Pharmacist Suspended for Six Months for Conducting an Inappropriate Internal Examination

The General Pharmaceutical Council (GPhC) Fitness to Practise Committee investigated a pharmacist following a complaint from a female patient (Patient A). The pharmacist, who worked as a locum Clinical Pharmacist, was found to have conducted an internal vaginal examination without proper consent, clinical justification, or appropriate training.

On 16 July 2021, he:

1. Did not ask Patient A if she wanted a female practitioner or a chaperone.
2. Did not explain what the examination involved or why it was necessary.
3. Conducted a vaginal examination despite Patient A presenting with abdominal pain and no reported issues with her vaginal health.
4. Failed to record key details of the consultation, including the examination itself.
5. Later admitted that he had no formal training in conducting such examinations.

The complaint led to his immediate suspension from the medical practice and a subsequent GPhC investigation.

Findings:

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

1. Failure to Obtain Informed Consent:
   • Patient A was not given sufficient information to understand the nature of the examination.
   • The committee noted:“The registrant’s failure to explain the procedure left the patient unable to provide informed consent, violating fundamental principles of patient-centred care.”
2. Performing an Unjustified Medical Examination:
   • The pharmacist had no clinical reason to perform an internal examination.
   • A GP later confirmed that an abdominal scan—not a vaginal examination—would have been the appropriate investigation.
   • The committee ruled:“The examination was not clinically necessary and fell outside the pharmacist’s scope of practice.”
3. Lack of Competence and Training:
   • The pharmacist admitted that his only knowledge of vaginal examinations came from reading and watching online training videos.
   • He had never received formal training or practical experience.
   • The committee determined:“A pharmacist independent prescriber must not exceed their professional boundaries. This examination was beyond the registrant’s competency.”
4. Failure to Maintain Proper Records:
   • The pharmacist did not document that the examination took place.
   • The lack of record-keeping suggested poor professional judgment and a failure to follow best practice.
5. Breach of Professional Boundaries:
   • The committee emphasised that while the examination was not sexually motivated, it was completely inappropriate given the circumstances.
   • The lack of patient privacy, failure to offer a chaperone, and absence of justification were all serious concerns.

GPhC Determination on Impairment:

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

• Failure to uphold fundamental standards of patient care.
• A serious breach of professional boundaries.
• Potential damage to public confidence in the pharmacy profession.

The committee stated:

“Patients have the right to expect that any medical examination is clinically justified, competently performed, and carried out with full consent. The registrant’s actions fell significantly below those expectations.”

However, the committee acknowledged that:

• The pharmacist admitted his mistakes and expressed genuine remorse.
• He ceased working as a clinical pharmacist and committed to avoiding such examinations in the future.
• He had taken continuing professional development (CPD) courses to improve his record-keeping and understanding of patient consent.

Given these factors, the committee found that:

“The registrant’s risk of repeating this behaviour is low, but a regulatory sanction is necessary to uphold public confidence in pharmacy.”

Sanction:

The committee imposed a six-month suspension, considering:

• Aggravating Factors:
  • A serious breach of patient trust and dignity.
  • A lack of training or competency in performing the procedure.
  • Failure to obtain proper consent or provide patient privacy.
• Mitigating Factors:
  • The pharmacist admitted his mistakes and showed remorse.
  • He had no prior fitness to practise concerns in over 13 years.
  • He took steps to ensure this would not happen again, including leaving clinical practice.

The committee ruled that:

“A six-month suspension is necessary to reflect the seriousness of the misconduct while allowing the registrant to return to practice after demonstrating insight.”

A review hearing was not required, as the committee was satisfied that the pharmacist understood his obligations and was unlikely to repeat his misconduct.

Key Learning Points for Pharmacy Professionals:

This case highlights critical lessons regarding professional boundaries, informed consent, and the scope of pharmacy practice.

1. Pharmacists Must Not Perform Procedures Beyond Their Training and Competency:
   • Performing medical examinations requires appropriate qualifications and experience.
   • Independent prescribers must recognise the limits of their expertise and refer patients when necessary.
2. Informed Consent Is Essential for Any Medical Examination:
   • Patients must understand what an examination involves before consenting.
   • Failure to properly explain a procedure undermines trust and violates professional ethics.
3. Maintaining Patient Dignity and Privacy Is Fundamental:
   • Chaperones should always be offered for intimate examinations.
   • Patients must be given privacy to undress and cover themselves appropriately.
4. Record-Keeping Is a Key Professional Responsibility:
   • All consultations must be accurately documented, particularly those involving medical examinations.
   • Failure to keep proper records can raise serious fitness to practise concerns.

Conclusion:

This case serves as a strong reminder that pharmacists must understand their professional boundaries and responsibilities.

While the pharmacist avoided removal from the register, his six-month suspension reinforces the importance of informed consent, patient dignity, and ensuring all clinical actions are within professional competence.

Pharmacists must always act in the best interests of patient safety, maintain professional integrity, and respect the limits of their expertise.