AUTH/2366/10/10 - Ex-employee v Lilly

Conduct of representatives and meeting arrangements

  • Received
    21 October 2010
  • Case number
    AUTH/2366/10/10
  • Applicable Code year
    2008
  • Completed
    08 April 2011
  • Breach Clause(s)
    2, 9.1 (x2), 15.2 (x2) and 19.1
  • Sanctions applied
    Undertaking received
  • Additional sanctions
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  • Appeal
    Appeal by complainant
  • Review
    May 2011

Case Summary

An ex-employee of Lilly complained about the conduct of representatives and the arrangements for various meetings in 2008 and 2009.

The detailed response from Lilly is given below.

The complainant noted that an endocrinologist from the US toured a Lilly sales manager's region and presented to diabetologists. The complainant alleged that the sales manager instructed representatives to encourage the doctor to speak about the off-licence use of Byetta in combination with glitazones.

The Panel noted that the slide set used by the doctor contained a slide which read 'Approved Clinical Uses of Byetta'. The second bullet point stated 'Byetta is not approved with glitazone drugs or insulin'. The Panel considered that it was confusing to state, under a heading of 'Approved Clinical Uses' what Byetta was not approved for. The Panel considered that it would have been preferable if the doctor had been given written guidance on how to respond to unsolicited questions about the unlicensed use of Byetta. Nonetheless, the Panel considered that there was no evidence to suggest that representatives had encouraged the doctor to speak about the offlicence use of Byetta in combination with glitazones as alleged. No breaches of the 2006 Code were ruled including Clause 2.

The complainant stated that the same sales manager instructed a representative to contact two diabetes specialist nurses (DSNs). The meeting, in 2008, was at a restaurant and attended by the sales manager, two representatives and the two nurses. The sales manager did not discuss business and made no presentation. The matter was investigated internally and Lilly decided that there was no case to answer.

The Panel noted that for any meeting, held by a pharmaceutical company and attended by health professionals, certain basic principles must apply including, inter alia, the meeting must have a clear educational content and the subsistence provided must be secondary to the nature of the meeting, must be appropriate and not out of proportion to the occasion.

The Panel noted that the meeting at the restaurant had two items for discussion on the agenda. No written agenda had been provided. Five people attended the meeting – three from Lilly and two local DSNs. One of the representatives recorded that the meeting had lasted four hours. The Panel queried the length of the meeting vs the content of the agenda and considered that with regard tobalance the meal was out of proportion to the occasion. The Panel was also concerned that the meeting took place in a part of the restaurant open to the public.

The receipt for the meal showed that the bill was paid at 11pm. The cost of the meal, including beverages, was £192 ie £38.40 person. The Panel noted with concern that in Lilly's initial response it had referred to a fixed price menu of between £10.90 and £22 per head. The actual cost was greatly in excess of that and was only provided to the Panel following a request for further information. The Panel considered that this was unacceptable; self regulation relied upon a full and frank disclosure of the facts.

The Panel queried whether the £38.40 per person exceeded that which the two nurses would have paid if they had paid for the meal themselves. The Panel further noted that the bill showed that the group had consumed seven pints of beer, two gins, two whiskies, seven whisky liqueurs and three large glasses of red wine. In the Panel's view this amount of alcohol was excessive and inconsistent with the aims of a business meeting.

The restaurant bill and two taxi fares (assumed to be for the nurses) had been submitted on the expenses of one of the representatives under the heading of 'Group Sells'. The expense account for the evening had been approved by the manager who had been at the meeting. In the Panel's view this was unacceptable; the meeting expenses should have been submitted by the most senior person present ie the manager, for approval by his manager.

The Panel considered that overall, the hospitality provided had been excessive and in that regard it ruled a breach of the Code. The Panel further considered that the manager had not maintained a high standard of ethical conduct. Breaches of the Code were ruled.

The Panel considered that the overall arrangements for the meeting were such as to bring discredit upon the industry. A breach of Clause 2 was ruled.

The complainant stated that in 2009 a Lilly representative left food at a general hospital diabetes department without any educational presentation. The representative spoke to one nurse and asked her to let the others know that she would put them down for a meeting that day if they should be asked.

The Panel noted that the representative had arrived at the hospital with sufficient food for her pre-planned meeting. The meeting was a group sell event and the cost of the food was approximately £11 per head. Four nurses had previously confirmed their attendance but on the day only one turned up. The Panel noted that the representative had stayed as long as possible, waiting for the other three nurses to arrive. The Panel further noted Lilly's submission that during that time the representative had a product discussion with the one nurse using approved sales material. Eventually the representative had left, leaving the remainder of the food for the nurses who had not turned up.

The Panel considered that the circumstances were unfortunate but the fact that one nurse turned up supported the fact that a meeting had been planned. It also appeared that the representative and the one nurse discussed a product as planned, ate some of the food and the remainder was left for the other three.

The Panel considered that, although within the Lilly guidelines, the cost of the hospitality for a lunchtime meeting was on the outer limits of acceptability. Nonetheless the Panel considered that the arrangements were not unacceptable. It was unfortunate that only one of the intended audience had turned up. Nonetheless a product was discussed with that one nurse. The Panel considered that the representative had maintained a high standard of ethical conduct. Only the remainder of the food had been left. No breaches of the Code were ruled including Clause 2.

Upon appeal by the complainant the Appeal Board noted Lilly's submissions that in advance of the pre-planned meeting, the sales representative had entered the names of the four nurses who she had expected to attend, into the customer relations management (CRM) system. On the day of the meeting, the representative had arrived with sufficient food for the meeting. Of the four nurses expected, one turned up. Whilst waiting as long as possible for the others to arrive, and before she had to leave for another meeting, the representative had discussed a product with the one nurse using approved sales material.

The Appeal Board was very concerned to note that it was revealed in Lilly's response to the appeal, that before leaving the meeting, the representative had asked the one nurse that attended whether it would be acceptable for her to include the other nurses' names on the CRM system as attendees, as a way to justify the food expenditure to Lilly.

The Appeal Board noted that the complainant had submitted that the senior DSN had contacted him after the meeting because she was furious about the representative's conduct and because the DSN who had attended the meeting was new and inexperienced. The complainant further alleged that there had been no product discussion at the meeting.

Lilly had submitted that in subsequent email correspondence between the sales representativeand the senior DSN, the senior DSN had accepted the representative's apology. Nonetheless, the Appeal Board noted that the names of the three nurses (including the senior DSN) that had not attended the meeting had remained on the CRM system.

The Appeal Board was concerned to note from Lilly's representative at the appeal that, in the course of the representative's disciplinary procedure, further details about the meeting had emerged including that the senior DSN had been at least upset, if not furious as alleged by the complainant. This was in contrast to Lilly's statement in response to the appeal that the nature of the senior DSN's reaction was new information, not previously available to Lilly. It appeared that some people in Lilly knew that the senior DSN had been at the least upset before the Panel had made its ruling in this case, but the information had not been given to those within the company dealing with the complaint. The Appeal Board was concerned that lack of communication within Lilly meant that it had not provided more complete information to the Panel; self regulation relied on full and frank disclosure. The Appeal Board asked that Lilly be advised of its concerns in this regard.

The Appeal Board noted that both parties agreed that the senior DSN had been upset, albeit to a greater or lesser extent, by the representative's conduct. The Appeal Board considered that the representative's actions in asking the one nurse who had attended to collude with her in recording the attendance of the three other nurses in order to justify the expenditure on the food was entirely inappropriate. The Appeal Board considered that the representative had failed to maintain a high standard of ethical conduct and a breach of the Code was ruled. The appeal on this point was successful.

The Appeal Board was concerned that the senior DSN had been upset by the representative. The Appeal Board ruled that high standards had not been maintained in a breach of the Code. The appeal on this point was successful.

The Appeal Board noted that the complainant and Lilly differed as to whether a product discussion had taken place between the representative and the nurse. There was insufficient evidence to support either party and thus the Appeal Board considered that the complainant had not proved this part of his complaint on the balance of probabilities. The Appeal Board considered that, although within the Lilly guidelines, the cost of the hospitality for a lunchtime meeting was on the outer limits of acceptability. Further, the Appeal Board considered that the food had been purchased on the basis of the reasonable expectation that four nurses would attend. The representative had not been informed beforehand that three of the nurses would not attend. This was most unfortunate and left the representative to decide what to do with the excess food; on the particular facts of this case, including the relatively small amount involved, theAppeal Board decided that the arrangements were not unacceptable. The Appeal Board upheld the Panel's ruling of no breach of the Code. The appeal on this point was unsuccessful.

The Appeal Board noted its rulings above, however it considered that the circumstances did not warrant a ruling of a breach of Clause 2. The Appeal Board upheld the Panel's ruling of no breach of Clause 2. The appeal on this point was unsuccessful.