Why do pts do this ?

Emergency insulin could have saved man’s life

I posted about this incident a couple of months ago.  I thought that this was just a aberration of a Pharmacist and/or prescriber’s office staff.. that seem to have little concerns about their actions or lack of actions and how they impact a pt’s quality of life or in this case … life itself..

I got a call last night from the wife of a Pharmacist friend… Her husband is retired and disabled and is insulin dependent… so he must have his prescriptions filled at a local pharmacy… they have chosen to patronize the “third largest player” in the chain pharmacy game..

In the particular state in which they live, technicians are required to be neither registered, nor certified… so technically they are totally exempt from the oversight the Board of Pharmacy. The wife, tried to fill her husband’s insulin pen… was told by the technician that there was no refills left. However, the wife informed the tech that there was a new Rx on file.. Tech.. for some reason.. was unable to find the Rx on file… and told the wife.. that the doctor would have to be contacted…

First issue is since when are technicians allowed to make decisions that can compromise the pt’s quality of life and/or  be life and death for the pt ?

Basically, practicing pharmacy without a license.  Regardless, if techs in a state are required to be registered or certified … Pharmacists are still responsible for the actions or inactions of the techs working under them.  In today’s Rx dept environment,  techs are a vital part of the operation, but some Pharmacists allow techs to assume to much authority and/or techs assume too much authority and the Pharmacist does little/nothing to stop this. The consequences and collateral damage could be substantial for all involved.

Seemingly, all too many Pharmacists and Rx dept staff ignore the human frailty of being forgetful or procrastinating on a task.

Perhaps this is just more of the McPharmacy issues so many in pharmacy talk about… could it be that those in community pharmacy are just failing to educate/train pts in what they should expect from the system ?  Is this just another example that those working in the Rx dept has allowed pts to establish their own expectations of what should be expected from the Rx dept ? And leaving the pts to do so.. their expectations tend to increase, which will ultimately lead to failure to meet expectations.

How many of us have forgotten to buy some groceries before we ran out, ran out or nearly ran out of fuel in our vehicle, forgot to pay a bill on time. None of our memories are perfect .. and yet we expect pts … to function with perfect memories.


13 Responses

  1. Several years ago I was working as a volunteer in a group that responded to people at the request of Police or Fire departments who had just found out about the passing of loved ones to help them through the first minutes of the loss until family could arrive to take over. One of the cases I was called to was the tragic death of a diabetic man who had been without his insulin for a period of time and appeared to die from a diabetic coma. His family told me that they had been trying for the better part of a week to get his insulin refilled through his physician’s office. I was told his Pharmacist had also been calling in refills to this same doctor’s office and calls were allowed to be unreturned over a weekend. Yet still this man was allowed to die all for the lack of insulin which is so readily available. It seemed so unnecessary that this poor man died.

    His death was so tragic and could easily have been prevented. I do not know where the failure in the systems of prescription refills failed but in this man’s case, it certainly did.

    I no longer volunteer for that organization who does great work and no longer live in one of the cities in which they do their work here in the US. My role was to be with the family until they could get other family support with them and to inform them of their next steps in the process of what to do when someone suddenly dies. Yet I felt such personal anger at this man’s death myself because it was so uncalled for and could have been prevented.

  2. Gene: The current cost for one 10ml vial of NPH is less than $22.00. If sold OTC a markup is added, if sold RX a dispensing fee of between $7.00 to $12.00 is added. You can look up the prices on the Ontario Drug Benefit Formulary for all the other formulations, single vial or prefiled syringes or the 5 pack vials for pens. Where are you shopping for $200 insulin and why?

    • Welcome to the USA.

    • I did some research on Canada’s drug pricing policies:) You Provincial authorities dictate to manufacturers how much they can charge. Here in the US it’s a Wild West. Over the past 1-2 years many generics went up in price 4-5 times. Simple Lidocaine 5% ointment now cost $260. Seriously, who can possibly afford that?

  3. You are stating”all too many Pharmacists and Rx dept staff ignore the human frailty of being forgetful or procrastinating on a task” and this accusation is based on what??.
    Did you friend ask to speak with the pharmacist? It seriously could have been an honest mistake on behalf of overworked and exhausted staff. There is no need to start playing a blame game and especially generalize the situation.

  4. What place, city or state in the U.S. Requires an Rx for insulin? Here in Canada it is an OTC, just walk into any pharmacy and ask for it. Also you don’t need an Rx for insulin needles either.

    • The newer insulins like Lantus and Levimir came on the market as Rx only. Others depended on the state. In my state of Indiana for many years, the majority of insulins did not require a prescrition unless you needed your insurance to pay for them. When insulins became the DNA based only available, the price skyrocted to where patients had to have their insurance pay for them even though Rx was not required. It was only recently in my state, a prescription is now required for ALL insulins. One can still purchase needles without a script but on a signature in my state. However, this system has been abused so it is up to individual pharmacies how they handle it. Some states require a prescription for them also.

      In this case, IF I was the RPh, and could not find the Rx on file, I would have done a one time refill if it was after hours since she had the pen or there was a record of it on the computer and then contacted the MD next business day, let him/her know what happened and what we did and asked for further refills. Pharmacist discretion on a life saving med….I and many other pharmacists have done this on medically life supporting classes of meds only (not controls) for years for customers without blowback. The tech should have immediately notified the RPh on duty not made the decision on his/her own

    • The only problem, is that that frigging insulin costs a fortune these days. How many people could afford to pay $200+ out of pocket, even if it was an OTC. And insurance companies are not really jumping to provide an override in emergency situations. I once had to spend almost an hour on the phone when the patient traveled to another state for the holidays and forgot her vial at home.

      • True that…I remember when a bottle of Lilly Insulin averaged somewhere under 30.00 before the Humulin line came on the market. Ideally after all these years, one would think these current non animal based insulin manufacturers would have recouped their R&D costs by now and be able to lower the prices….But I suppose they see it as a captive market product….sad and greedy

        • I can remember when there was U-40 and U-80 and U-40 was $0.99 and U-80 was $1.98 .. of course .. minimum wage was $1.25… average Rx price was $4-$5 and Rph’s made $4.xx-$5.xx/hr

  5. Stebe can you please explain at which point a technician starter practicing pharmacy? As far as I see it, there were no refills left and the script, which was supposed to be on file was not there(could it be that the doctor was supposed to send the script, but did not do it?)
    The technician stated that the doctor must be contacted and most likely gave the note to the pharmacist, which in turn was supposed to call a doctor and get a prescription over the phone.
    At which point this patient’s safety was jeopardized?
    By the way, please remind us the last time your store/gas station manager calling you to remind you you are almost out of gas?

    • Apparently the wife went to another one of the chain’s stores and they were able to find the “stored rx” in the system… Since the first store is the one that they normally patronize.. it should have been readily available.. if the tech/Pharmacist had looked. I have no information that the tech conferred with the Pharmacist on duty.. If you click on the link in this post – first line – a similar situation… a thirty something DIED. I am not suggesting that we call everyone on refill reminders.. but.. we profess to be healthcare providers… we profess to be medication experts… we should know the potential adverse health consequences to pts .. especially on certain medication … like insulin … and others… It seems to me that more and more Rx dept staff are quicker to justify a reason to “just say no”.. than to spend the time to find a reason to say “YES”.

  6. The state of Pharmacies in our country now has failed and is still failing patients. These chain Rx’s have no care for the patient’s health, especially not the pain patients, but not for others either, as this article outlines. I have experienced this many times when living with someone who suffered from Grave’s Disease (hyper-thyroidism, a potentially fatal disease if not controlled with timely doses of anti-thyroid meds), as well as anxiety, depression and ADHD, and a reading/comprehension issue due to the ADHD for which he was not properly medicated as this person had no insurance and had to go to a free clinic (and no way could afford the ACA (lol) deductible of $460 per month). Thyroid patients frequently have issues with medication conflicts as their systems do not metabolize chemicals as other people with properly functioning thyroids do. There are warnings. At no time during the six year period of time I dealt with helping this person understand his medications did any pharmacy staff or manager ever take the time to explain the meds or conflicts in prescriptions as they came up during various other health emergencies for this patient. They simply ask “do you have any questions about this medication?” Which one does not have questions until they may use the medication; they all simply staple the general warning paper onto the bag of meds and off you go. One has to read the entire warning paper to find out that…lo and behold, there is a warning against using with hyper-thyroidism. Of course, we would expect the doctors to know this at the time of prescribing but it is the prime purpose of Pharmacists to have the knowledge of the medications and to warn a patient verbally even before filling a script and taking the money for same, especially as he used only one pharmacy the entire time and they knew his regular monthly med was for methimazole, anti-thyroid. In this patient’s case, due to his learning disabilities, he had trouble reading/comprehending the medical warning paper; that is where I tried to help him out. When I first met him, the local hospital that takes uninsured patients had him on a cocktail that was about to stroke him out. It was I who read the info and told him to stop taking that combination and he was able to resolve the issue at his next doctor’s appointment. He could have died and indeed was close to death by stroke when I met him. So yes, it is incumbent upon us as patients, as citizens of the U.S.A., to educate ourselves in Medicine, Pharmacy and Law, if we want to have a fighting chance to survive. And these people get paid to do what exactly?? I wish I could collect a fee for every time I had to go behind one of these Pharmacy ‘professionals’ and try to do their job for them. Sadly, becoming a trend in just about every situation with all kinds of employees in this country, having to go behind and make sure the job actually gets done right. De-evolution at it’s finest.

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