Dilemma 7: Fidelity, Promise- Keeping, Loyalty to Patients and Impaired Professionals<br />Heather R. Champagne<br />
Dishonest Colleagues: Intentionally Shorting Tablet Counts<br />After Lorraine, a registered pharmacist, counseled her elderly patient, Mr. James, about his three cardiac maintenance medications at pick up, she was surprised by Mr. James’ final question, “Would you please open these prescriptions and count them for me so that I know I’m getting what I paid for? There was a letter in my favorite advice column last night that told about how you can get shorted on your prescriptions, so I just want to make sure all the pills are there. No offense meant, you understand. I just can’t afford to pay for pills and not get them.”<br />Mr. James’ prescription had been filled by Lorraine’s boss, Glenn, who also owned the pharmacy. Lorraine decided to humor Mr. James and opened the first bottle. To her surprise the prescription was short by three tablets. She immediately made up the difference. The remaining two prescriptions were also short by the same amount. Lorraine added the correct number of tablets to Mr. James’ prescriptions and assured him they contained the correct number of tablets.<br />Mr. James was not the only patient with concerns about shortages that day. Several clients had read the same article and asked for a tablet count. Lorraine took several calls from angry customers complaining of being shorted. She noted all the prescriptions and noticed they all were maintenance medications and all had been short. Glenn had also filled all the prescriptions.<br />When Glenn arrived at the pharmacy, Lorraine told him about what she had discovered and the number of dissatisfied clients that called to complain about shortages. She expected Glenn to have a reasonable answer. He stated “It’s really a shame that advice column printed that letter. We’ll have to stop shorting maintenance prescriptions for a while until people get over the excitement and the need to count every pill.”<br />Lorraine could not believe what she was hearing. ‘You mean that you have been intentionally shorting prescriptions?” Glenn shrugged his shoulders and said “Just the maintenance ones and only on the higher-end products. People don’t miss three or four pills a month and the pharmacy recouped a steady amount. Besides, they always come in for a refill before they run out, so the patients aren’t harmed. Most people forget to take a pill now and then anyway so they never miss the shortage. Four pills a month times three maintenance prescriptions for most patients, times over 1000 patients on these meds – that adds up to a lot tablets that I don’t have to purchase. I won’t stay in business long if I can’t make a profit somewhere. No one is harmed and the pharmacy can stay in business and provide good service to many people who need us.”<br />Lorraine had always admired Glenn but his nonchalant admission of guilt instantly changed her mind about her employer. She had never knowingly shorted a prescription. How could she work for someone who did it as a matter of course? Furthermore, what should she do about this dishonesty in her colleague?<br />
As defined by the Academy of Pharmaceutical Physicians and Investigators: “Members and certificants shall exhibit the highest standards of integrity and be honest, open, objective and accurate in all of their professional activities. Members and certificants shall not lie, steal, cheat or engage in fraud, subterfuge, misrepresentation of fact, or partial or delayed disclosure of information in a misleading manner. Members and certificants shall act honestly and openly in all professional relationships and shall not participate in, condone or be associated with dishonesty, fraud or misrepresentation. Members and certificants shall accurately represent their own and their associates’ qualifications, education, experience, competence and affiliations in all spoken, written or printed communications. Members and certificants shall not fabricate data, withhold meaningful relevant data, leave significant errors in published data uncorrected, or present portions of others’ work or data as their own.”<br />GLENN MUST HAVE MISSED THE MEMO!<br />Integrity<br />
<ul><li>Non-malfeasance: The term malfeasance refers to breaking the public trust; Glenn has done so by intentionally shorting pills from his customer’s prescriptions. Glenn lacks the principal of non-malfeasance because he is putting the patient in harm’s way by not giving him his complete prescription of cardiac medications.
Beneficence: This principle not only means to not harm another person, but to actually do more good and to benefit others. Glenn is not benefitting his customers by shorting their prescriptions nor is he doing good by breaking their trust and being dishonest.
Fidelity: Glenn has broken this ethical principal; any loyalty he established with this patient, and the many others who have called in about shorted prescriptions, has been broken.
Justice: Glenn’s decision to short his customers on their prescriptions is not acceptable ethical behavior and he is not treating his customers equitably. </li></ul>Glenn Lacks Several Ethical Principles. . .<br />
<ul><li>Lorraine had always admired Glenn but his nonchalant admission of guilt instantly changed her mind about her employer. She had never knowingly shorted a prescription. How could she work for someone who did it as a matter of course? Furthermore, what should she do about this dishonesty in her colleague?
What should Lorraine do? Should she report Glenn for his infidelity or should she just let it go?
What about the customers? They are paying for pills they are not receiving, and many of them may not be able to afford to do that.</li></ul>Lorraine is in A Dilemma!<br />
If Lorraine should decide not to report Glenn she is putting the health of all customers at risk because she knows he is shorting their prescriptions. She would be keeping her fidelity to her employer but ignoring the principles of non-malfeasance, beneficence, and justice in regard to his customers. Not only could she put her job at risk, but she could also put future jobs at risk if they got caught; although Lorrain was not actively shorting prescriptions, she knew it was happening, and who would want to hire someone who would let this happen? Lorraine could also feel guilt should she decide to not report Glenn; although she could always simply find a new job, that doesn’t mean she will be able to let go of what Glenn is doing. <br />Letting it Slide<br />
Lorraine is so upset and disgusted at the behavior of her colleague that she thinks it is in the best interest of all involved to report his actions. She could not believe that he could so easily lie to his loyal customers for personal gain; furthermore, he was putting the health of everyone not receiving their entire prescriptions at risk. Although Glenn could potentially lose his job, business, and license, Lorraine reports him. She did not want to work for someone so dishonest; she did not agree with his actions and did not want to risk her career by not reporting him. Lorraine is confident that her decision is ethically and morally sound and she feels she has helped the customers by turning Glenn in. Although Lorraine jeopardized her own fidelity to her employer, she instituted non-malfeasance, justice, and beneficence in regard to the customers.<br />Reporting Glenn<br />
<ul><li>Association of Clinical Research Professionals and the Academy of Pharmaceutical Physicians and Investigators, . (2007). Code of ethics & professional conduct. Retrieved from http://www.appinet.org/FunctionalMenuCategory/AboutAPPI/CodeofEthicsProfessionalConduct.aspx </li></ul>Resources<br />