Theme: Professional Ethics

A pharmacist is a person who is trained to prepare, monitor and sell medicines. Under the law, a registered pharmacist^{(( Section 2(i), Pharmacy Act, 1948))} is a person whose name is entered in the register of the State where they are residing or carrying on the profession or business of pharmacy.

A register will include the full name and residential address of the registered person, the date of their first admission to the register, their qualifications for registration, professional address,  the name of their employer etc.^{(( Section 29,  Pharmacy Act, 1948))}

Qualifications needed to be a pharmacist

Qualifications of a pharmacist differ from state to state. The State Pharmacy Council of each state lays down certain qualifications for a person to be registered as a pharmacist. The Pharmacy Council of India approves such qualifications.

Education/Degrees

An individual of at least 18 years can be eligible for registration as a pharmacist for the first time. After paying the required fee, their name will be added to the register of the State where they reside or carry on their pharmacy business/profession,^{(( Section 31, Pharmacy Act, 1948))} if they have:

• A degree or diploma in pharmacy or pharmaceutical chemistry or a chemist and druggist diploma of an Indian University or a State Government, or a prescribed qualification granted by an authority outside India;^{(( Section 31(a), Pharmacy Act, 1948))} or
• A degree of an Indian University other than a degree in pharmacy or pharmaceutical chemistry. In addition, the person should have been engaged for at least 3 years in compounding drugs in a hospital, dispensary, or another place where drugs are regularly dispensed based on prescriptions of medical practitioners;^{(( Section 31(b), Pharmacy Act, 1948))} or
• Passed an examination recognised by the State Government for compounders or dispensers;^{(( Section 31(c), Pharmacy Act, 1948))} or
• Been engaged for at least 5 years in compounding drugs in a hospital, dispensary, or another place in which drugs are regularly dispensed based on prescriptions of medical practitioners. This period is calculated starting from the date for application of registration as notified by the State government.^{(( Section 31(d), Pharmacy Act, 1948))}

Other qualifications

In addition to the above qualifications, a person will be eligible for subsequent registration as a pharmacist:

• If they are a registered pharmacist in another state.^{(( Section 32(1)(b), Pharmacy Act, 1948))}
• The Pharmacy Council of India can approve  qualifications granted by any authority outside India, with regard to making Indian citizens eligible for registration as  Pharmacists. The Council approves an application only after the qualification guarantees a minimum level of skill and knowledge. However, non-citizens can also qualify for registration if they come from countries where persons of Indian origin (who have the required qualifications) can practice pharmacy.^{(( Section 14, Pharmacy Act, 1948))} Here, to have their name entered in the register, the person should have passed a matriculation examination or any other equivalent examination.^{(( Section 32(1)(c);Section 14, Pharmacy Act, 1948))}

While helping clients, pharmacists have certain duties:

• A pharmacist is not bound to attend every person who asks for their service. However, a pharmacist should always be ready to respond to the sick and injured.^{(( Regulation 8.1(a), Pharmacy Practice Regulations, 201))}
• Pharmacists should always maintain the confidentiality of their patients. For instance, a pharmacist should not reveal any issues or defects of patients observed during medical attendance. However, if the laws of the State require a pharmacist to give such information, they can do so. Pharmacists can also give such information if they think it will protect a healthy third party from a communicable disease like malaria, COVID-19 etc.^{(( Regulation 8.1(a), Pharmacy Practice Regulations, 2015))}
• While giving a prognosis, a pharmacist should not exaggerate or minimize the seriousness of the patient’s condition. In addition, pharmacists should ensure that the patient, patient’s family and close friends have knowledge of the patient’s condition so as to serve the best interests of the patient and patient’s family.¹
• Pharmacists should respond to any request for their assistance in an emergency. They should not deliberately commit an act of negligence that may deprive the patient from necessary medical care.^{(( Regulation 8.4, Pharmacy Practice Regulations, 2015))}

Patient Counseling by Pharmacists

Upon receiving a prescription drug order, and after reviewing the patient’s record, a registered pharmacist should personally initiate discussion of matters that will optimize the drug therapy or care of the patient. The pharmacist can conduct the discussion in person, or by telephone etc.

The discussion should include appropriate elements of patient counseling.^{(( Regulation 9.3(a), Pharmacy Practice Regulations, 2015))} Such elements may include the following :

• Name and description of the drugs^{(( Regulation 9.3(a)(i), Pharmacy Practice Regulations, 2015))}
• The dosage form, dose, route of administration, and duration of drug therapy^{(( Regulation 9.3(a)(ii), Pharmacy Practice Regulations, 2015))}
• Special directions and precautions for the drug^{(( Regulation 9.3(a)(iv), Pharmacy Practice Regulations, 2015))}
• Common side effects, adverse effects etc. that may be encountered, including their avoidance, and the action required if they occur^{(( Regulation 9.3(a)(v), Pharmacy Practice Regulations, 2015))}
• Techniques for self monitoring drug therapy^{(( Regulation 9.3(a)(vi), Pharmacy Practice Regulations, 2015))}
• Proper storage of the drugs^{(( Regulation 9.3(a)(vii), Pharmacy Practice Regulations, 2015))}

The patient or their agent can always refuse such counseling.

Role of pharmacies during counseling

The pharmacist has to maintain a record of drugs administered to the patient.^{(( Regulation 9.3(b), Pharmacy Practice Regulations, 2015))}Further, pharmacies providing patient counseling have to keep in mind that:

• Only registered pharmacists can be involved in counseling.^{(( Regulation 9.3(d)(i), Pharmacy Practice Regulations, 2015))}
• Facilities should be provided for confidential conversation, and patient confidentiality must be maintained.^{(( Regulation 9.3(d)(ii), Pharmacy Practice Regulations, 2015))}
• Proper documentation is necessary.^{(( Regulation 9.3(d)(iv), Pharmacy Practice Regulations, 2015))}
• Counseling should be for the patient’s benefit. In every consultation, the benefit to the patient is of foremost importance. All registered pharmacists engaged in the case should be frank with the patient and his attendants.^{(( Regulation 9.3(d)(vi), Pharmacy Practice Regulations, 2015))}
• During counseling, punctuality should be maintained.^{(( Regulation 9.3(d)(vii), Pharmacy Practice Regulations, 2015))}

However, please remember that the law does not give pharmacists the power to open pharma clinics to diagnose the disease and prescribe medicines.^{(( Clarification on Pharmacy Practice Regulations, 2015 notified by Pharmacy Council of India in Gazette of India No.17 dated 16.1.2015))}

If these duties are not fulfilled and you face issues as a pharmaceutical client/patient, then you can file a complaint against the pharmacist.

1. Regulation 8.3, Pharmacy Practice Regulations, 2015 [↩]

Some of the ethical practices for pharmacists include:

Handling of Drugs/Medicines by Pharmacists

Pharmacists should take all possible care to dispense a prescription correctly by weighing and measuring all ingredients in correct proportions, with the help of scale and measures (visual estimations must be avoided). Further, a pharmacist should always use drugs and medicinal preparations of standard quality, and should never adulterate the preparations. A pharmacist should be very careful in dealing with drugs and medicinal preparations known to be poisonous, or used for addiction  or any other abusive purposes.^{(( Chapter II, Code of Pharmaceutical Ethics))}

Hawking of Drugs/Medicines

Hawking of drugs and medicines is discouraged. Therefore, pharmacists cannot engage in door-to-door solicitation of the products. To prevent self-medication using drugs, pharmacists are discouraged from distributing therapeutic substances without expert supervision.^{(( Chapter III, Code of Pharmaceutical Ethics))}

Fair Trade Practice

Cut-throat competition, aiming to capture the business of another pharmaceutical establishment is discouraged among pharmacists. Cut-throat competition includes:

• Offering any sort of prizes, gifts or any kind of allurement to customers
• Knowingly charging lower prices for medical commodities, compared to the reasonable prices charged by a fellow pharmacist.

In case any order or prescription intended to be served by a particular dispensary is brought by mistake to another dispensary, the latter should refuse to accept it and should direct the customer to the right place. Imitation or making a copy of labels, trademarks and other signs and symbols of other pharmaceutical establishments are also not allowed under the law. ^{(( Chapter III, Code of Pharmaceutical Ethics))}

Advertising and Displays

In connection to selling medicines to the public, a pharmacist should not use displays that are undignified, or which contain the following:³

• Any wording design or illustration that reflects pharmacists or an individual in a bad light.
• A disparaging or derogatory reference to other suppliers, products, remedies or treatments. Even if the comments are direct or implied, it is not allowed.
• Misleading or exaggerated statements or claims.
• The word “Cure” in reference to an ailment or symptoms of ill-health.
• A guarantee of therapeutic effect
• An attempt to increase fear through advertisements.
• An offer to refund money paid by a customer
• A prize, competition or similar scheme.
• Any reference to a medical practitioner or a hospital, or the use of the terms “Doctor” or “Dr.” or “Nurse” in connection with the name of a preparation not already established.
• A reference to sexual weakness, premature ageing or loss of virility.
• Indecent references to complaints of sexual nature.

If a pharmacy knows, or  could reasonably know that a preparation is advertised by such means, such preparations should not be displayed in the pharmacy.

Any complaint with regard to professional misconduct of a pharmacist can be brought either before the State Pharmacy Council or Pharmacy Council of India for disciplinary action.^{(( Regulation 14(a), Pharmacy Practice Regulations, 2015))} Every State Government is required to set up a State Pharmacy Council.^{(( Regulation 14(b), Pharmacy Practice Regulations, 2015))} States are also free to form Joint State Councils with mutual agreement.^{(( Section 19, Pharmacy Act, 1948))} The list of all State Pharmacy Councils in India can be found here.

Procedure to complain

The procedure for filing a complaint against a registered Pharmacist may vary from state to state. This is because they are determined by the respective State Laws and in few states such as Kerala,^{(( Kerala State Pharmacy Council Rules, 2012))} Tamil Nadu,^{(( Tamil Nadu Pharmacy Council Rules, 1953))} and Maharashtra,^{(( Maharashtra State Pharmacy Council Rules, 1969))} you would require to submit your complaint in writing to the Registrar of the State Pharmacy Council and the grounds of the complaint also has to be stated.^{(( Rule 85, Kerala State Pharmacy Council Rules, 2012; Rule 90, Tamil Nadu Pharmacy Council Rules, 1953; Rule 63(3), Maharashtra State Pharmacy Council Rules, 1969))}

Generally, the complaint should state the description and address of the complainant. This is because the complaint does not have a provision for anonymous complaints. If any information in the complaint is not within the personal knowledge of the complainant, the source of such information and the reasons why the complainant believes it to be true must be clearly stated.^{(( Rule 63(4), Maharashtra State Pharmacy Council Rules, 1969;Rule 86, Kerala State Pharmacy Council Rules, 2012; Rule 91, Tamil Nadu Pharmacy Council Rules, 1953))}

Punishing a Pharmacist

Once a complaint is received, the appropriate Pharmacy Council will hear the practitioner. If they are found guilty, then the Council will provide a punishment.

The punishment is determined by the Council and it can even direct removal of the name of the practitioner from the corresponding register altogether or for a specified time period. This means that the pharmacist will not be able to practice for that period.^{(( Regulation 14(b), Pharmacy Practice Regulations, 2015))}

The actions of a registered pharmacist which shall qualify for misconduct and those actions which can be complained against include:

Violation of Law

• Violations of regulations under the Pharmacist Act (including violations associated with the duties of a pharmacist, which can be found here).^{(( Regulation 13(a), Pharmacy Practice Regulations, 2015))}
• If a registered pharmacist working in a pharmacy is also found working in another pharmacy/, pharmacy college/institution/industry/any other organization as a teaching faculty or otherwise, this is an act of misconduct.^{(( Regulation 13(u), Pharmacy Practice Regulations, 2015))}

Handling medicines

• Dispensing medicines which require prescription, without the prescription of the Registered Medical Practitioner.^{(( Regulation 13(b), Pharmacy Practice Regulations, 2015))}
• Substitution of the prescription without approval/consent of the Registered Medical Practitioner.^{(( Regulation 13(c), Pharmacy Practice Regulations, 2015))}

Registration certificate and information related

• Allowing the owner of the pharmacy to use their pharmacist registration certificate without attending the pharmacy.^{(( Regulation 13(d), Pharmacy Practice Regulations, 2015))}
• Giving their pharmacist registration certificate at more than one pharmacy.^{(( Regulation 13(e), Pharmacy Practice Regulations, 2015))}
• Not maintaining the prescription/dispensing records of patients for five years, and refusing to provide these records within 72 hours when the patient or an authorised representative makes a request.^{(( Regulation 13(f), Pharmacy Practice Regulations, 2015))}
• Not displaying the registration certificate accorded by the State Pharmacy Council in the pharmacy.^{(( Regulation 13(g), Pharmacy Practice Regulations, 2015))}

Improper Conduct or Crimes

• Committing adultery or improper conduct with a patient, or maintaining an improper association with a patient by abusing their professional position.^{(( Regulation 13(i), Pharmacy Practice Regulations, 2015))}
• Conviction by a court for offences involving moral turpitude or criminal acts.^{(( Regulation 13(j), Pharmacy Practice Regulations, 2015))}
• Using agents for procuring patients.^{(( Regulation 13(r), Pharmacy Practice Regulations, 2015))}

Confidentiality and Disclosure of Information

• Contributing to press articles and giving interviews regarding diseases and treatments which may have the effect of advertising or soliciting practices. However, pharmacists are free to write to the press under their own name on matters of public health and hygienic living. They can also deliver public lectures and talks under their own name, and announce the same in the press.^{(( Regulation 13(m), Pharmacy Practice Regulations, 2015))}
• Disclosing the secrets of a patient learnt in the exercise of their profession. However, disclosure is permitted:
  • In a court of law under orders of the presiding judicial officer;
  • In circumstances where there is a serious and identified risk to a specific person and /or community; and
  • In case of notifiable diseases.^{(( Regulation 13(n), Pharmacy Practice Regulations, 2015))}
• Refusing solely on religious grounds to dispense medicines on the prescription of a Registered Medical Practitioner.^{(( Regulation 13(o), Pharmacy Practice Regulations, 2015))}
• Publishing photographs or case reports of patients without their permission in any medical or other journal, in a manner by which the patient’s identity can be made out. However, if the identity is not disclosed, the consent is not needed.^{(( Regulation 13(p), Pharmacy Practice Regulations, 2015))}

Further, in case a registered pharmacist is running a pharmacy and employing other pharmacists for help, the ultimate responsibility rests on the registered pharmacist.^{(( Regulation 13(q), Pharmacy Practice Regulations, 2015))}

This is not a complete exhaustive list of all kinds of professional misconduct. However, circumstances that are not mentioned above may also qualify as professional misconduct, and the responsible pharmacy council can take action on the same.^{(( Regulation 14(a), Pharmacy Practice Regulations, 2015))} Further, this would mean that violation of any of the prescribed ethical standards of a Pharmacist, mentioned here, might also qualify as a ground for disciplinary action.