“I believe I am a danger to the public working for CVS.”

http://pharmacistactivist.com/2019/May_2019.shtml

Background

I have been a pharmacist long enough to remember the time when CVS was first started. Its leadership demonstrated a strong commitment to the professional role of pharmacists and their communication with patients. Television advertisements featured pharmacists counseling patients. I encouraged my students who were interested in a position in a chain pharmacy to seek an opportunity with CVS.

Very unfortunately, for both pharmacists and consumers, things have radically changed. Yes, smiling pharmacists are still featured in CVS advertisements. However, the reality of the employment experience of many CVS pharmacists has markedly deteriorated, even to the point of being dangerous.

The anonymous pharmacist (AP) who made the comment that is the title of this editorial is not one of my former students, but is known to me as an individual who is very caring and has the courage to communicate concerns. When AP learned that the Board of Pharmacy was holding a meeting at which pharmacy policies and working conditions would be discussed, AP submitted a letter. AP’s letter had to be submitted anonymously because, as AP stated in a separate message to me, “I know I would be terminated immediately for speaking against my employer.” The letter AP sent to the Board of Pharmacy includes the following statements:

This pharmacist must remain anonymous because, as difficult as AP’s working conditions are, AP must keep the position with CVS as there are not other employment opportunities for pharmacists available in that geographical area, a situation that now exists in many parts of the country. I am not in a position to judge, and do not fault any pharmacist for her or his decision regarding employment. However, when circumstances arise which place patients at risk, pharmacists must have the courage demonstrated by this pharmacist in making concerns known, even when it must be done anonymously. I was motivated by AP’s action and I have also written a letter to that Board of Pharmacy.

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April 29, 2019

To the Members of the _________ State Board of Pharmacy:

It is my understanding that you will be discussing policies and working conditions in pharmacies, and I wish to share my concerns that are based on information communicated to me by pharmacists who are employed in chain pharmacies. I am a pharmacist, and recently retired after 52 years as a member of the faculty at the Philadelphia College of Pharmacy at the University of the Sciences. I continue to write a monthly newsletter, The Pharmacist Activist (www.pharmacistactivist.com) in which I provide editorials and reviews of new drugs. Many of my editorials address concerns regarding patient safety in the use of medications, and the working conditions of pharmacists and pharmacy technicians.

I have received hundreds of responses to my editorials from pharmacists with whom I speak at meetings of pharmacy organizations, and via email and telephone communications. In addition, I have served as an expert witness in a number of lawsuits in which patients have been harmed because of dispensing errors or other medication-related problems. By far, the largest number of concerns of which I have been made aware are communicated to me by pharmacists working at CVS stores. The most common concerns that are provided include the following:

1. Concerns about patient safety and errors that are attributable, at least in part, to management-imposed policies, quotas, and working conditions.
2. Understaffing of pharmacists and pharmacy technicians that results in a stressful and error-prone workplace environment.
3. Policies and metrics that emphasize numbers (e.g., prescriptions, immunizations) and how quickly responsibilities can be completed (e.g., time to dispense a prescription).
4. Insufficient time to speak with patients about medications dispensed.
5. Policies and procedures with respect to how dispensing errors are to be handled.
6. Inadequate compensation for pharmacy technicians that results in frequent turnover and extra time required to train new technicians. As one example, a pharmacy manager informed me that when a Wendys restaurant opened nearby, five of the technicians left to work at Wendys because of its higher hourly wage.
7. No or insufficient authority to fire technicians who make frequent mistakes or who otherwise perform inadequately.
8. Having supervisors who are not pharmacists, that is occurring with increasing frequency.
9. Work schedules (e.g., 12- and 14-hour days with no or limited breaks; difficulty in scheduling days off/vacation time) that contribute to stress and errors. I often hear comments such as, “When I finish a long shift at the pharmacy, I am so tired that the specific activities of the day are a blur, and I only pray that there were no serious errors.”
10. Having to designate customers to receive automatic refills when they do not request it or even decline it.
11. Having to work “off the clock” without pay to complete activities the company expects to be done within defined time periods.
12. Fear of termination or retaliation if concerns are voiced. An increasingly frequent response from a supervisor is the following: “If you don’t like the way things are done here, I have five applications from pharmacists who would love to have your job, and maybe you should consider another opportunity.” Forms of retaliation have included assignment to another pharmacy with the chain that is a farther distance from the pharmacist’s home, or assignment to be a “floater” among several pharmacies on an unpredictable schedule. One chain pharmacist has told me that if a concern was voiced about working conditions at a meeting of the Board of Pharmacy, the pharmacist would be terminated before leaving the room.

I have written in greater depth regarding some of these concerns in many of my editorials. I would be glad to provide copies if it would be helpful.

There is information that chain pharmacies would have available that would be of value in your consideration of these matters. This information includes:

• the criteria for determination of the number of pharmacist hours and pharmacy technician hours for a pharmacy;
• the metrics that are used in the procedures for processing and dispensing prescriptions;
• the time within which a prescription is expected to be dispensed following receipt (including warnings/signals about the amount of time elapsed);
• procedures in which pharmacists at remote sites are involved in the review and processing of prescriptions;
• bonuses that are based on the number of prescriptions completed, and;
• records of dispensing and other errors, as well as resultant reports (e.g., to the Board of Pharmacy) and actions taken.

If I can be of assistance, please feel free to contact me.

Sincerely,
Daniel A. Hussar
Author/editor of The Pharmacist Activist

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More action needed

I have intentionally not identified the state in which this pharmacist practices or the specific board of pharmacy because I believe that the situations and concerns are of the greatest importance and exist in every state. If the concerns identified are ones you have experienced or otherwise share, I encourage you to communicate them to your State Board of Pharmacy or other appropriate authorities. If it will help, provide a copy of this issue of The Pharmacist Activist in support of your concerns. If you wish to do so, please use all or part of the above information verbatim as your own message – it is not necessary to identify me or the anonymous pharmacist as the source, and this statement provides permission to do that.

If you have had personal experiences or are otherwise aware of situations that are pertinent with respect to the matters addressed, I am interested in learning about them, as well as actions you are taking.

Filed under: General Problems