Pharmacist Issued Warning for Inappropriate Relationships and Boundary Violations with Two Patients

The General Pharmaceutical Council (GPhC) Fitness to Practise Committee investigated a pharmacist after concerns were raised regarding inappropriate relationships with two patients while she was working as a Superintendent Pharmacist at Bosworth Pharmacy, Nuneaton.

Between September 2018 and March 2019, she:

1. Developed friendships and later inappropriate relationships with Patients A and B, both of whom were long-standing patients of the pharmacy.
2. Engaged in WhatsApp conversations with Patient A that contained sexual overtones, including messages about massages and kisses.
3. Allowed Patient A to stay at her home after Patient A self-harmed and was discharged from hospital.
4. Failed to seek professional advice or take steps to separate her personal relationships from her role as a pharmacist.

The GPhC was alerted after Patient A raised a concern with the regulator in early 2019.

Findings:

The Fitness to Practise Committee found that the pharmacist’s conduct amounted to serious professional misconduct, considering:

1. Blurring of Professional and Personal Boundaries:
   • The pharmacist should have maintained clear boundaries with Patients A and B.
   • The relationships went beyond appropriate pharmacist-patient interactions, raising ethical concerns.
2. Sexualised WhatsApp Messages to Patient A:
   • The pharmacist sent inappropriate text messages that contained flirtatious and suggestive language.
   • Examples from the messages included:“I bet that would feel nice… my hands are cold too… any suggestions?”
     “I love kisses… all over?”
     “I give the nicest massage… I’ll bring the oil… wandering hands.”
3. Providing Shelter to Patient A Following Self-Harm Incident:
   • After Patient A took an overdose and was discharged from hospital, the pharmacist allowed her to stay in her home.
   • The committee found that this further blurred the professional boundary and could have caused confusion for the patient.
4. Failure to Seek Professional Advice or Guidance:
   • The pharmacist did not consult with senior colleagues or professional bodies about how to handle the relationships.
   • She continued to provide pharmacy services to both patients, despite recognising that boundaries were being crossed.
5. Potential Vulnerability of the Patients:
   • While the relationships were consensual, the committee noted a power imbalance, particularly given that Patient A had mental health struggles and had self-harmed.
   • Even if no coercion was involved, pharmacists are expected to be mindful of professional ethics when engaging with patients socially.

GPhC Determination on Impairment:

The GPhC ruled that the pharmacist’s fitness to practise was impaired, citing:

• Serious ethical breaches that undermined public confidence in the profession.
• Failure to maintain professional boundaries with patients.
• The need to uphold high standards of conduct in pharmacy.

The committee stated:

“The registrant’s behaviour, being in breach of four Standards for Pharmacy Professionals, amounts to serious misconduct that professional colleagues and the public would find deplorable.”

However, the committee also acknowledged that:

• The pharmacist had fully admitted to the allegations.
• She had demonstrated genuine remorse and reflected extensively on her actions.
• She had completed remedial training on professional boundaries.
• She had taken proactive steps to prevent recurrence, such as implementing new policies in her pharmacy.

Given these mitigating factors, the committee found that:

“While the risk of repetition is low, a formal warning is necessary to uphold public confidence in the profession.”

Sanction:

The committee issued a formal warning, considering:

• Aggravating Factors:
  • Inappropriate relationships with two patients over a six-month period.
  • Sexualised messages exchanged with a patient.
  • Allowing a vulnerable patient to stay in her home, further confusing professional boundaries.
• Mitigating Factors:
  • The pharmacist fully admitted to the misconduct.
  • She had never been subject to previous disciplinary action.
  • She had completed remedial training and demonstrated strong insight into her mistakes.
  • She had taken proactive steps to improve professional standards within her pharmacy.

The committee ruled that:

“A warning is sufficient to mark the seriousness of the registrant’s misconduct. There is no need for further restrictions on practice, as the risk of repetition is minimal.”

Key Learning Points for Pharmacy Professionals:

This case highlights critical lessons regarding professional boundaries, ethical conduct, and maintaining public trust.

1. Personal Relationships with Patients Can Breach Ethical Boundaries:
   • Pharmacists should be cautious about engaging in personal relationships with patients, as these can compromise professional integrity.
   • Even if interactions are consensual, they may still be deemed inappropriate.
2. Electronic Communications with Patients Should Remain Professional:
   • WhatsApp and other messaging platforms must be used professionally.
   • Sending flirtatious or suggestive messages to patients is unacceptable and can result in disciplinary action.
3. Vulnerable Patients Require Extra Safeguarding:
   • Providing personal support, such as allowing a patient to stay at one’s home, is inappropriate.
   • Pharmacists should direct vulnerable patients to appropriate medical and social services instead.
4. Early Reflection and Remedial Actions Can Mitigate Sanctions:
   • The pharmacist avoided suspension due to her proactive efforts to improve her conduct.
   • Taking responsibility early and demonstrating insight can influence regulatory outcomes.

Conclusion:

This case serves as a reminder that pharmacy professionals must always maintain clear professional boundaries with patients.

While the pharmacist avoided a suspension, her case reinforces the importance of ethical conduct, especially when dealing with vulnerable individuals.

The formal warning serves as a public acknowledgment of the seriousness of the misconduct, ensuring that pharmacists uphold the highest professional standards in all interactions.