Who is to blame for pharmacy mistakes?

Dennis MillerMany pharmacists will reflexively react to the above headline by proclaiming that the individual pharmacist who fills the prescription - and no one else - is fully responsible for any and all pharmacy errors. I feel that the issue is much more complex than that. When multiple factors are involved, the issues may not be so clear-cut.

See also: My most serious pharmacy mistake

Before you send me an angry e-mail accusing me of looking for excuses to justify every error made in the pharmacy, consider the following.

Two categories of error

I worked in one store with a young pharmacist who used to make lots of errors. One morning, two different customers returned with different prescriptions he had filled incorrectly. At that time, another large chain was known to send error-prone pharmacists to corporate headquarters for a couple of days for a refresher course in error prevention.

See also: Why I wrote "Pharmacy Exposed"

One pharmacist who had worked quite often in the same store with that young pharmacist commented to me that he desperately needed to attend such a refresher course. She told me, “Yeah, they need to start forwarding his mail to him [at such a course].” Her implication was that this young pharmacist needed extensive retraining or a complete transmission overhaul.

In my opinion, pharmacy mistakes can be divided into basically two categories, those that can reasonably be blamed on the dispensing pharmacist, as in the scenario recounted above, and those that can’t.

See also: Pharmacy dispensing errors

We all know some pharmacists who are an accident waiting to happen.

Some of our colleagues simply do not seem to understand how high the stakes are with each prescription we fill. Under pressure of work, do they become less mindful that ultimately the patient's life may hang in the balance?

And some do not seem to understand how eager lawyers are to take a huge bite out of our posteriors and that of our deep-pocketed employer.

I have the greatest sympathy for those pharmacists who are extremely careful in filling prescriptions yet occasionally make a mistake for any of the following reasons: severe understaffing, inadequate number of competent techs, 12-hour shifts, no meal breaks, no bathroom breaks, etc.

On the other hand, should we feel sympathy for those of our colleagues who are a real threat to the public safety? Are there some pharmacists who clearly deserve to be punished for errors?

The goal for such punishment is to serve as a wake-up call to extremely careless pharmacists.

See also: Does your pharmacy comply with quality assurance requirements?

Were you there?

I wrote two books (Pharmacy Exposed and Chain Drug Stores Are Dangerous) on chain working conditions and pharmacy mistakes, in which I compiled the top 50 or so most serious pharmacist mistakes that I came across in my research, along with - in many cases - the multi-million-dollar jury awards.

Since their publication, a few lawyers have contacted me to ask whether I would be willing to testify in pharmacy-mistake lawsuits. I have always declined. There is no way I can know the precise details of each case without having been in that particular pharmacy at the exact moment the error occurred.

I am no more of an expert on pharmacy errors than any other pharmacist. Only a pharmacist’s colleagues and techs know whether that pharmacist is a careful pharmacist or a careless pharmacist. In my opinion, there is no way I (or any other pharmacist) can testify in a pharmacy mistake case without having worked in the same store with that pharmacist for at least several days or weeks.

All of us would surely agree that there needs to be a mechanism to protect the public safety by weeding out truly careless pharmacists who would make mistakes regardless of the staffing level in the pharmacy. However, unless we have worked with those pharmacists, it is incredibly difficult to apportion blame between the carelessness of the pharmacist and extenuating factors.

Chain pharmacists usually have zero control over total tech staffing hours. As a result, pharmacy understaffing is extremely common in chain drug stores.

Ask yourself

• If a pharmacist is working more than 40 hours per week because his or her partner is sick or on vacation and the district office can’t find another pharmacist to fill in at that store, can the pharmacist be blamed if he makes an error while working 50 or 60 or 70 or 80 hours that week?

• On the other hand, if that pharmacist asked for those extra hours so that he or she could make a little extra money, does that fact increase the blame due the pharmacist if error occurs?

It is one thing to be asked (or pressured) by our bosses to work extra hours. It is another thing when we are the ones asking for those extra hours.

But if we need that extra money because of family expenses or unforeseen bills, might those be mitigating factors in the event of a mistake lawsuit?

• If we were up all night tending to a sick child, can we be blamed for making a serious mistake the next day?

• If we just had a big argument with our spouse or boss or the nonpharmacist store manager, can we be blamed for being so upset that we make a mistake?

• If our best tech is sick or on vacation and we are overwhelmed with prescriptions in a dangerously understaffed pharmacy, can we be blamed?

• If we’re filling in at another store for a colleague who is sick or on vacation and we arrive to find out that no techs have shown up, can we be blamed for making a mistake that day?

When the cause is understaffing

If a pharmacist makes a mistake as a result of severe understaffing, I do not think it is fair to punish the pharmacist who made the error and I do not feel it is fair for that pharmacist’s name to appear in the disciplinary actions section of the state board of pharmacy newsletter.

Unfortunately, laws and regulations are often wielded like blunt - rather than surgical -instruments. Pharmacists fear that they will not be given the opportunity to make the case that the error arose as a consequence of chain understaffing; they fear that they may not be allowed to offer other extenuating circumstances that were the primary cause(s) of the error.

I worked most of my career in North Carolina. That state did pass a regulation or guideline several years ago about the number of scripts that can be filled by each pharmacist per shift. However, when I worked in that state, that regulation/guideline was simply ignored by my employer.

What about the details?

Before you criticize me by claiming I am looking for excuses to avoid accepting blame for pharmacy mistakes, consider the fact that many of your colleagues feel that the specific details surrounding a pharmacy mistake are extremely relevant.

In our fast-paced world, when the board of pharmacy takes a one-size-fits-all approach toward disciplining pharmacists, the details and extenuating circumstances surrounding a serious pharmacy mistake can be ignored. I think that does a major disservice to those pharmacists who are very serious about preventing mistakes, but who occasionally make one anyway as a result of factors over which they have very little control.

Dennis Milleris a retired pharmacist living in Delray Beach, Fla. He is the author of two books (Pharmacy Exposed and Chain Drug Stores Are Dangerous), both available at Amazon.com. He welcomes feedback at dmiller1952@aol.com.