For you those of you who haven’t had your head stuck in the sand for the past 6-12 months…you are probably aware of the situation on the east coast where a RPH got into a “pissing match” with a non-pharmacist store manager over the a drive thru window remaining open.. when the RPH was one tech down and in the first 7 hours of this particular day (a Friday before the long Monday July 4th holiday in 2011) ~ 300 Rxs had been filled/verified. The RPH-DM.. got into the matter – via the phone – and insisted – via the non-RPH store manager that the drive thru window remain open.
Apparently, this non-RPH store manager, RPH-DM believes that their authority, and one must presume that their attitude reflects the attitude of their corporate employer, was the ultimate authority… and that patient safety and medication errors were of secondary concern over generating revenue. If one would make a guess.. it would be the cost of settling mediation errors has yet to exceed the profits generate by the concept of filling all the Rxs that you can… with the smallest/least amount of man hours that you can.
In this state, the preliminary action by the board is done as a mediation, with just one Board member present as mediator. If an agreement is reached, the full BOP then votes to accept or reject the agreement of the mediation.
In the end… all three entities involved – permit holder – RPH-DM & RPH/PIC were issued a WARNING LETTER…
Here are some of the excerpts from three of those letters:
For the Permit holder… Here is the allegation:
The permit holder permitted the PIC to dispense a high volume (451 Rxs) while working alone, and at times, to supervise five techs, which is in excess of the number permitted by a waiver granted by the BOP. Also, the permit holder and RPH-DM, caused a non-RPH store manager to enter the pharmacy, open the drive thru window on the same date, in violation of pharmacy law.
Response from the BOP in the WARNING LETTER :
You – permit holder – are warned that it is the legal responsibility of the permit holder to follow all laws regarding volume of prescriptions and technician supervision. In addition you are WARNED to defer to the PIC judgment regarding the safe operation of the Pharmacy. The state’s practice act…makes it clear that the PIC is the person who has “responsibility for the operation of the pharmacy in conformance with all statues and rules pertinent to the practice of pharmacy and distribution of drugs”
The representative board member present believed that the non-pharmacist store manager had indicated to the RPH-DM that the PIC objected to the opening the pharmacy drive thru and that under the circumstances of this case, it was unreasonable for the RPH-DM to send the non-RPH store manager to open the drive thru without even consulting the PIC.
For the RPH-DM… here is the allegation:
The RPH-DM caused a non-pharmacist store manager to enter the pharmacy and open the drive thru, in violation of the practice act.
Response from the BOP in the WARNING LETTER :
The representative board member present believed that the non-pharmacist store manager had indicated to the RPH-DM that the PIC objected to the opening the pharmacy drive thru and that under the circumstances of this case, it was unreasonable for the RPH-DM to send the non-RPH store manager to open the drive thru without even consulting the PIC.
For the PIC … here is the allegation:
You dispensed a high volume of prescriptions (451) while working alone, and at times, supervised five techs on July 1, 2011, in excess of the number permitted by a wavier granted by the BOP.
Response from the BOP in the WARNING LETTER :
You are warned that it is the legal responsibility of the PIC, as well as the permit, to follow all laws regarding volume of prescriptions and tech supervision.
Author’s OPINION/COMMENTARY…
I am not licensed in this state, so I don’t have a intimate working knowledge of this particular’s state practice act, but having practiced pharmacy for 42 years.. I think that I have a general knowledge of what most practice acts have in common.
In these letters there is no:
- addressing breaking the 12 hr work rule that is part of this state’s practice act – no cease and desist
- addressing the failed meal/rest break – mandated per state practice act – no cease and desist
- addressing the exceeding the volume/shift that the practice act deems dangerous – no cease and desist
- addressing the mandatory counseling – at least the federal law under OBRA 99. – no cease and desist. – Unless someone can tell me – or anyone – how you can supervise up to five techs, check/fill one Rx every 80 SECONDS and provide even the most minimum of consulting.. I would like to see how this can happen.
- the use of excessive RPH/tech ratios – no cease and desist.
- In regards to non-RPH store manger’s interference with the operation of the Rx dept (practicing pharmacy without a license ?) – no cease and desist.
- It would appear that the closest thing to a “cease and desist” is the WARNING letters… that all parties need to follow/obey the practice act.
Since there was no “cease and desist” to the permit holder in this WARNING LETTER… who believes that this chain has changed any of its methodology of operations in the stores in this state? Does anyone believe that the BOP and its inspectors are going to be looking for these violations from this chain’s stores in the state… or start looking at any store’s operations in regards to them observing/violating these particular parts of the practice act? These particular portion of the practice act was added a few years ago.. maybe it just takes this state a while to educate the RPH’s and permit holders on these new rules and begin enforcement?
Personally, I find it interesting that this particular BOP has NO CHAIN EXECS on it… unlike 75% of the other BOP’s in this country. So do these BOP members have more of a interest in the “business of pharmacy” rather than the ” profession of pharmacy” and patient’s health/safety?
Did you notice that the non-RPH was not directly addressed in this issue.. NO .. I did not leave out the WARNING LETTER that the BOP sent him/her… He/She did not get one… WHY??? because he/she is not licensed by the BOP for anything … thus the BOP has no authority over his/her actions… if you are paying attention.. this would STRONGLY SUGGEST that the non-pharmacist managers have ZERO AUTHORITY in the Rx dept..
DRUG TOPICS recently published a opinion article that I recently wrote STATE BOARDS OF PHARMACY – WATCH DOGS OR LAP DOGS if you wish to read some more details about what is going on in this country in regards to BOP’s and the practice of pharmacy…
Those of you in this particular state , and particularly those of you who work for this particular chain – you know who you are !! You had better start documenting and expressing concerns about all the practice act violations that you are being asked of you. These warning letters are public records.. no big secrets here.. the BOP has put in writing that you are responsible for observing the practice act.. If the non-RPH store manager comes in and tries to tell you how to practice pharmacy, if fact, if the non-RPH store manager comes into the Rx dept without the RPH on duty permission, may be – by itself – a violation of the practice act. There is a separate entrance/exit door that can be locked … for a reason…
Here are some (tongue-in-cheek) educational videos .. on your responsibilities and how you can CYA yourself in the corporate pharmacy world.. Yes, they could fire you.. but.. better than ending up like Eric Cropp .. I am sure that Eric could never perceive that he would ever be in the position that he finds himself today… JUST LIKE YOU DO !
Yes there is a growing surplus of Pharmacists… that just make you that much more expendable to the chains… most likely, they could care less if they fire you .. or their work environment/volume.. causes you to lose you license/livelihood/assets over a misfill… just look at how many multimillion dollar fines the major chains have paid over the last couple of years .. while “admitting to no wrong doing”.
If you are in one of the other 49 states… you may not have the Rx/shift rules… or the 12 hr work rule… but all practice acts expects one thing .. PERFECTION… do a misfill.. and your license could be toast… when is the last time that you saw a chain store being shut down because of a fine or because there was a misfill in a store??
When I first started working in a pharmacy.. a misfill was a major event.. they happened so seldom… today… misfills are so common .. that we have become jaded… How many of you, when you are informed about a misfill… the first thing you think about is if your “finger prints” or on this one… and then you start analyzing if – or how much – harm the patient may or should have suffered. How quickly does it become … just another non-event… when it turns out to be a “no harm – no foul ” event ?
It is estimated that community pharmacy KILLS 7,000 people each year.. if this is correct and using national averages.. would suggest that an additional 100,000+ people are harmed by medication errors…. that would mean that a commercial AIRLINER full of people are killed/harmed EVERY DAY by community pharmacy… how long before the law of probability catches up with YOU ?
It would appear that the typical BOP or chain employer could care less. They will each deal with the situation(s)… when they have to… and as long as you remain submissive, apathetic and silent about your work environment and patient safety… the chances of this changing is nil!
Filed under: General Problems
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