PHARMACIST STEVE

Fear is a two way street… you fear losing your job and the means of paying your bills and your corporate employer fears having their reputation damaged and losing profits. All the people in your corporation above you.. has fear of the ultimate boss “the stock market”. Fear and paranoia is rampant within the corporation… from the very bottom to the very top.
Those above you -particularly those who are not Pharmacists – may take the stance of anything that does not disrupt the status quo is permissible.

You need to read and reread your pharmacy practice act and the company’s policy and procedure manual (P&P).

The practice act will tell you EXACTLY what you are legally required to do to maintain your license
The P&P will tell you EXACTLY what the company expects of you.. and one of those things is to not break any rules/laws/regulations.
If a Rx gets mis-filled under your watch.. you have broken the company’s P&P and depending on how bad the outcome is.. will depend how much space the company tries to put between them and you.. and try to dis-a-vow any responsibility for causing the error.

Most people consider errors a problem that has a underlying system problem. We all know, that Pharmacists have little/no say in how the system develops, evolves or functions… thus Pharmacists may be more a victim of a med error than a cause.

The Pharmacist in charge or the “Qualifying Pharmacist” is the person the state BOP will hold responsible for any problems.. don’t believe so.. read your practice act. If you work for a corporation… the corporation is NOT A PHARMACIST… they legally cannot be charge with “unprofessional conduct” there is NOTHING professional about a corporation… It doesn’t hold a pharmacy degree, it does not hold a Pharmacist’s license.. without a licensed Pharmacists willing to accept the the legal responsibility of the Rx dept’s operation and other Pharmacists working along with him/her… the permit holder has no right to unlock the door on the rx dept, has no right to stock any legend drugs or controlled substances, nor the right to bill for any pharmacy/Pharmacist services… the PHARMACY LICENSE becomes WORTHLESS.

Expressing concerns to management is just that… you express concerns about something that concerns you that may lead to med errors and patient harm, harm the corp’s reputation, profits or those issues that are not in the corp’s best interest.

If you are a staff Pharmacist, that may mean that you need to express your concerns to the PIC.. and those concerns needs to be expressed in writing.
Never have a one on one conversation about concerns with management that is not followed up with a email.
Context of the email… should follow a following format:

As a follow up to our conversation on MM/DD/YYYY concerning ………………………………………. my understanding of that conversation was …………………………… and that you will take up my concern with …………………….
Unless I hear from you otherwise, I will presume that my understanding of this conversation is correct.
Send the email – read receipt – and send a copy to your home computer, print it out and take it home, or save it on a flash drive.
THIS IS VERY IMPORTANT.. the last thing that you want is for something to go wrong on your watch.. that you had expressed concerns about and those involved in those conversations… to defend the company’s position develops amnesia, or comes up with such statements as “that is not as I remember the conversation…”, “That is not what I said…”, “… there must have been some misunderstanding or miscommunication..”
If you can’t produce other documentation.. it is your word against theirs.
Just think about it.. when the company is doing something that is to protect itself… job review… reprimand … there is a piece of paper involved and your signature. Conversely, when they don’t want any paper trail or have to admit to what they have told you to do/say that is in a gray area of the law or P&P… there is not going to be any documentation.

Give it 30-60 days, if the person you have expressed your concerns to.. has let the subject drop.. then it is time to take your concern “up the ladder”. Once you start your concern up the ladder, you should CC Human resources or CCO (Chief Compliance Officer). It is their sole job to make sure that the company follows all rules/regulations & its own P&P.

If you don’t include HR/CCO in your expression of concerns.. particularly when P&P and laws are concerned… you run the risk of corporate management keeping HR/CCO out of the discussion… so that HR/CCO will have the defense that “.. we were not aware of the issue that this employee had.. if we were aware of this… we would have taken corrective action…”

It may take 6-12 months to elevate a “concern” to a “complaint”.. generally a concern will only become a complaint when you are forced to take it outside of the corporate infrastructure. Do not be afraid to send your concerns all the way to the corp President or Chairman.

If you have been with the corp for any time, you probably have numerous concerns, start addressing these one at a time… you don’t want to lump them all together, which could cause one or more to get missed – or intentionally ignored- giving the corp an excuse as to why it was not addressed. As soon as one concern is moved up the ladder… start the cycle with a new concern.

At this point, you should have accumulated a “stack” of emails expressing your concerns throughout the corp infrastructure.

At this point, you have the options of sitting on those emails – to be brought out when something goes wrong to defend yourself and prevent the corp from shifting all the blame to you for what went wrong… you will have substantial ammunition to give to your attorney, the media or both.

The other option is to take your concerns and raised them to the level of complaint to the pharmacy board, your attorney or both.. the last thing that you want to do is have to defend your license and reputation that was caused by something the corp did or did not do.

As as final note.. look at your state practice act and pharmacy laws.. to get a Pharmacist license and keep a license requires some pretty high standards of ethics and morals. Because our laws were written – and never amended – when the PIC and the owner were generally one and the same.. there are few/no states that have any moral/ethics standards for permit holders.. and the corporation are taking full advantage of this antiquated set of laws. Just look at the minutes of the typical pharmacy board meetings and actions… the fines and letters of reprimand are few and far between to permit holders.

If you don’t protect your license, reputation and just do along with whatever the corp wants you to do… when it hits the fan.. the corp will just step aside and let you “take the hit”… you are just one person to them… mostly expendable … they have their own job to worry about and the reputation of the corporation… to them.. nothing is more important to them than that…

Filed under: Mistakes/Errors