HOUSTON — When it comes to what happens behind the pharmacy counter, some industry insiders say the public has no clue.
“Wrong patient names, wrong drug, wrong directions,” said Texas pharmacist Bill Bradshaw, remembering the errors like a litany.
“It’s scary,” he said.
“I have gone home and said a prayer asking God to please not let me have made any mistakes that could have caused harm to a patient.”
The reason for his anxiety is something that the I-Team heard from pharmacists and pharmacy trade groups from across the state and the nation: That they’re being pressured to fill prescriptions faster, to do more with less, and with less qualified support staff.
It’s a change in the business that most of them say started happening primarily at big-chain pharmacies about ten years ago. And now they worry, it’s reached a breaking point.
“I kept saying ‘we’re going to hurt a child or hurt a senior citizen,'” said Joe Zorek, who worked as a Pharmacist In Charge at a CVS drug store.
According to Zorek, speed often competed with patient safety. He said at his store, they were timed on just how fast they filled prescriptions. If he was too slow, his computer would give him a warning in red.
The result?
“You would do whatever you had to do to push those scripts through,” Zorek said.
In addition, Zorek said his area manager would track his performance through reports called “metrics.” Those would measure whether he made prescription-filling time limits and if his store met many other quotas such as the amount of flu-shots and immunizations given.
“He would call daily to know what our numbers were,” Zorek said.
“And that we would have to get them up,” he added.
But Zorek claims there was another way that management would boost the store’s profitability. In a wrongful termination lawsuit that he filed against CVS/Pharmacy in federal court, Zorek argued that often the pharmacy’s manpower would be cut, in particular their support staff, the “pharmacy techs.”
The result, Zorek claims, was an increased workload that led to a marked increase in prescription dispensing errors and a possible threat to his patients.
And the I-Team found that when drug errors happen, the risk of harm is real.
“It’s a pain I’ve never had before”, said Dana Flink of an episode he had last November.
“I felt like my brain and my spine were actually expanding inside my head.”
Flink is describing how he felt after taking what he thought was a common antibiotic. The prescription medication had been filled at a CVS in Spring.
He eventually discovered that what he had actually been given was something he didn’t need–a medication for diabetes, a condition he didn’t have.
“I was stunned,” he said. “I mean I couldn’t believe I was taking something that was completely wrong.”
CVS says it has apologized to Flink for the error. (See statement below.)
But what happened is no shock to pharmacy experts like Professor Daniel Hussar of the University of Sciences in Philadelphia.
“The general public does not know what’s going on”, Hussar said.
Hussar has studied the science and business of pharmacy for decades.
He said that increased business competition and the desire to please stockholders has made some big-business pharmacies lose sight of their primary task, helping patients.
Instead, Hussar said the focus is numbers, profit, and money–and how to get more of it.
“For major corporations, in my opinion, errors have become a cost of doing business,” Hussar said.
But it’s a cost that concerns groups like the National Association of Boards of Pharmacy. In 2013, pointing to research and polls showing that the use of metrics tend to increase errors, the NABP asked states to restrict, regulate or prohibit their use.
So what about Texas?
The I-Team did an interview with Gay Dodson, the executive director of the Texas State Board of Pharmacy.
During that talk, she made a surprising statement.
Dodson: “I don’t believe any company in Texas is using metrics to say a pharmacist has to fill so many scripts.”
I-Team: “You’re telling me that not a single Walgreens, not a single CVS in this state is putting pressure…”
Dodson: “We haven’t seen it. We have not seen it. That it all I can go with.”
I-Team: “With due respect, a lot of organizations would say you’re blind.”
Dodson: “Uh, I understand.”
As for Walgreens and CVS, both declined an on-camera interview but sent us written statements.
Director of public relations Michael Deangelis of CVS/pharmacy told us:
“The health and safety of our customers is our number one priority and we have comprehensive policies and procedures in place to ensure prescription safety. We apologized to Mr. Flink for dispensing the incorrect medication to him last year. Prescription errors are a very rare occurrence, but if one does happen we fully investigate the incident to determine what happened in order to prevent it from occurring again.
As a health care company that strives to help people on their path to better health, we seek out new technology and innovations to enhance safety, we engage with industry experts for independent evaluations of our systems, and we are committed to continually improving our processes to help ensure that prescriptions are dispensed safely and accurately.
Pharmacists are the most accessible health care professionals in the community, and the services we provide in our pharmacies such as medication adherence outreach and immunizations are designed to help our patients stay healthy while lowering their overall health costs.
Like other companies, CVS/pharmacy also measures the quality and effectiveness of the services we provide in our pharmacies to ensure we are meeting our customers’ expectations. Our systems are designed to help our pharmacists manage and prioritize their work to best serve their patients.”
And Jim Cohn of Walgreen’s Media Relations wrote to us that:
“Our pharmacists today are able to provide a range of health care services that enable them to practice at the top of their licensure and training, while playing a more important role than ever before within the U.S. healthcare system. Quality, safety and accuracy are our top priorities and our quality team continuously tracks these criteria at every touch point within the pharmacy. We never ask our pharmacists to work beyond what they believe is safe, in their professional judgment. Walgreens has always been among the industry leaders for pharmacist pay and benefits, and a long-standing employer of choice in the industry.”