This pharmacist explains why state boards of pharmacy have largely failed in their responsibility to protect the public safety by failing to mandate safe staffing levels. To increase profits, the chain store business model is based on understaffing. The result is an alarming number of pharmacy mistakes.
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.
What Is the Responsibility of State Boards of Pharmacy?
It is the responsibility of state boards of pharmacy to protect the public safety in matters relating to pharmacy, pharmacists, and drug stores. For example, state boards of pharmacy license and discipline pharmacists.
A pharmacist wrote a letter to People’s Pharmacy
asking readers to contact their own state board of pharmacy if they have personal experience or knowledge of a pharmacy mistake. This pharmacist was hopeful that state boards of pharmacy would react by requiring adequate staffing levels in pharmacies.
In my opinion, many pharmacists have a naive view of the ability of state boards of pharmacy to stand up to the mighty drug store chains and force them to improve pharmacists’ working conditions and correct dangerously low staffing levels.
Pharmacists Fear Their State Board of Pharmacy:
Many pharmacists have great fear of state boards of pharmacy because these boards have the power to fine us for infractions or mistakes or, in a worst-case scenario, they can revoke our license to practice pharmacy. This can happen for things like selling narcotics or benzodiazepines illegally, but it can also happen for serious pharmacy mistakes that result in death or great harm to patients.
In my opinion, the mighty drug store chains are much less fearful of state boards of pharmacy in comparison to the fear that individual pharmacists feel toward these boards. That’s because the mighty chains can easily afford aggressive legal representation to fight with state boards of pharmacy.
State boards of pharmacy seem to be much less threatening in their interactions with the mighty drug store chains in comparison to their interactions with individual pharmacists. Individual pharmacists don’t have the legal and political clout that the big drug store chains have.
State Boards of Pharmacy Fear Being Labeled as Anti-business:
It is important to understand that state boards of pharmacy fear being labeled “anti-business,” especially by pro-business (as opposed to pro-consumer) politicians. Even though the various state boards of pharmacy have demonstrated varying levels of fortitude in standing up to the mighty drug store chains, my impression is that state legislatures have very substantial power over state boards of pharmacy, just as they have very substantial power over all state agencies and regulatory boards.
In my experience, when a brave state board of pharmacy attempts to pass rules addressing working conditions and understaffing, legislators often claim that the board has exceeded its authority. The big chains claim that these are employer-employee issues that are outside the purview of the state boards of pharmacy. Pharmacists are enraged by these assertions by chain executives.
Instead, the pharmacists would say,
“NO! These are public safety issues! The state boards of pharmacy have a duty to protect the public safety by mandating safe staffing levels to decrease the very common occurrence of pharmacy mistakes.”
Early in my career, a pharmacist I worked with told me that he would like to report the chain we worked for to one of our United States senators at that time: Jesse Helms. My immediate reaction was that Helms, being a well-known Republican, would typically be strongly pro-business. Therefore I thought this pharmacist was naïve and wasting his time, even though I did not tell him that.
My Conversation with the Head of a State Board of Pharmacy:
I once called the head of the state board of pharmacy in the state where I worked. I asked him if I could speak with him anonymously. He consented. Of course, I realize that it was possible (or even likely) that he could see my name if he had caller ID on his phone. I decided to tell him about my concerns anyway. I told him that the big chain I worked for was a threat to the public safety because, to increase profits, the chain engaged in the dangerous practice of understaffing, thus causing a very worrisome number of pharmacy mistakes.
The head of this state board of pharmacy responded in precisely the way I had hoped he would not. He said to me, “If you have a specific store in mind, we’ll send an inspector there to investigate.” I can’t remember precisely how I responded but my reaction was that the problem is not with an individual store or stores; it is a chain-wide problem.
The head of this state board of pharmacy was sympathetic to my concerns, but his offer to send an inspector to investigate a specific store was entirely inadequate and disappointing. He did, however, admit that his worst days were those in which he interacted with lawyers representing the huge drug store chains.
The Public Is Unaware of Understaffing Problems:
The business model of understaffing is profitable for the big drug store chains because it forces all employees to work at maximum output for their entire shifts. Pharmacists and techs are so busy as a result of understaffing that we seldom catch up on our work and often need to stay beyond the end of our shift to do so.
The mighty chain drug stores are able to get away with “murder” (figuratively and, in cases of serious pharmacy mistakes, almost literally) in part because the public has no idea how serious and widespread the problems of pharmacy mistakes and understaffing are. The big drug store chains know that pharmacy mistakes are inevitable with understaffing, so it is not surprising that they often pay multi-million-dollar settlements for pharmacy mistakes that cause serious harm or death.
The public wrongly assumes that aggressive plaintiffs’ lawyers keep the big chains from recklessly understaffing their stores, endangering the public safety, and facing huge payouts for settlements resulting from pharmacy mistakes.
Understaffing Is a Cold Economic Calculation Placing Profits above Public Safety:
In my experience, the mighty drug store chains operate based on a model of dangerously inadequate staffing levels regardless of the risk to the public safety and will do so until the cost of settlements for pharmacy mistakes exceeds the cost of adequate staffing.
Chain Store Corporate Spokespeople Respond to Reporters with Minimization:
When a serious pharmacy mistake occurs in a community, reporters for the local newspaper and TV stations often contact corporate headquarters for a comment or statement from that drug store chain. The chain spokespeople always seem to engage in the same tiresome minimization routine and claim that pharmacy mistakes are “rare” and that “even one mistake is one too many.”
Pharmacists are livid at those lies and deceptions from corporate spokespeople. Pharmacy mistakes are by no means rare at chain drug stores. Claiming that “one mistake is too many” implies that chain management has wrestled the problem of pharmacy mistakes down to a manageable level, and that the chain is actually approaching eliminating the problem. In fact, nothing could be further from the truth.
It is like an official at the National Rifle Association stating that even one death from a handgun is too many. It is like a corporate representative for distillers stating that even one death from drunk driving is too many. The fact is that the problems of pharmacy mistakes, handgun violence, and drunk driving are nowhere near manageable levels. They are all out of control.
Are Americans too Trusting of Large Corporations?
Many Americans assume that there is no way that mighty corporations such as chain drug stores would run their operations as recklessly as pharmacists and pharmacy techs witness every day. Thus the big drug store chains are banking on the ignorance of the public about the recklessness and arrogance of huge corporations.
In my opinion, corporate executives for the big drug store chains are just as ruthless as corporate executives at pharmaceutical companies, oil companies, insurance companies, Wall Street, etc.
The problem of pharmacy mistakes is so entrenched in our society because the public is not aware of how serious this problem is. The public is not aware that the state boards of pharmacy are intimidated by the massive legal and political clout of the huge drug store chains. Clearly a large segment of the public is not aware of the recklessness of huge corporations in general.
I am not optimistic that the massive problem of pharmacy mistakes will be fixed any time soon. In my opinion, resolving the problem of understaffing in drug stores is as unachievable and naive as hoping that gun violence will end, that deaths from drunk driving will end, that massive chemical companies will stop polluting our air and water, etc.
In my opinion, contacting your state board of pharmacy about a pharmacy mistake you’ve experienced is a good place to start. But I am not naive enough to hope or believe that state boards of pharmacy have the strength, fortitude, guts, independence, or cojones to stand up to the mighty chain drug stores.
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.
