The Scene Of The Crime

I was going to write an inflammatory piece about XXX and KYYYY HTTTTS today.  I was going to write down evidence that XXX seems to be on a downward spiral.  A friend in Alabama, an XXX Pharmacy Manager, reported that XXX is putting Coke coolers in the pharmacies, right at the drive-through.  I asked him,  ”What is next?  Chips, Jerky, Beer and Hot Pastrami Sandwiches?”  ”Don’t ask,” he answered.

I was going to take a shot at Rite-Aid too.  Just because it is effortless taking shots at Rite-Aid.  I just went to Google to get the Rite-Aid share price and found this:

Rite-Aid just can’t compete.
Worse, Rite-Aid is already crippled with debt and weak same-store sales. So it’s not as much a question of whether Rite-Aid will go under but when. Rite-Aid has tallied just a single profitable quarter in four years and continues to bleed red ink. The company’s debt-to-asset ratio is north of 75% and continues to climb, with the $6 billion it currently owes totaling about a quarter of the company’s total annual revenue.

Rite-Aid’s share price is $1.28 as I write this.  The company is a piggy bank for the executives.  $6 billion debt.  That is not sustainable.  The writer of that paragraph in red speculated the Rite-Aid could go the Borders route.  I can’t see that happening.  Walgreens would probably be interested in good locations in a fire sale.  They certainly would not take onthe debt.

XXX has been operating like they are just trying to survive.  They have been treating the professional staff like crap and pharmacists and good techs have been jumping ship all over the place.  I have a few e-mail that attest to this.  I will look at them, remove names and paste them here later.  In the KYYYY HTTTTS situation, I do think that this pharmacist could win this.  If the board comes out on his side, it could be more than a ripple effect.  It would be a tsunami.  If XXX does not negotiate a severance settlement with him and he wins in court, we will see every pharmacist saying to XXX, “Who’s your Daddy?”

I have a serious problem that these two companies have around 12,000 pharmacies between the two of them.  Just that the idea that the owners of 12,000 stores are cheaters and “thieves” bothers me.   Neither XXX or Rite-Aid hide the fact that they run dispensaries and are not the least bit interested in providing professional services.  At the very least, Walgreens has expressed in writing that they intend to promote patient-centric practice of pharmacy.  WAG is a huge company.  Like a battleship, it takes a while to change course.

Aren’t you uncomfortable with the way XXX and Rite-Aid operate?  I can’t imagine that it is pharmacists who are designing the programs that the pharmacists in the stores have to follow.

"Well, Doctor, consider this...."

Yesterday, my daughter-in-law called.  She has never called to speak with me.  This was a first.  Naomi is  DO, doing an internal medicine residency in Fargo, North Dakota.

She said, “Jim, for a month I had a pharmacist do rounds with me and you guys are amazing. I always want a pharmacist with me.  They made a huge difference in how I treated the patients.  They told me what drug to use and why.”

I said, “Well, Naomi, it is those guys who are amazing.  I can’t really count myself in since my formal education was over 40 years ago.  I know a lot about what I know about, but there is plenty that I do not know about.”  I told her that package inserts are my best friends.

She expressed that she missed having a pharmacist with her.

“Naomi, modern pharmacists are clinically trained they are fiddling their thumbs in the pharmacy these days.  Call any drug store and create a relationship.  Pharmacists are aching to use what they know.”

“Are you sure?”

“I am positive.  They would love to be included in the treatment of your patients and, in the end, those patients probably will take their prescriptions to that pharmacy.  Try a neighborhood pharmacy before you try a chain.”

“There are no chains in North Dakota, Jim.”

Pass out the Cuban cigars. Pop the corks. Wait'll they see the contracts now.

I see the wolves hiding in the woods ready to tear us apart.  One PBM controlling 35% of the market could doom independents.  That could make the chains even more anal.  Imagine the contract Express  Scripts/Medco will come up with.  This is not good.

The following paragraphs were lifted from three separate articles in The New York Times during the last 3 days

Express Scripts said Thursday that it would buy a smaller rival, Medco Health Solutions, for $29.1 billion, becoming the biggest pharmacy benefits manager in the country in one of the largest deals of the year.

Express Scripts said that it expected to realize about $1 billion in cost savings once the deal was completed, and that it would begin adding to earnings per share in the first full year after the deal closed.

The combination of the two drug benefits managers is the second-biggest deal announced this year, behind only AT&T’s $39 billion takeover of T-Mobile USA

The $29.1 billion cash and stock offer by Express Scripts for Medco Health Solutions is not just one of the largest deals of the year. It is also a huge antitrust roll of the dice. The combination would create a behemoth in the pharmacy benefits management industry. So much so, it looks like a provocation to trustbusters.

…..pooling customers and negotiating discounts from drug makers while pocketing a slice. Express Scripts, led by George Paz, says the combination will yield $1 billion in annual cost savings.

Where does that billion come from?  Pharmacy reimbursements?

It won’t be easy to convince the Federal Trade Commission that the deal will not decrease competition. The combined group would have about 35 percent of the market.

The company in question will be XXX and the pharmacist will be KYYYY HTTTT. Our use of the name of the company and the name of the pharmacist could jeopardize his case. I think you can edit your comments. If not, I will. This is the advice given him by his attorney.

You also cannot sign away your responsibilities to create conditions that are meant to protect the public.

I disagree with the Redhead.  I suspect that the North Carolina law restricting pharmacist shifts to 12 hours and requiring a 30 minute meal/rest break plus an additional 15 minute rest period is meant to protect the public from a rummy pharmacist.  It would be nice to think that the board wants to give you better working conditions, but that is not what the boards are mandated to do.   The boards are alive only to regulate the practice of pharmacy in order to protect the public.   Therefore, I don’t care if you sign 100 documents stating that you willingly work 14 hour shifts with no breaks, it doesn’t matter.  Who cares what you want?  This works in our favor.  What would happen if every XXX pharmacist complained to the board about the standard 14 hour shift?

Take some time to be proactive.  Review pharmacy laws in your state.  Report here.  Do you believe that XXX knows full well how thin the ice is that they skate upon?  Of course they do.  You cannot cheat like XXX does.  The corporate mentality is to press the envelope.  When KYYYY wins, dominoes will start to fall.  That is why they are doing an impersonation of the Assad family in Syria.   Heavy-handed management.  ”If you don’t do what we say, we have a pharmacist who will.”  The implied threat:  We will fire you.  They depend on you being afraid.  Fear is a terrific motivator.  XXX would be satisfied if they ran dispensaries rather than pharmacies.   Actually, the model XXX operations are dispensaries.  There is a difference.

In KYYYY HTTTT situation, XXX would be very wise to shut him up with a generous severance package.

The glass is more than half full for us.  Can’t you see how tenuous XXX’ situation is?  A corporate culture that condones cheating to make a profit is balancing precariously on a tight-wire.  When the emperor is a charlatan, he really has no clothes.  When the pharmacists in the stores give only lip service to the authority of the CEO and executives what you get is undermining and even sabotage.  I have heard from XXX pharmacists who are so resentful of the company that they go about clandestinely doing everything they can to make sure the company fails.  The interesting thing is that these men and women actually look like company superstars.  They make all of the “numbers” while they are being watched.  It is where they are not being watched where they say, “Screw it.”

I recently wrote a book entitled, “The Rebels of Comfort” (available at www.lulu.com. See link above). In it, I outline just how little power the CEO and executives have.   They have only the power that you give them.  If the only way they can get you is to instill fear, they will eventually be doomed.  KYYYY HTTTT took their best shot, their most draconian penalty and he will end up still standing.  The store manager will probably have to fall on his sword.  The District Manager will be disciplined for his bad judgment.   If the North Carolina Board is really in business to protect the public, there will be sanctions and fines.  Best of all, there will be publicity.

Employees of a company like XXX obey the company because of the worst reasons.  (From Rebels).  Habit.  Fear of penalties.  Principled responsibility (the company becomes a religion).  Selfish reasons (ie. bonuses).  identification with the dictator.  We just don’t care.   Lack of self confidence.

One small reminder.  You are the one who has an advanced education.  You are the highly trained medical professional.  You are the one who is responsible to the law.  You are the one who has patients, not just customers.   Non-pharmacist company employees, at every level, are just so-what? ho-hum!  You are the pharmacist.  Start acting like it.

I remember coming back to work after this vacation.  It was in the early 2000s.  My boss took me into the office and told me that my behavior with a certain customer worried him.  This patient had bullied me about his insurance.

“We can’t afford to lose customers,” my boss said.  Apparently, this guy promised to take his family’s prescription business elsewhere.  The problem was that the guy asked me to fix his insurance problem at five minutes before closing.  I told him it would have to wait until the next day.

The smell in the office was musty.  It was the depths of winter in Vermont.  Pipes had broken and the office filled with water.  The clean up was not done by a professional.   You could see the black mold along the baseboards.   I recall the picture on the wall.  A beach in Puerto Rico, taken on a family vacation.  The boss was years younger, trim and athletic.  I looked at him now.  He had a belly and was going bald.

“I give your customers exemplary service,” I told him.  ”That is what I do.  For every asshole who wants to try to intimidate me, there are a hundred who appreciate what I do for them.”  I waited for him to respond.

“Well, I know, Jim, but you have to…”

“….I don’t think I have to do anything.  I’ll give you my keys right now if you don’t want me to work here.”

“Well, I mean, I never said I didn’t want you to work here.”

“Good, that’s settled.  I’ll call this guy and make it better.  I’m good at doing that.”

“Will you do that?”

“Certainly, I will.  I will tell him that he needs to come in well before closing if he wants special attention.”

“Oh, please don’t make it worse.”

“I won’t”  Funny, but when I talked to the guy he acted as if I was an old friend.

New information near the bottom.

There is an advertised position for a staff pharmacist at WalMart about 20 minutes south of me. I called the recruiter – who I have talked to in the past and have his phone # from a previous job hunt – and he rather candidly told me that while they were required by law to advertise the position, they had reserve the position for a visa-holder, and that it was essentially filled. Is this legal? If so, it’s a hell of a depressing situation – not just for me, but for the American Pharmacist.

XXX Sued for Alleged Privacy Violations
Posted on March 11, 2011 by Hunton & Williams LLP

On March 7, 2011, Arthur Steinberg and the Philadelphia Federation of Teachers Health and Welfare Fund sued the Corporation (“XXX”), alleging that its unauthorized disclosure of protected health information (“PHI”) constituted an unfair trade practice. The complaint claims that XXX, one of the nation’s largest pharmacies, sent letters to physicians that listed their patients’ names, dates of birth and prescribed medications. The letters encouraged the physicians to prescribe drugs made by pharmaceutical manufacturers, who paid XXX to send them. This purported disclosure of PHI would violate the HIPAA Privacy Rule’s prohibitions against disclosing PHI for marketing purposes without an individual’s authorization.

This is the second major lawsuit filed against XXX in the past few year. Last December, a group of Texas pharmacies filed suit against XXX for violations of Racketeer Influenced and Corrupt Organizations Act (“RICO”) and misappropriation of trade secrets. The Texas complaint alleged that XXX disclosed PHI to pharmaceutical manufacturers for the manufacturers’ marketing purposes. In 2009, XXX paid $2.25 million to the Department of Health and Human Services (“HHS”) to settle charges that it violated the HIPAA Security Rule by dumping prescription records in dumpsters.

web link to this article: http://www.huntonprivacyblog.com/2011/03/articles/hipaa-1/cvs-sued-for-alleged-privacy-violations/

More from Peon:

I am getting responses from these state boards saying that they take action against the ownership of a pharmacy if they are responsible for creating a dangerous situation. Do any of you know, in your state, where your board has taken action against a Rite-Aid, XXX, Walgreen, Wal-Mart, and etc for incidences like what happened to KYYYY HTTTT? If you do, then please post it here, or better still, pass it along to Jim and he can pass it along to KYYYY. It might help KYYYY with his state board if they don’t do anything against XXX. What we need is a state board to really put a ‘bite’ into one of these chains, and when I say a ‘bite’, I am talking about a big fine.

Response from NYS Board of Pharmacy:

*

We presume this matter has been or is under review by the North Carolina Board of Pharmacy.

For our part, we note that unlicensed persons have no right to affect or influence how a professional practices.  Further, when we feel the ownership of a pharmacy is responsible for creating a dangerous situation we can and do take enforcement actions.

Formal complaints may be made over our website, noted below,

NYS Board of Pharmacy

89 Washington Ave., 2nd Floor West

Albany, NY  12234

Phone:  518-474-3817 ext. 130

Fax:  518-473-6995

Email:  pharmbd@mail.nysed.gov

From Jay Pee.  It appears that these state boards all “talk the talk”. Now, it is up to us to make sure they “walk the walk”.  A tired pharmacist is a dangerous pharmacist.  KYYYY HTTTT, after attending to the pharmacist’s duties for seven hours of one prescription every 84 seconds, had to be tired.  The conditions were dangerous.  Closing the drive-through was the right move.  The non-pharmacist store manager must be cited by the board.  He must be penalized with a personal fine.   XXX must be cited.  The pharmacy license in that store must be suspended for at least one week.  XXX must give KYYYY HTTTT a generous severance package, starting immediately.

Thanks to Peon, we are gathering a wealth of information.

"Relax, Sid. It's just North Carolina. That Board will run and hide. We are CVS-Caremark. Too big to challenge. Hardy Har Har".

We can win this one.  Write your letters this weekend. Let’s bring light to dark places.

The Oklahoma Board Executive Director went to a lot of trouble to answer Peon’s letter.  Jay Pee

Thank you for your email.

Below you will find the Oklahoma Pharmacy rules which might apply to the situation described in your email. The Board would expect that the pharmacist would {[535:15-3-16.(d)] If the pharmacy manager feels the situation warrants earlier Board review the pharmacy manager should} inform the Board. If a threat to public health is received in such a situation, the Board would immediately send an inspector or compliance officer, or the director, to the pharmacy to review the situation. If a staffing situation existed that, in the opinion of the Board compliance officers or director, created a threat to public health, the Board would hold registrants at the district manager level AND the pharmacy license responsible for the situation—not the reporting pharmacist. In addition, the Board rule specifies that a registrant[(535:15-3-16(g)] … shall not be subject to discipline by the employing pharmacy for completing a staffing report form in good faith. An employing Oklahoma licensed pharmacy that disciplined a pharmacist for completing a staffing report form in good faith and then contacting the Board would be in violation of this and other regulations and rules and would be subject to Board action. Board action may include fines, suspension, revocation, and/or additional penalties. In this case, it might be found that each prescription that was filled under such situations that a threat to public health was determined, a fine of up to $3000 PER PRESCRIPTION UNDER JUST THE SECTION OF ONE RULE. Additional rule violations might also apply, each with an additional fine of up to $3000 per instance.

Again, thank you for your letter and allowing me to provide you with the regulations and rules that are in effect in Oklahoma .

Sincerely,

john

535:15-3-2. Pharmacy responsibilities

(a) Pharmacy staffing responsibility. Each pharmacy shall employ an adequate number of pharmacists to perform the practice of pharmacy as defined by the Oklahoma Pharmacy Act with reasonable safety.

(b) Pharmacy manager. Each pharmacy, in order to obtain and maintain a pharmacy license, must have a registered pharmacist as the pharmacy manager.

(1) A pharmacy manager (i.e. pharmacist in charge) is designated by his signature on the original pharmacy application or by the appropriate notification to the Board as required in 535:15-3-10(a), and is responsible for all aspects of the operation related to the practice of pharmacy. These responsibilities include, but are not limited to the:

(A) supervision of all employees as they relate to the practice of pharmacy;

(B) establishment of policies and procedures for safekeeping of pharmaceuticals that satisfy Board requirements, including security provisions when the pharmacy is closed;

(C) proper record keeping system for the purchase, sale, delivery, possession, storage, and safekeeping of drugs;

(D) proper display of all licenses;

(E) annual controlled drug inventory; and,

(F) maintenance of prescription files;

(2) Failure of the pharmacy to have a pharmacy manager who fulfills these responsibilities is a violation of this code by both the pharmacy and pharmacy manager (PIC).

(3) No pharmacist may serve as a pharmacy manager in more than one pharmacy at a time.

(4) A pharmacy manager shall work sufficient hours in the pharmacy to exercise control and meet the responsibilities of the pharmacy manager.

(c) Pharmacy manager’s and pharmacy’s responsibilities. The following describe responsibilities of the pharmacy and pharmacy manager.

(1) Where the actual identity of the filler of a prescription is not determinable, the manager of the pharmacy and the pharmacy where the prescription was filled will be the subject of any charges filed by the Board of Pharmacy.

(2) The pharmacy and the pharmacy manager are responsible to establish and maintain effective controls against prescription errors or misfills.

535:15-3-16. Adequate staffing rules for pharmacists and pharmacies

(a) Adequate staffing to safely fill prescriptions is the responsibility of the pharmacy, the pharmacy manager, and the pharmacist. If conditions exist that could cause prescriptions to be filled in an unsafe manner they shall take action to correct the problem.

(b) In order to ensure adequate staffing levels there shall be a staffing report form available in each pharmacy. A copy of this form, when executed, will be given to the immediate supervisor and a copy must remain in the pharmacy for Board inspection.

(1) Such form shall include, but not be limited to the following:

(A) Date and time the inadequate staffing occurred;

(B) Number of prescriptions filled during this time frame;

(C) Summary of events; and

(D) Any comments or suggestions.

(2) Such forms are not to be sent to the Board.

(c) A pharmacist shall complete the staffing report form when:

(1) A pharmacist is concerned regarding staffing:

(A) inadequate number of support persons (cashiers, technicians, auxiliary supportive personnel, etc.); or,

(B) excessive workload;

(2) Filling out the form may enable management to make a better decision concerning staffing.

(d) If the pharmacy manager feels the situation warrants earlier Board review the pharmacy manager should inform the Board.

(e) Each pharmacy shall review completed adequate staffing forms and address any issues described as well as documenting any corrective action taken or justification for inaction to assure continual self-improvement. If issue is not staffing related, describe what measures are being taken to address the issue.

(f) Each pharmacy shall retain completed adequate staffing forms until reviewed and released by the Board. Such forms requiring further review may be held by the Board and may become part of an investigation file.

(g) A registrant including pharmacy, a pharmacy manager, or a pharmacist shall not be subject to discipline by the employing pharmacy for completing a staffing report form in good faith.

[Source: Added at 22 Ok Reg 2172, eff 7-1-05]

From Peon
I have a list, formatted for emailing, of all the state boards(except GA & TN).
I put this in the BCC field of the email. Only had to send one email and it will send emails to all these boards of pharmacy.

“Alabama State Board of Pharmacy” <hbobo@albop.com>,”Alaska Board of Pharmacy” <mary.kay.vellucci@alaska.gov>,”Arizona State Board of Pharmacy” <chunter@azpharmacy.gov>,”Arkansas State Board of Pharmacy” <charlie.campbell@arkansas.gov>,”California State Board of Pharmacy” <virginia_herold@dca.ca.gov>,”Colorado State Board of Pharmacy” <pharmacy@dora.state.co.us>,”Connecticut Commission of Pharmacy” <delinda.brown-jagne@ct.gov>,”Delaware State Board of Pharmacy” <customerservice.dpr@state.de.us>,”District of Columbia Board of Pharmacy” <patricia.dantonio@dc.gov>,”Florida Board of Pharmacy” <MQA_Pharmacy@doh.state.fl.us>,”Guam Board of Examiners for Pharmacy” <jane.diego@dphss.guam.gov>,”Hawaii State Board of Pharmacy” <pharmacy@dcca.hawaii.gov>,”Idaho State Board of Pharmacy” <Mark.Johnston@bop.idaho.gov>,”Illinois Department of Financial and Professional Regulation Division of Professional Regulation — State Board of Pharmacy” <FPR.PRFGROUP10@illinois.gov>,”Indiana Board of Pharmacy” <pla4@pla.IN.gov>,”Iowa Board of Pharmacy” <lloyd.jessen@iowa.gov>,”Kansas State Board of Pharmacy” <dbillingsley@pharmacy.ks.gov>,”Kentucky Board of Pharmacy” <pharmacy.board@ky.gov>,”Louisiana Board of Pharmacy” <info@pharmacy.la.gov>,”Maine Board of Pharmacy” <geraldine.l.betts@maine.gov>,”Maryland Board of Pharmacy” <mdbop@dhmh.state.md.us>,”Massachusetts Board of Registration in Pharmacy” <James.d.coffey@state.ma.us>,”Michigan Board of Pharmacy” <ramsdellr@michigan.gov>,”Minnesota Board of Pharmacy” <pharmacy.board@state.mn.us>,”Mississippi Board of Pharmacy” <fgammill@mbp.state.ms.us>,”Missouri Board of Pharmacy” <pharmacy@pr.mo.gov>,”Montana Board of Pharmacy” <roklein@mt.gov>,”Nebraska Board of Pharmacy” <becky.wisell@nebraska.gov>,”Nevada State Board of Pharmacy” <pharmacy@pharmacy.nv.gov>,”New Hampshire Board of Pharmacy” <pharmacy.board@nh.gov>,”New Jersey Board of Pharmacy” <boyerj@dca.lps.state.nj.us>,”New Mexico Board of Pharmacy” <debra.wilhite@state.nm.us>,”New York State Board of Pharmacy” <pharmbd@mail.nysed.gov>,”North Carolina Board of Pharmacy” <jcampbell@ncbop.org>,”North Dakota State Board of Pharmacy” <ndboph@btinet.net>,”Ohio State Board of Pharmacy” <exec@bop.ohio.gov>,”Oklahoma State Board of Pharmacy” <pharmacy@pharmacy.ok.gov>,”Oregon State Board of Pharmacy” <pharmacy.board@state.or.us>,”Pennsylvania State Board of Pharmacy” <st-pharmacy@state.pa.us>,”Puerto Rico Board of Pharmacy” <ecaballero@salud.gov.pr>,”Rhode Island Board of Pharmacy” <Catherine.Cordy@health.ri.gov>,”South Carolina Department of Labor Licensing and Regulation — Board of Pharmacy” <bundricl@llr.sc.gov>,”South Dakota State Board of Pharmacy” <randy.jones@state.sd.us>,”Texas State Board of Pharmacy” <gay.dodson@tsbp.state.tx.us>,”Utah Board of Pharmacy” <lpoe@utah.gov>,”Vermont Board of Pharmacy” <kkemp@sec.state.vt.us>,”Virgin Islands Board of Pharmacy” <lydia.scott@usvi-doh.org>,”Virginia Board of Pharmacy” <pharmbd@dhp.virginia.gov>,”Washington State Board of Pharmacy” <susan.boyer@doh.wa.gov>,”West Virginia Board of Pharmacy” <david.e.potters@wv.gov>,”Wisconsin Pharmacy Examining Board” <Kelli.Kaalele@wisconsin.gov>,”Wyoming State Board of Pharmacy” <BOP@wyo.gov>

This is happening fast. The Pharmacy Alliance has one stated goal: To get the boards to admit that a tired pharmacist is a dangerous pharmacist.  I had expected a nationwide program to start in a month or so.  It started today in North Carolina.  The letter-writing campaign is only the first step.  The next will be TPA press releases to major media outlets.  Print and Television.  Once they find out that XXX pharmacists are expected to work 14 hour shifts with no meal or rest periods, they will be all over it.  KYYYY, you might think about negotiating a severance package to keep you quiet.  One years wage sounds about right, plus full benefits for a year and a punitive settlement of at least $20,000.00. JP

Thank you for all you are doing.  Went by today to pick up my personal items and I’m feeling pretty down about things.  Wife broke down crying again this AM.

Thanks for listening and letting me vent.  My family and I appreciate all your efforts

KYYYY HTTTT was summarily punished for doing the right thing.  When you write to the NC board focus on patient safety.  The board doesn’t care if KYYYY doesn’t go pee when he has to.  They are mandated to protect the public.  Notice that no board member has connections with any of the huge chains.  We can do this.

Send all messages to Jay Campbell.  Letters directly to board members may prejudice them and cause them to recuse themselves.  The board will be judging on KYYYY claims.

North Carolina Board of Pharmacy

6015 Farrington Road #201,    Chapel Hill, NC 27517-8154July 11, 2011

Jay Campbell, Executive Director,  jcampbell@ncbop.org

North Carolina Board of Pharmacy

This letter is a request that the board review the circumstances of the firing of KYYYY HTTTT (North Carolina license pharmacist# 14905) by XXX.  We request that the board give consideration to the facts and intercede on Mister HTTTT’ behalf.  Mister HTTTT was a trusted and competent pharmacist in charge for XXX.  When he made a decision in an effort to assure patient safety, Mister HTTTT’ authority to close the drive-through was illegally usurped by a non-pharmacist.  At this point, Mister HTTTT realized that the situation in the pharmacy was dangerous and untenable and he asserted his responsibility to make sure that patient safety came first and he closed the pharmacy.  The board will recognize that this was his legal responsibility.  He had no other viable choice.

Mister HTTTT reports that at hour seven of a fourteen hour shift, he had already reviewed and verified over 300 prescriptions.  His intention was to counsel appropriately where the law required.  That is one prescription every 84 seconds, with inadequate help.  There was no uninterrupted break for nourishment or even a bathroom break.  Clearly, Kelly HTTTT was compromised.  It is to his credit that he took action as North Carolina Pharmacy Law requires before patients were harmed.

The Board of Pharmacy is mandated to regulate the practice of pharmacy in a manner that protects the public from harm or potential harm.  CVS consistently operates in a manner that not only disregards North Carolina Pharmacy Law, they flaunt the law.

I specifically point to: -21 NCAC 46.1804(b) and -21 NCAC 46.141(b).  The non-pharmacist store manager has absolutely no authority within the pharmacy.  Mister HTTTT determined that the conditions obviated the safe and effective distribution of prescriptions.   CVS disregarded the law.  Mister HTTTT was right and he was fired for asserting his authority as pharmacist in charge.  This cannot be allowed to stand.

It seems that the corporate culture at XXX-CCCCCCCC is based on getting profit by deceit.  They are a huge company and it appears that XXX is so far down the rabbit-hole of swindling and fraud that one wonders if there is hope that they can get out of it and join the many retail pharmacy companies that play by the rules.   Cases in point:  XXX agreed to pay a $75 million fine for violating the record-keeping requirements meant to control pseudoephedrine sales.  This had to be blatant disregard of the law, a thumbing their nose if you will.  Recently, dozens of members of Congress urged the Federal Trade Commission to resolve the matter of XXX-CCCCCCC unfairly restricting trade and engaging in activities that violate federal anti-trust laws.  It was stated, “It has become clear that XXX-CCCCCC’s model harms consumers and overall health care”.

A company that condones that kind of behavior at the corporate level can very easily fire Mister HTTTT at the store level for doing what a pharmacist should do.  XXX has made a statement in North Carolina.  “We will do it our way.  The laws of the state mean nothing to us.  We are too big.  They wouldn’t dare rock our huge boat.”

I urge that the North Carolina Board of Pharmacy stand up and make its own statement.  The behavior of XXX will not be tolerated.   Blatant disregard for the safety of the citizens of North Carolina will be punished.

I do not know if KYYYY even wants his job back.  There was a loss of income.   The last few weeks have been stressful, for both KYYYY and his wife.  They have small children.   The loss of his job for abiding by both the letter and the spirit of the law is arbitrary punishment for not bending to the will of the corporation.  I urge the board to do whatever means necessary to assure that Mr. HTTTT gets satisfaction, personally and legally.

Thank you for your attention.

Sincerely,

Jim Plagakis

I received distressing news today, via an e-mail.  A young pharmacist, who was the PIC at a XXX was fired.  This man is married with three young children.  The company said that he voluntarily resigned when he locked up the pharmacy and left the store a few hours before his shift was scheduled to end.  He felt that the distractions of not enough help and two drive-through lanes put the public at risk.  He closed the drive-through lanes, the store manager objected and the rest is history.  A few weeks later, after a suspension without pay, XXX said that he had resigned.

Ostensibly, this looks like a classic pharmacist in charge vs. non-pharmacist store manager.  This is a battle that the pharmacist rarely wins.  In my case, in the mid-1990s, we both went down.  I had a hissy-fit and quit a terrific job minutes from my house.  I did not work for over two months.  My next job was a 90 minute drive, one way.  The next time I saw the store manager, he was working as a detail man for a small pharmaceutical company.

This may bite XXX in the ass.  If this pharmacist can convince the state board this was a case involving patient safety, it could have far-reaching implications whether he gets his job back or not.  The board in this state is actually elected by pharmacists, not appointed by the governor.  If the board agrees that the pharmacist in charge has the discretion to make decisions that concern patient safety, precedent will have been established.  Perhaps this board is not top-heavy with chain drug store ringers.  Perhaps, this board will say, with no ambiguity, “Of course the pharmacist can make decisions that affect the welfare of the public.  XXX was in error forcing him to ‘resign’”.

Of course, pharmacists have not only the discretion, but the responsibility to look out for the welfare of the patients.  If CVS argues that the PIC has no such discretion, then the PIC is protected by the same labor laws that protect the girl in camera.  Somehow, legally in a court of law discussing labor issues, discretion is the key to being a professional.  These companies can get away with working pharmacists like draft horses by insisting that pharmacists have discretion and are, therefore, professionals.

XXX cannot have it both ways.  If the pharmacist cannot make choices that affect the patients, then he has no discretion.  XXX owes him for all hours over 40 at time and a half.  The famous 8AM to 10PM standard XXX shift will mean time and a half for all hours over 8.  A 14 hour shift would have to have a couple uninterrupted meal breaks and 15 minute rest periods.

XXX middle managers run the company with fear as a primary tool to keep pharmacists in line.  I’d bet that they have no clue how close they are to running the train off the tracks.  That is what happens when you perceive that you are all-powerful.  I have been observing our industry with a critical eye for 25 years.  Pharmacists have never been this agitated.  You and I can feel it in the air.  It crackles with energy.  We are less tolerant these days.

The young XXX pharmacist may have made a tactical error, but he made a good decision as a professional pharmacist.  Locking up and going home did not work.  Those of you who find yourself in such a situation must, I believe, use your discretion wisely.  The pharmacist is the last call in the pharmacy.  If the PIC is not at work, then the pharmacist on duty is the last word.  I’d guess that XXX does not like this fact of life, but tough shit.  The pharmacy is different from the rest of the store.

How would I proceed?   Carefully.  Always carefully.  You can start by practicing according to both the letter and the spirit of the law.  Getting in-your-face with them is not a good idea.

XXX would be smart to go tell our friend, “Ha ha, just kidding.  Come back to work.”

From a friend who is a XXX PIC in Alabama.  Very good advice.  Jay Pee