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FEAR Runs The Ship in Pharmacy

Jp Enlarged
A little imagination and you will get it.

A little imagination and you will get it.

I have known Pharmacists who could do what they pleased because the company was afraid of them. Really? Without a doubt. You know some also. Take a good look. I was a scary pharmacist for years. For the years 1984 to 1996 I lived in fear. FEAR motivated me.
I was afraid my good PIC thing, very good thing, with a 10 minute one way commute would change to a bad thing with a 60 minute one way drive. I was afraid that I would just lose my job. I had a family of four. With a minor child and a teenager and a lazy wife.
I was afraid that my 2 day a week 3rd RPh would be taken way. It eventually happened. That brought back 13 hour shifts. That was the end of lunch periods. I was in the habit of going to the deli in SAFEWAY and eating good food, reading the paper. You can actually relax in a half hour. The 3 minute walk down the mall was good, really good. When they took away our relief, we were back to hastily gobbled bad food.

More about fear later. This is about making demands and righting our dangerously listing ship.

“Power Concedes

Frederick Douglass

The Kxxxx Hxxxx Demand
The demand is that the operation of the Drive Through window be managed by the pharmacist on duty. K H closed the Drive Through on a day when his most competent technician was absent. He was working alone with one inexperienced technician and no cashier. They were filling prescriptions at a rate of one every 80 seconds. The two of them were expected to do everything, including manning the register and the Drive Through. Mister Hoots perceived that the situation was perilous and that patients were being put in danger. He was not able to consistently counsel appropriately. K closed the Drive Through. He was fired by CVS.
The pharmacist on duty will always be authorized to close the Drive Through when she perceives that patient care is compromised, pharmaceutical care is not being delivered or a frenetic pace is endangering the patient.
I do not know if any of the 50 states in our country authorizes a non-pharmacists to have authority in the pharmacy. As far as I know, every state recognizes that the legal Pharmacist in Charge is the person with 100% power in the pharmacy. When the Pharmacist in Charge is absent, the Pharmacist on Duty is the person with all of the clout. The non-pharmacist store manager has absolutely no say-so in the pharmacy. Check the state laws where you work. Post them prominently. Document any and all incidences when a non-pharmacist usurps the pharmacist’s authority. We must demand that the drug store companies make it very clear that the pharmacist is the last call.
In the K H vs. CVS case in North Carolina, is interesting to see how the Board of Pharmacy ruled. The non-pharmacist store manager clearly usurped Kelly’s authority when he came into the pharmacy and reopened the drive through. He can’t do that. Legally, Kelly holds all of the cards. The board copped out and scolded both K H and CVS.
We demand that drug store companies make unambiguous statements that non-pharmacists have no power in the pharmacy.
I am quite sure that there are plenty more demands that I can list here, but if we get the ones I have cataloged here, life at work would take a quantum leap from the soul-crushing working conditions to a sane, safe and satisfactory work experience with no stops in between. I have only one word if the companies ignore us. UNION. Yeah sure, Plagakis.

This is our profession. We have allowed non-pharmacists to mold our jobs. That has to stop. Pharmacists must maintain oversight over the MBA Masters of the Universe and even the CEO.
The free pass that we have given them just because of their positions has to stop. If the idea is stupid, we need to tell them. If the idea is dangerous, we need to shake them and tell them. If the idea is going to fail and result in a multi-million dollar loss,

    we need to grab them by the collar and leave some blood and teeth on the floor.
    Start being the Hunter instead of the Hunted.
    They are afraid of You

They are idiots for not treating you well and you are idiots for taking abuse when you hold all of the trump cards. They do not even have a business without you. With no pharmacy, Rite-Aid is a poor example of a variety store. What about that power do you not understand?
My last words today:
Practice Pharmacy In Compliance With All Laws and Regulations

1 Comment

HELLO, MY FRIENDS. 12-20-14. From Jim Plagakis

Jp Enlarged


Twenty years after Durham-Humphrey. There was no Big Pharma yet.  If they was a need for a drug, they made it. Even if it was cheap.

Twenty years after Durham-Humphrey. There was no Big Pharma yet. If they was a need for a drug, they made it. Even if it was cheap.

I have written this blog since the summer of 2005. Until recently, I wrote JP at Large for Drug Topics. The editor fired me a few weeks ago. She essentially said that I was out-of-touch since I no longer put my feet on the floor of a pharmacy, that I am retired and that what I write is no longer relevant.

I am insulted big time. She didn’t respect me enough to call. She fired me in an e-mail.

Oh, by the way, if I was physically able to put me feet on the floor of a pharmacy, my Walgreens Pharmacy District Manager in Texas all but guaranteed a job for me in Sarasota. Retired? Not really. An older guy with an active case of the “late effects of polio”? Yes. It isn’t pretty. After 4 months of forced to be off my foot, plenty of atrophy. Drop foot. Toes of right foot point inward. I think that I can recover, with extensive physical therapy. THAT’S THE BACK STORY.

What I wrote here and in JP at Large was an invitation for you to observe and make your own conclusions. My writing simple, declarative sentences would cheat you. It would be force-feeding a goose.

What I wanted was for you to live and think, “Is this really what JP writes about?”

You get home after a 14 hour 10:00 o’clock. Your spouse has a plate of food on the kitchen table.

You look at it, frown, pick it up and fling it into the sink.
“Meatloaf? I am sick of meatloaf. When will you learn?”
Your spouse is stricken. A dagger could not have hurt worse.
You grab two beers and a bag of chips and escape into the study.
You turn on the game. Your team is losing. Your stomach burns. You are consumed by guilt. What is wrong with you? This happens too much. Why does she take it? Great gulps of plaque-forming cortisol are dumped into your veins. (I know about cortisol you guys. My triple CABG was getting ready for 2014 with my first two wives)
I know that most of you are not the loose cannon depicted here, but plenty of you shook your head when you read this. “How could Plagakis know what an idiot I am?”

Had I wrote that for Drug Topics, it would have been spiked. The prevailing thinking in Cleveland seems to remain, “It can’t be that bad.”

Full disclosure, at a time of horrendous medical co-pays, losing the $400.00 a month that JP at Large EARNED is HUGE.

Buy my books..please.

I think I will take some time to redesign www,


Forever young and relevant.


VASCULAR SURGERY FOR JP. Tomorrow (12/4/14) JP at Large FIRED from Drug Topics 12/1/14

Jp Enlarged

The wound on my foot is stubborn. It is on the side of the right foot, just below the little toe. The DPM/Surgeon
did cultures after the first debriding. Cultures showed four aerobic bacteria and three anaerobic bacteria. INCLUDING Gangrene.
Antibiotics and a good surgeon working on the wound once a week and the wound is clean.

This is an ugly wound. A crater. With a Niagara of nice fresh blood, I should heal quickly. I will need Physical Therapy.
Some crazy atrophy from being essentially bed-bound since First week of October. I will be okay.


Now, the big story. JP at Large first appeared in Drug Topics in January, 1989. 250 columns. A total of around 200,000 words.

JP’s First book written solely for you.
This is my first BOOK written for Pharmacists


How does she know? She has no first-hand knowledge about what it is like doing a 14 hour shift at CVS. It might help if she
shadowed a chain pharmacist for a shift. THis person had to be dragged into the world of modern pharmacy. She often said, “It can’t be that bad”.

She insulted me. 25 years. 250 JP at Large columns. Countless messages from you that JP at Large IS Drug Topics. She fired me by E-mail. Shabby treatment, indeed. She did not get that I wrote FOR YOU.

It was a good ride. I will tell you where I end up.



“PHARMACY TIMES” Does Not Have A Clue. Our Man John, RPH sets them Straight

Jp Enlarged

I have been told that CVS has ordered 500 of these as pharmacy equipment, for a pilot project.
I have been told that CVS has ordered 500 of these as pharmacy equipment, for a pilot project. Next, will there be METRICS for this?

Good morning,

Below please find my comments regarding an article written by your Associate Editor, Meghan Ross. It is in reference to what I perceive as her trivializing one of the major issues facing our profession today when writing a news piece regarding oxycodone diversion.

Has Ms Ross ever worked under the conditions she describes as “an annoyance”? Has she ever worked in pharmacy at all? And if so, is she the one of the many who look down upon direct patient contact practitioners (ie dispensing community pharmacists) because she now considers herself “above” that portion of the profession having left it?

I am a community pharmacist who has been commended for my approach to that area of the profession. Interns from 3 major universities have claimed that I have “opened their eyes & completely changed their opinions of what community pharmacy can be”. I believe the type of work I do can move us to provider status & secure a future for the profession. But that work is easily undone by one short paragraph by those in publishing or academia who honestly, have no clue. See my comments below:

I won’t comment on this case or the veracity of the claims because I don’t have full information. I WILL comment on the Pharmacy Times author’s statement “to ease the annoyance of standing all day”. Has this author ever had a position like this? In almost two decades in the industry I have worked positions where I was required to stand for the entire length of a 15 hour shift. Often 3 days in a row. Believe me it is more than a mere annoyance. A few years of that and crippling
degenerative injuries of the ankles, knees & spine develop. Varicose veins and blood clots form. Hernias become common. There are reasons why the military and law enforcement do not allow personnel to work a standing post for that many hours. These are conditions that would be considered in violation of the Geneva Convention or called inhumane if suffered by a prisoner. Yet they continue to exist because a) employers will do whatever makes their job easier within what the law allows & b) the self congratulating “experts & pundits” in publications such as this or in professional organizations trivialize it. So instead of our government & profession seeing the danger to public health from fatigue based errors or personal health from these practices we label it as “BS” or “whining”. The result? Our profession never advances because instead of demanding professional conditions we allow ourselves to be treated like skilled labor and factory workers. You want “provider status”? Start acting like a provider, demand more of yourself, your employer & your profession and stop acting like a macho version of a sweat shop laborer claiming to be proud of how long you can sustain yourself standing or not using a restroom.

John R.Ph. From: John


From: Ryan.. Arizona State Univ. Get your Prescriptions from a Vending Machine.

Jp Enlarged

Ohmigawd. Will it NEVER END. Ryan reported that there is a telephone at the kiosk to call for counseling. Yah,
like college students are gonna take the time. What do you think of this.

Copy & Paste in your browser this link if you want to see the original newspaper article.

Vending machine replaces ASU on-campus pharmacy

By Corina Vanek
November 19, 2014 at 8:43 pm

An ATM-like vending machine dispensing prescription drugs opened Tuesday night on the Tempe campus as a replacement for the recently closed on-campus pharmacy.

The machine is created by a Minnesota-based company called InstyMeds, Christiana Moore, associate director of ASU Health Services, said in an email.

“ASU Health Services in Tempe will provide a new and innovative vending concept called InstyMeds, which will allow students to obtain prescriptions safely,” Moore said.

Moore called the machine a “secure option for students to receive prescriptions.”

Chemical engineering junior Justin Easa said he was not aware of the machine replacing the pharmacy, but he did not think a machine was the best option for dispensing drugs.

He said he thought it could be hard to monitor who was actually receiving the drugs and which drugs were being dispensed.

“I don’t know if there is a way to make it as secure as a pharmacy,” he said.

The machine contains the 50 most commonly prescribed medications to students, Moore said. These medications include antibiotics, asthma treatments, antihistamines, probiotics, anti-nausea medicine, medications used for quitting smoking and vitamins, Moore said.

“Narcotics and controlled substances will not be dispensed,” Moore said.

Students must visit an on-campus Health Services provider to gain access to the machine, Moore said.

Students will be issued a personalized security code after their appointment, and the code is only good for 24 hours, Moore said.

“In order to receive medications from the machine, students must input the security code and their date of birth,” Moore said. “For security purposes, the medication is scanned three times prior to dispensing to ensure precision and accuracy.”

Students can pay for the medicine using their own insurance and can charge the costs to their ASU account using the machine, Moore said.

According to the InstyMeds website, a doctor can electronically enter the prescription information and give the patient a voucher to access the medicine from the machine. It takes about 90 seconds for a prescription to be distributed.

The website says the machine is designed for a first fill of a prescription, meaning if a patient has a prescription he or she needs to refill, the patient would have to go to another pharmacy. The medicines inside are “short-term” type medicines, so patients with chronic health conditions will need to use a pharmacy.

The types of drugs in each machine are tailored to the needs of the environment, but allow quick access for people who need an available medication on site.

According to the website, the machine eliminates the danger of a person receiving the wrong prescription because if a medication is in the wrong place, it will not pass the barcode scan and will not be dispensed.

Moore said a phone attached to the machine will allow students to speak with a pharmacist or billing representative if they have questions about their medications or what they cost, Moore said.

Pharmacists generally advise patients about potential drug interactions, as well as if drugs should be taken with food or drink.

Students may still be feeling the pain of not having an on-campus pharmacy, but Moore said ASU Health Services hopes to make the switch easier with transferring options.

“ASU Health Services is committed to excellence in health care and provides innovative health solutions that meet the needs of ASU students,” Moore said. “After the closure of the pharmacy located on the Tempe campus in September 2014, students now also have the opportunity of receiving e-prescribing services that allow medications to be sent seamlessly to a pharmacy of the student’s choice.”

Reach the reporter at or follow her on Twitter @corinavanek

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