We Need More Of This. Defend Pharmacists. It is the Prescribers Who Need to be Nailed, Not WAG.

Jp Enlarged

Terry Forshee is a true Pharmacy Warrior.   More of us must publish the truth.  Pain patients blame the pharmacy when we cannot fill their prescriptions in a timely manner.  And when I say BLAME, they do damage with gossip and worse.  Pharmacists have been sued for causing unnecessary pain and suffering.  One poor bastard in Oakland really did not have OXY SR 80 mg in stock.  An old, established customer believed that he was lying and sued him.  Of course, he could prove in court that he did not do anything wrong.  But the cost of an attorney and other associated costs caused him to settle.  Not much.  Ten grand, I remember.   The damage to his independent pharmacy was not insignificant.

No pharmacist wants to deny necessary medicine to any patient.   We did not just fall off a turnip truck.  We know when the patient is a drug-seeker or a dealer.  Why else would they drive 60 miles from the “clinic” to your store when they don’t live anywhere close?  The DEA can trust us.  Rather than an adversarial relationship, why not cultivate pharmacies as resources?  If there is a true bad apple, nail them!   WAG, CVS & Rite-Aid are not corporate bad apples.  Walgreens has got to be on red-alert because a few pharmacists were idiots.  The Pharmacy DMs need to be pilloried first, then the in-store pharmacists.  

Next, a follow up report from the independent (Medicine Shoppe) owner who did her best to serve legitimate pain patients and may lose her store.  If she allows me to publish the letter I received from her yesterday.

Jay Pee

Not Jay Pee.  This past Monday in our Chilli staff meeting, we had a vigorous discussion of the rampant prescription drug abuse in our society. Many of you have commented on the need to do something about the problem. I believe that the universal feeling is that certain doctors are guilty of very lax processes of Rx issuance. Below is a letter to the editor of USA Today which was published last week. The author is Terry Forshee whom we know from our membership in PDS. He points the finger not only to the doctors but more importantly the DEA as a large part of the problem. I thought that you would be interested in Terry’s thoughts.

Letter to the Editor of USA Today

June 12, 2013

As a practicing community pharmacist I read with interest the story on the fine agreed to by Walgreen’s Pharmacies. Since they agreed to the fine I assume that Walgreen’s agrees that they had a lack of control and has now taken steps to correct this oversight.

My concern is how the DEA spokesperson is so quick to point the finger at pharmacist’s oversight, wholesaler’s oversight but never seem to accept responsibility for the ultimate source of this problem. After all, which government agency licenses practitioners and enables them to prescribe these drugs in egregious quantities? Exactly the DEA! Who licenses the clinics that open? Exactly, the DEA! Who solicits from ALL of the major Pharmacy Benefits Managers dispensing data that shows who is writing these prescriptions? Exactly, the DEA!

My point is, why don’t they act on the entity that INITIATES the prescriptions? Because they are infringing on a physician’s decision making and that scares them to death! They are not physicians! By the time they get around to the obvious, thousands if not millions of prescriptions have been written.

Instead they pick the easy target, the community pharmacist. They question OUR judgment and give us ZERO opportunity to respond or explain why our decisions are made. They limit our ability to purchase medications. They threaten our suppliers if they don’t collect our patient’s private health data and turn it over to them.

We are being used as scapegoats for the meth craze and now the oxycodone explosion. The DEA is a typical bureaucratic entity that rather than solve the actual problem, would rather collect fines and pat themselves on the back publicly than listen to community pharmacists who MIGHT actually have some good ideas on how to address this problem.

Pharmacists KNOW who writes these prescriptions. In fact, a pharmacist friend of mine in Bean Station, TN lost his life at the hands of a drug head 2 weeks ago trying to do what the DEA expected him to do. We can point the DEA to rogue physicians. What we are not allowed to do, is play physician. How can we be SURE that a patient is a dealer and not a patient in real pain? One might say that you can tell by looking or that you can tell by the amount of the prescription but that is only true to a certain degree.

In the pharmacy in which I work we have strict protocols to determine whether or not to dispense. If it were up to our decision making process we would have removed hundreds of thousands of illicit medications from dealer’s hands. Instead when we turn them down they continue to go from pharmacy to pharmacy until they find one that is either too busy or slips up and gives them their medication. The root cause is the WRITING of the prescription. So instead of rewarding us for taking care of our patients they place arbitrary purchasing rules and squeeze wholesalers to limit the amounts that we can buy…whether or not we are following the rules. In turn this causes us to treat legitimate patients like drug addicts because we can’t get enough medication to fill their prescriptions.

It is like most issues facing community pharmacists today. The better we do our job the less we are allowed to do our job.

The bottom line is this…community pharmacists are the true gatekeepers of our emerging healthcare system BUT the “system” refuses to utilize us and pay us for the benefits we provide to our nation. We are not even recognized as a healthcare provider by Medicare so that we can be paid for providing services to our nation’s seniors. It is time to quit compromising our ability to do the job for which we have been trained. It is time for the DEA to quit squeezing those who want to be part of the solution and go after the obvious problem…the people that they license to write the prescriptions and begin the process.

I realize that by even commenting on this I place myself open to retribution but it is time to focus this debate on the real issue and not on the healthcare professional that places his/her life on the line everyday to make the right decisions.

Terry Forshee

President/CEO at Take Charge Pharmacist Healthy Lifestyle Strategies

The following you either pay strict attention to….or you are an idiot.  This comment by PharmacistSteve is vital.  He explains that a pharmacist backed down Rite-Aid, had his PDM censured by the Board of Pharmacy, and got some pretty good bucks.  Essentially, the PDM ordered him to early refill.  He refused, got lambasted by the PDM.  It is not a controlled.  Fill it.  There was some anxiety, but he is young and survived it.  The PDM tried to interfere with his practice of pharmacy.  Originally, this guy contacted The Pharmacy Alliance.  He wanted to know what it is all about.  We explained that TPA is a pharmacist advocate first, on the high road.   He joined, asked asked our advice (Steve & Jay Pee) and then took his stand.  A very smart rat from the UK.  Not raised in the wimp American culture.  If you have been paying attention, you can easily guess the state where he practices.

A comment from PharmacistSteve.  The Pharmacy Alliance had a member – on the west coast -contact us about being written up by a PDM with Rite Aid for refusing to early refill a Rx for Zanaflex. The RPH contacted the BOP and they backed the RPH.. eventually the RPH engaged legal counsel and Rite Aid flew some “bigwig” from corporate HR out to the west coast to have a meeting. The last I heard, the RPH has left Rite Aid for another job and took a fairly LARGE SETTLEMENT with him/her

One thing that seems a constant.. if you notify legal/HR BEFORE you are shown the door… and engage legal counsel.. they are much more reluctant to screw with the RPH.

If you look at the pure financial aspects.. if you spend one day’s pay to keep you on the job and drawing a salary for weeks.. while you look for another job.. and end up with a settlement.. that investment in legal counsel .. is paid back many fold

23 Comments

23 Comments

  1. pharmacyslave2000  •  Jun 19, 2013 @3:18 pm

    I’ve commented numerous times on this subject and regular readers should be well aware of my stance on the matter. I am under NO obligation to dispense any medication to anyone. I don’t quite understand how a customer won any type of lawsuit against a pharmacist for refusal to fill. There must be more to the story. Are doctors being sued because they refuse to prescribe meds to a patient? Are lawyers being sued because they refuse to defend a person in court? If we are truly “professionals” then this never should have happened and the fact that it did sets an extremely bad precedent.
    ***
    I do agree that the prescribers HAVE to be held accountable. First, they are defrauding the insurance industry, and the federal government in some cases, by prescribing drugs to questionable patients and charging their insurance for the visit. Second, they are causing a danger to society by enabling these “patients” and pushing more drugs out into circulation. These docs have been untouchable for to long. If you cut the head off (the doctors) the body (the abusers) will eventually die.
    ***
    Some on this forum discuss “patient/senior abuse” if meds. are not dispensed. I say BULLSHIT! If I had my way, I would never dispense another CII again. I’d rather not have to deal with these people and all the issues that come with them, legitimate patient or not, and the above example in J.P’s post is a perfect example as to why I feel this way. I’ll be damned if someone is going to sue me, or worse yet threaten to kill me, for doing my job they way I see fit.
    ***
    There need to be vast changes with regard to CII dispensing. Everyone, i.e legitimate pain patients, legitimate doctors and pharmacists, needs to be protected. I would like to see CII rx’s be filled only at specialty pharmacies equipped to deal with those meds and patients.

  2. Pharmaciststeve  •  Jun 19, 2013 @5:31 pm

    Are doctors being sued because they refuse to prescribe meds to a patient?

    http://answers.google.com/answers/threadview?id=242272

    @Slave all you have to do is a simple GOOGLE search to get your answer.. IMO.. if the doc wrote the Rx – for a legit pt… and a RPH refuses… the onous drops down to the RPH.. for denial of service/care… pt/senior abuse.. discrimination under ADA

    All it will take is a couple of successful lawsuits.. and the whole system around dispensing controlled meds will have a dramatic change.

    The last decade was declared the “decade of pain” and Joint Commission made pain management a MAJOR STANDARD for those accredited by them. Legit pts will get more aggressive in defending their right to therapy…

    Some healthcare professionals will find themselves in the cross-hairs of attorneys who expect to make money on handling such cases..

  3. goose  •  Jun 19, 2013 @7:30 pm

    The real problem here is one I think everyone involved with the prescription filling process realizes. Simply stated, too many prescriptions to fill and verify in a day and pressure to fill as many prescriptions as possible.
    It’s a perfect storm. The suits don’t see CII Rxs, they just see Rxs. They want you to fill as many as possible and if more are for cash, that’s just better because it pushes the margins up. The volume clouds your judgement so that you don’t check things like you should. Keep in mind less support from technicians, usually with less training when you do have them.
    Throw in some bullshit metrics which distract you even more. It’s a wonder we catch anything.
    Don’t depend on the prescribers to police it, they make an early call on whether to treat the patient or shove them on down the line. Usually it’s the latter.
    I don’t know what the answer is but I’d be damned if I would let anybody tell me to either fill a prescription or not fill it.
    If our profession has come to that and we do nothing, you can have it.

  4. Pharmaciststeve  •  Jun 19, 2013 @8:17 pm

    The Pharmacy Alliance had a member – on the west coast -contact us about being written up by a PDM with Rite Aid for refusing to early refill a Rx for Zanaflex. The RPH contacted the BOP and they backed the RPH.. eventually the RPH engaged legal counsel and Rite Aid flew some “bigwig” from corporate HR out to the west coast to have a meeting. The last I heard, the RPH has left Rite Aid for another job and took a fairly LARGE SETTLEMENT with him/her

    One thing that seems a constant.. if you notify legal/HR BEFORE you are shown the door… and engage legal counsel.. they are much more reluctant to screw with the RPH.

    If you look at the pure financial aspects.. if you spend one day’s pay to keep you on the job and drawing a salary for weeks.. while you look for another job.. and end up with a settlement.. that investment in legal counsel .. is paid back many fold.

  5. Pharmaciststeve  •  Jun 19, 2013 @8:42 pm

    When the DEA goes after a doc’s practice.. they come in .. in SWAT gear… confiscate everything in the office including HIPAA information… they confiscate the doc’s home, cars, bank, brokerage… any/all assets.. gets the medical board to suspend their license.. Leaving the doc penniless and having to somehow defend themselves in court.

    Usually they find one or two bogus pts in a doc’s practice and promise them immunity (get out of jail card free )if they will testify against the doc.

    Those docs that have been exonerated.. have never recovered professionally and/or financially… and the pt’s from the doc’s practice are shunned by other practices.. because they were part of that “dirty practice”

    IMO.. all pharmacies should have a list of 6-12 items to profile new pts.. and a number of “red flags” that the pt is turned away..

    IMO.. all pts that repeatedly purchase control meds should be re-evaluated every 6 months or so… using a different list of “red flags”

    You will not “sanitize” a pharmacy practice overnight.. could take 2-6 months.. but just as the word gets out on the street that a pharmacy is “easy”.. it gets out that a certain pharmacy plays “hard ball”

    If you can’t turn away or discharge a pt from your pharmacy practice.. because you don’t want to lose the Rx count and revenue.. then you will probably have enough bogus pts that the DEA will come down on you.. sooner or later…

  6. bcmigal  •  Jun 20, 2013 @12:22 pm

    I’m with you, Goose and Slave. I have flatly told folks “we don’t fill prescriptions from your doctor”. Most pharmacists get a gut feeling when something is suspicious about a prescription. I have been in this business a long time and I have never had a pt complain that I refused them service.

    The corporate culture and its sweat shop mentality encourage pharmacists to suspend their better judgement. We are shamed and harassed during every conference call. More tasks and less help are the norm. We are providing pts with poisons that can harm or kill them and we may have a minute or two (on a good day!) to verify an Rx. Is this not extremely dangerous? Where is the outrage about this?

  7. Pharmaciststeve  •  Jun 20, 2013 @6:47 pm

    the “outrage” is HUSHED every pay day.. when more money is put into your bank account…

  8. Peon  •  Jun 20, 2013 @9:21 pm

    Terry Forshee pretty well sums up the problem of CII’s and drug abuse and places the blame squarely where it should be. It is the docs that are the problem. It is the DEA for lack of oversight of these docs. If it was possible, the DEA should be sued!

  9. A tech  •  Jun 21, 2013 @6:53 am

    The chain that employs me just sent down from corporate level a memo saying we should no longer inform the patients that we are out of medication, but that company policy states we should not fill something we do not feel comfortable with. In an area where armed robberies are rising at an alarming rate, why would I use the latter when the former would be more likely to save myself and my coworkers from potential harm/death? We are still using the old story to save our hides. One doctor in town has been thrown in jail, but for every one taken off the streets, two to three are popping up to replace them.

  10. Peon  •  Jun 21, 2013 @9:07 am

    A tech..corporate should stop micro-managing. Leave it to the pharmacist to make the decision as to what to tell the patient.

  11. Pharmaciststeve  •  Jun 21, 2013 @6:42 pm

    @Tech.. I am sure that the corp that you work for have ample video monitors that will help catch whoever kill one of the employees or customers..

    Here is a quote from Walgreens.. concerning the Benton Harbor MI incident where their RPH fired back on armed robber.. when his gun jammed..

    We’ve made significant investments in security technology in recent years, including increasing the number of digital surveillance cameras at our stores,” the company said. “We continue to invest in state-of-the-art security measures and high-definition surveillance equipment and hope that the apprehension of robbery suspects in the Benton Harbor area will prevent future crimes.”

    BTW… the web link to this article has been replaced with another story about this situation… but..I had copy/paste the quote to my blog when it was active…

    just go to my blog and search for “benton” and you can find what was said in a couple of different media

  12. pharmacyslave2000  •  Jun 23, 2013 @4:26 pm

    Pharmaciststeve, just one more reason CII dispensing should be removed from retail and dealt with in a more secure environment. Oh, sorry, that will never happen. A “patient” may get upset by the inconvenience and the corporations would miss out on their cash cow. Besides, pharmacists are dispensable anyway. One gets killed in a robbery, just grab the next new grad in line. BTW, I’m sure the family of the next pharmacist gunned-down by some asshole drug-seeker will sleep much easier knowing that the corporation has invested in the highest quality surveillance system.
    ***
    On a side note, I’ve been very strongly considering carrying a weapon at work. I would be fired immediately if anyone found out but I think it’s a worthwhile gamble. I can always find another job but I can’t come back from the dead and I would feel terrible if someone else was injured/killed when I could have prevented it.

  13. bcmigal  •  Jun 23, 2013 @6:57 pm

    All the surveillance footage in the world won’t replace a life. After we had a store robbed by a knife wielding drug crazed individual, not a thing changed. Oh, wait, one of the techs was so traumatized he was not able to set foot in a pharmacy again. No counseling, no inservice, not even a memo….what a surprise.

    Sorry, but I do not think the DEA is the evil one. If you look at the 100′s of thousands of oxycodone that was being ordered from the distribution centers and dispensed by the pharmacies involved, there does not seem to be any question that these numbers are out of the ordinary.

  14. Crazy RxMan  •  Jun 24, 2013 @10:54 pm

    Maybe it is just the state I work in, but I’m under the impression that no pharmacist can ever be forced to fill a prescription he or she is uncomfortable filling. I’ll check again, but that’s how I remember it in my state and that’s how I’ve been conducting myself after 5pm. If I’m not sure if it is a legitimate script or it’s too early or whatever, I’m just not going to fill it and that’s that. In most cases, I don’t really “refuse” to fill… I just say I need to verify the prescription and that might be Monday at 11am. There’s certainly nothing illegal about that.

  15. pharmacyslave2000  •  Jun 25, 2013 @6:33 am

    CrazyRxMan, my state is the same. We are under no obligation to fill anything. It is our right to use “professional judgement” and we have been told by our corporate managers they will indeed back us up. It’s no different than the Plan B issue from a few years ago. If you don’t fill comfortable filling a rx, you hand it back to the patient and give them information on a nearby pharmacy that may. The pharmacists that were getting in trouble in the Plan B cases were simply not giving the rx’s back, just refusing to fill and keeping the paper script. We’re making a mountain out of a molehill. If you don’t want to fill something or you don’t feel comfortable filling something then don’t. If you are forced by management, document it and present it to the appropriate parties. I personally don’t fill any controlled substances from out of state and I require a diagnosis code on all CII’s. None of this “fibromyalgia” bullshit either, legitimate diagnosis codes for real problems.

  16. Pharmaciststeve  •  Jun 25, 2013 @7:38 pm

    @Slave…

    If you think that Fibromyalgia is BS.. then you are either showing your ignorance, arrogance, phobia, or some other warped mindset.. to discriminate against a certain pt population..

  17. pharmacyslave2000  •  Jun 25, 2013 @8:06 pm

    Pharmaciststeve, I do not believe that fibromyalgia is a legitimate medical diagnosis. I believe it is a “catch-all” term for a collection of symptoms that a person may experience but that the doctor can not correctly diagnose. Generalized pain, lethargy, muscle weakness, etc. could be caused by any number of things. It’s a lazy diagnosis and it’s not helping the patient. Just another excuse for big pharma. to develop drugs and/or re-label existing drugs. Savella anyone? Worse, it’s an excuse for questionable doctors to prescribe pain meds. to questionable “patients”. Pharmaciststeve, we will never agree on the issue of pain management and it is inappropriate, and insulting actually, for you to question my intelligence and accuse me of “discrimination”. I never said I refuse to fill anything for patients with the diagnosis of fibromyalgia, I just refuse to acknowledge it as a legitimate reason for pain management medication.

  18. Pharmaciststeve  •  Jun 25, 2013 @9:49 pm

    @slave… perhaps you prefer the “label” that FM had before trigger points were association with FM…

    Previously FM was referred to as whining woman’s disease..

    Other than trigger points.. there are some 20 odd symptoms that can be related to FM..

    It was previously believed that FM and chronic fatigue were to separate diseases… but .. now they are believed to be at opposite ends of a continuous spectrum.. and a pt can be somewhere along that spectrum.. with intensity of symptoms varying where they are along that line between the two.

    I just try to educate/enlighten the “uninformed”… I can guarantee you .. that if someone you love becomes a chronic pain pt.. your belief and attitude will do a 180… of course those that don’t change… chronic pain is a major cause of divorce.. when one partner doesn’t understand.. what the other partner is going thru..

  19. MSDEMEANOR  •  Jun 25, 2013 @10:21 pm

    I agree with Pharmaciststeve.
    pharmacyslave.What the hell gives you the right to judge whether or not people deserve
    relief frome chronic pain?You are not a physician.You dont have a chart in front of you Fill the rx if it is legal and keep your judgements to yourself.
    Pain is still undertreated in this country.That is because of an inordinate fear of addiction
    and pompous blowhards like yourself who view people that seek pain relief through medicine as somehow being weak in character.
    I am not questioning you intelligence. However being smart does not mean you can not be a jerk. You have proved that.

  20. Peon  •  Jun 26, 2013 @7:03 am

    Fibromyalgia is indeed a chronic illness. I have personally known a number of people with fibromyalgia. They are not just whiners…not just complainers…not just lazy. They have a true illness and it turns their life into a living ‘hell’. In fact, I work with a tech that has fibromyalgia. A few days ago she broke down crying. She said that she has not had a joyful/feel good day in 10 years. Can you imagine feeling terrible every day of your life? The drugs they take are just to kind of make life a bit more bearable.
    -
    Jay Pee is correct “No pharmacist wants to deny necessary medicine to any patient. We did not just fall off a turnip truck. We know when the patient is a drug-seeker or a dealer.” We need to leave the filling of rx’s to the pharmacist. The DEA and the chains are attempting to define what a pharmacist can or cannot do with regard to filling a rx. This is just another area where our authority is being taken away from us. Just another instance of how we are being demoted to ‘peon’ status. We have gone all those years to pharmacy school. We come out of pharmacy school thinking we are ‘professionals’ and that we can use our ‘professional judgment’ only to learn that we are not allowed to use that judgment. We are labeled ‘professionals’ but are treated like ‘slaves’ and told what we can and cannot do. The issue is really one of ‘power’. Over the decades our power to manage and make our own judgments has been taken over by ‘others’. Now our ‘professional judgment’ is being stripped from us by the DEA and the chains.

  21. Cvsconsumesyoursoul  •  Jun 26, 2013 @11:40 am

    Like I have said before, they should outlaw any rx from crossing state lines. In this day and age with most chain pharmacies having stores every 20 miles or so there is absolutely no reason to not fill an rx close to where it was prescribed. In my case I run a mental flow chart and refuse on a consistent basis rx’s that don’t have a rational therapy. I’m sorry but NOBODY should be receiving 180-300 Percocet ever. Every person who has studied pain management therapeutics should understand that fast acting meds so nothing more than lead to severe addiction over time. There are no studies I have ever seen that indicate fast acting over long acting with breakthrough. Hell I have seen 4 OxyContin 80 mg tablets a day along with 240 Percocet 10/325 (2 q 4h). Really? So the game plan is to just take pain meds out the ass all day long? At that point secondary modalities like nerve blocks should be considered. Physicians do a complete shit job of explaining to patients that there is a huge difference between pain control for improved functionality and euphoria. How many patients have you heard saying the re formulated OxyContin “doesn’t work”? Why, because you don’t get as much euphoria? Then after years the doc gets worried when the DEA comes around the area and dump their patients. By then they are so physiologically addicted its ridiculous.

    What happened to the pill counts, contracts and piss testing along with rational therapy? I am not sure about you guts but I write Charles Dickens novels on my hard copies when there needs to be additional info. Additionally I feel that nobody, physicians included, can force me to fill anything. My state statues defer to “professional judgement” which would be pretty hard to find fault unless you are a complete moron. I would wager that there are things missing in these stories of pharmacists being disciplined or sued for not filling. I’ve told quite a few patients that the days of pharmacists blindly filling because a small piece of paper is presented, are over. My job is to protect the patient using all resources at hand. If the doctor is a pompous prick who is above diagnosis codes and engaging professional conversation regarding their approach to therapy, then I cannot, in good faith, provide a service in the best interest of the patient.

  22. Pharmaciststeve  •  Jun 26, 2013 @9:07 pm

    If anyone is interested in coming up to speed on FM.. here is a new article/study – just published last week

    University at Albany’s East Campus Biotech Company Makes Major Fibromyalgia Discovery

    http://www.albany.edu/news/39664.php

  23. Peon  •  Jun 27, 2013 @9:55 pm

    Steve, thanks for the update on FM. I am printing that article and will give it to one of my techs that has FM.

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