I asked Kxxxx Hxxxx if there has been any resolution to his complaint to the North Carolina Board of Pharmacy. He previously asked me to keep him anonymous and not mention the name of the drug store chain. I do not think that applies because he is not pursuing a wrongful discharge suit, but until he tells me to use his name, I won’t.
What good is the NC 12 hour maximum law if XXX pharmacists work 14 hours? What good is the law that makes the pharmacist the “law” in the pharmacy? What good is the NC law that mandates that the pharmacist perform her/his duties in a manner that protects the public?
Letter (To The Editor) Drug Topics, November 2011
From: David Work, Executive Director Emeritus, North Carolina Board of Pharmacy
David Stanley made some good points in his column about CVS in North Carolina. I was Executive Director when the 12 hour rule was adopted and applied. This was a direct result of a dispensing error made at an Eckerd drugstore by a pharmacist working a 16 hour with no meal break and/or scheduled bathroom break. Eckerd claimed that she “volunteered” for this shift. We also implemented a polcy, based on a Rule, which limits the number of prescriptions per day per pharmacist. I believe it would be in the interest of public safety for other states to take similar actions.
All very nice, Mister Work, but, since you left, the NCBOP seems to be the three monkeys. The Kxxxx complaint is 250 days old with nothing resolved.
The guy to ask is: Jay Campbell, Executive Director NCBOP jcampbell@ncbop.org
Kxxxx Hxxxx was getting Rxs out at a rate of one every 80 seconds. His experienced technician was sick. He could not safely continue. He closed the drive-through. The non-pharmacist store manager usurped Kxxxx Hxxxx’s legal authority and opened the drive-through. K closed the pharmacy and was fired. Kxxxx and his wife have triplets. They are toddlers. For a period, the stress of not having an income was over the top.
I do not know if any pressure brought onto the NCBOP would help – I would have thought the massive email campaign you engineered would have been enough to spur them to quick action, but apparently not. I suppose it is possible they are orchestrating a massive investigation – but I find it unlikely. Time permitting I will call them again to inquire this week or next week. I will let you know what I find out.
Davey, a student who understands that he has at least 50 years ahead of him with his feet on the floor, asked what he can do to help Kxxx. All of you can communicate your outrage to the Executive Director of the NCBOP. This is the letter I mailed last July. Please do not copy it verbatim, but you can use the information. This is an OUTRAGE. We need to hold the feet of the NCBOP to the fire. The question is: “Has CVS bought the board”. I am an idealist and I believe that we MUST DEMAND that all state boards live up to the mandated purpose to protect the public.
July 11, 2011
North Carolina Board of Pharmacy
6015 Farrington Road, #201
Chapel Hill, NC 27517-8154
This letter is a request that the board review the circumstances of the firing of Kxxxx (North Carolina licensed pharmacist) by CVS. We request that the board give consideration to the facts and intercede on Mister Hxxxs’ behalf. Mister Hxxxs was a trusted and competent pharmacist in charge for CVS. When he made a decision in an effort to assure patient safety, Mister Hxxxs’ authority to close the drive-through was illegally usurped by a non-pharmacist. At this point, Mister Hxxxs 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 Hxxxs 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, Kxxxx was compromised. It is to his credit that he took action as North Carolina Pharmacy Law requires before a patient was 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 Hxxxs determined that the conditions obviated his providing safe and effective delivery of prescriptions and made complying with counseling legal requirements impossible.
CVS is well known as a Goliath company that bends and breaks the rules. It seems that this is the corporate culture. The Federal pseudoephedrine sale recording requirement is a case in point. CVS agreed to pay a $77 million fine for neglecting to abide by the law. CVS flaunts the law at every turn. The executives in Rhode Island seem to be invested in only one thing, the bottom line and they will do anything, legal or illegal to get what they want.
It is a sad commentary that such a big player in the retail pharmacy universe gains a competitive advantage by cheating.
In the case of Kxxx, CVS broke the law. It cannot be any more clear. They cheated and they are probably cheating all over North Carolina. In this one case, they must be held accountable.
I urge the North Carolina State Board of Pharmacy to waste no time in taking effective measures that will give Kxxxx and his wife some relief as well as assuring, by example, the citizens of the State of North Carolina that disregarding the law, by any drug store company, large or small, will be punished.
Jim Plagakis
Come on, you guys. Step up. Your professional life depends on it and I am not overstating. The is no “Other guy” as in “Let the other guy do it.” If the NCBOP rules against CVS, the dam will be broken all over the country. Jay Pee
Here is a recent survey that drive-thru windows can contribute to med errors
http://www.pharmacy.ohio-state.edu/news/med_errors.cfm
IMO… the 14 hr hr in NC is ABSOLUTE… They have some sort of run about 150 Rxs/shift… the volume on this particular day seems to have exceeded that limit…the BOP has failed and continues to fail to enforce the practice act.
What I find strange – unless things have changed – since the USA TODAY report by Kevin McCoy.. there are no chain execs on the NC BOP.
The BOP is responsible to the AG’s office.. the BOP has the responsibility to enforce the practice act or refer it to the AG’s office to take action.
Where is the APHA… where is the NC Pharmacist Assoc… or is the corp that we routinely hear about paying multi million dollar fines while admitting no wrong doing… that is involved in this issue … being nothing more than a “school yard bully ?”… using their check book to evade the rules and regulations with immunity ?
How much of an investigation does it take to walk into this corp’s stores.. look at the hours of operation on the door and ask the RPH how many hours they are scheduled to work… if the RPH declines to divulge.. if the posted hrs are 08:00 – 22:00 .. how hard is it to walk into a store at 08:30 and return at 21:30 and see if the same RPH is on duty… GUILTY of practice act violation.
Does the BOP have the right to request payroll records to confirm/deny how many hrs are work?
Does the BOP have the right to request daily Rx count records?
IMO – “K” has the option of filing complaint/charges against the BOP for failing to enforce the practice act with the AG’s office… “K” could try and get the state Senator and/or Representative involved…
These are the people who pass the laws and would expect for them to be enforced.
One should ask …If this would have been involving drug diversion… how long would it take the board to act?
Is there anything I can do? I feel really bad for this guy. It could be me someday.
http://www.usnpl.com/ncnews.php
Here is a link to a page that lists all the TV and newspapers in NC… MOST have Facebook pages… how many people’s attention could be reached with a little “cut & paste” the same message on these Facebook pages?
I posted a link to a study that shows a relationship of med errors and the mere presents of a drive thru window..
Is the BOP being neglectful .. is the BOP willfully putting the health/safety of the patient in NC at risk?
This Pharmacist lost his JOB… how many pts in NC are being harmed or DIE from med errors and from the BOP’s lack of backbone?
here is a quote from the bottom of the NC BOP home page
The North Carolina Board of Pharmacy’s mission is to protect the public health, safety and welfare in pharmaceutical matters. The Board sets standards for academic and practical experience programs prior to licensure, issues permits to operate pharmacies and DME facilities, and annually renews licenses, permits and registrations.
The BOP is not going to listen to pharmacist that would be akin to prison guards taking directions from the prisoners! As professionals we need to leverage consumer groups to tell NOT the board that this is a safety issue but to complain to the State Assembly Members. Putting pressure on the “elected official” will usually get a response especially if it is a large influential group like AARP. Elected officials are just concerned about votes! This guy needs to get in front of a TV camera and let the people know in his community what is going on and then he needs to find himself a group of retired “nice little old ladies” that will take up his cause and raise Holy Hell!
I am not a pharmacist, nor will I ever be more than a customer. My local pharmacy knows me by name, never fails to counsel, always gets my prescriptions right. I am sure this is not specific to me, only to those who choose to fill their prescriptions there. Is there any way we customers can help? It’s been nearly a year with no resolution in sight. JP or anyone else who can provide me some guidance, please let me know, either by email (JP, you are more than welcome to provide my email address) or by replying here. Thank you.
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E-Mail address is: cp60188@gmail.com Are you in North Carolina?
I am writing a letter to the North Carolina State Board of Pharmacy. I know it must be ‘torture’ for Mr. Hoots, waiting on the board to take a stance on this issue. It is clear, and I do mean very clear, that Mr. Hoots case is one that clearly can establish a precedence, with regard to pharmacy law. How can a pharmacist be responsible for everything that takes place in the pharmacy, yet have no control over the pharmacy? Pharmacists are placed in untenable circumstances. This is also a case of a big corporation against a little peon. It will be interesting to see what happens. You would think the board is placed in a situation where they are going to have to follow their own laws. My guess is that they are trying to find some solution that gives a little to each side. I cannot imagine how they can do this, but my guess is that is what they are trying to do and that is why it is taking so long. As we pharmacist see it, it is one way or the other: we control the pharmacy or the corporations control it. If we have no control, then the boards should no longer be able to hold us responsible for anything that takes place in the pharmacy.
I am not defending CVS or the front end manager. Hoots should have kept the drive thru open and tell the patients it would take a couple of days to fill their Rx. Then he should have e mailed his DM of the situation and explain the next time it happens he will have to close the drive through.
Of course this is 20 20 hindsight. I probably would have done the same thing. Still it will not be the first time a pharmacist was canned for shit reasons from an asshole(is there any other kind?)DM.
Chalk it up and move on. It is a hopeless case.Being in the right means nada.
@Msdemeanor… first of all.. any non-pharmacist manager or non-Rx dept staff should only enter the pharmacy with permission of the pharmacist on duty… It is my understanding that this non-pharmacist manager regularly entered the pharmacy without asking for permission.
There are a lot of controlled substances on shelves and counters… under paid – over worked managers.. would not be the first time stuff disappeared.
Secondly, HIPPA information is all around and the non-Rx dept staff has no business in the Rx dept … is it a violation of HIPAA by itself?
A non-Pharmacist manager cannot open a pharmacy and is the opening of another service access point (drive-thru) by non-pharmacist and/or against the Pharmacist on duty wishes… fall under the same regulation… and by a person that did not have permission to be in the Rx dept in the first place?
IMO.. the chains hope that employees just “tuck their tails” and move on… never set a precedent doing that.. from what I have seen… the BOP’s are more than happy to see all of these issues just GO AWAY… other than drug diversion… IMO… collectively.. they don’t have much more backbone that the rest of our so called profession.
MSDEMEANOR, Steve is right about a non-pharmacist store manager coming into the pharmacy. First, any person entering the pharmacy area must be HIPPA trained for the company for which I work. I don’t know if this is a federal law or not. And, as Steve said, no one is suppose to come into the pharmacy without permission of the pharmacist. The pharmacy manager had no authority to open the drive-thru. Another thing that Steve mentioned is drug diversion by a store manager. I worked at a store where an assistant store manager kept coming back into the pharmacy chatting. I discovered the guy was getting Hydrocodone at another pharmacy and I alerted the pharmacy manager of this store. One of the techs at the store caught him grabbing a bottle of Vicodin off the shelf. He was arrested. That is why non-pharmacy personnel are not suppose to be in the pharmacy area. Also, in my state, it is illegal for anyone other than a pharmacist or state board licensed tech to touch the drugs in the pharmacy area.
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I agree with you that it would probably have been better for the CVS pharmacist to have simply left the drive-thru open, kept working at a normal pace, and start telling the customers the actual estimated wait time…which might have been come back tomorrow. But, like the CVS pharmacist, I would probably have done just as he did. Under the circumstances, with or without the drive-thru, and the lack of help, I would probably still have closed the pharmacy and left.
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This pharmacist has one of the best cases I have seen in a long time. There are a number of things that CVS violated. If the board just enforces its own laws, this should be a win for the pharmacist. I just wish there was a national outrage among pharmacists regarding this particular case and some pressure could be brought against the North Carolina Board.
This story is such a sad commentary on the state of the profession. This should be a simple case for the BOP but, instead, it is being drug out for much to long because, as Peon stated, I assume the BOP is trying to appease both sides involved. I vote for total abolishment of all Boards of Pharmacy. They are an impotent entity who won’t even enforce their own rules unless it is to use a pharmacist as a scapegoat. The majority of the Boards are simply puppets of the chains. There is no need for them.
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Reading stories like this and the Eric Cropp story make me feel truly alone in the profession. We really have no one to support us. No strong professional organization, no support from the Boards, no political lobby. I grow more angry, confused and frustrated every day. Am I going to end up in jail if I make a mistake? Will I be fired for ignoring the non-pharmacist manager? Where exactly do I stand on the corporate totem pole?
@Slave.. you are not alone… there are 100′s of RPH’s that read this and other such blogs daily and there are only a dozen or so that have enough chutzpa to post anything and those that do.. decline to use their real names..I know you fear for your job !
Look at the per-cent of RPH that don’t even belong to at least ONE ASSOCIATION… how do we expect representation if we force them to be enslaved to the corporate world for financial support… we put them in a position that they can’t represent us.. because they fear losing financial support of the corporations if they did.
We don’t hold the BOP’s feet to the fire.. if you want to blame someone .. look in the mirror… The PIC is responsible to the BOP for the legal operation of the Rx dept… if things are not being done well or pt’s health/safety is being put at risk.. do you have a legal/professional obligation to file a complaint/concern to the BOP against the PIC?
If you are the PIC and corp is coming down with mandates that you believe are putting pt’s health/safety at risk… you need to file concerns/complaints with HR/CCO.. IF you break your practice act… you are also breaking the company’s P&P… talk about being alone.. if you have expressed your concerns in writing… and the corp does nothing.. at least you can defend yourself that you tried to get things changed… but the corporation tied your hands… refused to make changes.. if you can’t completely exhonorate yourself… at least you should be able to drag the corp down with you.. all they care about is their reputation and their profits… they will throw anyone under the bus to protect those…
pharmacyslave2000, you are not alone. I think a lot of us pharmacists feel the same way. There maybe a ‘silent’ majority of pharmacists feeling just as you do. It is too bad that they don’t get on these forums and voice their ideas. From my talking with other pharmacists, I have found that most just don’t think things will change and that there is not anything they can do about it.
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Jim and Steve have been getting the word out regarding the risks of being a pharmacy manager for a chain. I cannot imagine holding that position in today’s environment. And, it is unbelievable that no matter what happens in the pharmacy, it is the pharmacy manager that is responsible. These BOP’s are simply nuts! They have their heads in the sand and are living in a time warp. The days of the independent pharmacist that managed his own store is gone. Yes, a few are left, but the vast majority of pharmacies are chain owned. A pharmacy manager for a chain is like a stuffed animal at the zoo and people are throwing baseballs at him. Just saying this reminds me of an old guy that I knew. He was passing the pharmacy and I stepped out to talk to him. He said we looked like monkey’s in a zoo. I thought ‘how true’! We live in that pharmacy cage and the people walk buy gawking at us.
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As Steve says, if you feel that patient safety is at risk, then you better send some emails to corporate and keep copies of each one of them! If you do nothing, and something bad happens, then you will be held responsible.
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There has been a lot of study in the healthcare area regarding ‘systems’. And, in some cases, errors have been examined from the point of view of a systems problem and instead of healthcare workers being held responsible, the point in the system where the error originated is fixed. This should have been what happened in the case of Eric Cropp. It was crazy to hold him completely responsible and send him to prison. Not a thing happened to the tech that made the mistake. How crazy can it get? Instead of the BOP’s holding the pharmacy manager for errors coming out of his pharmacy, they should be looking at the overall system. Why are those errors happening and how can it be corrected? Is the chain ‘pushing’ pharmacists to do more? Are there some kind of metrics that should be eliminated? Should there be more tech training?
Here is Eric’s side of the story
http://ismp.org/newsletters/acutecare/articles/20091203.asp
The tech had no consequences because – at the time – Ohio did not register/license techs..and the hospital did not require a tech to be certified to work there. The board has no authority over anyone or entity that doesn’t have a license granted by the BOP.
“the Board investigators determined that no system issues or adverse performance shaping factors played a role in the error”
AFTER THE FACT:
Although a few conditions described by Eric are disputed by the hospital, there is general agreement in many areas, as evidenced by the subsequent system changes that the hospital has employed to improve medication safety since the event.
Upon learning about the error, the Ohio Board of Pharmacy investigated the event and scheduled a hearing with Eric. The system allowed the Board to serve as “judge and jury” regarding possible revocation of Eric’s license, without the ability to appeal the decision.
All of you out there… that can keep up with increasing metrics and never make a mistake… you are excused of being concerned.. the rest of you…
I doubt if Eric every considered that he was putting his license, his livelihood and his freedom on the line.. when he went to work.
You also need to notice the consequences to Eric’s employer and the corporate pharmacy permit holder… NADA!
JP, Has this CVS pharmacist ever revealed this story publicly? I would love to start a petition on Change.org but It won’t work unless the full story can be publicized. Maybe that can place some pressure on the NCBOP.
No, I am in Illinois.
MSDEMEANOR, I had a few more thoughts regarding your comments that the pharmacist should have left the drive-thru open and told people 2 days. Ideally, I think you are right. Where I work, as the prescriptions begin to pile up, we start extending the wait time. It could be an hour and on very rare occasions even 2 hours. The CVS pharmacist could have simply started telling people it would be the next day or even 2 days, as you suggested, before their prescriptions would be ready. He had so many prescriptions to fill, at the time he dropped the drive-thru, that I doubt he could have filled tem before the day was out and that is excluding any new prescriptions. At that point, he should have started managing the situation instead of filling prescriptions. Telling people that dropped off new prescriptions that it would be 1 to 2 days. Telling the people that were waiting that it would be tomorrow before he could get them filled. This is how you mange too much work. You simply lower the amount of work you have to do. You do that by doing what I just said. The people dropping off new prescriptions that need them that day would probably take them to another store, which would be great. The people waiting on refills that were told it would be next day would either leave or say they are going to another pharmacy and have them call for a copy. I can imagine how it was for the pharmacist. He had not had a break, probably no lunch, and he was stressed to the max. I would have done the same thing he did. But, we don’t need to put ourselves in those situations. When CVS would not send him any more help, he should have been trying to reduce the amount of work he had to do that day. This is the only way we will survive in the corporate environment. We must have a strategy for dealing with these sort of situations. On one occassion, my input tech closed the drop off window at 3pm. She was overwhelmed. The store manager came back to the pharmacy and told her that if she did not raise it that he would call our DM. I told her to raise it. No matter how bad it gets, we cannot close those windows without getting in trouble. Now, we handle that problem by increasing the time we tell customers it will be before their prescriptions will be ready. If I see that we have all the prescriptions we can fill by closing time, I tell the tech to start telling people that it will be the next day before we can fill their prescriptions. You don’t refuse to fill prescriptions…you just increase the wait time to the point that people go to another pharmacy.
@Peon… great suggestion… to add to that suggestion… if you are not currently using a “basket system” .. start using one… then you can point to all the baskets stacked up near intake as to all the Rxs in from of the person at the window… that would create a better visual picture than a stack of paper scripts… 50-100 new rxs waiting to be filled don’t make the impact that 50 baskets stacked up. You have to print out the Escripts and refills labels.. make sure they are printed out promptly… and throw them into baskets and stack them up at the intake window.. Some stores use two different color baskets.. one for waiting and one for everything else. Pts see no one around the Rx area.. and presume that you are not busy… when they question the length of a wait.. just point to all the baskets with orders waiting to be filled. If you are allowed to staff only to a level that the Rx team is only allowed to fill 25/hr… you fill 25/hr… when the time to close comes.. you close and go home.. If you are not paid hourly… then you keep working after closing time… you are generating profits for the company and for no pay.. you are basically working off the clock… because the company has set staffing hours… below the typical Rx volume.. they expect FREE LABOR from you.. they don’t tolerate someone shoplifting or stealing from the company.. but does the company set the staffing levels to steal personal time from its employees?
Steve, pharmacists should not work past closing time off the clock! As you say, that is FREE LABOR for the corporation. You solve the problem of working past closing time by your use of ‘wait time’. You adjust the ‘wait time’ where you don’t have people waiting on prescriptions when it comes time to close. And, don’t work your staff past closing time either. If you do, then they will be forced to leave early on another day to keep from running over their allotted hours, which creates another bad situation for another day.
@Peon… my point exactly… if the allowed staffing hours causes Rxs to be 24 hrs behind most of the time and you end up catching up on slow days like .. Sat or Sun… so be it..
Back when I was “young” .. I had such a situation… but this was before computers and little PBM’s.. could not get more help for the volume… I RAISED PRICES.. growth leveled off.. but profits went thru the roof… Company was so happy with increased profits they didn’t say anything about growth dropping off.. We don’t have that flexibility today… time is all we have…
Off the clock in some states means you are not working and therefore not insured for mistakes or accidents…… I wonder how many errors happen off the clock. QRE reports should all contain a line that asks ” was the pharmacist off duty when the event occurred.” Then its the permit holders misfill. We have a systems problem, not a practitioner problem. We are “second victims” just waiting for our turn to face the judge…. its too crazy out there today!
This discussion has taken an interesting turn. The issues affecting retail pharmacy are more indicative a looming problem in society as much as anything else. No one is concerned with a “job well done” anymore, it has now become a “job done fast”. Quality and competentcy are second to speed. “Glasses in an hour”, “tire rotation in 30mins.”, “be seen by a doctor in 15mins.”, etc. are now marketing tools. It only makes sense for the brain-trust of corporate pharmacy to pile on.
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The major problem as I see it is that our customer base is totally ignorant of the processes involved in our job and if RAD tells them it should only take 15mins. to get a prescription well then that’s what they believe. I’ve tried the “stacking baskets”, inflated wait times, et. al to no avail. The customers don’t care about that because it doesn’t directly affect them. They are the most important person and they want to be treated as such because corp. America has drilled this into their heads. The first words out of 90% of the customer’s mouths is “how long will this take”. They don’t understand the process nor do they care. No gimmick we attempt to show them how much work there is matters.
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The only thing we can do is our best job possible. We will never make corporate happy nor we will ever make all the customers happy. My goal at the beginning of a shift is to try to get through the day as easily as possible. Make sure the customers are as content as they can be and appease the corporate overlords for one more day. I try to do all this without having a nervous breakdown or killing anyone with a med. error. It’s the best I can do and if it’s not good enough, so be it.
Here are few more pieces to the “puzzle”… the day this happened was FRIDAY July 1st… long 4th of July weekend.. Kelly was one tech down – one out sick… that week the store expected volume was ~ 2800 Rxs and the allotted RPH hours was 96… which had been reduced recently from 105 hrs. This hrs limit MANDATED that one day a week .. one of the three RPH’s had to work a 14 hr day.. all three RPH’s were down to 32-33 hrs/wk.. so that all could maintain their benefit packages.. they all had families.
Like other states.. according to the NC practice act there is no longer a Pharmacist in Charge … here is from the practice act
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(26) Pharmacist-Manager. The person who accepts responsibility for the operation of a pharmacy in conformance with all statutes and rules pertinent to the practice of pharmacy and distribution of drugs by signing the permit application, its renewal or addenda thereto.
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If you work in NC and you believe that you are the PIC.. WRONG… you are just a MANAGER – with all the legal responsibilities of a OWNER.. except you have NO SAY in many things in how the Rx dept functions..
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Here is :
Reprinted from the July 2007 North Carolina Board of Pharmacy Newsletter.
21 NCAC 46.2512 became effective on April 1, 2007. The rule, entitled “Pharmacist Work Conditions,” provides:
A permit holder shall not require a pharmacist to work longer than 12 continuous hours per work day. A pharmacist working longer than six continuous hours per work day shall be allowed during that time period to take a 30 minute meal break and one additional 15 minute break.
At its April 17, 2007 meeting, the Board voted to allow a six-month “grace” period for implementation. Accordingly, Board staff will begin enforcing the rule on October 1, 2007. Board staff strongly encourages employers to use this time to make any necessary changes to work schedules.
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According to this.. the BOP inspectors were suppose to start enforcing the 12 hr rule FOUR YEARS before this incident with “K”.. and where was his meal break.. as provided by both the practice act and the corporation own P&P? Is the BOP being negligent in enforcing it own rules?
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Could the BOP in some perverted decision.. hold “K” – as Pharmacy Manager for working a 14 hr day and taking no breaks…
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Also with the issue of the NC practice act that sets above 150 Rxs/shift (18.75/hr – based on a 8 hr shift) as a “potentially dangerous volume”.. if the corporate allowable RPH hrs for the week at ~ 30 rxs/hr.. is a anticipated volume 50% of what is considered “dangerous”… really negligent or just plan reckless?
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could the BOP – in again – some perverted decision – follow the letter of the law – hold the Pharmacist manager responsible for inadequate staffing for the anticipated volume.. even though.. “K” had no latitude for additional hours and the allotted hours provided for nearly zero overlap and/or two RPH’s on duty during that week.
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Should PIC’s in NC be filing complaints with their HR/CCO if these are issues in their stores.. Should the staff RPH’s in NC.. be filing complaints with their PIC.. if this is a issue in their stores?
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When a mistakes happens… guess who is going to be held liable?
It seems quite apparent that boards, like North Carolina, are trying to apply archaic laws to pharmacy. Chain pharmacy managers are not anything like pharmacy owners. From the NC board rules, it would seem that the pharmacy manager would be responsible for staffing, along with the lunch break and 15 minute break. He would be responsible for violation of the 150rx’s per shift. In effect, as the rule stands, it would seem that CVS would not have any responsibility because everything would fall on the pharmacy manager.
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The question becomes how will the board rule on the Hoots case? If they rule against Mr. Hoots and the pharmacy manager, then we can safely say that pharmacists working for chains in North Carolina are doomed. It is certainly time for North Carolina pharmacists to wake up to their situation. The question lingers as to the responsibility of chains, pharmacists, and pharmacy managers across the US. It still seems apparent that what happens in North Carolina is going to be a watershed for chain pharmacy practice across the US.
I just made a long post about this issue and the ramifications
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http://healthblog.steveariens.com/?p=972
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Where do we need to draw the line? — it is about patient safety…. stupid !
Steve, excellent post on your blog! It is time that chain pharmacists in the US wake up and pay attention to what is taking place around them with the BOP’s. The change in language from PIC to Pharmacy Manager is a significant one. All you chain pharmacy managers better take note of what is happening. These boards are treating you like the owner of the pharmacy. Since you don’t actually control pharmacy staffing levels, what are you going to do when something goes wrong and you go before the board and you are told that you are responsible for pharmacy staffing? You are responsible for your pharmacists getting breaks? In states where the board have set rx’s per hour, what are you going to do when you are dragged before the board when an error occurs and the pharmacist working that day had exceeded that level?
I told someone just the other day this issue is why I will never accept a PIC job again (unless that is my only option for a job). On the one hand, you are legally responsible for what happens in the pharmacy. While on the other hand, the chain dictates down important decisions like staffing and policies. It just doesn’t seem fair to this simple-minded southern pharmacist! What happens if I accept a PIC position at one of the big chains and they immediately cut staffing by say 10% or more? I’m still responsible for every prescription that leaves that pharmacy. And to add insult to injury, most chains pay little in terms of salary premium for these positions. If I am crazy enough to take on all that risk and liability shouldn’t there be at least a significant pay raise involved with those positions? But the BOPs are locked in with members of the chains all over the country. They will avoid these issues and call them “business decisions” or something similar. Well, what happens when a terrible misfill happens because of these “business decisions” being made by the chains? All of a sudden, we are professionals again and must take accountability for the mistake. It isn’t right. And this is what you get when the industry is controlled by people who have never filled one prescription in their life! The power shift needs to change from the managers and the executives back to the pharmacists. If that happens then we will be fine and things will improve. If not, there will be more of the same in the future. Fast food pharmacy is alive and well. And the worst part of it all is that we as pharmacists allowed all of this to happen to us without putting up much of a fight!
BTW, I will be happy to do what I can to help this pharmacist. If he needs a recommendation for legal counsel, have him contact me and I will refer him to some names. I can also write to the NC BOP although I must warn you they’ve already ignored my previous correspondence. Believe me, law or no law pharmacists in that state just like many others are working more than 12 hours without a legitimate break or rest. They are also filling more than 150 scripts a day or whatever other number your state BOP comes up with as a guideline. It is a shame but that is the reality. And with the expansion of the pharmacy school system and the saturation of the job market, if you complain your employer can simply find someone else to do the job. That is the reality we face now.
Also, I’d like to add that I was in a similar situation early in my career with the same crappy chain. While I didn’t close anything, I did work in very dangerous conditions that were conducive of mistakes. I asked a BOP member at that time what I should do if CVS ever put me in that same situation again in the future. His response: “close the pharmacy until they send you some help!” That is a direct quote from an active member of the BOP at that time. These BOPs have to be reasonable. They have to know at some point pharmacists are being pushed beyond their absolute limit of capabilities. And the resulting errors have nothing to do with the abilities or competence of the pharmacist involved. But alas, we will be the ones to carry the blame anyway.