1-ribboncryingeyevoteFirst they came for the mentally ill addicts, and I did not speak out—
Because I was not a mentally ill addict.

Then they came for the empathetic prescribers, and I did not speak out—
Because I was not an empathetic prescriber.

Then they came for the Pharmacists, and I did not speak out—
Because I was not a Pharmacist.

Then they came for me—and there was no one left to speak for me


A refresher course in CIVICS

It was so many years ago that I sat thru Civics Class…  I took the class in summer school at the local public high school. My parents sent me to 12 yrs of parochial school and because there was a religion class every day.. if I did not go to summer school.. I would not have a study hall .. because I was on the academic path to go to college. I went to the local high school several summers in a row and found the local high school much easier than my parochial school.  It was the summer before my SENIOR YEAR in high school.. I had just got my first car a few months before and it was SUMMER..  My focus on the details of Civics class was more about getting a passing grade than really what was going on about/within our government.. I had just turned 17…  it was SUMMER and come Sept .. I was going to be a SENIOR… Of course, back then… the government – both local,state, Federal.. was much less intrusive in our lives… The state I lived in had just imposed a TWO percent sales tax – today it is SEVEN PERCENT.

Over the last several years, I kept wondering why many “big wigs” in particularly Washington… would  seemingly break laws …”spit” in Congress’ face and walk away without any consequences… names like the head of IRS Lois Lerner, Attorney General Eric Holder and most recently Hillary Clinton.

Congress just seem to be impotent.. how can one of three branches of our government have no authority, they have hearings … AG Holder left office being held in contempt of Congress.

I struggle to understand why discrimination against chronic pain pts by those in healthcare goes unchallenged as violation of the ADA. It is well documented that the war on pts/doc was dramatically ramp up started during the 2009-2011 period and I wonder why.

So I started a little research on the three branches of our government… and found the following… the most interesting is A crucial function of the executive branch is to ensure that laws are carried out.  So it would seem that our President is at the top of the heap of ensuring that laws are enforced.I have made two other posts today that pointed out that both the FDA and OCR are failing their mission statements and we know that the DEA is failing their mission statement.  Congress passes our annual budget and while the House has passed a annual budget the Senate has failed to do so for 6-7 yrs in a row. IMO.. this election could be a watershed moment in our 240 yr history… leaving “the establishment” in charge of Congress and putting in a new President that is part of “the establishment”… will just be more of the same.  All you have to do is ask yourself… AM I BETTER OFF TODAY THAN I WAS EIGHT YEARS AGO  and do I want to better off in another four years ?

The Executive Branch

The executive branch consists of the president, vice president and 15 Cabinet-level departments such as State, Defense, Interior, Transportation and Education. The primary power of the executive branch rests with the president, who chooses his vice president, and his Cabinet members who head the respective departments. A crucial function of the executive branch is to ensure that laws are carried out and enforced to facilitate such day-to-day responsibilities of the federal government as collecting taxes, safeguarding the homeland and representing the United States’ political and economic interests around the world.

The Legislative Branch

The legislative branch consists of the Senate and the House of Representatives, collectively known as the Congress. The legislative branch, as a whole, is charged with passing the nation’s laws and allocating funds for the running of the federal government and providing assistance to the 50 U.S. states.

The Judicial Branch

The judicial branch consists of the United States Supreme Court and lower federal courts. The Supreme Court’s primary function is to hear cases that challenge the constitutionality of legislation or require interpretation of that legislation. The U.S. Supreme Court has nine Justices, who are chosen by the President, confirmed by the Senate. Once appointed, Supreme Court justices serve until they retire, resign, die or are impeached. 

The lower federal courts also decide cases dealing with the constitutionality of laws, as well as cases involving the laws and treaties of the U.S. ambassadors and public ministers, disputes between two or more states, admiralty law, also known as maritime law, and bankruptcy cases. Decisions of the lower federal courts can be and often are appealed to the U.S. Supreme Court.

Ontario to stop paying for higher-strength opioid painkillers

FentanylOntario to stop paying for higher-strength opioid painkillers


Ontario will stop paying for higher-strength opioid medications through its Ontario Drug Benefit (ODB) program next January as part of its strategy to address the growing problem of addiction to the painkillers.

Opioids such as fentanyl and morphine are often prescribed to patients with chronic pain, but can often lead to addiction and overdose deaths.

To help fight what it calls the “growing problem of opioid addiction in Ontario,” the province’s Ministry of Health and Long-Term Care announced last week that it would stop paying for the following higher-strength long-acting opioids from its ODB drug formulary as of January 2017:

  • Morphine, 200 mg tablets.
  • Hydromorphone, 24 mg and 30 mg capsules.
  • Fentanyl, 75 mcg/hr and 100 mcg/hr patches.

The province will also delist 50 mg tablets of Meperidine, also known as Demerol. 

The ministry said it was giving six months notice of the funding changes to give patients time to consult with their doctors about changes that may be required to their drug treatment plan.

“Physicians should initiate this discussion as soon as possible with any patients affected by these changes,” the ministry advises in a notice on its website. 

Ontario’s drug benefit plan pays the cost of many prescription drugs for those 65 and over as well as for those on assistance. 

Lower doses better for patients

The Ontario government’s action followed its establishment of a “pain subcommittee” to carry out a review of narcotics prescribed for pain management. 

“The subcommittee indicated that lower opioid doses may improve patient outcomes,” the ministry said in a statement. “Since many patients on high doses may be considered ‘opioid failures,’ tapering or withdrawing opioid treatment may result in improved mood, pain and function, with less sedation, fatigue, constipation, etc.”

Deaths linked to opioid use in Canada have soared in recent years. 

A 2014 study found that opioids were related to one in eight deaths among young people in Ontario.

Rates of opioid-related death in the province increased by 242 per cent between 1991 and 2010, rising from 12.2 deaths per million in 1991 (127 deaths annually) to 41.6 deaths per million in 2010 (550 deaths annually). 

More recently, British Columbia declared a public health emergency in April after a dramatic increase in the number of overdose deaths from opioids like fentanyl.

Of the 201 overdose deaths recorded in B.C. in the first three months of 2016, 64 involved fentanyl, according to the province’s medical officer of health. 


So they changed the nomenclature… what is the end game here ?


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Oct 27, 2015 – The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), no longer uses the terms substance abuse and substance dependence, rather it refers to substance use disorders, which are defined as mild, moderate, or severe to indicate the level of severity, which is determined by the number of …

What is Opioid Use Disorder in the New DSM-5 – Verywell

www.verywell.com › … › Information on Heroin Addiction

  1. Cached

Feb 17, 2016 – The diagnostic criteria for Opioid Use Disorder, a substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

2014: OCR received more than 17,000 HIPAA violation complaints – FEW FINED !!!

CVS Health and VA ring up the most warnings to OCR about possible HIIPAA breaches, ProPublica finds


Office of Civil Rights

Mission Statement

MISSION: The Mission of the Office of Civil Rights is to ensure equal employment opportunities for all applicants and employees, to promote a professional work environment free from discrimination and harassment, and to conduct training and timely investigations in compliance with civil rights laws and CDCR policy.

The U.S. Department of Veterans Affairs and CVS Health lead the list of providers receiving the most privacy complaints that resulted in corrective-action plans or technical assistance provided by the Office for Civil Rights (OCR) from 2011 to 2014, according to a report from ProPublica.

Some fines are issued by federal government to medical providers for violating the privacy and security of patients’ medical information in the Health Insurance Portability and Accountability Act (HIPAA), and the OCR will issue press releases and post details on the web.

But thousands of times a year, the OCR resolves complaints about possible HIPAA violations outside public view, according to ProPublica. The OCR sends private letters reminding providers of their legal obligations, advising them how to fix problems, and, in some cases, suggesting they make voluntary changes. 

ProPublica also published a tool it calls HIPAA Helper that makes public 300 of these closure letters.

With the tool, the public can see details of these cases and discover   repeat offenders. The letters were obtained the by ProPublica by requests to OCR under the Freedom of Information Act. 

In contrast, when federal officials take the less frequent step of fining medical providers for violating the privacy and security of patients’ medical information, they publish press release and posts details on the web.

In 2014, the most recent year for which data is available, OCR received more than 17,000 complaints, as well as tens of thousands of self-reported breaches of medical information.

“Most of the letters we’ve received were sent to two large providers, the U.S. Department of Veterans Affairs and CVS Health,” ProPublica reported. “But there are also notices of privacy violations sent to Kaiser Permanente, Planned Parenthood and the Military Health System.”

Both the VA and CVS received more than 200 privacy complaints that resulted in corrective-action plans or “technical assistance” being provided by the OCR from 2011 to 2014, ProPublica said.

CVS Health and the VA said in a statement to ProPublica that they are committed to protecting patient privacy.


Another Federal Agency FAILING its MISSION STATEMENT

To avoid shortages, FDA allows imports from 8 drug plants banned for quality shortfalls



Statement of FDA Mission FDA is responsible for protecting the public health by assuring the safety, efficacy and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation.

With the vast majority of drugs and drug ingredients being manufactured outside the U.S., the FDA has had to step up its international oversight and often ban products from plants that don’t meet its standards. But the FDA also has found itself increasingly having to walk a tightrope between drug safety and drug availability.

Because of the nature of the business, with companies in China or India often being a primary source of essential drugs, the FDA sometimes must exempt products and allow imports from plants that it believes have a poor record. Since 2013 the FDA has allowed 8 plants whose products are otherwise banned from the U.S. to go ahead and import some drugs or ingredients to avoid shortages, according to FDA Import Alert records.

There have been exclusions for 6 plants in India, including one operated by Canada’s Apotex and one by Wockhardt, an Indian company that has run into numerous FDA citations. The exempted facilities also include a Teva ($TEVA) plant in Hungary and a plant operated by China’s Zhejiang Hisun Pharmaceutical. The drugmakers have all indicated they take quality seriously and are working closely with the FDA to resolve their issues.

The agency this year found itself having to backtrack in the case of Hisun when it determined there was a shortage of a chemo drug often used to treat AIDS-related Kaposi’s sarcoma. The agency in September 2015, banned 15 drugs coming out of the Zhejiang Hisun because of “systemic data manipulation” in the facility. At the time, it excluded tuberculosis treatment capreomycin and 13 others over concerns that shortages might arise. Then in February it updated the order to also exclude daunorubicin HCl, the API used in the injected med DaunoXome because of a “critical drug shortage concern.”

In the case of the Teva plant, the FDA last month issued an import alert for all but two products at the Teva facility in Gödöllő: cancer treatment bleomycin and antibiotic amikacin.

The FDA will not address specific cases but has said that when it exempts certain drugs from an import alert due to shortage concerns, it “also often requests the manufacturer to take certain measures to enhance quality oversight for products that are offered for entry into the United States.”

But as Bloomberg points out, the FDA leaves that testing up to any drugmaker that buys the exempted ingredients. “There is no transparency,” Erin Fox told Bloomberg. Fox is director of the University of Utah’s Drug Information Service, which tracks drug shortages. “We just have to take FDA’s word that they think it’s OK.”

The FDA learned the hard way that it must sometimes balance the need for demanding companies’ GMP compliance and patients having access to needed drugs. It came under intense criticism in Congress some years back, when shortages arose after companies stopped production in some plants to address FDA citations.

It faced a particularly daunting situation in 2013 with the Boehringer Ingelheim Ben Venue plant Bedford, OH, a facility with deep-seated problems that had been responsible for dozens of recalls. But because the sterile injectable drug facility at the time was the only source for so many products, when it came time to lay out its mandates under a consent decree, the FDA allowed it to keep producing about 100 drugs considered “essential for patient care.”

Boehringer Ingelheim in 2013 finally decided to simply close the plant, leaving many drugmakers to scramble for production alternatives to keep drugs available. Johnson & Johnson’s ($JNJ) Janssen’s unit, which had dealt with supply issues for its popular breast cancer treatment Doxil, went so far as to get FDA approval to lease part of the Ben Venue plant and produce the drug there itself until it could arrange for another supplier. 


How does the DEA spell “job security”… R-A-I-D those in recovery ?

swatDoctor’s suspension has substance-abuse patients struggling


One medical facility is already feeling the fallout from the suspension, announced Tuesday, of a Durango doctor’s medical license.

Southern Rockies Addiction Treatment Services fielded multiple calls Thursday from patients who received prescriptions from Dr. Deborah Parr for assistance with substance addiction, said Sara Carver, director of clinical operations for the organization. “We started getting calls from her clients saying: ‘Oh my gosh, my doctor lost her license, and I need my medication. Can you help me?’”

Parr, a psychiatrist, is one of four doctors in Colorado whose license was suspended for allegedly recommending higher-than-normal marijuana plant counts to hundreds of patients. But those clients represent only a part of her practice, Carver said.

“Losing her medical license, even temporarily, means the addiction-treatment clients she sees are suddenly without their medication,” Carver said.

Unlike patients who were prescribed marijuana, there is not a readily available alternative to substance-abuse patients’ prescribed medications such as Suboxone, which is used to treat narcotic addictions, she said.

Carver also expressed concern about Parr’s history of prescribing opiate-based medications to individuals with histories of substance abuse.

“We are bracing ourselves for more inquiries today (Thursday), and fear that her questionable prescribing practices spill over into her prescribing practices in addiction treatment as well,” Carver said.

Southern Rockies Addiction Treatment, which treats about 100 clients, is booking intake sessions through next week to try to accommodate the increased call volume from Parr’s patients, said Daniel Caplin, the physician who runs the practice.

While Caplin’s practice is experiencing the brunt of the calls, there is potential that the emergency room at Mercy Regional Medical Center and detox of La Plata County also could be affected if individuals’ prescriptions lapse from not contacting a physician, he said.

La Plata County residents should be aware of issues surrounding substance abuse, said Stephanie Allred, senior director of clinical services for Axis Health.

“It’s a problem everywhere, and when people have mental health conditions, there are a lot of people who have co-occurring substance-abuse disorders,” Allred said.

When mental health conditions are not addressed, there is a tendency for self-medication, which can serve as the basis for a substance-abuse disorder or lead to relapsing.

To help individuals who are experiencing a substance-abuse crisis, Axis Health, which runs the detox center, offers a 24-hour hotline, said Sarada Leavenworth, senior director of strategy development and communications. “It can be critical for folks to have a way to reach someone who’s specialized in these questions and can supply support.”

Axis’ 24-hour hotline can be reached at 247-5245.

Luke Perkins is a student at Fort Lewis College and an intern at The Durango Herald. He can be reached at lukep@durangoherald.com.


Maybe this is why we are having so many OD’s from Heroin/fentanyl mix ?

The DEA/COPS are afraid of handling the product ???  so they just let it flood our streets ???


Nov 8th is the first day of the rest of your life… last election just over 50% of eligible voters – VOTED !

My fellow Americans, ask not what your country can do for you, ask what you can do for your country. - John F. Kennedy

When John Kennedy was sworn in as our 35th President.. our national debt was abt 300 BILLION

When Pres Obama took office in 2009 as our 44th President…our national debt was abt 12 TRILLION and his quote about us as a nation was:

“We are going to have to change our conversation; we’re going to have to change our traditions, our history; we’re going to have to move into a different place as a nation.”

As Pres Obama leaves office our national debt is approaching TWENTY TRILLION…

In each year of his Presidency … him and Congress increased our national debt abt THREE TIMES EACH YEAR what the first 34 Presidents amassed COLLECTIVELY.

If you are voting to see what your country can do for you…then the next chapter in our country history may follow the path of Cuba, Greece and Venezuela and/or other countries that have went down socialism’s path..

Image result for margaret thatcher quotes


Editorial: from a Professor of Pharmacy about CVS’ overall safety operation

CVS has an Exceptional Opportunity but Rejects It – To the Peril of its Customers and Frustration and Risk of its Pharmacists!


There is probably no other organization in American pharmacy that can match CVS with respect to the opportunity for having a strongly positive impact on the practice of pharmacy. It has approximately 10,000 pharmacies and extensive financial resources. It has thousands of highly capable pharmacists. Its leadership deserves credit for certain of the decisions that have been responsible for its growth and financial success. It has received accolades for its excellent decision to discontinue the sale of tobacco products.

But then I am pulled back to reality by headlines such as the following that appeared in the June 30th issue of The Boston Globe (Vivian Wang):

“CVS pays $3.5m to settle claims it filled fake painkiller prescriptions”

The story reports on allegations by DEA investigators that pharmacists in 50 CVS stores in Massachusetts and New Hampshire dispensed forged prescriptions more than 500 times. CVS responded by agreeing to settle the claims for $3.5m and to improve training of employees to recognize forged prescriptions. It said that it settled the allegations to avoid the cost and inconvenience of further legal proceedings. Apparently $3.5m buys the conclusion of the investigation, but many questions remain such as the following:

Are the pharmacists about whom the allegations were made still employed at CVS? If so, did they receive any disciplinary action? Have any of the alleged actions been reported to the State Board of Pharmacy? If so, did the Board take disciplinary action? If it was an owner of an independent pharmacy against whom such allegations were made, it could be anticipated that her/his pharmacist license might be suspended and that the subsequent ramifications might necessitate sale or closure of the pharmacy. There is a gross inequity with respect to the consequences that an owner of an independent pharmacy might experience when compared with those of a chain pharmacist and her/his company. This inequity can be defined by the number of dollars it takes to settle the allegations.

I wish to be clear that I deplore every situation in which a pharmacist betrays the public and our profession by dispensing prescriptions that he/she knows or strongly suspects are forged. However, to what extent does a company’s policies, culture, and work environment contribute to situations in which pharmacists make bad decisions? Related questions include: When a prescription is received, is there a specific period of time in which a pharmacist is expected to complete and dispense it? What are CVS’s expectations (quotas) regarding the number of prescriptions that must be dispensed before additional staffing (pharmacists and/or technicians) is provided? Is the number of prescriptions dispensed a factor in the determination of bonuses for pharmacists? What are CVS’s policies and procedures with respect to how its pharmacists should respond when they suspect a prescription is forged? For example, should the prescriber identified on the prescription be contacted to confirm that it is valid? Should the police be contacted when it is known that a prescription is forged? When a pharmacist declines to dispense a prescription, do the policies and procedures keep the potential for retaliation at the lowest level possible? There is no reason to think that these questions were even considered by the DEA and/or other investigators. Reaching the settlement was apparently based only on dollars.

I raise these questions because I consider them very important, and not to make excuses for bad decisions of pharmacists. Pharmacists must give the highest priority to their responsibilities to their patients and to the laws and ethics of our profession, and must not use company policies and/or pressure as an excuse for compromise or inappropriate actions. It is noteworthy that a CVS pharmacist with a physician who is CVS’s medical director have published an article in the New England Journal of Medicine (August 21, 2013) titled, “Abusive Prescribing of Controlled Substances – A Pharmacy Review.” However, to my knowledge, CVS has been silent about the problems that have been identified in its own pharmacies. A title for such an article might be, “Abusive Dispensing of Controlled Substances – The CVS Experience.”

Very regrettably, the situation identified above and as described in The Boston Globe is not an isolated experience. There are frequent reports in the news regarding errors, as well as problems pertaining to controlled substances involving CVS stores. These situations are almost always settled and I have heard the CVS standard response so often that I can anticipate it before they say it – We acknowledge no wrongdoing. We are settling the matter to avoid the cost and inconvenience of further legal proceedings. The safety of our customers is our highest priority. In the situations in which I am aware of some of the specifics, the truth is that there was wrongdoing, and customer safety did not have priority.

In addition to the many allegations of the DEA and other regulatory agencies, numerous lawsuits are filed against CVS, as well as other large chain and mail-order pharmacies, because patients have been harmed or died as a consequence of alleged dispensing errors, preventable adverse events and drug interactions, negligence, or other mistakes. I am sometimes contacted by attorneys involved in such litigation who request that I serve as a consultant and/or expert witness. Although the total number of lawsuits about which I have been consulted is relatively small, a number of them have involved CVS. In some of these situations, it has been my opinion that there is not sufficient basis for a lawsuit and I decline to participate further. In some other situations, I have worked with the attorneys who are defending CVS and its pharmacists. In a few situations in which patients have died or experienced severe harm, I have worked with the attorneys for the plaintiffs or their families who are suing CVS. I much prefer to not participate as an expert for plaintiffs in actions against pharmacists/pharmacies. However, when 1) it is absolutely clear to me that an error has been made and/or there has been serious negligence, and 2) the defendant pharmacy denies any wrongdoing or claims that its pharmacists have no responsibility to do anything other than dispense a prescription exactly as the prescriber has written it, I have agreed to work with the plaintiff’s attorneys. The cases in which I have participated as a plaintiff’s expert against CVS have involved deaths or serious/disabling, irreversible adverse events. In most lawsuits filed against pharmacies, very few people ever hear about tragedies that have occurred because these cases rarely go to trial where the news media would become aware of and publicize the circumstances. Rather, these lawsuits are almost always settled out of court and the terms of the settlement are classified as confidential.

As just one of the individuals who is contacted, I am aware of the specifics of a relatively small number of the lawsuits against CVS. However, it is my understanding that, at any given time, there is a very large number of active lawsuits against CVS. That this observation is accurate is essentially confirmed by CVS’s refusal to identify the number and type of lawsuits it is defending. This information will remain secretive until some attorney identifies a strategy to obtain it, a whistleblower provides it, or a court or state board of pharmacy is sufficiently concerned to force CVS to reveal it.

What should CVS do?

I have the following recommendations for CVS:

  1. Get rid of Caremark! In my opinion, it is a blatant conflict of interest for a corporation to own a pharmacy benefit manager/administrator (PBM) and a large chain of pharmacies, and the Federal Trade Commission should never have approved the acquisition of Caremark by CVS. Caremark’s inequitable and anticompetitive terms, policies, procedures, and audits are strongly and almost universally criticized by pharmacies other than CVS pharmacies. Concerns about direct and indirect remuneration (DIR) fees imposed by PBMs on pharmacies are the subject of a recent communication from the National Community Pharmacists Association (NCPA). For some pharmacies these fees can total thousands of dollars each month, and pharmacists responding to a survey identify CVS Caremark and Aetna as being the most egregious in this area.

    For Caremark to be able to provide incentives to use its mail-order pharmacy to patients enrolled in the prescription plans it administers is anticompetitive. It is ironic that, in 2004, the CEO of CVS at that time stated, “We are opposed to forcing patients to use a mail order service and then dictating which mail order pharmacy to use.”

  2. Walk your talk and actually give a high priority to patient safety! CVS’s hypocrisy with respect to its stated concern for patient safety is not acceptable. It is my understanding that the number of errors of commission and omission that occur in CVS pharmacies is astounding. Most of these errors are never known to anyone outside of CVS. However, as noted earlier, some have resulted in deaths and serious, irreversible harm.
  3. Value your pharmacists! CVS is fortunate in that it employs thousands of highly capable pharmacists. However, a large number of these pharmacists feel they are important to management only because of the license they hold and not because they are skilled professionals who could provide comprehensive services for patients and make recommendations that would improve employee morale and contribute to the success of the company.

    Many CVS pharmacists have strong concerns about their work schedules and what are often very long days in an understaffed and stressful environment in which they are expected to simultaneously manage lines of patients with prescriptions, telephone calls, the drive-through window, and requests for immunizations. The result is that pharmacists become disillusioned, demoralized, resentful, and burned out. They feel trapped by company policies and metrics. This situation is a recipe for errors, and errors occur. There are statistics but they are known only to CVS, and CVS will not reveal them. However, statistics and evidence of errors are not needed because sound judgment dictates that there is an increased risk of error in an understaffed and stressful workplace in which pharmacists have so little time to commit to each prescription and to speak with patients.

    As noted earlier, when serious errors occur CVS will have enough money (sometimes in the millions) to reach a settlement. However, the pharmacist involved in the error can be at risk of having her/his license suspended or revoked.

    How should CVS pharmacists respond? Many leave and find another position but this is increasingly difficult to do at a time in which the supply of pharmacists exceeds the number of positions available in many parts of the country. If employment conditions do not significantly improve, I anticipate that CVS pharmacists will form a national union or related organization that will include both the pharmacist store managers and staff pharmacists.

  4. A pharmacist should personally speak with every patient with a prescription! The “sign here” charade must be abandoned.
  5. Other pharmacies/pharmacists should be viewed as colleagues with mutual interests rather than competitors! CVS is intensively competitive, as are other large chains such as Walgreens and Rite Aid. In communities where these chains coexist, they are in very close proximity to each other, often just across the street or within the same block. I am aware of a situation in a mid-size community in Pennsylvania in which a CVS and Walgreens were essentially right next to each other and both were open 24 hours a day. However, no other CVS, Walgreens, or other pharmacy for miles around is open 24 hours a day. CVS and Walgreens give higher priority to competing with each other rather than serving the needs and interests of the community. In my community, CVS opened a pharmacy directly across the street from an independent pharmacy that had been in that location for decades.

Five recommendations are enough for now. I expect that the upper management of CVS will not agree with many or all of my observations. If that is the response, I offer to conduct a survey in which CVS pharmacists can respond anonymously to determine the extent to which they consider my comments to be valid.

CVS has an exceptional opportunity! At the present time it is not respected by many within the profession and by many even within its own company. However, it could regain the respect and positive reputation it enjoyed when the company started. At that time it promoted the professional role of the pharmacist and provided their pharmacists with the time to speak with patients and provide comprehensive professional services.

I am available to help as an unpaid consultant.

Daniel A. Hussar

Pharmacy’s Catch-22: Save a life — or save your livelihood?

Pharmacy’s Catch-22: Save a life — or save your livelihood?


Some in the pharmacy community are pushing for Pharmacist to be considered a “practitioners” , which basically means that there is hopes of being able to charge pts and insurance companies for services/advice that has nothing to do with the dispensing of medication. This article adequately describes the paradox that today’s corporate employee has to deal with.  When I was in school, the legal advice I was given that no matter what you did “in the pt’s best interest”.. as long as you did not charge for whatever you did… there was no “monetary motive” for your actions and you were  in a very safe position.  In today’s corporate environment, apparently any piece of inventory that is used without being paid for – regardless of the reason – it is considered THEFT.  In this – or similar example – LOSS PREVENTION would come down on the Pharmacist and probably get fired for saving the pt’s life.  IMO.. this ethical Dilemma is going to play itself out over and over in the coming year(s)… with now that bureaucrats are moving Narcan/Naloxone to a OTC status. The answer is… will Pharmacists be thrown under the bus ..by the corporation wanting to prevent NEGATIVE PR  for not “giving away” Naloxone for someone in front of them dying of a overdose  or will they be “fired” because the Pharmacist took care of a person in front of them dying from a OD without getting paid.

I remember staring out the window of my pharmacy school on a sunny day longer ago than I care to admit, suffering from a full-scale attack of senioritits. Graduation was just around the corner, and the professor was doing her best to keep the roomful of restless future pharmacists engaged in something productive. I was tuning in and out of the conversation until I heard the professor say something like the following.

“Say a person was walking past your pharmacy counter and suddenly started having serious chest pain. They’d never been in your store before, so they’d have no prescriptions on file with you. Would you give them a nitroglycerin tablet?”

I ignored what I thought a silly question (of course you would!) and went back to my daydreaming, until I realized to my amazement that a lively discussion was going on, with many soon-to-be professional pharmacists asserting that it would be the best decision not to offer relief to a person in serious distress.

When I took my first pharmacist job I asked my boss, who was then serving on the Ohio Board of Pharmacy, about this, and he chuckled.

“No matter what you do,” he assured me, “if you can frame it as ‘It was what was best for the patient,’ then you’ll be fine.”

Sound, commonsense advice for professionals who uses their judgment and expertise to make decisions, I thought.

Best, yes — but for whom?

Fast forward a couple decades, and as it turns out, that classroom discussion wasn’t so hypothetical after all. Consider this:

Katherine O’Connor was having an asthma attack while walking home in New Jersey with her boyfriend. Luckily, there was a drug store right there. But she only had $20, and the inhaler cost $21. And the pharmacist  wouldn’t give it to her.

“I said, ‘Can you just give her the pump? She’s on the floor wheezing … I didn’t know if an ambulance would get there on time. He said there was nothing he could do for me.”

The above came from a story reported by New York’s Fox5 TV that made its way around the internet a few years ago.

By the time I saw it, I wasn’t nearly so surprised as I was in the classroom that day long ago. It was an extreme case, but after 20 years spent working for chain drugstores, I can understand how the corporate environment could intimidate someone into making the wrong decision.

Don’t get me wrong. I’m sure that if you were to ask any of the corporate bigwigs directly, they would tell you not to leave an asthmatic wheezing on the floor of their store. But those same bigwigs are also constantly sending out memos that say you must do this and we have zero tolerance for that, while the company’s liability lawyers have done everything they can to come up with a policy for every situation, which employees violate at their peril.

So when a snap decision is called for, “What is our corporate loss-prevention policy?” can compete in an employee’s brain with “What is the best thing for the patient?”

This means we have too many pharmacists who want all the credit for being professional without ever taking the responsibility for making a decision, such as ones who won’t dispense syringes to a patient with insulin in their medication profile, or who tell a tourist with no refills on a blood pressure medication that they’re just out of luck over the weekend.

We’ve all worked with one of “those” pharmacists, and from what I’ve seen, correcting “those” pharmacists doesn’t seem to be a priority among the big chains.

Am I wrong?

I might be wrong. Maybe there are now state board regulators who would discipline a pharmacist for giving nitroglycerin to a heart attack victim. If so, I’m dying to hear from one.

But not so literally as the patient who might be affected.

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