Browsing the archives for the Jp Enlarged category.

The Guerrilla Pharmacist Goes INTERNATIONAL

Jp Enlarged

This is the message received from a Canadian pharmacist. Maria Gutschi. The package of GOODIES contained a copy of THE COMFORT TRILOGY, Editions 1, 2, 3 of THE GUERRILLA PHARMACIST and promotional materials. ie. the coming of Rex Guevara. With Snehal back in the UK, we have two international GUERRILLAS.

The picture is the first one up when you enter MARIA GUTSCG on the Search Line at Big Images. Our Maria? Probably NOT, but a compelling young woman. THis will be OUR Maria whenever I think of her.

Think about this: MARIA GUTSCHI HUNTED US DOWN. She asked me if a Canadian could jump on our speed boat. Yes, of course. Here is her Email to me.

From: Maria Gutschi (
Sent: Fri 6/05/15 4:04 PM
To: Jpgakis Plagakis (

Hi Jim
I just received your package of goodies yesterday, and am very impressed with the content and and even better the tone.

I am sending you a money order since US citizens cashing a Canadian cheque is problematic and often not accepted. I hope that is acceptable to you.

Here in Canada the Big Chains are flexing their muscles, but pharmacists are striking back. However, I am not sure this will make a difference if the colleges (i.e. Boards) of pharmacy do not respond. Some provinces are better than others.

As you can guess, the president for Rexall is from the USA.

HOWEVER, I believe the reason for pharmacy being the in condition it is in, is likely because of our personalities and work environment. Some Canadian researchers have done great work to delineate this.

Pharmacists are:


Avoid conflict

Defer to Authority

Want to be Nice rather then Right

A perfect population for the Masters of the Universe to exploit.

Keep up the good work

Maria Gutschi


APhA Finally Makes a Statement. Straightforward Reporting. WHERE IS THE POLICY STATEMENT?

Jp Enlarged

Under pressure: Performance metrics in chains may affect safety 
June 01, 2015
pressure that many chain pharmacists feel

“It’s all about numbers. That’s all they care about. You’re there and on your feet for 8 hours, and you’re at the mercy of the volume.”

The speaker was Bill Bradshaw, BSPharm, a semiretired former Walgreens pharmacist from Arlington, TX. He was describing the pressure that many chain pharmacists feel as they try to meet prescription fill-time goals while fielding phone calls, managing auxiliary staff, and keeping up with immunizations and customers’ medication therapy needs. 

The yardsticks companies use to evaluate how well pharmacists manage these complex professional duties are known collectively as “performance metrics.” It is a phrase that pops up frequently in pharmacists’ blogs, tweets and other online forums—and not usually in a positive way. A common thread is that use of metrics to help speed prescription flow often runs counter to good pharmacy practice and heightens the danger of increased medication error rates.

“It’s time pharmacists are protected from this metrics system,” wrote Katrin Olavessen-Holt, commenting on a Pharmacy Today Facebook posting of a March 3, 2015, CBS Sacramento article headlined “Call Kurtis: Pharmacists Concerned Employer Pressure Leads to Prescription Errors.”

“Speed and money over safety. Never a good thing!!,” added Carrie Wellman Arbuckle. The article describes the potential downside of performance metrics in California. The Today posting drew more than 325 “likes” from Facebook followers.

Major chains: Different view

The three major pharmacy chains have a different view of the metrics they use to evaluate pharmacy performance. And they cite their efforts to smooth pharmacy workflow and ensure customer satisfaction and safety. 

CVS/pharmacy spokesman Michael DeAngelis responded to Today ’s request for comment with a statement saying that CVS, like other companies, “measures the quality and effectiveness of the services we provide to ensure we are meeting our customers’ expectations and helping them to achieve the best possible outcomes. Our systems are designed to help our pharmacists manage and prioritize their work to best serve their patients.”

Jim Cohn, a Walgreens spokesman, said in an e-mail that “quality, safety, and accuracy are our top priorities, and we make it clear to our pharmacists that they should never work beyond what they believe is safe, in their professional judgment.”

At Rite Aid, spokeswoman Ashley Flower stated that the chain was “highly committed to patient safety and care,” adding, “We have a strong safety record because of our ongoing education and training for pharmacy associates as well as our continued investment in technology.” Rite Aid, she said, uses “various metrics to ensure we are consistently delivering a superior customer experience and helping those we serve achieve the best possible health outcomes.”

The safety equation

While the chains do invest heavily in new technology systems, workflow design and training programs to meet the expanding demands on pharmacists’ time, there is always the risk that ever-increasing prescription volume and bottom-line considerations may tilt the safety equation to the negative side. Moreover, policies created at the top to ensure that pharmacists are well equipped to handle both dispensing and patient care responsibilities can encounter obstacles as they filter down to supervisors, who themselves may be under pressure to perform. 

David Nau, BSPharm, MS, PhD, president of Pharmacy Quality Solutions Inc., noted that many studies in the past had shown an association between volume of work and medication error rates. “One thing that makes a difference,” he said, “is that the complexity of work, or the workload issue, is intertwined with staffing and processes. Part of the issue of reducing distractions of pharmacists is finding the right balance of workload and the pace of work.”

Some pharmacists maintain, however, that the balance can be thrown off kilter by technician staffing that fails to account for the high number of prescriptions that pharmacies are called on to dispense. “They keep cutting tech staff hours, regardless of the volume,” said Steve Ariens, BSPharm, national public relations director for the Pharmacy Alliance, a pharmacists’ advocacy group. He likened it to the slave galley rowing scene in the 1959 movie classic Ben-Hur. “Rowing faster and faster: that’s pharmacy,” he said.

Bill Bradshaw said it was “practically impossible to do your job the way it was supposed to be done with the help that they gave you.” At one Fort Worth, TX, Walgreens where he worked, “it was very intense,” he said. A doctor he consulted told him that he was suffering from post-traumatic stress disorder. He finally left the pharmacy after about 3.5 years. During that time, he said, “That one store had five pharmacy managers. They just couldn’t handle it.”

‘From green to yellow to red’

One widely used performance metric tracks prescription dispensing time from customer drop-off to pick-up bin. The limit is often set at 15 minutes. David Stanley, BSPharm, a California pharmacist who worked for both Rite Aid and Walgreens, told Today that both chains used computer clocks to monitor the time. The clocks “would slowly turn from green to yellow to red,” he said, “depending on how quickly prescriptions were getting out the door.” 

Stanley added that he saw “nothing wrong” with metrics in general, particularly if used to evaluate quality, but “the problem I’ve run into is that they choose their metrics poorly. And they lose sight of the goal, which is happy customers and pharmacy practice the way it is supposed to be practiced.”

He described a prescription label policy that Rite Aid had in effect when he worked there several years ago. “We were told never to print more than five labels ahead,” he said, but “we had our own way of doing things, which was to print labels for as many prescriptions as we could and get them as close to being filled as we could. That way, when it was slow, you could work on the label pile and basically get a few out the door in between customers. It was a great system,” he said. “When we started following their directive, it actually slowed us down and it worked against their larger goal of happy customers and quality prescriptions.”

“They didn’t want to hear it,” he said.

Lawsuits against chains

Some pharmacists have brought lawsuits against chains. Joseph Zorek, BSPharm, for instance, has a current suit against CVS Health. He told Today that performance policies and “intimidation” he encountered as pharmacist-in-charge at a Harrisburg, PA, CVS pharmacy, led to various physical ailments and disability—the basis for his legal action.

Zorek described one metric CVS used to evaluate performance. “They wanted us to sign up all patients to ReadyFill,” the chain’s automatic prescription-filling program. He said his patient base consisted of a higher-than-average number of senior citizens, who “felt much more comfortable being in charge of their own prescriptions. As a result, my metric for signing up people was low.”

Zorek added that he felt he could “play ball” with most of the other requirements. “They had a 15-minute constraint” for measuring prescription fulfillment time. “That was fine,” he said, “but normally Murphy’s Law would set in, and something would go wrong.” Describing a hectic pharmacy scene in which techs were often called away to take over busy cash registers and pharmacists were forced to handle calls on 10 different telephone lines, he said, “Your mind was in too many places. The error rate started to go up. We were making stupid little mistakes: using the son instead of the father, wrong address, improper doctor. ”

Still, Zorek said, he “enjoyed the pace and working with people”—that is, until the company began cutting technician hours. His wife, Paula Zorek, who also worked at CVS, as a technician and technician trainer, said that in 2011, every store was losing technician hours. “They upgraded the computer software,” she said, “and they thought they could do more with less. It didn’t work out that way.”

2012 ISMP/APhA survey

Anecdotal complaints about the use of metrics and pharmacy workload have circulated for years. In 2012, the Institute for Safe Medication Practices (ISMP) launched a survey in collaboration with APhA. One aim was to assess the impact of prescription fill-time guarantees on pharmacy safety. A total of 673 pharmacists responded, most of them from chain drug and grocery/mass merchant pharmacies. A major finding was that 83% of those working at pharmacies with advertised time guarantees believed that the guarantees were contributing to dispensing errors. 

In response, the National Association of Boards of Pharmacy (NABP) issued a statement resolving that NABP “assist the state boards of pharmacy to regulate, restrict, or prohibit the use in pharmacies of performance metrics or quotas that are proven to cause distractions and unsafe environments for pharmacists and technicians.” 

Fewer errors: One solution

Are there solutions for reducing the potential safety hazards of performance metrics and prescription time-filling guarantees? Nau, whose company supports health plans, PBMs, and community pharmacies in their efforts to measure and improve medication use quality through its EQuIPP program, said that “we actually find that when pharmacies synchronize the refills of patients on chronic medications, it helps to smooth out the workflow and balance the ebb and flow of volume throughout the day.”

That should help lead to fewer errors, he noted. He also said that as “pharmacists do more to be proactively engaged in managing their patients’ regimens, it will help to balance the workload. So when issues arise, that communication will help to identify potential issues before they become a major event for the patient.”


Read and Rejoice. More than hope.

Jp Enlarged

Too Old.  Too Female.

You Will Love This. Almost as good as sex… ah well..

Case No.: 1:12-CV-1715-VEH

On February 19, 2015, the jury returned a verdict in favor of Plaintiff James R.
King (“Mr. King”) and against Defendant CVS Caremark Corporation (“CVS”) on
age discrimination and willfulness. (Doc. 153). In accordance with this jury verdict,
which awarded Mr. King $1,065,383.15 (one million sixty-five thousand three
hundred eight-three dollars and fifteen cents) in compensatory damages on his age
discrimination claim, FINAL JUDGMENT is hereby ENTERED in favor of the
Plaintiff, James R. King, and against the Defendant, CVS Caremark Corporation, in
the amount of $2,130,766.30 (two million one hundred thirty thousand seven hundred
sixty-six dollars and three cents). 29 U.S.C. § 626(b). See Formby v. Farmers and
Merchants Bank, 904 F.2d 627, 631 (11th Cir. 1990) (“Under section 7(b) of the
2015 Jun-03 PM 04:28
Case 1:12-cv-01715-VEH Document 179 Filed 06/03/15 Page 1 of 2
ADEA, 29 U.S.C. § 626(b), an employee is entitled to receive liquidated damages
when an employer “willfully” violates the ADEA. Upon proof of an employer’s
willful violation of the Act, the employee is entitled to receive double damages.”).
DONE and ORDERED this the 3rd day of June, 2015.
United States District Judge
Case 1:12-cv-01715-VEH Document 179 Filed 06/03/15 Page 2 of 2

No Comments

This Went Via Email to all Guerrilla Writers, Subscribers and contributors.

Jp Enlarged

To all you Guerrillas From JP

The Student Pharmacist Edition of The Guerrilla Pharmacist is ready. I will ship a whole bunch of copies to Goose tomorrow morning. He will be attending a Preceptors’ Conference sponsored by Purdue in a couple weeks. Goose will be using the Student Guerrilla to promote change. Let us be able to say, “It all started at Purdue.”

Fred Mayer has requested 20 copies. When ready, I will send them.

My view is that we either make a difference with students & new pharmacists (No matter where they went to school) or it is pretty much game over. The companies will continue to engage in gentlemen’s warfare and they will win no matter how big our guns are. You see, it is simple. No matter how big your guns are, if you don’t use them, it is like having no guns at all.

Truthfully, I don’t want to give up the fight. Not when I know that guerrilla warfare will kick the shit out of gentlemen’s warfare. We have right on our side, but we can’t depend on that to help us. It has never worked before.

I am still waiting to see results. There has been only one new subscriber in the last two months. Has anyone taken the advice given in Guerrilla?

So far, only one young man (who I have named Rex Guevara). He works for a huge retail company that has taken bullying beyond anything I have seen before. One hint, it is not a drug store company. Treating pharmacists the same way they treat the baby department employees might just seem normal to them. I still do not have Rex’s complete story, but I will soon begin the process of creating The Saga of Rex Guevara. I will give you a trailer. Rex will win and, if he has patience, he will win big time. He is a 30 year old man who has taken the advice given in Guerrilla and put it to use. He started before there was a Guerrilla. He has been reading my blog for a long time. This kid is 30 years old, he saw the value of the advice and he did not hesitate. The company managers who try to get him to engage in Gentlemen’s Warfare are doomed. One of them came to a meeting with Rex and the store manager. The message was, “Rex, you are not a good fit with XXXXXX Store.” A few minutes later, this person walked out of the meeting in tears. Guerrilla Pharmacists do not take prisoners. The Store Manager kept very quiet, kept the eyes on the floor with crossed arms.

Why only one pharmacist? I can speculate, but fear isn’t good enough. I think apathy. Rex Guevara will prove that they will not go after him because they know that it would be their assess if it proceeds beyond, we better just leave him alone.

Gary Ellis, The Independent Whisperer, expressed a concern that Guerrilla would just be another whiny bitchfest. He may have had a valid worry.
Because it looks like many of you are still hoping that things get better, still trusting that someone else will make a move, still dreaming that the APhA will go back to the days of William Apple when the organization with the magic name was active in protecting the rights of pharmacists. Still think that the State Pharmacy Boards will look out for you. Oregon, but only because it is clear that conditions and metrics will put the public in jeopardy. The rest of the boards seem to be heavily influenced by the companies.

I will get around to sending each of you a copy of The Student Pharmacist Edition. That will delay #4 for a few weeks, but you will see my thinking.

The comments that you guys send me cause me to be encouraged. But, apathy seems to be the predominant condition.

With a glut of pharmacists/robo-dispensers willing to work short weeks for short wages, it is time for action. Your $10,000.00 a month job could be reduced to $6,000.00 a month.

It is now or never. If you take guerrilla action, any attempt to lower your wage could be judged to be retaliation. Illegal.

If you want additional copies of The Student Edition, they are $5.00 each plus $1.61 postage. We can discuss the price for bulk orders.



Was it a mistake? SIX Long Years. Huge Debt. NOW THIS!

Jp Enlarged

A few years ago, a friend who is a Pharmacy Manager for CVS in rural NW Alabama reported that CVS wanted to have the pharmacy open on Christmas day. Ronald was earning $65.00/hour plus at the time. CVS offered him quadruple time to work on Christmas. $260.00/hour. Eight hours would total out at $2.080.00. QUADRUPLE TIME is not the offering for Christmas these days. Why would they have to? A boiler-plate UNION contract would get you two and a half times pay. 8 hours regular holiday pay plus 12 (Time & a half) hours pay for working the holiday. That would compute to $163.00/hour. $1,304 for 8 hours on Christmas Day.

Lets not be stupid. There are plenty of NAPLEX trained PharmDs (with pharmacist licenses) doing push ups at the local bar, waiting for the call offering her a 30 hour per week job. It would be naive and hypocritical to suggest that all of these glutty pharmacists chose your profession because they had a burning desire to practice pharmacy. C’mon, man. It was the money. You know it and I know it. It is pathetic that the kids who have pursued pharmacy for high professional reasons get screwed. Too much of anything and the price goes down. JAY PEE


I have been shown that, in selected areas, Walgreens is offering pharmacists $45.00/hour today, maybe $35.00/hour down the road. What’s to stop them? CVS is firing older pharmacists with trumped up reasons and hiring cheaper newly licensed RPhs. Rite-Aid, Target, Wal-Mart, Kroger, Safeway and others will be right behind. To rub salt in the wound, they are reducing hours. Some below 30/week to eliminate benefits. What’s to stop them?

A powerful union?
A union may be necessary. WAG, CVS, RAD and the others can only blame themselves.

It may take some time, but it MAY balance out. If they can get work done for 45.00/hour, that’s no different than an independent asking for an extra discount from a supplier. You may want to examine the possibility of having your own drug store. It is very possible.

I can’t see how all these new schools are able to find students. Maybe the students aren’t aware of the declining quality of compensation. Lets look at it this way. If this enables WAG to finally allow pharmacists to do DUR, etc, without the stress and pressure of a prick of a manager, screaming about the metrics, maybe it’ll improve the outcome for the patient. Also, maybe they’ll have a consultation/compliance specialists whose job it would be to counsel the patient, and use technology to improve patient compliance, and therefor reduce the number of drug related morbidity and mortality. It could be a win win for them. Break down the clinical and professional components of the pharmacist, from the mechanical dispensing process. Heck, next move is to have the “pharmacies from home”, where home is India, or China or Jamaica or better yet Cuba.

Times they are a changing. The at-home counseling specialist could do “FaceTime” with the patient, in their own language, even. Just imagine your face with the voice of Sanji Patel from India, speaking Vietnamese, with a British, or French accent. Actually, how would anybody know if there is really a pharmacist “at-home”. It could be a student using a specialized Google search with a bunch of canned consultations for the 50 most popular meds, in different language modules. The robot R.Ph., 12 cents an hour for electricity. Think of it.

Last word. It is YOUR profession. Not WAG’s, Not CVS’s, Not RAD’s, Not Wal-Mart’s. It is now or never. Once the snowball picks up sped, it will be impossible to stop.

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