State Boards of Pharmacy -- watchdogs or lapdogs?

When most of our pharmacy practice acts were first promulgated, our profession consisted mainly of independently operated community pharmacies, and the pharmacists who ran them volunteered to operate the state Boards of Pharmacy (BOPs).

At that time, the independent pharmacist/PIC (pharmacist in charge) and the permit holder were one and the same. Any action taken by the board against the PIC was basically taken against the permit holder as well.

I can remember a drug chain -- HOOK’s, based in Indianapolis -- which, with 240-odd stores, all in the state of Indiana, was one of the top 10 chains in the country, by store count. It was one of the profession’s “mega-chains.”

It is now reported that chain executives hold positions on 75% of the state BOPs. One may well suspect that these pharmacists are dramatically removed from the “practicing pharmacists” who served on the early BOPs 30-odd years ago.

Who wouldn’t like to see one of today’s “executive pharmacists” on the TV show “Undercover Boss”? One wonders how well any of them could meet the weekly metrics that these companies now make mandatory -- if they could meet them at all.

State actions

In January 2012, The Pharmacy Alliance (TPA) sent an e-mail to all 51 state BOPs, outlining nine points that we believe all BOPs should address. All nine points focused on the need to improve the work environment, the need to improve patient health and safety, and the need to reduce medication errors.

North Carolina. The North Carolina BOP has had on its books some “work safety” issues, including a call for a 12-hour maximum workday and mandatory breaks, and a stipulation that processing more than 150 prescriptions per shift should be considered dangerous.

In May, the BOP addressed a pharmacist’s complaint against a major chain; the complaint was charging that he was routinely scheduled for 14 hours, that the store anticipated a weekly prescription volume that was 50% ABOVE what is considered dangerous, and that he was getting no breaks, as well as other issues in violation of the practice act.

The pharmacy board’s response? It gave the permit holder, the RPh/DM (district manager) for the permit holder, and the RPh/PIC a WARNING LETTER. Some believe that was one notch above doing nothing.

Oregon. Last fall the Oregon BOP hosted an online survey on workplace safety to which some 1,300 registered pharmacists responded. Of the chain pharmacists who responded, 75% stated that it was their opinion that their workplace environment did not support patient safety.

In response, the Oregon BOP recently promulgated regulations that will allow it to fine and suspend the permit holder for failing to provide a safe work environment.

Wyoming. Also in the last year, the Wyoming BOP promulgated new regulations to enable it to dictate certain work conditions, such as mandatory meal and rest breaks.

Matt Mead, governor of Wyoming, killed the new regulations with a line-item veto, stating that the pharmacy board did not have the authority to take such actions.

State inaction

Remember that e-mail that TPA sent to the state BOPs?

Idaho. The Idaho BOP sent a response. “Overall, IPLC [Idaho Pharmacy Leadership Council] did not believe that the safety issues of concern existed in Idaho.”

State of things to come?

Nevada. There is an issue right now before the Nevada BOP, concerning a pharmacist’s medication error.

The permit holder’s response -- in part -- to the BOP:

“... The accusation fails to state any allegations that permit holder itself performed any act incompetently directed, approved or condoned the actions alleged to have been taken by the Pharmacist, or failed to take any action required by permit holder...”

Abracadabra, allakhazam. Some BOPs/legislatures have removed the term “Pharmacist in Charge” from the practice act, replacing it with such labels as “Pharmacist Manager,” yet the legal responsibilities have gone unchanged.

Whatever label you give the PIC, that individual is responsible for the entire legal operation of the prescription department.

This is like putting on one person’s shoulders all the responsibilities that the owner would have, while denying that same person any of the authority to make changes to improve the work environment to maximize patient health and safety.

The question has yet to be answered: Is the oversight of our profession being done by a group of “watchdogs” or “lapdogs”?

Steve Ariens is National Public Relations Director for The Pharmacy Alliance (www.thepharmacyalliance.com). You can e-mail him at steve@steveariens.com.