On May 3, 2013… there was a post on Jim Plagakis  http://www.jimplagakis.com/?p=6203

The basic story is about – what I believe – describes what is going on with WAGS and patients that need control meds for legit medical needs.

It would appear from this posting that WAGS/DEA or some sort of “bean counter(s)” has plugged some numbers into their spreadsheet and determined how many controls a particular store should be dispensing.

It would also appear from this post that the WAG’s RPH… was subject to some sort of audit… during which his attorney was not permitted to be present and the results of this audit has been classified as “confidential” and will not shared with the RPH and or his/her attorney.

I have revised my website  http://www.steveariens.com/

I am going to put my experience and services out there for anyone who wishes to sue any entity that is causing or potentially causing harm to patients..  especially those who suffer from “subjective diseases “, I will be on the Plaintiff’s side of the court room. It is all outlined on my website. I will assist pts in appealing their denied claims from their insurance companies… stats indicates that approx 50% of all denied claims on appeal will be approved.

I will work with RPH’s to properly document and develop a process with which they can use to establish a “paper trail” of wrong doing by their employer.. that is/could cause pt’s harm/death, while protecting their job. If you capitulate to the demands of your employer.. you are the healthcare professional… it may be decided that you have the legal/moral responsibility to provide/fill these legal Rxs.  If you have not objected to the mandates of your employer.. how are you going to defend yourself… against a charge of denying care/service ?

IMO.. there is going to be a growing number of lawsuit over denial of care/service… The genesis of this .. appears to be the corporate entities and/or the DEA .. but the RPH .. is going to be caught in the middle of this “war on patients”… and if they are not careful.. will become the “ground zero”  by patients trying to get their needed therapy.

IMO.. we are being placed in a potentially no win situation…but … capitulating to edicts of your employer… you are also capitulating your professional responsibilities.

As Will Rogers once stated    If you’re on the right track, you’ll get run over if you just sit there – Will Rogers

Just refusing to fill these legit prescriptions… may not completely exonerate the Rph from being part of these up and coming lawsuits.

Most of us basically work alone… only RPH on duty… sure there are some techs working along with you… but they are not a real part of our “pharmacy fraternity”… that 5-6 yrs of college that creates that common bond… just think about it.. there is only some 250,000 – 300,000 in the ENTIRE COUNTRY ! That is a fairly elite group…

We listen to and solve problems all day… we have no speed limit… it is like the Autobaun in Germany… drive just as fast as you want or your vehicle can go.. if we were a NASCAR race car.. we would have to be overhauled after every 400-500 mile race.

My daughter has a Masters in Psychology and is a Family Therapist.. she has been expanding her practice  (http://www.shefaariens.com/) by doing talk therapy/counseling via Skype

Did you know that a lot of mental health therapists have their own therapist… because all they do is listen to is other people’s problems and try to get them a solution. They have to talk to someone… to deal with the personal stress of their profession.

The closest thing that we have to a support group.. is local/state/national association… and that is a push…to call it a support group.

I know that most of you are scared of upper management and most have you sign an agreement that you not say anything bad about your company and/or another company.

Let’s use my blog as a quasi support group… you don’t have to post directly to the blog… email (steve@steveariens.com) something that you are afraid to post even under a pseudonym … I’ll “laundry” all the information (IP address & email) of where/who it came from and either post it anonymously or using your pseudonym on this blog… either as comments to something that I have blogged about… or as its own blog posting.

There are a fair number of Senior/Mature Pharmacists that are more than willing to give advice. If you have read a few of my posts you know that I call it like I see it and corporate pharmacy is no friend of mine…. there are others out there like me…

Tell me what you think?…. send a email to your Pharmacists friends/colleagues giving them this post’s address or my email address.

I have seen this statement a couple of times in the last few days… from RPH’s working for BIG STUPID…

Apparently some narcissistic customer ….complained about pharmacy staff “keeping their heads down” and not acknowledging them right away.. and they took the complaint to heart…

According to a quote from one RPH coming from a “shirt” … ” we are not supposed to view dropping everything to immediately greet a customer or answer the phone as an interruption”..

I guess you can call a SKUNK a  KITTY … and it works .. until  you get SPRAYED !

So now, it would appear that the most recent “new process” is for all employees to work with “their heads up”… I guess that RPH’s and techs are suppose to work  with one eye on the computer and the other scanning the store for pts to stroll within voice range.

Study after study demonstrates that interruptions are the genesis of mistakes/errors and that people that try to multitask are less efficient in getting tasks done.. So .. if these multiple studies are correct.. this new process is counter productive to the staff being efficient and meeting the already dozens of metrics that are already measured.

Here is one of my pet peeves … that this new mandate… makes me – as a customer in any store – BP goes up…

I am standing in line to be waited on… and the store employee stops and answers a phone call and takes care of the person the phone needs/wants… I am standing in line .. ready to make a purchase and they put the person on the phone – IN FRONT OF ME … who may or may not come in the store and spend any money.

Maybe customers should start complaining to companies about being “pushed back in line” when the phone rings..

There is a lot of “antidotal talk” about all the medication errors that happen in garden variety community pharmacy.. seemingly more talk about those errors in the chain store industry.

There was even a survey done by the Oregon BOP a couple of years ago http://www.oregonlive.com/health/index.ssf/2012/02/workloads_chain_stores_add_to.html

The RPH’s in that survey believed that working a chain pharmacy was three times more dangerous/unsafe.. than working in a independent pharmacy.

It is strongly suspected that corporate pharmacy settles a lot of medication errors with $$$ and non-disclosure agreements and everything is buried in the corporate archives.

What would happen if staff RPH’s made copies of medication error forms and redact the HIPPA information and send a copy anonymously to the state BOP and the pt’s doctor and even to local reporter(s).

I wonder how some of the RPH’s at NECC – that had their licenses revoked.. would be doing today… if they had said something.

Healthcare is one of the few industries that can hide/bury their mistakes… if a airliner falls out of the sky.. or even slides off a runway… it hits the national news

Just pay attention to how many different industries/businesses find themselves in the local/national news when something goes amiss…

Collectively we fill some 3-4 BILLION Rxs a year… even with a 0.001 % error rate..  that would be 3-4 MILLION medication errors a year.. not every one is going to be extremely serious or deadly.. but.. they are MISTAKES…

IF you are satisfied/happy with that many med errors on your license… do nothing.. you may be able to dodge that one very serious bullet .. MAYBE NOT !

Right now .. because of the NECC mess.. the BOP’s are on thin ice and higher scrutiny by the media…  we did nothing during the RPH shortage to improve work environment safety… and many regret this now… this is another opportunity to make a difference… will you let it pass by and regret not doing something at some point in the future ?

If you follow how the Federal government operates… you have to wonder if they are providing an example of how corporate America is suppose to act/function..

Maybe this administration has gotten caught with their “hand in the cookie jar” more than previous administrations…but.. it would appear that various Federal employees are pushing their immunity from being sued..

We have the Bengazhi situation.. where four American were killed and there is seemingly untold number of reasons why this happened and why rescuers were not sent

We have the IRS scandal… basically denying or dragging their feet  in approving non-profit approval for  “certain groups”. The interim head of the IRS was “thrown to the wolves” forcing him to resign… although.. he was scheduled to retire in THREE WEEKS.

We have the AP scandal… where the FEDS intercepted emails and phone calls of a number of reporters..

And these are just the current issues in the news…

It seems that corporate America… is taking this sort of behavior as an example of how they should function.

Hardly a month doesn’t go by that we don’t see a multimillion dollar fine for some corporate wrong doing.. Many of these wrong doings – by federal law – should exclude the vendor out of Medicare/Medicaid and the guilty party… should be imprisoned …  BUT.. that never seems to happen to those who are behind corporate wrong doings !

Could the Feds just consider all of these fines as just a “back door” corporate tax?

Maybe it is all just one big Monopoly game and a check is a substitute for a  “Get out of jail free” card .. or .. is used to exchange for such a card ?

Here is a 60 MINUTES report on the NECC mess.. a number of things that lead up to that catastrophy … are being echoed in community/retail chain setting… how much longer before retail/community errors start making the national news?

Will it be the President of one of the chains that will be testifying before Congress claiming that the staff did not follow company policies and procedures.. or will it be the PIC and or other RPH staff testifying… knowing full and well if they tell the truth… they will be unemployed  and/or if they plead the FIFTH.. the BOP will probably yank their license.. The PIC .. after all .. is legally responsible for the legal operation of the Rx dept…

In the case of NECC.. the corporation was small enough.. that the President of the corp was also a RPH.. so he took the blunt of the problems.. although the PIC of NECC .. also got his/her license revoked…

The cost of selling ethics – and your soul – for a paycheck.. can be a life changing event !

FDA meeting resistance on compounding

http://www.nwaonline.com/news/2013/may/19/fda-meeting-resistance-compounding-20130519/?business

From the article:

Inspectors for the U.S. Food and Drug Administration and the Arkansas State Board of Pharmacy saw things entirely different from each other as they inspected the Lee Pharmacy in Fort Smith on Feb 19, 2013. The federal inspectors found seven areas of concern in the pharmacy. State inspectors gave the pharmacy a Class A rating.

Wonder who is going to come out on top of this squabble?

I recently wrote about CVS’ announcement about their 23% increase in net profits

http://www.pharmaciststeve.com/?p=3581

Over the decades, I have seen the PBM’s claw back every increase of profits that community/retail pharmacies has managed to cobble together..

Back in 1969 when the “drug cards” came on the scene… wholesalers worked a gross profit in the upper teens.. the only discount that community pharmacies got was 2% for paying promptly and community pharmacies typically generated a gross profit in the mid-high 40% range.  AWP ( Average Wholesale Price) was the rule and generic utilization was in the very low single digits.

By the mid-70′s… the 2% prompt payment was replaced with a 10% discount on of AWP.. the number of products available generically started to increase and the FEDS started implementing MAC (Maximum Allowable Cost) for Medicaid. PBM’s started moving the “dispensing fee” downward.

As time passed, the PBM’s chipped away at the dispensing fees and reimbursement was becoming AWP less a  increasing per-cent..

Will this announcement by CVS of increased profits… set the wheels in motion for the PBM’s to claw back these “excessive profits”.. to be mostly put in their coffers ?

And as corporate pharmacy tries to keep/increase their profits.. where do you think they are going to look to.. to make it happen?

This has been my view for the last month… I took a month off.. for some R&R at our beach condo ( Panama City Beach)..

Actually, looking at my/this blog and https://www.facebook.com/PharmacyRouletteYouBetYourLife

I was still quite active…

I had not even gotten home.. before the texts started… some 460 miles from home and abt 11:00.. I get a text .. so-and-so called in sick .. can you come to work at 13:00…

Me: I am 460 miles from home.. at least 7-8 hrs before I get back to the area

Them: can you drive FASTER ?

Me: Only if you will pick up the cost of the tickets…

Them: No thanks…

I am still glad that I am very semi-retired !!

Generic use reached 84% in 2012, study finds

http://www.drugstorenews.com/article/generic-use-reached-84-2012-study-finds?utm_source=MagnetMail&utm_medium=email&

A number of years ago… it was thought that 75% generic utilization was going to be “the top”.. now it appears that ..that estimate was wrong..

Does this mean that step-therapy is really making an impact on generic utilization…

The “Elephant in the room” is at some point.. probably in the not too distant future… there is going to be no place to go… generic utilization is going to max-out and will average Rx prices start to climb?

With Obamacare coming.. when we reach the max-out of generic utilization.. will we see a pricing system similar to Canada and other countries with a national health insurance program.. where drug companies have to “bid” to have their drugs paid for..

On the down side, where is the money going to come from for R&D for new/improved drugs?

This was posted on another blog

http://amavenrx.com/forum/topic/show?id=6374337%3ATopic%3A47450&xgs=1&xg_source=msg_share_topic

Regarding HB 6645, enabling physicians to prescribe a lethal dose of barbiturates to assist terminally ill patients to end their lives, I can’t help but remember a lesson from Ethics 101: For every right, there is a corresponding duty.

As a pharmacist, I never signed up to assist people in killing themselves. Who will have to duty to dispense the lethal dose to the patient? I am passionate about, and have dedicated my career, to medication safety. Family members have testified to the emotional suffering they experienced while fulfilling a loved one’s wish to end their life through means such as suffocation.

Imagine if you came to work to find out your job description had changed to include providing the tools one needs to commit suicide. No one should put that responsibility on health care professionals such as doctors and pharmacists, who will have the duty to honor this new “right.”

This is addressing a bill in CONN .. which was defeated…

http://www.citizenlink.com/2013/04/16/victory-hb-6645-connecticuts-assisted-suicide-bill-defeated-in-committee/

The question has to be asked with the defeat of this bill.. is they ask as if this (medication) is the only means for someone to end their life?

How many times .. have we filled a Rx when the legit medical need is in question…but.. we dispense it anyway.. because we don’t have solid evidence to back our doubts?

Does anyone believe that at some point in the not so distant future.. that there is going to be a restricted availability to test/procedures.. due to the pt’s age, co-morbidity issues, or some other composite of issues that a “formula” determines that the cost of such test/procedures exceeds the “value” of the pt to our society..

How to control workplace cruelty

http://management.fortune.cnn.com/2013/04/23/bullying-cruelty-work-office/

From the article:

While managers are familiar with the idea of bullying, the concept of “mobbing,” a term coined by Duffy and her co-author Len Sperry, is less understood. “Workplace mobbing,” Duffy says, is “nonsexual harassment of a coworker by a group.” The purpose is to remove the individual from a particular unit or from the larger organization, which may occur through termination, medical leave, or quitting. Whether or not the group is successful in removing the individual, “this typically protracted traumatizing experience” often results in humiliation and degradation “with significant financial, career, health, and psychosocial losses,” Duffy says.

From a DRUG TOPICS article :

http://images2.advanstar.com/PixelMags/drug-topics/digitaledition/05-2013.html

The vast majority of RPH’s reported increased stress levels… the genesis of this increase staff stress levels… but.. at some point.. when do a number of RPH’s start of physically/mentally suffering from such increased stress levels… could some/many of these RPH’s be on the verge of PTSD?  Does anyone in management really cares ?

Rx dept staff members can’t be “rebuilt” or “reconditioned”… like a lot of the mechanical pieces in the Rx dept..

Does the fact that a person is drawing a paycheck .. make corporate bullying .. “acceptable”

IMO… it would seem like a number of people didn’t learn to leave their grade school – junior high- high school tactic behind as they entered adulthood.