A.J. Takes it to the Texas Board. 11-6 AJ’s Post-Game Report

Jp Enlarged

Please NOTE, in this new format, you can access the “comments” at the bottom of each post.  I like the standard font.  It is a decent size to read.  

Please watch this girl recite the Mission Statement of the Texas State Board of Pharmacy. It is just 22 seconds.  

11-6-13 Take the time to read AJ’s Follow-Ups in the “Comments”.  Really good stuff.  I smell the gunpowder of a Revolution.  How many Guerrillas are out there.  Read what AJ has to say.  I honestly believe that he has set the stage for action all across the land.  Clearly, the members of the Texas State Board KNOW what is going on.  They just need a good reason (like publicity) to bring the hammer down.  You guys can do it.   I sense that AJ will lead this parade. Here is a taste of what AJ reported to us.  Read all of his Comments to get the complete picture.  How about you guys in other states.  Will you sit on your hands?  ”Let Texas do it”   Contrary to what you might think: Washington, Florida and Texas are the three leaders in change (Not talking about pharmacy necessarily).  Change starts in those three places.  It has to be continued though.  These state bureaucracies like to take each others lead.  Now, how about following Oregon?

If you have not accessed Comments before, scroll to the bottom of the post and click on the comments.

 I believe North Carolina has a limit on Rx’s filled per shift. JP has wrote about it last year here…

.http://www.jimplagakis.com/?p=5317

JP has also wrote about how the pharmacy rules and regs in most states are 40 years behind. The majority of pharmacies today are run by big corporations. The laws have not changed to reflect this. The laws in Texas still hold the permit holder and the PIC equally responsible. Back in the day in the majority of pharmacies the permit holder and PIC were one in the same.
.
After I made my statement to the State Board the Board members could ask questions if they wanted to. One of the Board members asked me why with the rules and regulations governing the pharmacist in charge did I fell a ratio was necessary. She further explained that she felt the Boards over site of the PIC was sufficient enough to compel the PIC to do what was right.
.
Oh boy she couldn’t have served up a bigger meatball for me to knock out of the park! I thanked her for asking the question and told her there was a glaring hole in the Texas pharmacy rules and regulations concerning this. I went on to explain how pharmacy was no longer run by individual pharmacist and how the PIC at corporate run retail chain pharmacies had absolutely zero authority to make any decisions concerning the operation of the pharmacy. Her reaction was almost comical! When I said there was a glaring hole in Texas pharmacy law her jaw dropped and her mouth formed a big O the size of a small basketball. Then I saw her mouth to one of the other Board members “WHAT”. Amazingly this was obviously the first time she had ever heard this.
.
I went on and gave her a scenario where a PIC was fined $2000 by the Board for a violation and the permit holder, a multi-billion dollar a year for profit retail chain, was also fined $2000. The $2000 hits the PIC in the pocket pretty hard. How hard does the $2000 hit the multi-billion dollar company? How big of a deterrent is that fine to them? I further explained the PIC has to go back and work in an environment where they have zero authority to affect any change concerning the reason they were fined.
.
As I was finishing I could see at least two Board members nodding their heads in agreement. So not all the Board members were clueless to this. That’s why I felt compelled to testify in person. Of the 22 pharmacists there I was the only rank and file regular pharmacist testifying. The Board never hears from people like me. That’s a problem. More regular working pharmacists need to go to the Board meetings so they can hear what it’s really like out there.  AJ

Letter that AJ sent before the meeting.

Texas Board of Pharmacy members,

.I ask you to carefully consider the implications and unintended consequences of changing the pharmacist to technician ratios. I also ask the Board to carefully consider the statements made in favor of changing the pharmacist to tech ratio in all classes of pharmacies. I have read many of the comments submitted in support of a change. An overwhelming majority of the comments in favor have been sent in by corporate retail chain pharmacists and middle managers. The central argument in nearly all these comments has been how dangerous it is to work with too little staff. The Board of Pharmacy does not limit the number of technicians that can work in a pharmacy. It limits the number of technicians one pharmacist can supervise in a pharmacy. The problem these pharmacists and middle managers have is with their respective companies and their refusal to provide an adequate number of pharmacists. It is not the ratio the Board of Pharmacy has set.
.
Retail pharmacists have been pushed to their breaking point. There has never been more tasks, responsibilities and liability placed on pharmacists than there is now. I have personally experienced this as a PIC at two different grocery store chains in two different states. As the PIC I had absolutely no discretion concerning the staffing of the pharmacy. The staffing decisions were made by non-pharmacist corporate middle managers thousands of miles away. The staffing ratios outlined by the TSBP are the only protection a PIC has against dangerous and unsafe staffing. Removing this regulatory check will endanger the health safety and well being of the citizens of Texas.
.
Pharmacy technicians are an invaluable part of the pharmacy team. There is no doubt they alleviate some of the massive workload forced onto pharmacists by corporate retail chain pharmacy management. Sub Chapter B, Rule 291 (C) states, “Pharmacists are solely responsible for the direct supervision of pharmacy technicians and pharmacy technician trainees and for designating and delegating duties”. Sub Chapter B, Rule 291, (2) Duties (i) states “a pharmacist verifies the accuracy of all acts, tasks, and functions performed by pharmacy technicians and pharmacy technician trainees; (ii) pharmacy technicians and pharmacy technician trainees are under the direct supervision of and responsible to a pharmacist”. This alone is an enormous task for one pharmacist. Add to this the responsibility and liability of dispensing and counseling on 300 to 400 prescriptions in a 12 to 14 hour shift, immunizations, record keeping and ensuring compliance with state and federal law and it becomes impossible. Removing the ratio requirement and allowing more technicians into the pharmacy does nothing but increases the stress on the pharmacist and endanger the public.
.
I ask the Board to carefully and thoughtfully evaluate the following question. Who benefits from a change in the pharmacist to technician ratio? The citizens of Texas certainly will not benefit. The pharmacists licensed by this board will not benefit. The only benefit will be to the big corporate pharmacy chains that have so aggressively lobbied you for this change. I believe it will be a huge mistake for the Board to ease and/or voluntarily give up regulatory control at a time when our health care system is undergoing a massive change with millions of people entering the system via the Affordable Care Act. This is a time for the Board to be ever more vigilant in order to protect the heath, safety and welfare of the citizens of Texas.

Respectfully,  Arden J. Hill, RPh, PharmD

 

17 Comments

17 Comments

  1. broncofan7  •  Nov 4, 2013 @6:27 pm

    congrats AJ! 4:1 ratio approved but the elimination of the ratio was put down to be looked at after a study is conducted….

    “Breaking News!

    The Texas State Board of Pharmacy votes to withdraw the pending proposed rules regarding the elimination of pharmacist to pharmacy technician supervision ratio. A task force will be appointed to review duties of technicians and educational requirements. The ratio issue also may be addressed by the special task force.

    The Board also approved developing new proposed rules rasing the ratio from 1:3 to 1:4.

    My thanks to those of you that took time to comment on these proposed rules – regardless of your position. Your participation is important”

  2. AJ  •  Nov 4, 2013 @11:22 pm

    Sweet! That was fast! I thought they were voting tomorrow. This is great news! I’m a little disappointed with the change from 1:3 to 1:4.
    .
    Awesome they voted to withdraw the pending proposed rules regarding the elimination of pharmacist to pharmacy technician supervision ratio.

  3. broncofan7  •  Nov 5, 2013 @12:05 pm

    AJ…some bad news for you: Re: Class G

    “A 1:4 ratio was proposed in the interim for Class A and B pharmacies, and 1:8 ratio for Class G pharmacies. The Board will vote on the proposed ratio change in February 2015.”

  4. AJ  •  Nov 5, 2013 @6:41 pm

    Hey broncofan7 where are you getting your updates? I haven’t been able to find anything.
    .
    Actually the 1:8 ratio proposed for a Class G is fine. Having no ratio is unacceptable in any class of pharmacy. The profession is not run by individual pharmacists any more. It’s run by big mega corporations who care only about profit. Where there is a will there is a way to cheat and abuse the system. A minimum ratio is a good start to prevent abuse.
    .
    Now that my pharmacy activist career has started who is with me to lobby the Board for maximum limits on prescriptions a pharmacist can fill per shift?

  5. Laura Lea  •  Nov 5, 2013 @8:07 pm

    Yeah. Love how the pharmacy SUPERVISORS with WAG are “in support” of this… pay more techs and fewer pharmacists reduces staffing costs and increases their bonus. -_- I’d like to know when they last spent an 8-10 hour day running around like a decapitated chicken while trying to keep on top of flu shots, Counseling, data review, product verification and of course all the adherence calls, late-to-refill calls, and MTM they want us to perform…

  6. broncofan7  •  Nov 5, 2013 @8:39 pm

    Here you go AJ:

    https://www.facebook.com/AIPTexas

    and the Texas Pharmacy Association via email….

  7. RalPh  •  Nov 6, 2013 @1:09 am

    AJ,

    If the rxs per shift were to be feasible, I’m behind it for my state. I wonder if there are any studies.

    the chains have the metrics to hang themselves by.

    The siphoning off to central fill may have eased the pain and staved off pushing us too hard, for now. I’m just starting to see hours cut due to decreased rx volume. More on it soon.

  8. AJ  •  Nov 6, 2013 @8:40 am

    I believe North Carolina has a limit on Rx’s filled per shift. JP has wrote about it last year here…
    .
    http://www.jimplagakis.com/?p=5317

    JP has also wrote about how the pharmacy rules and regs in most states are 40 years behind. The majority of pharmacies today are run by big corporations. The laws have not changed to reflect this. The laws in Texas still hold the permit holder and the PIC equally responsible. Back in the day in the majority of pharmacies the permit holder and PIC were one in the same.
    .
    After I made my statement to the State Board the Board members could ask questions if they wanted to. One of the Board members asked me why with the rules and regulations governing the pharmacist in change did I fell a ratio was necessary. She further explained that she felt the Boards over site of the PIC was sufficient enough to compel the PIC to do what was right.
    .
    Oh boy she couldn’t have served up a bigger meatball for me to knock out of the park! I thanked her for asking the question and told her there was a glaring hole in the Texas pharmacy rules and regulations concerning this. I went on to explain how pharmacy was no longer run by individual pharmacist and how the PIC at corporate run retail chain pharmacies had absolutely zero authority to make any decisions concerning the operation of the pharmacy. Her reaction was almost comical! When I said there was a glaring hole in Texas pharmacy law her jaw dropped and her mouth formed a big O the size of a small basketball. Then I saw her mouth to one of the other Board members “WHAT”. Amazingly this was obviously the first time she had ever heard this.
    .
    I went on and gave her a scenario where a PIC was fined $2000 by the Board for a violation and the permit holder, a multi-billion dollar a year for profit retail chain, was also fined $2000. The $2000 hits the PIC in the pocket pretty hard. How hard does the $2000 hit the multi-billion dollar company? How big of a deterrent is that fine to them? I further explained the PIC has to go back and work in an environment where they have zero authority to affect any change concerning the reason they were fined.
    .
    As I was finishing I could see at least two Board members nodding there head in agreement. So not all the Board members were clueless to this. That’s why I felt compelled to testify in person. Of the 22 pharmacists there I was the only rank and file regular pharmacist testifying. The Board never hears from people like me. That’s a problem. More regular working pharmacists need to go to the Board meetings so they can hear what it’s really like out there.

  9. broncofan7  •  Nov 6, 2013 @8:49 am

    Good Job AJ! May I ask who the presiding board member was who asked you the question that you responded to appropriately?

  10. AJ  •  Nov 6, 2013 @9:10 am

    Joyce Tipton Director of Pharmacy at Memorial Hermann Memorial City in Houston, Texas.
    .
    Reading her bio on the Board website shows all her experience lies in hospital and academia. I’m sure she had never heard and certainly never experienced what I was talking about.
    .
    Another good reason for the regular in the trenches pharmacist to appear and testify to the real story.

  11. AJ  •  Nov 6, 2013 @9:51 am

    I want to make it clear I was impressed with the proceedings and with the Board members. The Board is not some evil group out to get pharmacists. They are pharmacist just like the rest of us.
    .
    I do believe they’re in somewhat of a bubble. They are insulated from what’s happening in the profession, especially in the last ten years, because they’ve been practicing for many years and hold upper level management positions. There not down in the trenches working seeing all the negative changes.
    .
    As I was sitting there it hit me. Every pharmacist knows the Board’s mission is to protect the public from bad pharmacists. Corporate retail chains have taken over the profession. Shouldn’t the Board’s mission change to reflect this? I think the Board should shift it’s focus to protecting the public from bad corporate retail chains instead of PIC’s who have zero authority over the operations of the pharmacy. I think the non-pharmacist middle managers who set the corporate polices and metrics chain pharmacists are forced to follow should be held accountable, not the PIC.
    .
    In fact I will go a step further and say Texas should have two classes of community pharmacy, a Class A-Chain and a Class A-Indy. The Class A-Indy would operate under essentially the same rules and regs we have now. The Class A-Chain would be for corporate run chain pharmacies that operate pharmacies in more than one state or anyone who owns and operates more than 10 pharmacies with in any one state. The rules and regs would include higher fines and accountability placed on corporate officers, middle managers and anyone else who sets and enforces polices that PIC’s are forced to follow.

  12. Pharmaciststeve  •  Nov 6, 2013 @8:09 pm

    @AJ .. I take exception that those people on the BOP are just like us.. while they may have the same degree and license.. they are NOT PRACTICING PHARMACISTS… and that is a MAJOR difference in being in oversight of the profession and public safety

  13. oregon rph  •  Nov 7, 2013 @12:34 pm

    Looks like Oregon’s board is ahead of the game; now how to get pharmacists to use its new rules and report their own employer.

    http://www.oregon.gov/pharmacy/Imports/Rules/June12/855-041-0016.pdf

    Does anyone know if such drug outlet violations would fall on the PIC or the company itself?

  14. AJ  •  Nov 7, 2013 @9:10 pm

    Pharmaciststeve, at least in Texas most of the Board members are practicing pharmacists. As I said in my last post many of them hold high level positions and are insulated form the negative changes the pharmacists down in the trenches see daily. two of them are independant pharmacy owners…
    .
    Jeanne Waggener, President – Pharmacy Manager for Wal-Mart Pharmacy
    .
    Dennis F. Wiesner – H-E-B, a Texas Food-Drug chain, Senior Director for Privacy, Pharmacy, and Governmental Affairs
    .
    Buford T. Abeldt, Sr., Treasurer – Abeldt’s West Loop Pharmacy in Lufkin.
    .
    Christopher M. Dembny – This guy as 110 pharmacies listed under his employment history on the Board website
    .
    W. Benjamin Fry – Owner of Fry’s Prescription Pharmacy
    .
    L. Suzan Kedron – partner with Jackson Walker, LLP in Dallas.
    .
    Alice Mendoza – director of pharmacy at CHRISTUS Spohn Hospital Kleberg
    .
    Phyllis Stine – Public representative?
    .
    Joyce Tipton – Director of Pharmacy at Memorial Hermann Memorial City in Houston, Texas
    .
    Charles F. Wetherbee – private law practice since 1971, in Austin,
    .

  15. AJ  •  Nov 7, 2013 @9:19 pm

    Woo! Hoo! Word travels fast! Had a 2.5 hour meeting with my director and Human Resource this afternoon. I guess the count down is on to see how long I keep my job! Any bets?

  16. RalPh  •  Nov 8, 2013 @3:16 am

    AJ, you sound in good spirits, but I am worried about you now. What did you guys discuss? Are you able to discuss that here?

    Did they mention how they found out? whether they had a policy against a pharmacist speaking out like that (as if they could)? etc

    Even if you can’t talk about it here, document the hell out of the conversation.

  17. AJ  •  Nov 21, 2013 @9:07 am

    Still employed!
    .
    Thanks to Broncofan7 working some kind of Jedi mind trick on me I may be moving on to bigger and better things.

Leave a Reply

Allowed tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>