By Dennis Miller, R.Ph., the author of The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets.
Pharmacies were dangerous places before the pandemic because of understaffing and extremely high stress levels. Things are even worse now with the pandemic as pharmacy techs are leaving in waves. NBC News recently did a major investigative story on this issue.
Adiel Kaplan, Samantha Springer and Vicky Nguyen, “The latest worker shortage may affect your health: Pharmacies don’t have enough staff to keep up with prescriptions,” NBC News, Dec. 28, 2021
Most of the people behind pharmacy counters who count pills and fill medication bottles are pharmacy technicians, not pharmacists — low-wage workers in positions that don’t require college degrees. Working in a pharmacy was always fast-paced … but in recent years the workload and stress had increased to unsustainable levels, while staffing and pay failed to keep up. During the coronavirus pandemic, the pace quickened further, especially once pharmacies began giving Covid-19 vaccine shots. …
“It got to the point that it was just such an unsafe working environment, where you are being pulled a thousand different directions at any given time,” [one pharmacy tech said]. “You’re far more likely to make a mistake and far less likely to catch it.” …
A survey of pharmacy technicians from Ohio’s pharmacy board this month revealed that 60 percent of the 2,560 respondents felt their workloads didn’t allow them to provide for patients safely. …
Lea Polites, a Walgreens technician in New Jersey, said she is burned out and looking for another job. She showed NBC News local listings for a hotel clerk, a grocery store assistant manager and a cable sales representative, which all started with higher salaries than she was being paid as a technician. “If you want someone to take the job seriously, you might want to pay more than the local grocery,” she said. “They’re driving all the good people away.”
Pharmacy Techs Work Hard for Low Pay:
There are about 420,000 pharmacy technicians in the United States. Pharmacy techs are the workhorses in pharmacies but, according to this NBC News article, their median pay is only $16.87 per hour. The reality is that it is much less expensive to hire techs than pharmacists.
According to a recent survey of pharmacists’ salaries in Drug Topics, “In 2020, the majority of pharmacists who responded to the survey reported earning a salary of more than $120,000 or an hourly wage more than $61.” (Jennifer Barrett, “2020 Pharmacy Salary Survey Results: Salaries Stabilize as Stress and Job Dissatisfaction Soar, Drug Topics,
December 7, 2020)
No Minimum Standard on Preparation for Pharmacy Techs:
The entry-level degree required to become a pharmacist is now a doctorate (Pharm.D.) which typically requires six years of college. In contrast, there is no minimum national standard for the training of pharmacy technicians. In many states, pharmacy techs are not required to have a high school diploma. Many states and employers require technicians to earn certifications after a certain number of months of work.
Clearly the big drug store chains have chosen a fast food model to increase profitability. Pharmacists are required to check the prescriptions filled by as many as four or five techs.
The public needs to know that poorly trained pharmacy techs and dangerously understaffed pharmacies are a threat to the public safety. The situation is more urgent now during the pandemic than ever.
Multi-million Dollar Jury Awards:
At the end of this article I have briefly described six cases of major real-world mistakes involving pharmacy technicians and the resulting multi-million dollar jury awards. These cases illustrate how incredibly high the stakes are in the preparation and dispensing of prescription drugs.
The pharmacist on duty is, of course, required to check and approve all work done by pharmacy technicians. But with severe understaffing, pharmacists can’t spend as much time checking prescriptions as they would like.
Pharmacists and techs span the spectrum from very careful to surprisingly careless
Pharmacists and techs span the entire spectrum from those who are extremely careful to those who are surprisingly careless and who seem to be oblivious to how high the stakes are with each prescription dispensed.
Pharmacy customers have no way of knowing which pharmacists and techs are careful and which are careless. But customers can be certain that pharmacy staff know which description fits their co-workers. Of course, they’ll never let you in on that dirty little secret.
An immoral business model based on understaffing
Paying technicians better would help tremendously, but the big pharmacy chains have for decades operated on an immoral business model based on understaffing. Understaffing increases profits by forcing everyone to work at maximum output for their entire shift. But understaffing unquestionably increases pharmacy mistakes.
How does chain corporate management respond to this criticism? Chain spokesmen absurdly claim that patient safety is the chain’s number one priority. Pharmacists and techs laugh at that baldfaced lie. Store profits are, by far, the primary concern to chain store corporate management.
The insurers for the big chains pay out huge settlements for people harmed by pharmacy mistakes (often in the millions of dollars) and typically require a gag clause in the settlement so that the person harmed by the error (or his/her survivors) does not disclose details of the case or settlement.
It’s cheaper to pay settlements than to have safe staffing levels
Many pharmacists feel that chain corporate management has made the cold calculation that settlements for pharmacy mistakes are simply a cost of doing business, no different from payroll, leases, janitorial services, licenses, electric bill, water bill, phone bill, grounds keeping, etc.
Chain corporate management has determined that it’s more profitable to base their operations on understaffing and then compensate customers harmed by the inevitable errors, rather than provide adequate staffing for the safe filling of prescriptions. If the pharmacy staff at your drug store appear very stressed, you can bet that the opportunity for mistakes is significantly elevated.
State boards of pharmacy are doing a poor job protecting the public safety
State boards of pharmacy exist to protect the public safety. For decades, pharmacists have been contacting state boards of pharmacy regarding the immense dangers as a result of understaffing. But the state boards of pharmacy are typically intimidated by the enormous legal and political clout of the mighty chain drug stores.
A few state boards of pharmacy have fined the big chains for dangerously low staffing levels. But the overall situation with understaffing at chain drug stores has been scary for decades. Many pharmacists have tremendous disdain for state boards of pharmacy for not doing more to protect the public safety by mandating safe staffing levels.
Pharmacists are responsible for all work done by pharmacy techs
Let me emphasize again that pharmacists are responsible for checking and approving all work done by technicians. Thus the following lawsuits are typically directed against the pharmacist on duty and his/her employer. The tech who actually made the error is not always included in the lawsuit.
Huge Jury Awards for Pharmacy Mistakes Involving Technicians
[1] $25.8 million award in Florida–Teenage pharmacy technician at Walgreens dispensed the powerful blood thinner warfarin (Coumadin) to Beth Hippely for a treatable stage II breast cancer. The dose dispensed was 10 times the prescribed dose, causing cerebral hemorrhage.
Source:
Avni Patel and Brian Ross, “Walgreens Told to Pay $25.8 Million Over Teen Pharmacy Tech’s Error,” ABC News, March 1, 2010
[2] $7 million settlement–Emily Jerry, a two-year-old Ohio girl, died after a pharmacy technician improperly compounded an intravenous chemotherapy solution.
Sources:
Reid Paul, “Former pharmacist indicted for manslaughter after med error,” Drug Topics, Sept. 17, 2007, p. 10.
[3] $15 million settlement–A pharmacy technician dispensed the anti-asthma drug theophylline to a nursing home patient instead of the pain killer Darvocet. The patient deteriorated and ultimately died.
Source:
Health Providers Service Organization—HPSO. (1999). Pharmacy. Medical Malpractice, Verdicts, Settlements, and Experts, 18(7), 41
[4] $7.7 million award in South Carolina–An error involving a pharmacy technician caused kidney transplant patient Tiffany Phillips to take 1,250 mg of prednisone daily for 3 days, instead of 250 mg daily, resulting in loss of kidney.
Source:
“Pharmacy error nets $8 million jury award,” Law Office of Gerald Oginski, New York Medical Malpractice and Accident Trial Lawyer, Posted on Dec 21, 2006
[5] $7.1 million award in Massachusetts–A pharmacy technician failed to dilute the adult blood pressure medication enalaprilat, causing infant Joey Rice to receive more than 100 times the proper amount.
Sources:
“Pharmacists, technician found liable for millions in medication error,” American Journal of Health-System Pharmacy, Vol. 59, Issue 12, Jun 15, 2002, pp. 1143-1144
Anne Barnard, “Family Awarded $7.1m for Overdose, The Boston Globe, March 28, 2002
[6] A 5-year-old Virginia boy died after a pharmacy technician entered the wrong dose of imipramine (for bedwetting) into the computer, five times greater than the dose prescribed.
Source:
Institute for Safe Medication Practices, “Tragic community pharmacy error—one year after owner talks about workload stresses to NY Times,” August 23, 2000
Final Words:
Technicians are critically important for the functioning of pharmacies. Employers should pay them commensurately so that they don’t leave for better-paying and less stressful jobs. Oppressive productivity metrics like number of prescriptions filled per hour and payroll utilized in the process are inappropriate in health care. We need to ban business models based on efficiency from our medical system. As it is now, quantity is more important than quality.
Dennis Miller, R.Ph. is the author of The Shocking Truth About Pharmacy: A Pharmacist Reveals All the Disturbing Secrets. The entire book is available for download from Amazon for 99 cents.
You may be interested in an article in The New York Times on a related topic. Here’s the link.
