‘Don’t Punish Pain’ Texas chapter head says opioid crackdown hurts many who need help

https://kfdm.com/news/local/dont-punish-pain-texas-chapter-head-says-opioid-crackdown-hurts-many-who-need-help

SOUTHEAST TEXAS — There are 50 million Americans suffering from chronic pain and the opioid crisis is making the hurt even worse.

Many say the fight against opioid addiction is punishing those seeking relief.

We discovered the problem only a couple of weeks ago while doing a story about how the opioid epidemic is on the rise on our area.

Immediately after that report aired, we heard from many of you telling us about another crisis stemming from opioids. The challenge–to find doctors who will prescribe them for those who must have relief.

John Schoellman is head of the Texas chapter of ‘Don’t Punish Pain.’ He’s sounding the alarm on how the effort to combat the opioid crisis is creating another crisis.

“What’s happening with the chronic pain patient now is they don’t get their medication now, some have heart attacks, their blood pressure goes up so high they have heart attacks,” said Schoellman. “Some actually go to the streets and try to get the pain medicine because they’ve been cut completely off, and this exactly goes against what they’re trying to fix, the drugs, the overdoses.”

Schoellman suffers from chronic pain after years of repairing televisions. Still, he led an active lifestyle, thanks to the prescription pain medication he received, which came to an abrupt end.

“They told me, look, we can’t give the pain medicine any more.”

The Centers for Disease Control and Prevention, reacting to the opioid addiction epidemic, urged doctors not to prescribe opioids to chronic pain patients like Schoellman to avoid the risk of addiction and overdose.

“CDC guidelines, which were written in 2016, were written by a group of addiction specialists, not pain doctors. They didn’t even request a pain doctor on the committee.”

The CDC walked back those guidelines, warning abruptly discontinuing a patient’s opioid prescription could lead to greater harm. Schoellman and many others with chronic pain found it severely altered their lives

“That was horrible for them,” said Schoellman. “They’d been taking it for 20 to 30 years as prescribed and able to work like myself, and then when the guidelines came, we couldn’t do anything any more.”

Despite the CDC’s about-face, Schoellman says the Drug Enforcement Administration continues to target doctors. That, he says, has had a chilling effect on them. Schoellman says the lack of pain management is having a debilitating impact on his health.

“I wouldn’t have a surgery one, and I would be active. I would be a contributor to society and not a dependent on it or a burden, because I had to go on disability because of it and I hate that.”

But Schoellman is contributing to society. The College Station man who once fixed televisions now goes on tv to raise awareness.

Schoellman and his group plan to rally in Austin at the Texas Medical Board on March 20, demanding a solution to their suffering.

“You have to fix it. We’re not part of the opioid crisis, we are a casualty of the opioid crisis.”

Schoellman now has a pain pump device in his body delivering medication to his back, but he says it provides only limited relief.

That Don’t Punish Pain rally in Austin is noon until 1:30 p.m. March 20 at the Texas Medical Board.

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Attorneys Looking for Class Action Participants, Health Care Providers Firing Doctors & Contact Congress

http://nationalpainreport.com/attorneys-looking-for-class-action-participants-health-care-providers-firing-doctors-contact-congress-8843669.html

Pain Patient Advocacy Attorney Surfaces

Attorneys in Louisiana are looking into bringing legal action on behalf of patients nationwide suffering from chronic pain lasting 3 or more months, or suffering from:

• associated with a cancer diagnosis;
• pain from sickle cell disease;
• palliative or nursing home care;
• pain from nerve injuries;
• pain from osteoarthritic changes;
• chronic intractable pain

They are also looking for patients who are experiencing difficulties in getting pharmacies to fill their legitimate prescriptions for opiate medication as written by their treating medical provider.

For more information about the firm, visit their website.

Let us know if you contact them and what they tell you. Know they are looking for enough patients to create a class action—so they’ll be asking for a lot of personal information. Decide whether you want to participate.

Big Health Care Provider Pushing Poor Patients

United Health Care is dropping doctors from its Medicaid network to move its poor and working-class families to medical practices owned by the giant health care provider

Here’s the story from nj.com

Chronic Pain Advocate, Terri Lewis Ph.D. brought this article to the attention of her followers on Twitter:

UHC is dropping hundreds of doctors in its NJ Medicaid Dr network. The move is forcing thousands of low-income patients to forsake longtime physicians.

Will this impact specialty, chronic care?

You betcha.

Are You Talking with Your Elected Officials About Chronic Pain?

We ran a story this weekend making sure that each of you—from your couch, your car or your phone, can tell you elected official about chronic pain.

We received a lot of positive reaction for the reminder.

Do you know who your congressman/congresswoman is? You can find out here.

I don’t mean to nag—ok maybe I do—but you should tell your story to him/her. Tell it efficiently (don’t complain, just inform) and encourage them (or one of their staff) to contact you, your social media group or a sympathetic doctor/nurse/provider.

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The Real “Death Panels”: Oregon Medicaid planned to cut off opioids to chronic pain patients

https://tarbell.org/2019/03/gambling-with-lives-oregon-medicaid-cutting-off-opioids-to-chronic-pain-patients/

At the height of the Tea Party and Republican campaign against the Affordable Care Act, the GOP raised a false alarm about “death panels” that would purportedly kill the disabled based on a subjective judgment and “pull the plug on Grandma.”

But to real grandmothers like 60-year-old Wendy Morgan, who has suffered excruciating back and neck pain in the wake of two botched surgeries, degenerative disc disease and severe pain from MS for decades, there’s now a genuine death panel:  the Oregon Health Authority’s pain and evidence committees. They were slated on March 14 in Salem to finalize mandated opioid cut-offs to zero for Medicaid patients with chronic back and neck pain conditions, plus fibromyalgia. 

“This is going to come as quite a shock to a lot of people,” Wendy said before the vote. She had made preliminary plans with her husband to kill herself last spring after her opioid dosages were already cut 97 percent under pressure from government  agencies. “I never did anything wrong, always followed the doctor’s orders, but I was treated like a drug addict.” She managed to function as a homemaker even after she was forced to quit her sales job in 2009 and go on disability, but after her primary care doctor dropped her for using high doses of opioids and her pain specialist started a drastic taper in 2016, “I felt like killing myself,” she said. She went weeks without sleep, remained housebound, unable to even shower without agony and sunk into a deep depression. “It was an absolute nightmare,” she says.

Her husband, Larry Gordon, a retired postal worker, briefly but angrily testified on her behalf at a hearing in January before OHA’s Health Evidence Review Committee (HERC), as his wife of over 40 years sat quietly next to him.

If the plans are eventually voted in, the agency will target overwhelmingly disabled patients with 170 separate medical conditions that cause spine and neck pain for a total forced cut-off to zero opioids; these draconian limits  go far beyond even the CDC’s 2016 recommended voluntary 90 Morphine Milligram Equivalent (MME) upper limits for new — not long-term — pain patients. These voluntary guidelines have been “weaponized” in drastic cut-offs nationwide and spurred a wave of suicides by chronic pain patients.

Larry, dressed in a blue ball cap, windbreaker and blue jeans, proclaimed, “Doctors are abandoning patients left and right. Look at what’s happening in the real world: there’s people dying. If you take opioids away from intractable pain patients, they only thing they have left is to go straight to suicide. I had to tell my children that their mom’s going to kill herself because no one else will help her.”

Larry and his family have been petitioning local stakeholders, including the Oregon Medical Board and local newspapers, in order to bring attention to chronic pain patients’ access to painkillers. Click Here To Read The Gordon Family’s Full Story In Letters

Fortunately, Wendy recently found through a network of pain patients a Portland clinician willing to quietly resume her high dosages of methadone and occasional oxycodone pills, amounting to a quite rare medication level of 1100 MME. It’s not clear how long this arrangement will last, but for now, she says, “This nurse practitioner saved my life.” Her pain is worse than before because the years of forced tapering worsened her MS, but at least she can visit her grandchildren, go to their recitals and ball games, take a shower. “I can live a normal life.” 

Now that the Oregon panel has tabled the vote, she can breathe a sigh of relief if her other supply of medication fails — for now. 

That option was about to be closed off to a significant portion of patients –variously estimated between 60,000 and 80,000 chronic pain patients — who are part of the 25 percent of  all Oregonians who are on Medicaid. This latest delayed Oregon action flies in the face of mounting alarms by three former White House drug czars and over 300 leading health professionals and academics who warned in an open letter to CDC and Congress about the dangerous, unintended consequences of the  harsh crackdown on opioids for legitimate pain patients, as chronicled recently in The New York Times. These professional critiques have been joined by over 120 pages of anguished testimony from patients across the country about the agonizing impact of the resulting  hard-line approaches in their lives.

True, rigorous evidence that such policies are driving up suicides rates is relatively scarce, even though there are horrifying examples of patients like Jay Lawrence in Tennessee shooting himself on a park bench with his wife holding his hand. However, an important study published in 2017 in the peer-reviewed journal General Hospital Psychiatry found that veterans cut off from opioids after long-term use engaged in suicidal actions and thoughts at a rate nearly 300 percent higher than the overall veterans community, whose members are already killing themselves at a rate of 20 people a day. 

Oregon’s proposed but now tabled actions are even more extreme than the CDC guidelines spurring such tragedies, says the organizer of that open letter, Dr. Stefan Kertesz, a noted addiction researcher and primary care doctor specializing in vulnerable populations at the University of Alabama at Birmingham. “They’re gambling with the lives of a subset of patients,” he says. “There’s something cruel in going after patients with these conditions: it’s completely untested and there’s no evidence that you can swap in yoga and cognitive therapy across the state for opioids.” (Note: Like Kertesz, most, but not all, of the hundreds of clinicians across the country protesting the national and Oregon opioid cut-offs actually don’t have a history of sleazy ties to the drug industry.)

Look, for instance, at the dangers facing people like Sierra Brown, a former nurse who once had private insurance but is now a disabled Medicare-Medicaid patient who was denied pain medication for her damaged spine resulting from previously undiagnosed lupus and Sjorgen’s auto-immune disease . She fears she will continue to be treated like a drug-seeking addict if the influential Medicaid policies are eventually voted in. (She and others point out that Medicaid’s prescribing standards also influence private insurers.) Yet she has been given a reprieve of sorts: after showing up vomiting in agony at an ER last month, she was diagnosed with pancreatic cancer, but only after the admitting doctor first told her, “If you’re here for pain medications, we’re not giving you any.” Now, she is viewed as a near-angelic victim of cancer, and was generously provided with all pain medications she needed to be taken every few hours, from Dilaudid to Tramodol. “Pain-wise, I’m fine,” she says, relatively speaking. “Their attitude totally flipped. It’s totally disgusting.” But once she achieves her hoped-for remission  because they spotted her cancer early, “I’m scared I won’t be getting any pain medicines because of the law’s crackdown.”

In Oregon, making the case for keeping opioids away from patients like Sierra when they don’t have cancer, is the alternative medicine community. Some of them don’t seem to be much more immune from conflicts of interest than drug company shills, critics say. In fact, the ad-hoc Chronic Pain Task Force, an advisory subcommittee that’s helping drive Oregon’s move to shut off opioids for pain patients, is dominated by holistic practitioners with a financial stake in ending opioids by hyping a smorgasbord of alternative therapies that have weak or limited evidence that they work for any chronic pain patients at all  — let alone with that minority of long-term chronic patients who use opioids.

Indeed, OHA commissioned the nationally respected Oregon Health and Sciences University (OHSU) to do a review of the skimpy evidence on the efficacy of tapering and alternative therapies. In its rush to back alternative therapies as an “evidence-based” replacement for the removed opioids, the Medicaid agency brushed aside the OHSU findings that  \concluded the studies’ quality were variously “very low” for tapering, and “limited” or “insufficient” for the alternative therapies.  Even the agency’s own summary of the available  evidence branded all of the holistic therapies, some with potentially major  new funding streams, as having “no clinically significant impact” on long-term pain. Instead, the agency seems to be relying in part on a 12-year-old survey of the personal opinions of an earlier OHA advisory panel that found these alternative medicine  treatments as somehow having “fair” to “good” evidence for “moderate benefit.” In addition, Kertesz asks about the OHA’s dismissive approach to the new OHSU review it commissioned: “Why are they ignoring their own report that says there’s no evidence that a mandatory taper has been properly assessed, and certainly hasn’t been proven to be safe and effective?”

As of this writing, the OHA press office didn’t reply to repeated emailed and phoned requests for comment or rebuttal to the criticisms aimed at the now-tabled opioid proposal.

Oregon-style forced taperings continue unabated, with doctors across the country reacting to mounting pressure from agencies including state licensing boards and the DEA to slash their opioid prescribing — and then kicking out their chronic pain patients who have become known as pain or opioid “refugees.” Human Rights Watch recently issued a stinging report condemning such actions: “Many patients are involuntarily cut off medications that improve their lives or say they are unable to find a doctor willing to care for them.” Yet Oregon is the only state — so far — that tried to move so decisively to adopt these potentially deadly practices as official state policies. One possible factor, argues University of Southern Illinois rehab specialist, Terri Lewis: The financially-strapped Oregon Medicaid system is moving under a Medicaid waiver to reduce spending and limit care for disabled chronic pain patients who merit palliative care but aren’t actually getting it. 

This proposed punishing crackdown doesn’t stem primarily from what patients often see as sheer sadism on the part of officials. Instead, it’s driven apparently both by a desire to save money and  a well-meaning yet misguided, simplistic and wrong-headed response to the alarming rise of opioid-related drug overdoses, largely from illegally manufactured fentanyl — not legally prescribed pills. It’s an oft-told story:  how Big Pharma companies and their crooked distributors ramped up an oversupply of opioid pills starting in the late 1990s, but much of the flooding of the marketplace was clearly fraudulent and intended to hook a new generation of substance abusers who already had addiction histories. Why else flood one West Virginia town of 9,200 people with nearly 21 million pills?  Yet while prescriptions have fallen nationally nearly 20 percent since 2012, overdose deaths haven’t been stemmed at all, rising to as high as 70,000 deaths in 2017, more than AIDS, guns and car crashes killed people in any one year. Yet as few as 15 percent of opioid deaths today are due to prescription drugs, often stolen — even as 75 percent of  new heroin users started by using  “diverted” opioid pills they weren’t prescribed. Kertesz has pointed out that today’s prescription drug dosage limits are  a “funhouse mirror image” of the drug industry’s earlier propaganda to lower the “pain score” of patients and give out way more pills: it is still a focus on a number, not on the actual well-being of  patients.

Meanwhile, Oregon’s chronic pain patients remain political orphans whose plight is largely ignored by people across the political spectrum. They are scrambling on their own in blog posts, on Twitter and Facebook to try to get other people — or even their own factionalized pain community —  to fight back against the steamrolling impact of the Oregon Medicaid rules that will surely flatten them if the tabled rules come up for another vote.  Amara is a disabled Medicaid patient and co-founder of the Oregon Pain Action Group. She is suffering from a host of severe disc injuries following a botched epidural during childbirth and lives in intractable pain.  She told Tarbell, speaking anonymously for fear of retaliation, “It’s catastrophic and things are already so bad.”

She and others have been given a reprieve, but the specter of this cutoff still looms in the future if Oregon decides to go ahead with their plans in a future date. Pain patients know that their quality of life — if not their lives — are hostage to a delayed state vote. Tarbell will keep monitoring this proposed vote to see if it returns. 

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https://youtu.be/Li5fDlsZX4Y

https://youtu.be/8deCPp52x5Y

Dr. Kline and his patients . Suddenly, without any reason given, I was visited by two inspectors from the North Carolina medical board, who said they were there to have me surrender my federal narcoses licence. when i asked for the charges, I was told to talk to the board, and when I asked if I could continue my practice, They said to talk to the board. No reason, no evidence.

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https://www.nytimes.com/2020/02/21/health/pharmacies-prescription-errors.html

Pharmacy employees at Walgreens told consultants late last year that high levels of stress and “unreasonable” expectations had led them to make mistakes while filling prescriptions and to ignore some safety procedures.

But when the consultants presented their findings at Walgreens’s corporate offices this month, there was no reference to the errors and little mention of other concerns the employees had raised.

That’s because senior leaders at Walgreens had directed the consultants to remove some damaging findings after seeing a draft of their presentation, a review of internal emails, chat logs and two versions of the report shows.

In one instance, Amy Bixler, the director of pharmacy and retail operations at Walgreens, told them to delete a bullet point last month that mentioned how employees “sometimes skirted or completely ignored” proper procedures to meet corporate metrics, according to the chat logs and the draft report.

A slide detailing “errors resulting from stress” was also removed. The consultants, a group from Tata Consultancy Services that was examining the company’s computer system for filling prescriptions, had included the slide among their “high level findings.”

Pharmacists in dozens of states have accused Walgreens, CVS and other major drugstore chains of putting the public at risk of medication errors because of understaffed and chaotic workplaces, The New York Times reported last month.

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, answering phones and tending the drive-through, to name a few — while racing to meet corporate performance metrics they characterized as excessive and unsafe.

The pharmacy chains have pushed back on the complaints, saying staffing was sufficient and errors were rare. Walgreens told The Times that its pharmacists knew “they should never work beyond what they believe is advisable.”

But the consultants heard similar complaints in interviews with workers at eight Walgreens pharmacies last year. Both versions of the consultants’ report noted “a widespread perception that there is not enough time to respond to all pharmacy tasks.”

In the deleted slide on stress-related errors, the consultants wrote, “We were told that pill bottles had been found to contain more than one medication.”

They said they “heard multiple reports of improper behavior” that was “largely attributed to the desire” to meet a corporate metric known as “promise time,” which ensures that patients get prescriptions filled within a set amount of time.

The Times reported last month that such metrics often factor into employee bonuses and performance reviews.

The final presentation was delivered about two weeks ago at the drugstore chain’s corporate campus in Deerfield, Ill. The consultants had been seeking approval of the research report from various departments at Walgreens. They have since moved to the next step in the project — improving the pharmacy’s computer system.

A Walgreens spokesman, Jim Cohn, said the Tata consultants had been helping the company get a “better understanding” of how employees used the computer system.

The draft report, he said, included “information gathered through informal engagement with staff at a handful of stores.” Changes reflected in the final version were intended “to help ensure that the report appropriately focused on the most relevant aspects of the technology and user experience,” he said.

Mr. Cohn added that Walgreens took “any concerns seriously to ensure the appropriate parties are aware and working to address them.”

A spokesman for Tata Consultancy Services, a major information technology firm based in India, declined to comment. The company recently announced it had signed a $1.5 billion deal to run Walgreens’s technology operations.

Like Walgreens, CVS — the country’s largest pharmacy chain — has disputed assertions from some employees and state boards that its drugstores are understaffed and overburdened.

Image

In a statement posted on its website last month, CVS said, “We fundamentally disagree with the recent assertion in The New York Times that patient safety is at risk in America’s pharmacies.”

Since then, the Oklahoma State Board of Pharmacy released a complaint against a CVS pharmacy in Owasso, a suburb north of Tulsa, regarding a medication error made last year. The board took the rare step of citing the pharmacy in addition to the pharmacist involved in the error.

The Oklahoma board cited inadequate staffing in its investigation of the mistake, which involved a young man who received only one-fourth of his prescribed dose of anticonvulsant medication, according to the complaint.

The patient’s father discovered the error, but only after the young man had taken the incorrect dose for about 18 days, during which his seizures became more frequent and more violent, according to the complaint. His mother reported that during one seizure, he fell and gashed his forehead.

After the mistake was reported to the pharmacy board, an investigator for the state checked 200 prescriptions at the Owasso pharmacy for accuracy and found a 9.5 percent error rate, according to the complaint. Some errors were minor — like portions of directions that were missing — but others were more significant. A patient was told to take the wrong dose, for instance: one tablet instead of one-half.

The board wrote in the complaint that it had received “several letters of concern from various CVS employees regarding the lack of adequate staffing” at the company’s pharmacies.

Across the country, pharmacists who work at CVS and elsewhere have reported that their corporate offices have cut the hours of technicians who help behind the counter, and have pared back or eliminated shifts with overlapping pharmacists.

The Oklahoma investigator, who was at the Owasso CVS for three and a half hours, noted that the phone rang “almost constantly, with rarely a five minute break in between calls and several instances of more than one line ringing at a time,” according to the complaint.

The investigator also observed “almost constant foot traffic” in the store and a routinely packed drive-through.

The complaint states that on the day of the error involving the anticonvulsant medication, the pharmacist on duty was responsible for checking 194 prescriptions in a six-hour shift — about one every two minutes.

The store’s lead pharmacist told the state board that he had no control over staffing. He had complained about staffing to his district leader, but the district leader also had no power to make changes, according to the complaint.

He said that CVS had “almost completely eliminated pharmacist overlap” — meaning that only one is on duty at a time — and that pharmacists at his store worked about 20 to 30 hours per week unpaid so their colleagues were “not left in an impossible situation.”

He also said that internal reports for less severe errors were sometimes not completed because of a lack of time created by staffing issues.

CVS faces up to $75,000 in fines and possible suspension or revocation of the Owasso pharmacy’s license. The matter is scheduled for review at the pharmacy board’s meeting in May.

A CVS spokesman said the company looked “forward to addressing the allegations” at the upcoming hearing, adding that “our record of patient safety is outstanding and we are committed to continuous improvement.” CVS and other chains have declined to provide their error rates.

In a letter to employees after The Times’s article last month, Larry Merlo, the chief executive of CVS Health, said he was “deeply disappointed by the article’s portrayal of our company and industry.”

But this week, a company spokesman said that in response to the article, CVS planned to examine its metrics, both the quantity and how they are used to assess pharmacists.

A group called Pharmacist Moms, which says it represents 32,000 female pharmacists, also responded to the article, posting a letter on its website and social media accounts that said, “We feel strongly that patient safety may be compromised due to the overly stressful working conditions at chain pharmacies.”

The group’s founder, Suzanne Soliman, said in the letter, “Pharmacists work in difficult and demanding conditions and are often unable to voice concerns over patient safety.”

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Pharmacists for Healthier Lives Offers Perspective on Opioid Crisis

Pharmacists for Healthier Lives (PfHL) – a coalition of pharmacy and healthcare organizations raising awareness of how pharmacists help people live their healthiest lives – today announced the launch of a campaign designed to

educate consumers on the critical role pharmacists play in helping patients use prescribed opioids safely and effectively.

Naturopathic medicine іѕ a fоrm оf alternative remedy thаt focuses mоrе оn thе process оf prevention оr self-healing, rаthеr thаn cure. Thе method оf treating wіth naturopathic drugs involves certain natural therapies practiced bу naturopathic doctors. Thе centuries old scientific theories аnd philosophy goes іntо creating thіѕ fоrm оf drug wіth magical abilities thаt cure wіthоut harming wіth side-effects. Even thе vascular аnd interventional radiologists іn thіѕ area help intercede bеtwееn thе possible diagnosis stage usually mаdе bу thе general physician specialist tо thе specific condition оr disease state involved іn thе particular bodily process аѕ manifested bу thеѕе radiographic tests results аnd images. It’s important tо note thаt wіthоut thеѕе highly visual results thаt соmе оut frоm thе specific procedures, іt wоuld bе nearly impossible tо correctly make аn accurate diagnostic оr prognosis.
Modern researches hаvе proved thе efficiency оf therapeutic uѕе оf age-old supplements created frоm natural substances. You can check your health problems, by Kurated doctor.

Physicians practicing natural medicine believe іn primary аnd complementary mode оf medication аnd treatment. Durіng thе process оf treatment, thеу cooperate wіth doctors practicing conventional medical treatment аnd refer patients frоm аnd tо different disciplines оf thіѕ fоrm оf science whеnеvеr thеу think thаt іѕ required.

The campaign includes videos featuring coalition partners that will run on Facebook this month and can be found on the PharmacistsforHealthierLives.org website.

As the medication experts on a patient’s healthcare team, pharmacists can identify health problems associated with pain management and addiction.  – emphasis on ADDICTION !

They are specially trained to provide counsel and set a course of action to ensure best patient outcomes, thus reducing the risk of addiction and you can read more information about health on Health Blog.

“When it comes to information about pain management and the risks involved with taking opioids

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Any Chronic Pain Patients who have had any PHARMACY OR PHARMACIST REFUSE TO FILL A LEGITIMATELY WRITTEN PAIN PRESCRIPTION PLEASE REACH OUT TO THESE ATTORNEY’S IMMEDIATELY!!! Here we go people, Here We Go!!!!

https://seekingjusticeforpainpatients.com/

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CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 1

CVS Places Consumers at Risk of Harm, And is Destroying the Profession of Pharmacy! – PART 2

CVS is Destroying the Profession of Pharmacy – PART 3*

CVS is Destroying the Profession of Pharmacy – Part 4

CVS is Destroying the Profession of Pharmacy: Part 5!

CVS is Destroying the Profession of Pharmacy: Part 6

https://pharmacistactivist.com/2020/February_2020.shtml

As much as I wish it wasn’t true, I can’t deny that CVS/Caremark/Aetna/O

mnicare/etc. has become the most dominant and powerful force in health care! Its resources and influence far exceed those of all the national pharmacy organizations combined. One could even conclude that CVS is even more powerful than the government. When the government has information regarding illegal or otherwise inappropriate programs and actions of CVS, the corporation always has enough millions to obtain a settlement in which it is able to claim “no wrongdoing.”

CVS has had an exceptional and unprecedented opportunity to greatly improve the quality and safety of health care and drug therapy for patients, to be a powerful advocate for the professional role of pharmacists, and to be a trusted and respected employer for its thousands of pharmacists, pharmacy technicians, and other employees. However, because of corporate greed and an obsession with even greater profits and pleasing shareholders, the programs and actions of CVS have had exactly the opposite consequences.

Consequences

The consequences include denying millions of consumers the counseling and other services that pharmacists are in a position to provide, thereby placing them at risk of serious adverse events and even death as a result of errors and other drug-related problems. The risk exists not only for consumers who use the huge network of CVS stores, but also for those who use its Caremark mail-order pharmacies and the thousands of other pharmacies who must participate in CVS/Caremark-administered prescription plans that compensate pharmacies below drug product cost or otherwise in amounts that are insufficient to provide needed services. With its ownership of one of the largest chain pharmacies, health insurance companies (Aetna), PBMs (Caremark), and long-term care pharmacies (Omnicare), CVS exerts vast power and influence not only within its own operations, but also on the other companies and individuals who must “compete” with the negative forces of the CVS entities.

A second consequence of the policies and decisions of CVS is the devaluation of the services pharmacists have the ability to provide. Community pharmacists are the face of the profession of pharmacy for the public. However, when CVS management-imposed metrics, quotas, staffing reductions, and harassment make it difficult for its pharmacists to even greet, let alone provide consultation for patients, its pharmacists have little or no time to communicate with patients. The result is that the knowledge and skills of pharmacists that should be applied for the benefit and safety of their patients are denied and essentially unknown to their patients. As one of the largest employers of pharmacists, CVS management suppression of the use and visibility of the knowledge of pharmacists devalues their abilities, damages the standards for pharmacy practice, and is destroying the role of pharmacists in assuring appropriate and safe drug therapy. This destructive impact is not limited to CVS stores, as inequitable CVS/Caremark programs impose economic and service-diminishing restraints on thousands of other pharmacies.

A third consequence of the policies and actions of CVS management is the destructive effect on the morale and performance of its own pharmacists and pharmacy technicians. I know of no other organization in which management is reviled and resented to the extent that it is at CVS. I do not seek out criticisms of CVS – they are forwarded to me by CVS pharmacists and others who know that I am concerned and sympathetic to their dilemma of demeaning and stressful working conditions in a position in which they must stay because employment elsewhere is not available. I do not participate on social media websites, in part because I can’t keep up with emails, even in “retirement”. However, many of the comments that do appear on those sites are forwarded to me, often in descriptive language that I don’t condone and won’t print. “Hate” is not an overstatement of the attitude of thousands of CVS employees toward its management, but they don’t have options and they are trapped. If this is the situation that exists among the employees who best know the working conditions and their resultant risks for patients, the circumstances must be exposed and the public must be on guard for its own safety.

“Chaos at Chain Pharmacies”

On January 31, 2020, a bombshell investigative report was published in The New York Times (Ellen Gabler; page A1) titled, “Overloaded Pharmacists Warn They’re Making Fatal Mistakes: How Chaos at Chain Pharmacies is Putting Patients at Risk.” Ms. Gabler’s very thorough investigations, interviews, and reporting include specific examples of errors, quotes from CVS and other chain pharmacists voicing concerns regarding working conditions and increased risks for errors, and interviews with concerned physicians and officials of medical associations and others. Because of fear of retaliation and being fired, at least one of the CVS pharmacists agreed to be interviewed only following assurance that his identity would not be revealed.

I urge you to read the entire story. Examples of specific comments of pharmacists and others that are included in the story are provided below:

During her extensive investigations Ms. Gabler sought information/clarification from CVS and other chain pharmacies regarding what she had learned from their pharmacists and others. The following are some of the responses (or more accurately non-responses) from CVS:

CVS response to NYT article

The New York Times investigation and report clearly hit a nerve in CVS management. On the same date (January 31) the article was published, CVS issued a press release that includes the following comments; my Editor’s notes/observations are added in parentheses:

(Editor’s note: CVS must have anointed itself as America’s pharmacy. The NYT investigation specifically applied to chain pharmacies, and primarily CVS.)

(Editor’s note: As they say in the direct-to-consumer ads for prescription medications, “Your experience may vary.” I will have more to say about this claim in Part 2 of this series.)

(Editor’s advice: Pharmacists should have another job offer in hand prior to providing “feedback.”)

(Editor’s note: In addition to closing “poor-performing” stores, CVS is reducing pharmacist hours and technician hours, a reality that can’t be reconciled with its claims. Increasing pharmacy technician to pharmacist ratios is NOT the answer to safety concerns, and would only further add to the supervisory responsibilities and stress of pharmacists for whom “more time” will supposedly be provided. Many CVS pharmacists currently work numerous hours “off-the-clock” to finish basic responsibilities, and have little or no time to speak with patients.)

(Editor’s questions: I understand that “safe” and “effective” are criteria for quality health care, but what is the basis for CVS identifying “efficient” as a criterion, and what are the parameters for demonstrating efficiency? What are the specific “services” that pharmacists provide for which CVS measures quality? Counseling of patients? No! Potential allergic reactions identified and prevented? No! Intervention on behalf of a patient that results in a prescription that would place a patient at risk not being dispensed? No – unless it is a negative evaluation because one less prescription was dispensed and valuable time was consumed without any payment.)

(Editor’s question: Is it just a coincidence that the number of reductions in staffing levels is far greater than the number of increases in staffing levels?)

(Editor’s interpretation: “Management reserves the right to define “legitimate.”)

(Editor’s interpretation: Management will not take action that might be viewed as retaliatory based on the specific concern a pharmacist identifies. However, it is often able to allege a violation of some obscure policy, or inefficiency because of advancing age to discipline or fire a pharmacist.)

(Editor’s note: Presumably management knows the identity of the pharmacist and the particular pharmacy for which survey responses are provided. Is it surprising that a majority of responses were positive when pharmacists anticipate that a negative response would result in management holding them responsible for the negative culture and impose disciplinary action?)

(Editor’s note: This statement is true, but it faults the employees who voice concerns and demeans the validity of concerns.”)

(Editor’s note: Other jobs for pharmacists are not available in many parts of the country. A current CVS pharmacist has provided the best response to management’s flaunting a low turnover rate: “The turnover rate at CVS for pharmacists with another job offer is nearly 100%.”)

Other responses

The New York Times article immediately went viral and has elicited thousands of responses from pharmacists, consumers, and many others. The CVS press release response has also resulted in many responses, primarily from CVS pharmacists and pharmacy technicians who are highly critical of CVS management for the lack of credibility of its “defense.” Some of these comments, as well as my recommendations, will be included in Part 2 of this series in the March issue of The Pharmacist Activist.

As difficult as it is to have one’s employer criticized in the media, common sentiments of CVS pharmacists and technicians have been encouragement and appreciation to reporter Ellen Gabler and the New York Times for the awareness, understanding, and communication of the risks for patients and the working conditions experienced by CVS employees. As one CVS pharmacist states: “Thank you for this article.”

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