Interview with the author of the second book on community pharmacy medication errors

Interview with Dennis Miller, R.Ph., author of the recently published book CHAIN DRUG STORES ARE DANGEROUS:  How Their Reckless Obsession With the Bottom Line Places You At Risk for Serious Harm or Death.  The paperback version of the book is a massive 630 pages and is now available on for $13.32 (at no profit to the author).
Pharmacist Steve:  How does your current book differ from your previous book, PHARMACY EXPOSED?
Dennis MillerPHARMACY EXPOSED is 753 pages in length.  It discusses a wide range of issues and controversies in pharmacy.  An editor at a pharmacy magazine suggested to me that I should consider narrowing the focus of that book by perhaps dividing it into two books.  I took her advice.  My new book focuses primarily on chain drug stores.  There are approximately 220 pages of new material in CHAIN DRUG STORES ARE DANGEROUS that are not in PHARMACY EXPOSED.
Pharmacist Steve:  Why do you feel that chain drug stores are dangerous?
Dennis Miller:  It is my view that the chain drug store model based on speed and understaffing guarantees that mistakes will occur.  Many pharmacists feel that the chains have made the cold calculation that it is more profitable to sling out prescriptions at lighting speed and pay customers harmed by mistakes than it is to provide adequate staffing so that mistakes are a rarity rather than a predictable occurrence. 
Pharmacist Steve:  Have you considered the possibility that the chains will sue you because you have written a book claiming they are dangerous?
Dennis Miller:  Yes I’ve considered that possibility.  Of course, in America anyone can sue anyone for any reason.  My view (I hope I’m right) is that it is less likely that I can be sued for claiming that the business model of an entire industry is flawed and dangerous.  If I had stated that Chain A or Chain B or Chain C is dangerous, I think that would be much more risky legally.  My brother suggested that I put a small picture of the top four or five chains on the front cover of my book.  It is my feeling that that would be asking to be sued. 
As I said, I think that the entire chain model is flawed and dangerous because it is based on speed and understaffing.  I’m not focusing on any single chain.  I have worked for three major chains in my career.  I think that some chains have policies that result in fewer pharmacy mistakes.  I think that some chains provide better staffing levels than others.  I’m not saying that all chains are equally dangerous.  I’m just saying that the very common chain model based on speed and understaffing places the public at risk from serious pharmacy mistakes.  Some chains have a very bad reputation among pharmacists as regards working conditions, understaffing, and the ease with which serious mistakes can occur.
Pharmacists Steve:  What is your prescription for solving this problem?
Dennis Miller:  I think that the state boards of pharmacy are intimidated by the immense legal and political clout of the big chains.  I’m hoping that some directors of state pharmacy boards stand up to the mighty chains even at the risk of having those chains complain to whatever state entity oversees that state board.  The chains try to influence state legislators by claiming that the state board of pharmacy is anti-business or that it is overstepping it’s authority.  The chains claim that working conditions are employer-employee issues outside the purview of the state boards of pharmacy.  I hope that some directors of state boards of pharmacy show courage and stand up to the big chains even though it may place those state board directors’ jobs at risk. 
The primary job of the state boards of pharmacy is protect the public safety.  Most of the pharmacists I know feel that the state boards of pharmacy are doing a horrifically poor job in protecting the public from pharmacy mistakes.  Many pharmacists feel that the state boards need to figure out some realistic way to require safe staffing levels in pharmacies.
Pharmacist Steve:  What do you hope to accomplish in writing this book?
Dennis Miller:  My hope is that the general public becomes outraged at the common occurrence of pharmacy mistakes.  My hope is that public anger will force the chains to provide adequate staffing for the safe filling of prescriptions.  It is absurd to me that chain drug stores are based on the same model as McDonald’s, Burger King, and Wendy’s, complete with drive-thru windows.  Most of the pharmacists I know feel that having drive-thru windows at drug stores is beyond absurd.  But the public has a hard time believing that the chains could be so reckless when human health and safety are at stake. 
I think that newly licensed pharmacists experience culture shock when they realize how dangerous their workplace is as regards the ease with which pharmacy mistakes can occur.  I wonder whether many of these new graduates fully understand just how high the stakes are.  When I first got my license and went to work for a major chain, I subconsciously felt, “Surely this company wouldn’t place me in a situation that exposes them to such tremendous liability if I make a mistake.”  Guess what?  The big chains do precisely that every day. Young graduates need to realize that fact. 
Pharmacy students need to realize that they will not be coddled by the big chains the same way that they were coddled by their professors in pharmacy school.  It is my contention that speed in filling prescriptions is the primary criterion used by the big chains in determining whether pharmacists are doing a satisfactory job.  The big chains have no use for clinical pharmacy.  In pharmacy school, students assume that their drug knowledge will be their biggest asset in their career.  They are shocked to quickly learn that the chains view a pharmacist’s speed in filling prescriptions as infinitely more important than that pharmacist’s drug knowledge.
Pharmacist Steve:  How have you made your case in your book?
Dennis Miller:  One method I’ve used is to describe real-life pharmacy mistakes that I’ve made myself or that I’ve seen personally during my career.  For many years, I have collected articles that describe major pharmacy errors that result in huge jury awards and/or the death of the patient or customer.  So far I have thirty-four cases in which a pharmacy mistake resulted in a jury award of at least a million dollars and/or resulted in the death of a patient or customer.  This list does not include the several dozen deaths resulting from the New England Compounding Center tragedy.Here are the top four awards that I am aware of in pharmacy mistake cases.1. $31.3 million award in Illinois–Walgreens pharmacist dispensed diabetes drug glipizide instead of gout drug allopurinol, leading to renal failure, stroke, and death

2. $30.6 million award in California–Thrifty-Payless pharmacist dispensed 100 mg of phenobarbital to girl instead of 15 mg prescribed, causing brain damage

3. $25.8 million award in Florida–Walgreens pharmacist dispensed blood thinner warfarin in 10 times the dose prescribed, causing cerebral hemorrhage

4. $21 million award in Illinois–Walgreens pharmacist dispensed adult diabetes drug glipizide to infant girl instead of anti-seizure drug phenobarbital

Several years ago, my own stepfather was given the type-2 diabetes drug Glucophage at a WalMart pharmacy in Florida, instead of the anti-hypertensive Toprol XL. My stepfather has never had any type of diabetes. Luckily I was visiting my mother and stepfather when my stepfather asked me why the pills in his refill bottle looked different from the Toprol XL he was expecting.

Pharmacist Steve:  Good luck with your new book.
Dennis Miller:  Thank you.

2 Responses

  1. I agree with Bcmigal that the general public doesn’t give a rats ass concerning the practice of pharmacy today. With more hour cuts coming Jan 1, the chance of something getting by us increases. Today the CVS system was down for a few hours this morning…playing catch up to me only spells disaster. Dennis Millers book is a great read….nothing shocking to those of us that have been round for more than a few years….I ordered three copies of the book and will order a few more today. One copy for myself, another for the law firm and the third went to a medical writer at a Philadelphia newspaper. I plan to send others to some major East Coast papers…something has to been done now…it’s a long shot getting someone to write about our concerns, however I’m going to give it my best. I encourage others to do the same….very small investment could equal results.

    Joe Zorek

  2. I am not convinced that they general public really cares about the extremely stressful work conditions that exist in pharmacies. Folks seem to have only 2 concerns: ” how long and how much?” As long as the “misfill” does not occur with their prescription, they don’t give a hoot.
    Our company has decided that meeting the metrics is not enough. Managers are encouraged to view the security tapes to “see” why the wt/pt is not being met. If scores are low because of the lack of tech help, the labor hours will be cut even more.
    The fiduciary duty of the company to the stockholders takes precedence over the health and safety of the customers. Sadly, this is the new normal.

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