Patient Counseling and Prescription Transfer: Language Barrier and HIPAA
A patient with limited English proficiency presents a prescription for warfarin 5 mg at a pharmacy in Anchorage. The prescription is from a clinic that serves many non-English speakers. The pharmacist speaks only English. The patient has a friend with them who offers to interpret. The pharmacist is busy and decides to skip counseling because of the language barrier, thinking the friend can explain. The prescription is a transfer from another pharmacy, and the pharmacist must also complete the transfer. The patient's INR is stable, but the dose was recently changed from 2.5 mg to 5 mg. The pharmacist dispenses the medication without counseling and tells the friend to explain the new dose. The friend does not mention the dose change. The patient later takes the old dose and has an adverse event.
1. Did the pharmacist meet the patient counseling requirements under Alaska law? What are the consequences of failing to counsel?
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Alaska law (12 AAC 52.240) requires a pharmacist to offer counseling to each patient receiving a prescription. The counseling must be provided in a manner the patient can understand. If the patient has limited English proficiency, the pharmacist must use an interpreter or other means to ensure effective communication. The pharmacist cannot delegate counseling to a friend without ensuring the information is accurately conveyed. Skipping counseling because of a language barrier is a violation. The pharmacist should have used a qualified interpreter, perhaps through a language line, or ensured the friend interpreted accurately. The failure to counsel, especially with a dose change, contributed to an adverse event. The board may take disciplinary action for unprofessional conduct, including failure to counsel. The pharmacist could face a reprimand, fine, or suspension. The pharmacy may also be liable for negligence.
2. What are the requirements for transferring a prescription between pharmacies in Alaska, and did the pharmacist handle the transfer correctly?
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Under Alaska law (12 AAC 52.240), a prescription may be transferred between pharmacies if certain conditions are met: the transfer must be communicated between pharmacists, the transferring pharmacist must record the transfer, and the receiving pharmacist must obtain all necessary information. For controlled substances, additional rules apply. Here, the prescription is for warfarin, a non-controlled drug, so transfer is allowed. The pharmacist must ensure the transfer is documented, including the name of the transferring pharmacist, the pharmacy, and the date. The pharmacist must also verify the prescription's validity. The pharmacist in this case did complete the transfer but failed to counsel on the dose change. The transfer itself may have been handled correctly if documentation was done, but the failure to counsel is a separate issue. The pharmacist should have reviewed the prescription, noted the dose change, and counseled the patient appropriately.