions are met:

• The professional has charged or received payment from the individual (or a third party on behalf of the individual) for a healthcare service provided by the professional;
• The professional has contributed to a health record or file for the individual;
• The individual has consented to the healthcare service recommended by the professional; or
• The professional prescribed a drug to the individual for which a prescription is needed.

To engage in a relationship with a former patient, a registrant must ensure that at least one year has elapsed after termination of the therapeutic relationship and that there is no vulnerability or dependency on the part of the patient. Termination often requires the registrant to take active steps to end the professional-patient relationship, as outlined in the College’s guideline, Ending the Pharmacist-Patient Relationship. It also requires the registrant to cease providing any healthcare and pharmacy services (including pharmaceutical advice) to the patient.

A pharmacy staff member or any other registrant who has received assessment, treatment or any other pharmacy services from a registrant is also considered to be a patient for the purpose of applying the sexual abuse provisions. There is no exception for registrants whose spouses are registrants themselves.

Routine Care Should Not Be Provided to Spouses

Registrants are not permitted to provide routine care to individuals that they have an existing sexual relationship with, including spouses.

The only exception in the RHPA to the above definition of a patient for sexual abuse purposes is if all of the following conditions are met:

• There is an existing sexual relationship between the person and the registrant at the time the healthcare service is provided;
• The healthcare service provided to the person by the registrant was minor in nature or was provided in an emergency; and
• The registrant has taken reasonable steps to transfer the person’s care, or there is no reasonable opportunity to transfer care.

Under the Treating Self and Family Members Policy, a minor condition is one that is not urgent or serious and does not require a physician’s intervention. An emergency is when an individual is experiencing severe suffering or at risk of sustaining serious bodily harm. Note that a minor condition may encompass, but should not be confused with, a “minor ailment” which has additional criteria for the purposes of the Pharmacy Act.

In addition, registrants should be aware that providing healthcare to themselves or closely related family members is usually considered to be inappropriate and a conflict of interest.

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