Case Study 11

Pharmacist - disclosure of sensitive prescription information - notifiable diseases and public health interests - issue of consent

A pharmacist contacted my Office seeking advice in relation to correspondence he had received from the Director of Public Health, Eastern Health Authority regarding a proposed scheme for pharmacists to assist in the surveillance of Tuberculosis. Pharmacists were asked to submit a form which detailed personal information of patients using anti-tuberculosis therapy prescriptions. The pharmacist was concerned that while the objectives of the proposal were well intentioned, he should not disclose sensitive information he held in trust without patient consent.

I contacted the Director of Public Health to establish whether this personal information had been fairly obtained as required under section 2 of the Data Protection Act. The Director of Public Health explained that one of his functions in relation to his duties as Medical Officer of Health relates to the surveillance and control of infectious diseases. Tuberculosis is a notifiable disease. There was significant public health concerns in relation to tuberculosis and the Department of Health, therefore, had instructed Directors of Public Health to seek such information from pharmacies.

Having considered this response I contacted the Secretary General of the Department of Health and Children. I drew his attention to sections 11 and 14 of the Infectious Diseases Regulations 1981(the statutory basis for reporting notifiable diseases) which provide that the responsibility to notify the Health Authority of an infectious disease falls on a doctor, not on a pharmacist. I assured him that I understand the importance from a public health perspective of having a reliable tuberculosis reporting system in place but, as Commissioner, I must ensure that such a reporting system respects the provisions of data protection law. I questioned why it was necessary to require pharmacists to notify Health Authorities of prescriptions - only doctors can issue a prescription and they have a statutory obligation to report an incidence of a notifiable disease. I pointed out that such reporting by a doctor is covered by section 8(e) of the Data Protection Act, 1988 which lifts the restriction on disclosure if it is "required by or under any enactment or by a rule of law or order of a court". However, there was no statutory basis for reporting by pharmacists of notifiable diseases.

The Department of Health and Children informed me that reporting by pharmacists was introduced following a report of a Working Party on Tuberculosis in 1996 so as to enhance the tuberculosis surveillance system and ensure that appropriate contact tracing could be achieved. The Department, having considered the issues raised by me, decided that the reporting of this information by pharmacists should cease and wrote to each Director of Public Health informing them of the situation and advising them to notify all pharmacists in their functional area.

I was pleased that the Department took appropriate steps to address the issues involved in this case. "Fair obtaining" and fairness and transparency require that personal details obtained for prescription purposes cannot be subsequently used for other purposes without express consent or , if there is a real public health need, a clear statutory basis.