“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
President Reagan’s words back abt 40 yrs ago … seems now to apply to many and many more industries and not just to our government. Our our insurance industry – and not just health – are more than willing to take your money and then use “vague terms” within the policy not to pay a claim. Our Florida condo got hit by Hurricane Michael (Cat-5) .. only the 3rd-4th time a Cat-5 had come ashore in the USA… I did not pay for wind or flood insurance because our unit is on the top floor and I put 150 MPH windows which was covered by 120 MPH metal hurricane shutters. But Michael took part – abt 20%- of the roof off of the complex – of course the roof was blown off over the top of our unit.
The ceiling our our condo is a concrete slab and was built in 1984 and no one had bothered to seal the penetrations and conduit runs… so water ran into our unit.. and we had a few inches of water in our unit because the water just kept running on down to the units below us, but all the flooring, all the baseboards, all the drywall from the floor and up 4′.. had to be replaced. Our insurance told us that the water in our unit was INDIRECTLY WIND DRIVEN – NO COVERAGE… I though OK… the Association was responsible for the roof… but the FL legislatures in 2009 passed a law that no association nor their insurance was responsible for any damage to a owner’s unit cause by failure of the common property – like the roof !
Being a pharmacist, I was always under the impression that the FDA was over the safety & purity of medications in our system. Well my faith in that federal agency has been totally shattered. I got one of Barb’s long acting pain meds filled in FL and for the first time she got some made by Rhodes Pharma (Purdue pharma company). When she started talking them she claimed that she was not getting an relief from them – the technical term is lacks efficacy – She had been taking this particular med for years and this is the first time this had happened… This med is a “12 hr dose – long acting med – and 2-3 hr after taking a dose – NOTHING… so thinking that it could be a solubility issue … so I instructed her to cut a tablet in HALF and take both halves. Another 2-3 hrs passed and NOTHING…. so I instructed her to CRUSH a tablet and take it… 2-3 hrs later NOTHING..
I have had other pts tell me that their medications – different opiate – from Rhodes pharma – DID NOT WORK…
I reached out to Rhodes Pharma, figured that they would want to analyze these tablets… at first the person I talked to was a little hesitate to have them analyzed but I asked the question that the Rhodes had no concern that this would suggest that raw opiate material may be being diverted at their manufacturing facility.
Reluctantly he agreed to pick up the tablets…. and having waited a month since they were returned, I reached out to Rhodes pharma to get the results of the analysis. I had to leave a voice mail for 5-6 days in a row before anyone would return my call. I asked when I was going to get a copy of the analysis of those tablets and was told – somewhat in a matter of fact tone that they were not going to analyze those tablets and that they were standing behind the analysis reports at the time of being manufactured.
So the fact that Barb took THREE TIMES HER NORMAL DOSE within 6-9 hrs without any noticeable efficacy was of little concern to them.
So not to be deterred, I reached out to Division of Pharmaceutical Quality Operations III Office of Regulatory Affairs U.S. Food and Drug Administration Office: 313-393-8189 and talk to a representative and this office handles only Michigan & Indiana. Sent the representative all the information that I had concerning this particular med… got a couple of emails from the representative but now a week or so later … can’t get a voice mail return call nor a response to a email.
Have you ever seen a picture or demonstration of a room that has a large family of roaches residing and when you turn the lights on…. they all scatter back into the hiding places ? That is the mental picture that I am getting on this particular issue.
I have read stories about pharma manufacturing plants overseas where various mandated documentation involving the production of medications have been proved to be falsified/fabricated and no actual reality as to what was really done.
Is it just an illusion that those working for the Feds and in turn for US… really don’t give a crap about the actual duties of their job ?
I have already advised our PCP of this issue – who had been prescribing this to her for years – and I hope that he will share with the 5 other prescribers in his practice. I would recommend to any pt that is being prescribed Rhodes Pharma products to request a product provided by one manufactured by a different pharma.
Hello, my name is Alexandria and I am a pharmacy technician of 8 years from Alabama. I must admit to you that this letter, this speech, was not easy to write down. I started and stopped more than once, and gave up hope that I could make a difference more times than I can count.
I believe the best way to start, would be to tell you my personal story.
In 2012 I was hired at CVS pharmacy, as a technician. In my state (at the time) the requirements were simply for the applicant to be a high school graduate, and over the age of 17 in order to be licensed in the state to work in the pharmacy. My mother and sister are pharmacists, so my first job being in a pharmacy simply made sense. Within a year I quickly realized that the field of pharmacy was not for the faint at heart. Within 18 months of being hired at CVS, I studied and sat for my national certification exam, and passed. Thus becoming a nationally certified pharmacy technician. I was extremely proud of this certification, but also came to realize that in my state, this certification meant very little. Though some employers do pay more for a nationally certified tech. In 2014 my career took a turn for the worst. I was living alone at the age of 19, and was working part time. It was at this point that it became mandatory for full time benefits to be offered to all full time employees, that is, employees working over 32 hours a week. Instead of CVS offering insurance and benefits to the employees that had been working these hours, they simply did something cruel. They sent out a statement saying anyone listed in the system as “part time” was not allowed to work over 29 hours a week, so they didnt have to offer them health insurance or benefits. This became the start of my downfall. Full time positions were hoarded, and the amount of shifts available for technicians to work became very slim. There was one particular week in January of 2014 where I was only scheduled to work one single, five hour, shift. FIVE. I quickly went from paying my bills, to living in absolute poverty. My car was repossessed, I was unable to keep my lights on consistently, and I was having to go to food banks to keep food in my pantry. I searched and searched for a full time pharmacy tech position, which landed me driving to a store an hour away, making less than $11 an hour, simply to keep my lights on and to have health insurance. Living this way took a toll on me mentally. I was placed in a psychiatric unit in April of 2014 at my own request, due to overwhelming depression and suicidal thoughts. My attempts were in vein however, and in September of 2014 I attempted to take my own life. As I was still in my mandatory wait period before my full time benefits at CVS went into effect, I immediately returned to work. I attempted suicide on a sunday, and was back working the following wednesday. I had no short term disability available to me, or even paid vacation, and I couldnt take off work. I had to pay my bills.
Lets fast forward to January of 2015. Things took a turn for the better. I found a CVS closer to my house, in need of a full time technician. I was able to transfer to this store, where I met some of the most influential people present in my life. The troubles at CVS were just beginning though. You see, each store is allotted an amount of hours they are allowed to schedule technicians to work. For example, every 11 scripts filled was equal to 1 hour a technician was allowed to work. So in a store doing about 500 scripts a day, 3500 scripts a week, they were allotted 318 hours to divide among their technicians to work per week. If this amount of hours was exceeded, consequences were severe. No overtime was allowed, period. This amount of technician hours began to dwindle, though the amount of business did not. The amount of stress the whole staff was under was extraordinary! As one who had just overcome a mental health crisis, this was not a healing environment, in fact it was harmful. I was given more and more responsibility the longer I was there, for the same amount of pay. In october of 2017 my sanity eventually left me, I began having intrusive thoughts of self harm, thoughts of suicide, and I decided it was time for my career at cvs to end.
There are a few points I would like to make regarding this part of my life. The first being the manager I had at my final CVS store was amazing, and is still a close friend of mine to this day. The pharmacists are held under such suffocating standards, where speed, and volume are valued over accuracy. Pharmacists are measured on EVERYTHING, how many scripts did you fill per hour? How many flu shots did you give? How many patients agreed to get their medications refilled?
I have watched pharmacist after pharmacist question their career choice. They all went to school to learn to heal the sick, not to become a victim of overwhelming corporate standards.
The second point being,patients are being harmed by these standards.
I once witnessed a pharmacist accidentally fill the restless leg medication “Requip” instead of the mood stabilizer “Risperdal” for an autistic child, a misfill that had potential to do honest harm to the patient had the error not been caught by their guardian. Simply because the time needed to thoroughly verify a prescription filled for a patient, is not available.
The third and final point is, the employees are being driven to the point of absolute mental exhaustion. The pharmacists are paid well, but at a cost to their well being if they cant keep up with the corporate standards. The techs, however, are the real victims here. Pharmacy techs are notoriously under paid and under appreciated. We, as a whole, are expected to do as much as we can, for as little amount of pay as possible. Most of my coworkers at cvs lived in government subsidized housing, and required government assistance to be able to feed their families. In my particular case, not being married and having no children, I was simply, poor. I had a roof over my head, clothes on my back, lights and water. But I couldnt afford to buy a decent amount of groceries, nor could I afford a car payment.
I then left CVS for Walgreens, who offered better pay. Though I quickly came to realize that, though the pay was better, the expectations were very much the same. The pharmacists are crushed to death, and the technicians get absolutely no recognition.
This brings me to present day,
I accepted a position at an independent compounding lab, which is an extremely different environment. The employees are treated more as equals, though still not paid, in my opinion, our worth.
I approached the owner of the business I work for, expressing my thoughts at a recent New York Times article published about the dangers of large chain retail pharmacies. I expressed interest in wanting to make a difference for pharmacy techs, wanting to bring light to how we suffer. My boss, bless his soul, stone walled my interests by simply saying “ If you want to make a difference, go to pharmacy school.”
All due respect to the owner of the business I work for, not having “PharmD” at the end of my name, does not make me less entitled to a job with safety, reliability, and mental stability.
Which brings me to why I am here with you. In light of the recent COVID-19 crisis, it has been brought to light just how under appreciated pharmacy staff, techs in particular, are. Many business offered free services to health care workers, and many pharmacists and technicians were denied these services, being told they were not essential healthcare workers.
I have several goals in sharing this information with you.
The first being, pharmacy technicians are the backbone of every pharmacy you can find. There is no pharmacy in this country that does not have at least one technician running the show behind the scenes. This being said, we are entitled to more rights and duties. Technicians in my state are not allowed to give injections, are not allowed to take verbal orders from doctors, nor are allowed to transfer prescriptions from another pharmacy. CVS takes this to an extreme, technicians are not allowed to do even the most mundane of technician duties and are all but banned from doing anything other than running a cash register, and counting pills. The national certification exam is an excellent qualifying exam in showing proof of a technicians abilities to follow procedure and law. There is absolutely no reason why techs should not be allowed to do the aforementioned duties. Pharmacists are extremely overwhelmed as it is, and allowing their techs to assist them more thoroughly would be an excellent benefit for every pharmacies efficiency, and patients safety.
My second goal being, pharmacy technicians deserve better pay than what we are given. I was started at CVS in 2012 at $9 an hour. When I left in 2018, holding the second highest position a tech can have and being nationally certified, I was at $12.18 an hour. Walgreens started me at much higher, $14 an hour, but the ability to get raises was not offered except in very rare situations, and there were some of my coworkers who had gone almost three years without getting a raise. There is no base line pay for pharmacy technicians, nor is our value acknowledged. There is no one fighting for the right for techs to have more pay, nor do most pharmacists acknowledge that their staff deserves better pay, and appropriate recognition.
My third and final goal is, mental health should be considered as important as physical health in this field. Mental health days should be given just like sick days, in fact, should be mandatory for each employee to take. I was suffocated at CVS, and I caused a lot of harm to myself and my overall well being by not taking time for myself to put the pieces of my mental well being back together.
So here I am, 25 years old, married, life is pretty great. But the shadows of the mental health struggles I went through in 2014 are still there. Pharmacy technicians are suffering at the hand of corporate leaders, being over worked and under paid and it is taking its toll on my coworkers mentally.
I hope this opened your eyes a little to the struggles of a small town pharmacy technician.
This is the beginning of my journey to make a difference, and I thought reaching out to you was the best place to start.
Thank you.
The above video clip is a simulation of the training program for pharmacy chain techs… to weed out those who can’t run at 110% for up to 12-14 hr days. There was a recent article in the New York Times about a OK board of pharmacy audit of 4 CVS pharmacies where it was uncovered that 22% of prescriptions filled had errors.. not all the errors were major life threatening errors… but a error is a error !
The 13th Amendment was signed in 1860 that abolished SLAVERY, and apparently replaced with the MINIMUM WAGE. CVS recently reported ONLY a 250 BILLION DOLLAR PROFIT for their last fiscal year and it is reported that their President Larry Merlo only gets paid 36.5 million/yr.
The fine that the OK BOP imposed on CVS Health amounted to only a FEW MINUTES of CVS’ annual profits…. just the cost of doing business their way.
You only have one health, but these pharmacy chains have very deep pockets to settle any damages that is done to pts that have entrusted their health to their understaffed/overworked Rx dept staff. It is almost a certainty that all thousands of those stores will be opened for business the very next day and may not even miss a single minute of business & profits.
Hi Steve, is there a chance you could publish this ASAP?
It would mean a lot to Nancy if there were a lot of pain patients watching. Thanks, V.
Hello, I'm not sure how many of you knew Al Knowles, he recently passed away and
his fiance is streaming his service today. Al had traveled to one of the FDA meetings
and Nancy said he'd met some of you who had been there.
It'll mean a lot to Nancy if people are watching. Al's death is another side to
this war - pain patients postponing important tests, surgeries, etc.
Knowing your pain won't be controlled or you'll face discrimination
when they find out you are a pain patient, is a big deterrent.
If Al had done a colonoscopy, it's very likely the cancer
would have been detected much earlier and he might
have had time to fight it. V.
------------------------------------
From Nancy Hodgeson:
Live Streamed Memorial services will occur at 6 pm Sunday Central Time, July 19th
and will public on Al Knowles FB page.. Because of Covid there will not
be a regular service. Thank you everyone for understanding.
There will be an ash releasing ceremony later from Costa Rica
after it is extremely safe to travel again. Please stay safe everyone.
This showed up in my inbox Does the word “HEALTH” in relation to CVS must primarily reference their bottom line “health” since they recently reported a 250 BILLION profit in their most recent fiscal year.
Recently there was this fine from Oklahoma pharmacy board from a audit from four of CVS’ stores where the audit showed ONE our of FOUR Rxs was MIS-FILLED – a 22% error rate. The fine imposed, represented only a FEW MINUTES of CVS’S annual corporate profits. Anyone who believes that such fines are going to make them adjust their corporate staffing policies is delusional. It would seem that anyone who continues to patronize a CVS store is putting their own health at risk. I am sure that the Rx dept staff at the CVS stores cares about pt safety, but you can only do so much when you are only provided a fraction of the staffing hours that would allow them do their job safely.
This was a SavOn pharmacy in a Albertsons grocery store
I recently herniated a disc in my back a little over a month ago that has not only caused me great pain but has also made me unable to work at the business I own without pain medication as I am on my feet for at least 5 hours, and do not have employees
My doctor prescribed me 40 Percocet but when I went to pick them up the pharmacist said I could not get them unless my doctor called in a prior authorization. Eventually they allowed me 28 instead of 40 without the prior authorization. The next week I was getting low and asked for another prescription from my doctor and he sent in another one. I got the same story about how I cannot pick it up without the PA but this time they didn’t even allow me to get the 28 and said I could not get any without it due to my insurance and that I could not pay cash.
I called my insurance and they said they didn’t have any problems with me paying cash for it and that it’s the pharmacist that makes that call. I called the pharmacist and he tried again to tell me it was all my insurance doing it before finally saying that it was him that didn’t want to fill it without the PA. This all happened on a Friday and now my doctor is gone for the weekend and I have no options to get relief.
From your website it does not seem like this is legal, as there are no reasons why I should be denied if he’s still willing to prescribe them if I get insurance to cover it, but won’t if I just want to pay cash. I am 29 years old and feel as though he is discriminating against me because of my age but cannot confirm that is why. I don’t know what to do but to lay in agony until Monday to get my doctor to call in on my prior authorization. It makes no sense to me why this needs to be the process when my doctor approves my treatment and I am willing to pay myself for it, and that the pharmacist repeatedly told me it was my insurance holding me up and his hands were tied until I talked to them and found that wasn’t the case, and he admitted it was him that didn’t want to prescribe it.
I would like to file a complaint but am not sure if my case is legitimate and if so where to file the complaint.
With each issue in this 6-part series of commentaries regarding CVS, an even larger number of responses and experiences are forwarded to me. There appears to be no limit to the evil, greed, and lies of this company. This commentary includes the experiences of two very courageous, and now former, CVS pharmacists, as well as excerpts from Ellen Gabler’s third article on the dangerous working conditions, errors, and harm to patients, at CVS and other chain pharmacies in the July 16th issue of The New York Times.
Lisa Cairo’s experience
I first came to know Lisa at the beginning of the Pharmacotherapeutics course in which I was one of the faculty participants. As the course coordinator, I would come to the classroom around 7:30 am to be certain that the AV equipment, etc. were ready for the start of the 8 am classes. One student, Lisa Cairo, was already in the classroom studying when I would arrive. I was surprised by her early arrival and learned that she had two young children, had a 2-hour commute each way between her home in New Jersey and Philadelphia, and that to arrive in time for her 8 am classes, her train’s departure time from her hometown was 5:30 am. The hours each day of her train commute and early arrival at our college were the primary times that she could devote to studying her coursework. I was very impressed by her commitment to learn and attend classes, while also fulfilling her responsibilities as a wife and mother and working part-time in a pharmacy.
Following her graduation I did not have any communication with Lisa for a number of years until I received the following email message from her at 12:55 am on June 20:
“I am writing in regards to your articles about CVS. I was employed with CVS for 16 years both as a technician and as a pharmacist. During my last few years at CVS, pharmacy supervisors were constantly changing. I had been at my store during that time for about 8 years and was currently the PIC (pharmacist in charge). I had a 24-hour store where on a Monday dispensing 750 prescriptions was typical. I was maintaining the numbers and doing everything I was supposed to. I gave excellent customer service and because I lived in the area and had 6 children in the school system, customers felt comfortable confiding in their pharmacist.
One day I was called to the office and told I was immediately being moved to their slowest store which barely did 100 prescriptions a day. Rumor had it that a pharmacist from another store who liked to play teacher’s pet wanted my hours, worked her magic, and got what she wanted. My customers were so upset that they were calling me at my new store and I would tell them to call the 1-800 number and voice their opinion. There were so many angry customers that the supervisor called me and told me to stop giving out the 1-800 number. I was one of the strongest pharmacists in the district put into a store where I was useless. The supervisor refused to move me to a busier store.
During that time I became pregnant with my daughter. One day while entering information into the computer I looked down at the floor and saw a puddle of blood. I excused myself from the pharmacy to clean up and then went back to work. Within a few minutes there was another puddle of blood on the floor despite the layers of paper towels I had used to prevent something from occurring. At this point, my technician’s face was white as a ghost and I was afraid for my baby. I called the store manager and said that I had to lock up and drive myself to the hospital. I told the manager that I would call the supervisor along the way. I did call the supervisor who scolded me for closing up before a replacement arrived. My visit to the emergency room determined that I was most likely pregnant with twins and that the heavy bleeding was the result of losing one of them. My discharge papers from the emergency room stated that I should take one week off from work, and work no more than 8-hour shifts unless a stool was provided for my use. My supervisor said stools were not allowed and that 8-hour shifts were not available. Eight-hour shifts were available at my previous 24-hour store so that was a lie I was being told. I was told that, if I could not work when I was scheduled, I would need to go on early disability. I was capable of working but they refused to make exceptions for my condition. I continued to work but I hid a bunch of boxes in a corner as a makeshift stool to get me through until I went on disability. I knew that once I had the baby I was moving on to another position. CVS didn’t actually fire me but they did everything they could to make it difficult and uncomfortable for me.
My marriage was never a solid one and I had made a mistake. Several years later I filed for divorce. Because I received a higher salary than my ex, I had to pay him out. When I filed for divorce, I also applied for a PharmD program because I knew that the PharmD would be necessary to remain stable in the work force as a single parent. I didn’t want to be at risk for a lay-off or unable to find a job like so many pharmacists with a bachelor’s degree in pharmacy are now discovering. So I now have student loans to repay. It’s okay. I now have my PharmD degree.
There was one other big change in my life. I began pharmacy school when my oldest daughter, Nicole, was 6 months old. I wanted to give her everything I didn’t have as a child. She saw me walk the stage at graduation when she was in kindergarten. I tried to lead by example. I did my very best to be a good role model. But it wasn’t enough. Nicole became addicted to drugs. I saw it early on and intervened. My ex denied that there was a problem and said it was a phase that she would grow out of. It was a very tough period of time with her lying and stealing from me, and my waiting up late at night wondering where she was. I was the disciplinarian while my ex was not concerned.
I received my PharmD degree in May 2017. I was on top of the world. My world crashed July 22, 2017. Nicole died from an overdose of heroin that was laced with fentanyl. Life has not been the same. I missed many of my kids’ events because I worked endless hours for CVS. My relationship with my children would most likely be different if I didn’t work the grueling shifts I did. I hope something comes about with what you are doing. I felt helpless when I left CVS.”
I responded to Lisa that her message brought me to tears and asked that she provide me with her phone number so that I could speak personally with her. She provided it to me and we spoke later that day. Lisa followed with a quick email and photo “to show you how beautiful my Nicole was.” I responded:
“She is beautiful, Lisa, and could have been a model. Her beauty is an inspiration looking forward to help your younger children achieve what Nicole might have achieved.”
Most of Lisa’s experience at CVS was during the last 20 years. However, more recently she has been working as a hospital pharmacist. Many current CVS pharmacists would say that the working conditions at CVS are even worse now than when Lisa was employed there. I highly commend and greatly appreciate her sharing her experience with me so that I may communicate it with the hope that other pharmacists can learn from it and take action to avoid circumstances that can have such a destructive impact.
Shayra Ramirez’s experience
Shayra Ramirez worked for CVS for more than 25 years, most recently in Florida UNTIL last August. Ellen Gabler’s comprehensive coverage in two stories in The New York Times earlier this year (“How Chaos at Chain Pharmacies is Putting Patients at Risk”) captured what Shayra has experienced and motivated her to share her own experience:
“In the last two years patient service/care in CVS has been declining steadily, mostly due to the lack of technician hours. Our technicians have a key role in keeping the pharmacy going, by entering the prescriptions in the system, physically counting and preparing the medication, attending the register, dealing with insurance, etc. The lack of tech hours made our work very hard, as we had to deal with a bigger workload with no help, and the situation became so hectic that, after months of written complaints to CVS management, I led a meeting of five pharmacists with the District Manager in April, 2019. Our main complaint was that the lack of technician help did not allow time for pharmacists to keep proper track of expired medication, interactions, appropriate drug and dosing, etc. We asked for a solution in order to avoid putting patients at risk. In that meeting it became crystal clear that CVS was only worried about meeting metrics (immunizations, prescriptions, etc). We were told that increasing the hours for technical help was out of the question, and that we were obligated to meet the metric scores required. When I asked how we were supposed to do so, the District Manager said that he didn’t have an answer and that that was our problem. They showed no interest whatsoever in dealing with our concerns about patient safety. I was very vocal at that meeting and it was obvious that neither my District Manager nor my Supervisor were happy with my comments. My colleagues who attended the meeting, as well as myself, immediately became persona non grata for CVS management.
From that moment on, we kept receiving pressure from management to increase the metrics while they continued cutting technician hours, and some of these pressures included write ups for some of my colleagues with the threat of termination. Finally, my time came: in late August last year, my District Manager had me come to the office, after more than ten days pressuring me personally to persuade our patients to receive vaccines (I guess there is monetary gain from it, as it is a big part of the metrics). I then challenged him when he was saying that ‘the company stresses immunizations because they care about the well-being of our patients,’ because it seems that what they really want is to meet their goals with the vaccines; and he did not like that.
On August 29th, I was out of town on vacation while West Palm Beach was under Hurricane Alert. I entered in the CVS Human Resources website and I found no access to most of my regular things on my account and a note encouraging me to apply for Cobra to cover my medical expenses…starting August 30th!! With my arrival date in Florida unclear due to the weather, I was fired and nobody in CVS had the decency to warn me. A funny thing is that the Sunday after (9/1/19) my District Manager sent me an email telling me that all my shifts for that week were covered. I guess he meant ‘next’ and all the weeks of my life because I had been fired, but not even there did he have the decency to communicate it to me.
A few days later, I received the letter of termination in the mail. The formal reason for my being fired is that I contradicted a company policy because I rang up a personal sale for myself in the register for one of my own medications (again, due to a lack of help and trying not to distract my technicians from more important work). Under normal circumstances, this would have resulted in just a verbal or written warning (our policy was that personnel in charge are to be given 3 formal warnings before letting people go). In my case, I was immediately terminated. In my case, this is a clear case of retaliation.
I mention all this because I felt very angry when I read in The New York Times article, ‘When a pharmacist has a legitimate concern about working conditions, we make every effort to address that concern in good faith,’ CVS said in a statement. This is not true. There is no concern at all, and CVS management does not like to be challenged in order to improve the quality and safety of the pharmacy service for their patients.
Obviously, they don’t want me working for the company anymore because I speak too clearly for them. I told the District Manager that I felt we were harassing patients to get vaccines and that I also felt like I was selling myself in order to meet the metrics, the goals, and ultimately, his bonus. It is disappointing that with 25 plus years of service, I was terminated this way only for trying to address something we pharmacists knew long ago: we are putting our patients at risk, and I believe it has not been a fair way to treat me or the patients.”
Shayra Ramirez wrote personally to Ellen Gabler at The New York Times to voice her appreciation for her articles about the terrible working conditions at CVS and the subsequent increased risk of harm to patients, and for Ms. Gabler so effectively increasing public awareness of these dangers at CVS stores. Shayra has demonstrated exceptional courage in voicing her concerns to CVS management. Her concerns for the safety of her patients resulted in retaliation and termination, but will have the result of emboldening others to take a strong stand against a company whose greed and evil must no longer be tolerated. CVS will be hearing more from Shayra and those of us who support her!
Ellen Gabler and The New York Times
As I prepare this issue of The Pharmacist Activist on July 16, I have received Ellen Gabler’s story in today’s New York Times, titled, “CVS Fined for Safety Issues at Oklahoma Pharmacies.” The article begins:
“In a rare public rebuke of the nation’s largest retail pharmacy chain, state regulators in Oklahoma cited and fined CVS for conditions found at four of its pharmacies, including inadequate staffing and errors made in filling prescriptions.
While the fine of $125,000 on Wednesday was small for CVS Health – it paid its chief executive $36.5 million in total compensation last year and is the country’s fifth largest company – the move validated concerns raised at multiple drugstore chains across the country by pharmacists and technicians who say understaffed workplaces are putting the public at risk.”
The article includes a number of examples of errors, and the results of a visit from Oklahoma Board compliance officers to a CVS store at which they “witnessed a chaotic scene including the phones ringing almost all of the time, along with constant foot traffic and drive thru traffic.” In an audit, “the officers found an error rate of nearly 22 percent, or 66 errors out of 305 prescriptions.” In another CVS store, “inspectors said a computer screen showed more than 99 prescriptions waiting to be filled and more than 99 calls needing to be made.” The article also includes an interview with a former CVS district leader who had the courage to repeatedly voice concerns about the budgets for staffing, and who was subsequently terminated.
Ms. Gabler has provided a valuable service for consumers and the profession of pharmacy by exposing the consequences of corporate greed and negligence. This article and her two previous articles earlier this year should be required reading for all pharmacists and pharmacy students. Pharmacists and pharmacy students should challenge our professional organizations and colleges of pharmacy to take actions in addressing the dangerous workplace conditions that exist. We should no longer tolerate their silence!
The state faulted the company for prescription errors and inadequate staffing, a rare action that followed complaints at drugstore chains across the country.
In a rare public rebuke of the nation’s largest retail pharmacy chain, state regulators in Oklahoma cited and fined CVS for conditions found at four of its pharmacies, including inadequate staffing and errors made in filling prescriptions.
While the fine of $125,000 on Wednesday was small for CVS Health — it paid its chief executive $36.5 million in total compensation last year and is the country’s fifth-largest company — the move validated concerns raised at multiple drugstore chains across the country by pharmacists and technicians who say understaffed workplaces are putting the public at risk.
CVS also agreed to distribute a memo to its pharmacists in the state, highlighting a law that requires them to take action if working conditions in their pharmacies could lead to problems safely filling prescriptions. The memo is to make clear that they are not to face retaliation for documenting and reporting such issues.
In a statement, a CVS spokesman said the company agreed to the terms to “avoid the time and expense of a protracted hearing process and to foster a positive working relationship” with the Oklahoma State Board of Pharmacy. The spokesman said the action did not constitute an admission of guilt by the company on all counts.
The state board inspected the four pharmacies from mid-2019 to early this year after receiving multiple complaints about errors and overwhelmed staff members.
One of those errors occurred last year when a developmentally disabled teenager received one-fourth of his prescribed dose of anticonvulsant medication from a CVS in Owasso, a suburb north of Tulsa, according to a complaint filed by the board. The boy took the incorrect dosage for 18 days, during which his seizures became uncontrollable, causing him to fall and hit his head, said his father, Aron Brown.
The convulsions were “nonstop” and “violent,” Mr. Brown said. “You have no idea what kind of shame we feel about this — that we couldn’t figure out what was going on.”
As part of its agreement on Wednesday, CVS will pay a $75,000 fine for that incident — the highest amount allowed under state law for this case — and its Owasso pharmacy will remain on probation for two years. While pleased the board had addressed the matter, the boy’s parents said they were worried that the action was not strong enough, and that it could allow other patients to be harmed in the future unless CVS made substantial changes to its business.
“A $75,000 fine? That is nothing to them,” said the teenager’s mother, Rachel Banning. “These things are going to keep happening if they don’t fix their staffing issues.”
Pharmacists in dozens of states have accused CVS, Walgreens and other major pharmacy chains of putting the public at risk of medication errors because of poorly staffed and chaotic workplaces, The New York Times reported in January.
In letters to state pharmacy boards and in interviews with The Times, pharmacists said they struggled to keep up with an increasing number of tasks — filling prescriptions, giving flu shots, tending the drive-through, answering phones and calling patients — while racing to meet corporate performance metrics they characterized as excessive and unsafe.
The pharmacy chains, including CVS, have pushed back on employees’ complaints, saying staffing is sufficient and errors are rare.
Most state investigations focus on pharmacists, not conditions in their workplaces. In Oklahoma, the state board has begun investigating broader workplace issues when responding to complaints and doing routine inspections.
In mid-January, two board compliance officers went to a CVS in Bartlesville, Okla., to investigate a complaint of a mislabeled prescription. There, they “witnessed a chaotic scene including the phones ringing almost all of the time, along with constant foot traffic and drive thru traffic,” according to a complaint filed against CVS.
The officers discussed the error with the head pharmacist, noting that she said “she had lost a considerable amount of her support staff, and that the pharmacy was operating with little help, so she was not terribly surprised that an error could have occurred.”
In an audit, the officers found an error rate of nearly 22 percent, or 66 errors out of 305 prescriptions. Some of the mistakes were minor and would not affect a patient — such as the incorrect name of a prescribing physician — but others were more significant, like instructions for medications that were unclear or substantially different from what they should have been.
Days later, a prescriber complained of insufficient staffing at a pharmacy in Moore, about 10 miles south of Oklahoma City, saying calls were placed on hold for up to 60 minutes. Compliance officers reported finding one pharmacist and one technician who had fallen behind on work.
The officers recorded a 6 percent error rate, according to the complaint. Some of the errors were substantial, including the wrong dose of an antibiotic for a 1-year-old, the incorrect frequency for an antiviral drug (every two hours instead of 12) and multiple errors involving the frequency of a narcotic.
There were several reported errors involving testosterone; in one case, the dose was doubled for a female patient. The compliance officers also noted mistakes related to blood pressure, gastric disorder and steroid medications that had been dispensed to or entered for the wrong patients.
Errors were also flagged in a complaint about a pharmacy in Choctaw, east of Oklahoma City, in February. Inspectors said a computer screen showed more than 99 prescriptions waiting to be filled and more than 99 calls needing to be made.
When asked about the backlog, the pharmacist said that employees were several days to weeks behind, according to the complaint, adding that they had been given an extra 17 hours of technician help but could not find anyone who would work only 17 hours.
A teenager received a quarter of his prescribed dose of anticonvulsant medication from CVS, leading to uncontrollable seizures, according to a complaint.
Similar staffing concerns were detailed in the case involving the disabled teenager. The pharmacist on duty that day, according to the complaint, was responsible for checking 194 prescriptions in a six-hour shift, about one every two minutes.
The store’s lead pharmacist told the board that he had no control over staffing, and that while he complained about the issue to his district leader, she also had no power to make changes.
That district leader, Amanda Dixon, who is a pharmacist, told The Times in an interview this week that “district leaders were repeatedly voicing their concerns about the budgets” for staffing at CVS pharmacies last year.
Dr. Dixon said that many pharmacies in her 19 stores were short-staffed, that customer complaints were on the rise and that she was worried about patient safety. She had worked for CVS for almost six years until November, when, she said, she was terminated for a policy violation involving another employee, although she believes she may have been retaliated against by the company because of the board’s investigation.
In its statement on Wednesday, Michael DeAngelis, the CVS spokesman, said that “if a pharmacist has a legitimate concern about working conditions, we make every effort to address that concern in good faith.” He added that any suggestion the company retaliated against a district leader was false.
In addition to the fines, the state board said it “strongly recommended” that the company follow through on nearly a dozen recommendations for all of its Oklahoma pharmacies, including increased training for technicians and changes to how staffing needs were determined.
The board also advised eliminating tasks that might overburden pharmacists and removing some metrics they are required to meet. Phone calls pharmacists often must make, it said, could be outsourced to a corporate call center.
Mr. DeAngelis said the company would review the board’s recommendations, noting that CVS had reduced its overall metrics this year and was planning to increase staffing in the fall to help handle vaccines for flu season.
President Reagan’s words back abt 40 yrs ago … seems now to apply to many and many more industries and not just to our government. Our our insurance industry – and not just health – are more than willing to take your money and then use “vague terms” within the policy not to pay a claim. Our Florida condo got hit by Hurricane Michael (Cat-5) .. only the 3rd-4th time a Cat-5 had come ashore in the USA… I did not pay for wind or flood insurance because our unit is on the top floor and I put 150 MPH windows which was covered by 120 MPH metal hurricane shutters. But Michael took part – abt 20%- of the roof off of the complex – of course the roof was blown off over the top of our unit.
