FU cancer! Sharing my journey to live and my strategies along the way.

http://www.youtube.com/@stage4pancreaticcancer

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https://linktr.ee/DocToks

 

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Back when most all State Pharmacy Practice Acts were codified into law, each pharmacy had to have a designated pharmacist as Pharmacist in Charge (PIC) and responsible to the board of pharmacy for making sure the pharmacy observed and adhered to the state’s Pharmacy Practice Act laws. Typically, since most pharmacies were independent pharmacies, the PIC was the pharmacist/owner of the pharmacy. Back when I opened my independent pharmacy in 1976, some 75%+ of all pharmacies in the country were independent pharmacies. I can remember a time when some independents were “Walgreen Agency stores”, I forget exactly when, but Walgreen canceled all those “agency ” contracts and then started expanding the company-owned pharmacies. At one point Walgreens was claiming that they were opening a new pharmacy every 15 HOURS – 7 days a week. They projected that their “saturation point” would be 12,000 stores. At one time they got up to 10K and now they are down to 8K stores.

Along the way, many states changed the term “Pharmacist in Charge” in the state pharmacy practice act, to “Responsible Pharmacist”. Maybe this was done at the request of chain pharmacies when they surpassed having > 50% of community pharmacies.  So these Pharmacists were responsible for everything going right – or – wrong in the Rx dept, but IN CHARGE OF NOTHING!

What’s Gone Wrong at Pharmacies? A CVS Store in Virginia Beach Holds the Answer

https://www.barrons.com/articles/pharmacies-medication-mistakes-cvs-e405367a

As pharmacist-in-charge—an official designation in Virginia—regulators expected Ward to have full control over the pharmacy. But neither Ward’s accomplishments, nor her status on a state permit, were enough to get the resources she believed were needed to run the pharmacy safely, mainly the budget for more staffing hours. Records reviewed by Barron’s show Ward at odds with corporate calculations that cut staffing in her store, despite the fact that the number of prescriptions filled there was on the rise.

When Ward ultimately resigned from CVS in early 2020—after three years at the Virginia Beach store—she sent a warning to the state’s pharmacy regulator. A note, written on her state permit, said she was leaving her position because of “dangerous working conditions due to corporate greed which resulted in sweatshop conditions.”

That note spurred a state investigation of the Virginia Beach store. A sample of 200 prescriptions reviewed by a Virginia inspector found a 37% error rate—some of those mistakes had the potential to harm patients, state regulators determined. Staff members described other errors to state officials, including one that sent a pharmacy customer to the hospital emergency room with an allergic reaction. Employees testified that they understood remarks by the store’s district manager as a threat to their jobs, and that they faced rising pressure to do more with less, including making customer calls required by CVS—even as their queue of unfilled scripts piled up.

CVS’ own store records showed that pharmacists at its Virginia Beach store logged 13 errors, such as “wrong dr-g” or “wrong strength,” between October 2019 and April 2020.

The investigation culminated in a $346,250 fine against CVS from Virginia’s pharmacy board in March 2022, as well as an indefinite probation for the Virginia Beach store. CVS has appealed the board’s order.

CVS declined Barron’s request to discuss specifics of the case, citing the continuing litigation.

The company is “committed to ensuring there are appropriate levels of staffing and resources at our pharmacies using a combination of staffing, labor hours, workflow process, and technology to do so,” a spokeswoman said in a statement to Barron’s.

The company spokeswoman said CVS has an “excellent safety record” and that dispensing errors are rare. “When we learn of a prescription error, the first priority of our pharmacy teams is caring for the patient, taking steps to correct the error, working with the patient and the prescriber,” she said.

Over the past several years, staff at chain pharmacies nationwide have sounded alarm bells about low staffing levels and grueling working conditions. This past fall, those concerns captured national headlines when some pharmacists staged walkouts across the country just as the busy vaccine season was under way.

Nearly 66% of pharmacy professionals reported burnout in 2022, according to the Well-Being Index, a survey developed by the Mayo Clinic, and 73% reported emotional problems—higher than rates for physicians, nurses, and medical students.

“I’ve made dispensing errors that I’ve caught. It’s not a matter of if, it’s just a matter of when,” says Catherine Cooke, a professor at the University of Maryland School of Pharmacy who studies medication safety. “We do need to think about the conditions in place that are contributing.”

Pharmacists have submitted anonymous reports on workplace conditions over the past two years to a portal launched by pharmacy trade associations. In the latest quarterly data, nearly 20% of reports included a near-miss medication mistake and 4% reported an error that resulted in patient harm.

In 2022, 82-year-old Jon Williams had recently been hospitalized in Florida and diagnosed with subdural hematomas—bleeding on the brain—when he and his wife went to their local CVS for his prescriptions, according to a lawsuit. Instead of receiving his prescription, he was given one intended for a “Johnny Williams,” the suit said—Eliquis, a blood thinner that can increase bleeding risk. After taking the wrong medication, the suit alleges, Williams suffered severe headaches and the hematomas grew in size, requiring surgery.

Williams returned home, but was hospitalized again that summer, and experienced a change in speech and a facial droop, according to the suit. CVS denied claims that it was negligent. The two sides agreed to settle in November, according to court records. CVS wouldn’t comment on the matter to Barron’s, and an attorney for Williams said he had no comment.

It’s difficult to get an industrywide picture of how common pharmacy mistakes have become. “There really isn’t good data about how many dispensing errors are occurring,” says Nancy Lewis, a researcher who co-chaired an American Public Health Association task force on medication safety. In 2021, the group estimated that nearly 2.3 million dispensing errors a year—roughly 6,200 a day—could potentially harm patients.

One factor clouding the issue is the use by chain pharmacies of so-called patient safety organizations, where data about mistakes are collected for analysis, but are typically kept private and cannot be subpoenaed.

The pharmacy industry is regulated by state boards of pharmacy, which are composed of pharmacy industry professionals—appointed by a governor—who monitor licensing and the practice of pharmacy. They have not historically imposed rules on how pharmacies must be staffed, though that is beginning to change in some states, including California and Virginia.

That’s part of what makes the Virginia pharmacy board case triggered by Ward so unusual. After two hearings, the pharmacy board issued its six-figure penalty against CVS—its largest in recent years—in March 2022. The Virginia Beach store’s indefinite probation meant that it is subject to unannounced inspections and required to submit quarterly reports on the number of staff hours and prescriptions dispensed every week. The board declined to comment further on the case.

In appealing the judgment, CVS called the fine “grossly disproportionate,” disputed the board’s prescription error data, and said “not a single patient was harmed due to any CVS alleged wrongdoing.” CVS also insisted that the board failed to explain how it calculated the penalty.

The case produced more than 1,000 pages of records and transcripts reviewed by Barron’s, the full extent of which hasn’t been reported previously. It’s a rare glimpse inside the way the pharmacy industry’s troubles have played out at the store level. Employee testimony at a state pharmacy board hearing in 2022, and Barron’s conversations with individuals involved with the case, show a pharmacy staff that felt frustrated and overwhelmed, district management that appeared unable or unwilling to address their concerns, and corporate decisions on staffing that seemed untethered to conditions at the store.

Ward, the CVS pharmacist whose complaint spurred the investigation, worried about speaking out. But she saw the situation in the pharmacy as untenable. “It was all about the hours. It was all about the money,” she tells Barron’s.

CVS #8302 on General Booth Blvd. in Virginia Beach is tucked into a leafy parking lot at the corner of a busy intersection—one of the more than 9,000 U.S. locations operated by the country’s largest pharmacy owner by revenue.

Despite the ubiquity of CVS, its retail pharmacy business has become an increasingly challenged business. The rising power of pharmacy-benefit managers, or PBMs, which control the amount pharmacies are reimbursed for the dr-gs they buy, has eaten away at store profit margins across the industry, even at CVS, which owns a PBM.

In 2023, CVS’ pharmacy segment accounted for roughly one-third of CVS’ $358 billion in revenue. Total prescriptions climbed to nearly 1.65 billion. While CVS’ pharmacy revenue rose 7.5% last year, adjusted operating income was down 8.7%. The company is in the midst of a three-year plan announced in 2021 to close 900 stores and shift those prescriptions to other CVS locations nearby.

The realities facing pharmacies were on full display at CVS’ investor day in December, when the company forecast lower pharmacy profits in 2024—and unveiled a new reimbursement model to shore up the retail side. “It’s time for us to chart a new course,” CEO Karen Ly–h said at the event. Executives reiterated CVS’ approach of the past decade: growing prescription volumes, improving operating efficiency, and selling lower-cost generic dr-gs, while “elevating the levels of safety, quality, and service to our patients,” said chief pharmacy officer Prem Shah.

Staff at the Virginia Beach store describe a different reality, telling state officials that corporate priorities put customers at risk. According to Ward’s testimony, despite being responsible for the pharmacy, she had no control over its staffing, which had proven inadequate given rising volumes. During Ward’s time at CVS, her Virginia Beach pharmacy was open 24 hours. The store typically had one pharmacist on duty, assisted by pharmacy technicians, whose budgeted hours could fluctuate week to week. In 2019, Ward’s team filled 11,000 more prescriptions than the prior year, while working with 1,500 fewer technician hours, according to records and testimony in the case; prescription volume rose 9% during 2019 as technician hours decreased 12.5%.

Victoria Ward, a former CVS pharmacist, resigned in early 2020. She later testified about poor working conditions at her store. Source: Virginia Beach Circuit Court  Staff in the pharmacy department tried to “root each other on” during difficult days, Ward testified. Still, the combination of too few workers and too many demands took a toll, employees told state officials. Some patients yelled when prescriptions weren’t ready. It could be hard to concentrate. After a holiday shift with only two people on duty, one technician said she “went home and cried her eyes out.”

The tone coming from a new district leader, who started in 2019, also troubled employees. During a staff conference call that July, he referred to recent layoffs at a competing pharmacy chain and said CVS pharmacists should be “happy” to have jobs, according to multiple accounts; staffers said they interpreted his comments as threatening their job safety. The impression he gave was that “pharmacists were basically replaceable, expendable,” one staffer testified.

In addition to filling more prescriptions with decreased staffing, Ward said that performance metrics set by CVS’ corporate office took workers’ focus away from the pharmacy counter. Her staff was required to make more than 100 “patient care queue,” or PCQ, phone calls each week, asking customers to refill prescriptions. An employee had to make three attempts to reach a patient, Ward said, and was required to do so even when, in her judgment, the patient was unlikely to need a refill yet.

Ward says that when she prioritized filling patient prescriptions over making PCQ calls, she would “get in trouble” with her district leader. “I would get text messages saying, ‘Hey, this is unacceptable. Why are these calls so low?’” she says. On Saturdays, when only two employees were scheduled to work, they had to juggle the PCQ calls on top of pickups, drop-offs, and the “drive-through going crazy,” said Ward.

Still, there was little Ward could do about the number of staffing hours budgeted. If she tried to add staff time to the scheduling system, she said she would get a message from a corporate employee telling her to cut hours. When she objected to a 70-hour reduction the week of Thanksgiving 2019, her district leader forwarded a note from CVS’ corporate scheduling team: the hours “are accurate based on labor budgets and recent script results.”

Later that month, Ward told her district leader that the pharmacy was “incredibly behind.” She texted, “Is there any way I can get a few extra hours to catch up. Not asking for much.” The manager responded: “Unfortunately there’s a clear message to stay under hours week to week, that’s what we’re given and expected to use to get the work completed.”

When pressed by a state inspector, CVS offered limited details about the scheduling system. In response to a state subpoena for policies and procedures on scheduling, a lawyer for the company said, “CVS does not have policies related to pharmacy scheduling.” The lawyer said, “hours are determined by CVS’ Workforce Management Team,” a corporate group, and that guidance on hours reflects “a number of factors,” including budgeted prescriptions and “recent trends.” The pharmacist in charge doesn’t determine the number of staffing hours needed “in part to lessen the burden of his/her administrative tasks,” the lawyer said, and because he or she “does not have access to all of the factors used to determine and plan for anticipated workforce needs.”

An excerpt from Victoria Ward’s testimony to the Virginia Board of Pharmacy in February 2022. Source: Virginia BEach circuit Court
Ward told the pharmacy board she was never given an answer to the question of why her staff hours were shrinking as prescription volume went up. With her team filling about 500 to 600 prescriptions a day, she said, they were left open to “a lot of potential mistakes.”

In its appeal, CVS referred to the characterizations around staffing levels as “subjective opinions of a small handful of pharmacists and technicians.” Virginia has since issued new pharmacy staffing regulations aimed at preventing fatigue and distraction.

CVS told the state inspector that it reports mistakes to a private entity called a patient safety organization. PSOs, authorized under a 2005 law signed by President George W. Bush, were created to encourage healthcare providers to report and learn from mistakes. As an incentive to disclose mistakes, the legislation granted confidentiality protections for information reported to a PSO. The law gives latitude for how these PSOs are controlled and operated; CVS in 2014 established a PSO called Enterprise Patient Safety Organization. Virginia law allows companies to use PSOs to satisfy the state’s own obligations around analyzing prescription errors.

During Virginia’s investigation, CVS cited the confidentiality provisions of the federal law in declining to provide additional information about dispensing errors.

CVS told Barron’s it encourages staff to report errors without fear, which “allows us to learn from our mistakes and work to continuously improve our systems to support pharmacy teams in providing patient care, in partnership with our PSO.”

But pharmacy employees said understaffing contributed to mistakes. Multiple employees said that one patient was dispensed 100 extra tablets of Percocet, a schedule II na—–c. Ward testified that she discovered the error when she noticed the store’s inventory counts were off. She said she called the patient, and another staffer testified that the patient didn’t want to come back to the pharmacy to return the extra amount. According to Ward, she asked CVS if she should report the incident to the Dr-g Enforcement Administration, as is required when controlled substances are lost or stolen. “I was told by corporate not to, because we know where it [the medication] is,” Ward testified.

The Virginia pharmacy board cited the Percocet error in its final ruling. CVS, in its appeal, said two staffers who reported the incident to the state investigator had no firsthand knowledge of the event.

In another incident, a pharmacy technician said that in 2019, a customer came to fill a prescription for his son on a night when the pharmacy was “slammed.” The father was given the wrong dr-g, according to the staffer, with consequences: The “son had an allergic reaction and was taken to the emergency room.”

Afterward, the father “didn’t sue or complain,” the technician said. “He felt bad for the CVS staff.”

Pharmacist Kellye McNulty recalled working Thanksgiving Day 2019—the week of staff cuts that Ward found extreme. McNulty says she had to work alone part of the shift and almost walked out because it was so stressful. A CVS lawyer at the pharmacy board hearing said a different pharmacist was listed to work that day and a technician was scheduled to be on duty; McNulty testified that she switched with the other pharmacist and the technician didn’t stay the whole time.

McNulty had taken shifts at more than two dozen CVS pharmacies in the area. She considered all of them to be understaffed. When she came to Ward’s pharmacy, McNulty said she ran around enough to break a sweat. “You go fast, you just get it done, and you are going to hurt somebody,” she told the state pharmacy board. “It’s just a given. And as a pharmacist, that’s your worst fear. Corporate will survive if they ki-l somebody but is a pharmacist going to?”

Signs outside a CVS store in Virginia Beach. In 2022, the company instituted a national lunch break for most of its pharmacy counters. Photograph by Jeremy M. Lange
The issue of insufficient breaks for pharmacy staff frequently came up in the Virginia testimony. In 2022, CVS implemented a national lunch break for its pharmacies, with most store counters closing from 1:30 to 2 p.m. daily.

In December 2019, in Ward’s final months on the job, her frustrations spilled over during a store visit with her district leader and a regional loss-prevention manager. “I told them that someone was going to die with these working conditions,” she testified. The visiting manager told Ward that her district leader was “not the one to blame” about the schedule, and that “this is from corporate,” according to her testimony.

The district leader, who was later replaced, told the state inspector that he didn’t recall the specifics of the exchange. CVS didn’t make the loss- prevention manager or four other corporate employees available for interviews with the state inspector.

Ward believed she’d done all she could do. She gave her two weeks’ notice in January 2020.

When the Virginia pharmacy board heard the case in February 2022, Ward was one of the first to testify. She says it was scary to face CVS, but also: “I knew I had a point.” The proceeding stretched well into the night. Two technicians who testified that day had left pharmacy work behind for another industry. One of the board members who voted to penalize the company for understaffing was himself a former CVS district leader, who worked more than 30 years at the company.

McNulty stopped taking shifts at CVS early last year and said she is no longer employed there. She still works at a hospital pharmacy in Norfolk, Va. Despite the stressors at CVS, she says she kept working there because she loved talking with patients and explaining their medications to them. Some nights it felt like she had groupies. But there’s no love lost for CVS. The fine the company received in the pharmacy board case? “Coffee change,” she says.

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I have often heard politicians/bureaucrats say “No one is above the law”, but it seems the more appropriate phrase would be, “No one is above the law except those who are in charge of enforcing our laws”

DATA is the NEW GOLD RUSH. This week, a graphic with text popped up on FB, and as I read it.. It appeared to be a psychological profile of ME! I asked Barb to read it.. One of her comments was about at least one sentence in the text, where she said, “I’ve heard you say this about yourself” It was no more than 100 words. The overall context of the graphic did not surprise me, I am pretty aware of who I am, the fact that FB could create such a concise of who I am.

Frontier. Now the fastest supercomputer in the world, it can perform more than 1 quintillion (10¹⁸) floating-point operations per second. That’s a 1 followed by 18 zeros, also known as an exaflop. Essentially, Frontier can perform as many calculations in one second as 100,000 laptops. In the US, researchers are installing two machines that will be about twice as fast as Frontier

I have read about people scoffing at the idea of having an implanted chip. 85% of adults have a smartphone. The only way that a person can keep a smartphone from tracking you is by wrapping it in Aluminium foil. I have not seen anything to confirm or deny, when the phone says the battery is DEAD, is it really dead, or does it have the “juice” to continue to ping cell towers to track you?

I know of one chronic pain pt who had an implanted morphine pump and the pt lived in a “Mayberry town” and one of the local police officers was your “Barnie Fife” type of cop. “Barney” somehow found out that this person had this implanted pump and at the time, the state this person lived in had a ZERO TOLERANCE, and every time this “Barney” saw this person driving… he would issue a ticket for a DUI. This person ended up buying and driving a dozen different cars, licensed and insured in his wife’s name. Making it harder for “Barney” to spot him.  This person went to the state capital and convinced the legislature to amend the state law to exempt chronic pain pts from ZERO TOLERANCE.

There are cities with cop cars riding around with license plate readers. Just imagine, when – if they aren’t already – interfaced. A plate reader tells a cop in a patrol car, that the person the car is registered to has Rxs for controlled meds, would the “Barney Fife” type cop pull them over to see if they have any controlled meds on them that are properly labeled? That is technically ILLEGAL!

What could really be scary, is when – NOT IF- we go to all digital money, the Federal database will know every purchase you make or could block you from purchasing certain items. The possible combinations of means of invoking controls on all of us … are virtually endless.

The articles listed below are not conspiracy theories, Congress has had high-ranking Federal officials in front of Congressional hearings, under oath, who have refused to confirm nor deny these things are going on.

Here are a few examples of what our DOJ/AG is doing that would support the statement in the first sentence of this post:

ATF keeping database of nearly 1-billion records of gun sales

The federal government is prevented by law from establishing or maintaining a database of gun owners, but that’s not stopping the Biden administration from collecting and digitizing millions of firearms transactions conducted by FFLs across the country.

Alarming’ surveillance: Feds asked banks to search private transactions for terms like ‘MAGA,’ ‘Trump’

Federal investigators asked banks to search and filter customer transactions by using terms like “MAGA” and “Trump” as part of an investigation into Jan. 6, warning that purchases of “religious texts” could indicate “extremism,” the House Judiciary Committee revealed Wednesday. the committee also obtained documents that indicate officials suggested that banks query transactions with keywords like Dick’s Sporting Goods, Cabela’s, Bass Pro Shops and more. The House Judiciary Committee and its subcommittee on the Weaponization of the Federal Government have been conducting oversight of federal law enforcement’s “receipt of information about American citizens without legal process and its engagement with the private sector.”

DEA Pursues Vast Expansion of Patient Surveillance

The Pharmacy Prescription Data system, as the RFP calls it, would cede patient-level data to the federal drug-war agency to a far greater extent than comparable existing databases. The current Automated Reports and Consolidated Orders System (ARCOS), created by the Controlled Substances Act alongside the DEA itself, only monitors controlled substances’ manufacture, supply chains and distribution. 

RFP for DEA’s Prescription Data Software
The DEA’s desired ability to search controlled-substance prescriptions to this degree targets seemingly mundane behaviors—like the number of times a patient paid in cash for a Schedule II substance like Adderall or OxyContin, or the geographic distances between patients and their prescribers and pharmacies.

The US dollar could go digital. Here’s what you need to know

the United States is the latest to signal “urgency” in researching a potential digital version of its dollar via a Central Bank Digital Currency, or CBDC.

Part of President Joe Biden’s executive order regarding digital assets on Wednesday includes “placing urgency on research and development of a potential United States CBDC, should issuance be deemed in the national interest,” according to an accompanying fact sheet released by the White House. All told, around 100 countries are exploring CBDCs at one level or another, International Monetary Fund managing director Kristalina Georgieva said during remarks at the Atlantic Council think tank last month. 

Automatic License Plate Readers: Legal Status and Policy Recommendations for Law Enforcement Use

They also leave a data trail. Historically, it would have been virtually impossible for law enforcement to routinely surveil all drivers. However, with the growing use of automatic license plate readers (ALPRs), police can now receive alerts about a car’s movements in real time and review past movements at the touch of a button. ALPRs could prove valuable in police investigations and for non–law enforcement uses like helping government agencies to reduce traffic and curb environmental pollution. But legal and policy developments have failed to adequately address the risks posed by this highly invasive technology

 

 

 

 

 

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In 2017 Rite Aid had abt 4500 stores, in 2019 Rite Aid had a 20:1 REVERSE STOCK SPLIT which moved its stock that was < 1.00 up to in the low $30/share range.  Recently – pre-bankruptcy – the stock price was again < $1.  Anyone who owned Rite Aid stock when it officially declared bankruptcy, their shares became WORTHLESS.  Rite Aid is now left with 1600 stores, which may be “sold off”.  If they are sold off, most likely, the “BIG BOYS” will come in and will buy those stores up at fire sale prices and most stores will be closed and Rx business transferred to one of their closest stores. I have seen times when there is no close store and they have closed down the store, rebuild a new store in their “footprint” and reopen the stores under their name.  How many “pharmacy deserts” will be created, will not be known until all the dust settles from the bankruptcy.

The Scoop on Rite Aid from Anonymous:

As of yesterday we are “Rite Aid 2.0” – the closures of 600 stores are over. Selling to competitors isn’t out of the question however. 2/3rds of middle management is gone. 50% of pharmacy DMs and 75% of retail DMs. Elixir sold for $575m. AP was cut in the field significantly. Each pharmacy DM was put up to 30 stores. There’s now 5 divisions instead of 10. 58 regions instead of 111. Conference call yesterday was basically explaining the restructure and saying if you’re here now your store isn’t closing and your job is safe.

The asset sale ended 2 days ago. The auction allowed anyone to bid on anything, but RA can choose whether or not to accept the bids. All remaining 1600 stores are profitable.

Lots of various administrative office workers in corporate, positions that didn’t add value, etc. so payroll went WAY down. Store employees basically weren’t affected. Things are looking up unless they sell to CVS or WAG, or if they go to Ch. 7 somehow.

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CVS pharmacist’s death becomes a cautionary tale of crushing stress at work

https://www.usatoday.com/story/news/investigations/2024/02/08/cvs-pharmacist-ashleigh-anderson-death-rallying-cry/72406578007/

On the morning she died, Ashleigh Anderson researched her symptoms.

Nausea.

Jaw pain.

Chest pain.

Cold sweats.

“I think I am having a heart attack,” the 41-year-old texted her longtime boyfriend from the CVS store in Seymour, Indiana, where she had just begun her shift as the sole pharmacist on duty.

It was Sept. 10, 2021. Retail pharmacy was reeling from the pressures of the pandemic, and frontline workers like Anderson were dangerously burned out. For months, they had been filling prescriptions and vaccinating patients without bathroom breaks or a bite to eat.

Anderson’s phone buzzed.

“I hope not!” replied her boyfriend, Joe Bowman, who suggested the symptoms could just as easily be indigestion, stress or something with her lungs.

Anderson was a smoker, and her job induced plenty of stress. But she had just been to the doctor two weeks earlier and, according to her family, received a clean bill of health.

“Can you take a long lunch and decompress?” Bowman asked.

“I can’t,” she texted back.

The CVS in Seymour was a 24-hour store whose pharmacy counter never closed, not even for lunch. Patients came at all hours to pick up medications, ask questions and get shots. It was a relentless grind made worse by the recent departure of two staff pharmacists and the pharmacy manager. In their absence, the remaining crew struggled to fill the hundreds of prescriptions coming in each day and had soon fallen behind by more than 1,000.

Tensions were especially high that week after Anderson learned her boss had assigned her the role of pharmacy manager despite her repeated refusals to take the promotion.

“I am livid,” she messaged a coworker four days earlier when she discovered the change in the company’s HR system.

State law at the time required every pharmacy to designate a pharmacist in charge, someone to hold accountable for complying with regulations and to discipline for violations.

But Anderson didn’t want the extra responsibilities. After 17 years with CVS, including previous stints as a manager, she was content being a regular staff pharmacist. She could clock in, clock out, and go home to Bowman and her beloved basset hounds without the job following her there.

If anyone could handle the gig, though, it was Anderson.

Whip-smart, selfless and dependable, she had managed one of the busiest CVS pharmacies in Indiana just a few years out of college. When a historic flood inundated her store in 2008, she kept working until the National Guard arrived in boats to rescue everyone. The following year, she won the company’s highest honor, the coveted Paragon Award.

Anderson was calm amid chaos. But that morning when she texted Bowman, she was worried.

If she was having a heart attack, she needed immediate medical attention. But if she left without another pharmacist to take her place, she would have to close the counter. Prescriptions would get even more backed up. Patients would be upset. And the store’s performance, closely tracked by a series of corporate metrics, would suffer more than it already had.

Anderson couldn’t reach her boss, so she texted his assistant at 10:11 a.m.

“I know this sounds crazy but I am having symptoms of a heart attack. Can you get someone here long enough for me to go to the ER and get checked out?”

Three minutes later, the assistant called. The two spoke briefly, then hung up.

“I talked to Jessica,” Anderson texted Bowman, referring to the assistant. “She told me to close and go, but I told her to find someone if she could.”

Bowman replied: “Are you coming home or going to the closest ER? Do I need to pick you up?”

Home was 35 minutes to the south, in Henryville, Indiana. The closest emergency room was just down the street, at Schneck Medical Center. Anderson could drive there in three minutes.

The assistant called again, and the two spoke for 46 seconds.

Then Anderson sent Bowman what would be her final text: “Bob is coming now. I will go to Schneck here. Hopefully it’s nothing and I will come back to work.”

Fifteen minutes later, Anderson collapsed on the pharmacy floor.

A customer who happened to be a nurse raced behind the counter and started CPR while a pharmacy tech called 911, a coworker told USA TODAY.

First responders arrived within minutes. They ventilated her. They gave her chest compressions. They jolted her with a defibrillator. Nothing made a difference. They loaded her onto an ambulance and drove her to the emergency room at Schneck. Her pupils were fixed and she had no pulse.

Staff at Schneck administered three rounds of epinephrine to stimulate Anderson’s heart, but it had long since stopped pumping blood. Her skin became mottled.

She was gone.

An autopsy later revealed severe atherosclerotic cardiovascular disease with 99% blockage of her left descending coronary artery, leading to what’s referred to as a “widowmaker” heart attack.

“If she had gone in quickly when she realized she was having a heart attack,” said Dr. Eric Topol, a longtime cardiologist and the executive vice president of Scripps Research, “the artery would have been opened up, and she most likely would have survived.”

By waiting, Anderson had made the ultimate sacrifice to an industry that notoriously demands too much of its workers.

Corporate culture’s role blamed in Anderson’s death

Over the past decade, corporations like CVS, Rite Aid, Walgreens and Walmart have steadily slashed pharmacy staffing levels while saddling remaining employees with a burgeoning list of additional duties.

Stores that once had two pharmacists and six pharmacy technicians filling an average of 500 prescriptions a day now may have half the staff and an even higher prescription volume – plus an endless crush of vaccine appointments, rapid COVID tests and patient consultation calls.

Every task is timed and measured against corporate goals that reward speed and profits. Staff who do not fill prescriptions fast enough, answer the phones quickly enough or drum up enough vaccination business can face discipline, reassignment or termination.

Read USA TODAY’s investigation:Prescription for disaster: America’s broken pharmacy system in revolt over burnout and errors

No chain exemplifies this ethos more than CVS, dozens of current and former pharmacists told USA TODAY. Many recalled how they have been pressured to work through sickness, physical injuries and mental breakdowns.

One pharmacist said her boss refused to give her a day off even though she was suffering a full-blown panic attack. Another said he was asked to stay behind the counter instead of taking his injured son to the emergency room. Two pharmacists said they worked while actively miscarrying because their bosses couldn’t find anyone else to cover their shifts.

“You’re just programmed that if you’re sick or you need to go home, you can’t. You have to wait until someone comes,” said Wendy Lear, a former CVS pharmacist who worked while miscarrying.

Although she had never met Anderson, Lear knew her name.

They all did.

Word of Anderson’s death spread like wildfire among retail pharmacists. It became a cautionary tale of corporate martyrdom. It spawned a hashtag, #SheWaited, and a social media campaign that urged pharmacists to listen to their bodies, stand up to their bosses and take care of themselves.

Not long after she died, a bright orange billboard went up on Interstate 65 in Indiana, between Seymour and Henryville. It featured a photo of Anderson along with the hashtag and a simple message: “Your job can wait, your heart can’t.”

Anderson’s family had paid for the sign.

“We were trying to get exposure to this, because we thought it would gain media attention, and CVS would have to deal with this on some level,” said Larry Anderson, Ashleigh’s father. “But unfortunately that didn’t pan out.”

USA TODAY interviewed Anderson’s father and stepmother, her long-term boyfriend and 10 former colleagues who worked with Anderson at various times during her career with CVS. Many of them described Anderson’s dedication to a job that, some of them believe, ultimately killed her. Some of those colleagues still work for the company and spoke on the condition of anonymity to protect their jobs.

The media organization also examined text messages and calls to and from Anderson’s phone the morning she died, as well as reviewed a summary of her final moments detailed in a coroner’s report obtained through a public records request. A reporter additionally spoke to dozens of retail pharmacists from CVS and other chains across the country about the conditions and demands of the job.

Taken together, the interviews and records paint a portrait of an industry that conditions employees to work beyond their limits and put their own needs behind those of the job. So strong is the culture that those close to Anderson say that even when she got permission to close the pharmacy, she must have decided it was in her best interest to wait for backup before seeking help.

“She was, in our opinion, afraid to go to the emergency room and be told, ‘No it’s not a heart attack at all, it’s just anxiety,’” said her father, Larry Anderson. “Because then she would have to come back and face her bosses.”

Michael DeAngelis, CVS’ executive director of corporate communications, called Anderson’s death a “tragedy that never should have happened.” He pushed back, though, on the notion that CVS bears responsibility for her death, noting that she was told to leave and highlighting the company’s “culture of safety.”

Under no circumstances, he said, does CVS expect or want its employees to work when they are unwell, and it encourages them to seek medical treatment when necessary.

“It’s impossible for me to comment on why Ashleigh made the decision she made,” DeAngelis said. “I think, by and large, pharmacists are highly dedicated health care professionals, and I would not be surprised if there are pharmacists who have the mindset of, ‘I need to keep taking care of my patients,’ versus ‘I’m afraid of being punished by my employer.’”

Although they acknowledge Anderson alone made the call to wait, Larry Anderson and his wife, Donna, still blame CVS for her death. If the company cared about its employees, Anderson said, it would have properly staffed its locations so that no one pharmacist was stuck behind the counter, reluctant to leave.

“There is an intimidation factor,” Larry Anderson said. “You don’t feel like you can take your lunch. If you have a doctor’s appointment, you’re extremely reluctant to do it. You just can’t be away from work.”
Pharmacist was a rising star at CVS

Anderson grew up in and around Lafayette, Indiana, the eldest child and only daughter of Larry and his first wife, Nancy.

As a girl, Anderson was adventurous, spirited and naturally gifted. She excelled at everything, especially academics, and she had a soft spot for animals. Friends and family often called her “the smartest person in any room.” She didn’t even have to try.

She graduated high school as class valedictorian, and attended the prestigious Purdue University, located in her hometown. Anderson could have chosen any major, but she gravitated toward medicine and especially liked the idea of becoming a veterinarian. The only problem: She hated the sight of blood.

“She was maybe a year or two into college when she decided to go into pharmacy,” her father said. “Pharmacy was an option that allowed her to be in the medical field without seeing a lot of blood.”

Anderson threw herself into her studies, learned everything she could and earned a doctorate of pharmacy in 2004. She was 24 years old. Bursting with optimism and eager to prove her worth.
Ashleigh Anderson (center) graduated from Purdue University in 2004 with a doctorate of pharmacy. She is pictured here with her parents, Larry Anderson and Nancy Rockstroh, at her graduation ceremony.

No one was surprised when she quickly landed a job. CVS was lucky to get her, they thought. Anderson felt like she was the lucky one. She loved everything about her work as a retail pharmacist – the fast pace, the stimulating environment, the patient interactions. It was endlessly challenging, and Anderson relished a challenge.

Her coworkers soon took note.

“I knew right from the start that she was going to be our next boss,” said Trish England, who worked as a pharmacy technician at the CVS in Columbus, Indiana, where Anderson started her career. “She was a rising star. She was the best pharmacist we had. They praised her for everything she did.”

CVS soon promoted Anderson to pharmacist in charge at one its busiest locations in the state. Employees working in Columbus at the time recall handling between 3,000 and 6,000 prescriptions a week.

Anderson thrived in her managerial role. She was a master of the pharmacy who could rattle off the answer to any question, efficiently clear a queue of backlogged prescriptions and make patients feel like she really cared.

She ran a tight ship, her coworkers said, and was an absolute stickler for quality control.

“CVS has a thing where technicians count prescriptions out and put them in a box that takes a picture and sends it to the pharmacist to verify and look at it,” said one pharmacy technician. “She made us take the pills and bundle them in groups of five so she could count them herself. We all grunted, like, ‘Why do we have to do this?’ But it was all for patient safety.”

Anderson’s competency initially intimidated some of her coworkers, who said they thought she was “scary” or “cold” until they got to know her. Then they became fiercely loyal, describing her as a true friend whose warmth was surpassed only by her wit.

Managers at other stores sent their pharmacists to Columbus to train with Anderson. Around the time she won the company’s Paragon Award, she was invited into its emerging leaders program, a stepping stone to upper management.

Anderson set her sights on a district leader position, a role overseeing a dozen or so pharmacies and ensuring they hit their corporate targets. She seemed a shoo-in for it.

“She was one of the best pharmacists in the area,” recalled a CVS pharmacist who was sent to train under Anderson. “She was the kind of pharmacist people wanted other pharmacists to be.”

Then, one day, Anderson stunned her coworkers by leaving it all behind.

In August 2013, she abruptly transferred from the Columbus location to a lower-volume CVS in Greensburg, Indiana, where she worked an overnight shift as a staff pharmacist. She dropped out of the emerging leaders program. She stopped talking about career advancement.
Ashleigh Anderson is buried at Tippecanoe Memory Gardens in West Lafayette, Indiana. Atop her grave sits a large headstone, upon which are etched five drawings representing the most important parts of her life. A basset hound, a golfer, a palm tree and two half-full wine glasses each appear in one of the panel’s four corners. Occupying the most prominent spot in the middle is a mortar and pestle – the iconic symbol of a pharmacist.

It made no sense, her colleagues said. Some figured she just needed a change. Others assumed corporate forced her out for falling short of its rising targets.

“It was always numbers, numbers, numbers – you have to hit your numbers,” said a pharmacist who worked with Anderson in Columbus. “The district manager would come in and be like, ‘How come you can’t hit this number? How come you can’t hit that number?’”

At the same time, he said, the store’s prescription volume was exploding as staff size steadily dwindled. CVS decided not to replace a pharmacist who had recently left, and there were fewer technicians at any given time.

“Working conditions just got worse and worse and worse,” England recalled. “The more we did, the more they expected us to do.”

When the numbers fell too far behind, “they took her out.”

But one former colleague said Anderson’s performance at the store wasn’t the issue. It was an ethics hotline complaint that led to her removal.

A pharmacy technician took offense at the way Anderson had handled a situation, said the former colleague, a longtime CVS administrator who worked closely with Anderson over the course of her career.

“She was snappy,” the colleague said of Anderson. “You have to be snappy in that job, but one day she said something in the heat of the moment that she probably should not have said.”

Human resources investigated the complaint, the colleague said, and determined Anderson should step down. The decision gutted Anderson, who felt she did not get a fair hearing.

“They knocked her down a peg,” Donna Anderson said. After that, she stopped trying to be anything more than a staff pharmacist.

Anderson spent the next several years commuting from Columbus to the CVS in Greensburg and then the one in Shelbyville and then the one in Nashville, Indiana. All were within 30 miles of her house.

When she and Bowman bought a newly constructed home in Henryville, 50 miles to the south, Anderson sought a shorter commute.

She found it in Seymour.
Anderson feared dying alone

The final CVS in Anderson’s career sat at the intersection of a busy commercial strip, flanked by a large parking lot, which on that late summer morning was teeming with emergency vehicles.

Khandie Tharp would have seen them had she pulled in just minutes earlier. But the pharmacy tech was late for her shift, and, by the time she arrived, the lot was eerily empty except for two crying coworkers.

One of them approached Tharp as she got out of her Mustang to tell her what had happened. Distraught, Tharp got back in her car and drove to the hospital.

During her 18 months working at the Seymour CVS, Tharp had bonded with Anderson. The experienced pharmacist had taken the new tech under her wing and given her the support she needed to excel in an environment rife with seemingly endless tasks.

In rare lulls, the two shared details about their lives and learned they had a lot in common. As neither of them had any children, they confided in each other about their fears of dying alone.

Tharp was determined that morning not to let that happen.

She introduced herself to the emergency room receptionist and asked that someone inform Anderson of her presence. Since she was not family, staff could say nothing about her friend’s condition but promised to let someone know Tharp was there.

And then she waited.

“I wanted her to know that somebody was there for her,” Tharp said. “I was there for her.”

Bowman was at home when his phone rang. The call came from the CVS store in Seymour, and when he answered, he heard the rattled voice of another pharmacy tech saying Anderson had collapsed and that paramedics were on their way.

Bowman jumped in his vehicle and kept a lookout for state troopers as he sped north on I-65 to Schneck Medical Center, not knowing what he would find when he got there.

Tharp greeted him when he arrived. The two had never met, but she recognized him from photos Anderson had shared. Bowman was grateful she was there.

A doctor appeared and asked Bowman to follow him into a room. Bowman knew right then that Anderson was gone. He remembers feeling his feet carry him into the room and his ears listen to the doctor explain that her heart had stopped.

The explanation ended, and Bowman was led into another room. This one held Anderson’s body. Bowman was given time to say goodbye.

Time passed – five minutes, an hour, an eternity – before Bowman reappeared in the waiting room. He looked at Tharp and shook his head. She knew then, too. Tharp felt her knees buckle. Bowman caught her before she fell. Then the two strangers cried together in the hospital over a woman they both loved.

It was Bowman who broke the news to Anderson’s parents.

When they saw his number pop up on their phone, Larry Anderson said, he and Donna figured Bowman was calling to thank them for the large patio umbrella they’d had delivered that morning to his house.

Instead, Larry Anderson said simply, “What a shock.”
Family seeks answers amid misunderstanding

When the shock wore off, the family wanted answers as to how a seemingly healthy, active woman in the prime of her life could collapse and die at work.

They knew CVS had expected Anderson to work through lunch breaks and bathroom breaks, that she felt pressured to come in even when she was sick. They knew her job stressed her. Now they wanted to know if it killed her.

Larry Anderson said he found the numbers for his daughter’s boss and his assistant and called them, but neither one would talk.

“After two or three attempts, her boss finally did talk to me, but he was very careful of what he would say to me,” Larry Anderson said. “He said he had been instructed not to answer (questions) and said ‘I shouldn’t even be talking to you.’ But he was trying to be nice.”
Members of Ashleigh Anderson’s family stand next to her gravestone in Tippecanoe Memory Gardens in West Lafayette, Ind. From left are her stepfather Mike Rockstroh, mother Nancy Rockstroh, stepbrother Jeremy Stockdale, brother Nate Anderson, father Larry Anderson and stepmother Donna Anderson.

Even the company’s gesture of establishing a scholarship in his daughter’s name at Purdue fell flat, he said, when CVS made a one-time donation of $10,000 that December instead of sustaining it annually as the family thought it would. 

DeAngelis denied that CVS avoided conversations with the family or that it ever committed to funding a scholarship beyond the one-time donation. 

“We regret if there was any misunderstanding,” he said.

Misunderstanding was taking root online, too. Messages about Anderson’s death started appearing on Facebook, Reddit and Twitter. They claimed her bosses had forbidden her from seeking immediate medical attention and made her wait until a backup pharmacist arrived. 

Among those who saw the posts was Bled Tanoe, a former Walgreens pharmacist who amassed a large online following advocating for better retail pharmacy working conditions under the hashtag #PizzaIsNotWorking – a nod to companies’ hollow offerings of free pizza to appease stressed employees.

Anderson’s death struck Tanoe as further evidence of an industry that mistreats its employees, she told USA TODAY. She wanted to amplify the story and create a new hashtag around it. So she reached out to CVS pharmacists in Indiana to verify the story. They confirmed that Anderson could not leave, according to messages Tanoe shared with USA TODAY. 

In October, Tanoe launched the #SheWaited hashtag, and the story exploded among retail pharmacists online. By the time Tanoe heard the details might not be correct, she said, her sources had either stopped talking or were no longer sure, and the story had already taken on a life of its own. 

Regardless, Tanoe said, the message behind the movement she started remains the same.

“It is established in our profession, there is a culture where you cannot put yourself first,” said Tanoe, who also is the vice president of the online pharmacist advocacy community, RPhAlly. “It might not be written in a handbook and they would never say it to your face, but the message, through their actions, is that the company comes first.”

In the two years since her death, Anderson’s name has transcended social media. 

It now echoes through the college classroom of Haley Howard, an assistant professor of pharmacy practice at Manchester University in Fort Wayne, Indiana, where she teaches first-year students about professional self-advocacy.

Howard uses Anderson’s story to remind her students that they have a right to reasonable working conditions and to voice their concerns. Most importantly, she tells them, they can’t fulfill their duty to care for their patients if they don’t take care of themselves first. 

It’s one of several examples Howard includes in an accompanying slide show that shares advice with future pharmacists about how to advance their careers at a time when many are leaving the profession and enrollment to pharmacy schools is in decline.

Howard, who also works as an acute care pharmacist at Cameron Memorial Community Hospital in Angola, Indiana, never met Anderson. But she said she heard about her death from a fellow pharmacist who had heard about it from somebody else. It felt, she said, like a wake-up call that more people needed to hear.

“Pharmacists need to be in safe working environments,” Howard said. “I wanted to share with my students and say, ‘This stuff happens in pharmacy, and it shouldn’t be happening.’”

Emily Le Coz is a reporter on the USA TODAY investigations team. Contact her at elecoz@usatoday.com or on X @emily_lecoz.  

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